Tickborne Relapsing Fever Diagnosis Obscured by Malaria, Togo

• Main Authors: Annika Nordstrand, Ignas Bunikis, Christer Larsson, Kodjo Tsogbe, Tom G. Schwan, Mikael Nilsson, Sven Bergström
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2007-01-01
• Series: Emerging Infectious Diseases
• Subjects: Malaria; Borrelia; public health; West Africa; diagnostics; antimicrobial drug treatment
• Online Access: https://wwwnc.cdc.gov/eid/article/13/1/06-0670_article
• ISSN: 1080-6040; 1080-6059

Given the prevalence of relapsing fever (RF) in Senegal, this disease may cause illness and death in other areas of West Africa. We performed a cross-sectional, clinic-based study to investigate the presence of RF in Togo during 2002–2004. Blood samples from patients with fever were examined for RF spirochetes by microscopy, PCR, and DNA sequencing of amplicons and for antibodies to the glycerophosphodiester phosphodiesterase antigen. Although no spirochetes were seen in blood smears, ≈10% of the patients were positive by PCR and ≈13% were seropositive for spirochetes. DNA sequencing demonstrated that Borrelia crocidurae and B. duttonii were present. Most patients were treated for malaria whether or not plasmodia were observed. Thus, many RF patients originally had a misdiagnosis of malaria, which resulted in ineffective treatment. The inability of microscopic analysis to detect spirochetes compared with PCR demonstrates the need for tests with greater sensitivity.