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Diagnosis of relapsing typhoid fever

Alexey Kryvenko, medical expert
Last reviewed: 03.07.2025

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Diagnosis of louse-borne relapsing fever is based largely on epidemiological anamnesis data - stay in an area where louse-borne relapsing fever occurs. During the first attack, the main symptoms are taken into account: the acute onset of the disease, hyperthermia from the first hours, severe pain syndrome (headache, muscle pain), early enlargement and soreness of the spleen and liver, subicteric skin and sclera. In subsequent attacks, the typical appearance of the temperature curve helps in diagnosis.

The most informative method of specific laboratory diagnostics is the detection of Borrelia obermeyerii in the peripheral blood during fever (rarely during apyrexia). A smear and a thick drop of blood stained according to Romanovsky-Giemsa (as in malaria) are examined.

The clinical blood test reveals moderate anemia, thrombocytopenia, increased ESR, normal or slightly elevated leukocyte count. A small amount of erythrocytes, protein, and hyaline casts are found in the urine.

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Indications for consultation with other specialists

Consultations with other specialists are indicated if complications arise: if a ruptured spleen is suspected, an urgent consultation with a surgeon is necessary; if signs of infectious toxic shock appear, a resuscitator is needed.

Example of diagnosis formulation

A68.0. Epidemic relapsing fever, severe form (Obermeyer spirochete in blood smear). Complication: rupture of the spleen.

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Differential diagnosis of relapsing fever

Differential diagnostics of louse-borne relapsing fever is carried out with malaria, tick-borne relapsing fever, leptospirosis, influenza, typhus, meningitis, pneumonia, and hemorrhagic fever. Mistakes can be avoided if we take into account the details of the epidemiological anamnesis (staying in the period corresponding to the duration of the incubation period in an area where louse-borne relapsing fever occurs), repeated attacks of fever, and the results of a thorough examination of blood smears in patients who fell ill suddenly, with high fever, pronounced signs of intoxication, rapid and significant enlargement of the spleen and its soreness.

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