title: Absence of focal neurological involvement in tick-borne relapsing fever in northern Tanzania.
abstract: The aim of the study was to chart incidence and clinical features of tick-borne relapsing fever in Tanzania. Consecutive patients with fever and spirochetes demonstrated in a thick blood smear at Haydom Lutheran Hospital from 1 January to 31 December 2003 underwent clinical and cerebrospinal fluid (CSF) examination. Forty-four patients were included, making an estimated minimum annual incidence of 11 per 100 000 population in this region. The mortality rate was 2.3% (95% CI = 0-12). The most frequent complaints were generalized malaise (93%), headache (86%), nausea and vomiting (52%). None of the patients [0% (95% CI = 0-8)] had focal neurological symptoms. Cell count in CSF was normal in 22 and slightly elevated (6-12 leukocytes/mm(3)) in 20 patients. Two of three pregnancies had a poor outcome. Jarisch-Herxheimer reactions, bleeding complications and ocular manifestations were infrequent. In conclusion, tick-borne relapsing fever is a common disease in the Northern highland of Tanzania, but in contrast to other parts of the world, neurological involvement is uncommon in this area.
authors.affiliation: Haydom Lutheran Hospital, Haydom, p.o. Mbulu, Tanzania.
authors.forename: E
authors.initials: E
authors.lastname: Mayegga
authors.forename: U
authors.initials: U
authors.lastname: Ljøstad
authors.forename: A
authors.initials: A
authors.lastname: Mygland
authors.forename: P
authors.initials: P
authors.lastname: Monstad
mesh_terms: D000293:Adolescent; D000328:Adult; D001899:Borrelia Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D006261:Headache; D006470:Hemorrhage; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009325:Nausea; D009422:Nervous System Diseases / Q000209:etiology* / Q000382:microbiology; D012061:Relapsing Fever / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D012189:Retrospective Studies; D015996:Survival Rate; D013636:Tanzania / Q000453:epidemiology