Tick-borne relapsing fever during pregnancy: a case report.
BACKGROUND
Tick-borne relapsing fever (TBRF) is uncommon. Vertical transmission in the gravid woman may result in spontaneous abortion, preterm delivery or perinatal mortality. We report a case in a pregnant woman who experienced a Jarisch-Herxheimer reaction (J-HR).


METHODS
A 24-year-old woman at 23 weeks' gestation had a relapsing fever of unknown origin and nonspecific complaints. Her peripheral blood smear demonstrated spirochetes consistent with TBRF caused by Borrelia. Treatment with antibiotics precipitated J-HR. Supportive measures and appropriate antibiotic therapy resulted in a clinical cure and normal term delivery.


CONCLUSIONS
The diagnosis of TBRF should be considered in individuals with recurrent fevers, especially those who have been in mountainous regions where Borrelia hermsii exists. Individuals receiving antimicrobials should be closely monitored for a J-HR.
Guggenheim
Jennifer N
JN
Department of Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado, USA. guggenheimj@exempla.org
Haverkamp
Albert D
AD
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001898:Borrelia / Q000302:isolation & purification; D004917:Erythromycin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011256:Pregnancy Outcome; D012061:Relapsing Fever / Q000175:diagnosis* / Q000188:drug therapy; D017282:Tick-Borne Diseases / Q000175:diagnosis*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004917:Erythromycin