title: Tickborne relapsing fever diagnosis obscured by malaria, Togo.
abstract: 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, approximately 10% of the patients were positive by PCR and approximately 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.
authors: Umeå University, Umeå, Sweden.
authors: Annika
authors: A
authors: Nordstrand
authors: Ignas
authors: I
authors: Bunikis
authors: Christer
authors: C
authors: Larsson
authors: Kodjo
authors: K
authors: Tsogbe
authors: Tom G
authors: TG
authors: Schwan
authors: Mikael
authors: M
authors: Nilsson
authors: Sven
authors: S
authors: Bergström
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D012061:Relapsing Fever / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014037:Togo / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials