title: Maternal mortality in a rural Tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy.
abstract: Relapsing fever is a disease caused by one of the species of Borrelia. It is often misdiagnosed as malaria and can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics. A 19-year-old Tanzanian woman was admitted after a term home delivery that day. She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni. The patient continued treatment with procaine penicillin fortified for relapsing fever. Several hours later the woman died, probably due to JHR. This case of a patient with relapsing fever who died from a JHR stresses the importance of adequate diagnosis and treatment which should include careful monitoring, especially for the first hours after starting antibiotics.
authors: PHC Laboratory, PO Box 916, 1180 AX Amstelveen, The Netherlands. p.melkert@gmail.com.
authors: Ilona
authors: I
authors: Rustenhoven-Spaan
authors: Peter
authors: P
authors: Melkert
authors: Ellen
authors: E
authors: Nelissen
authors: Jos
authors: J
authors: van Roosmalen
authors: Jelle
authors: J
authors: Stekelenburg
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019446:Endotoxemia / Q000139:chemically induced*; D017809:Fatal Outcome; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D063130:Maternal Death; D010402:Penicillin G Procaine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D012061:Relapsing Fever / Q000188:drug therapy*; D013636:Tanzania; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010402:Penicillin G Procaine
keywords: Jarisch-Herxheimer reaction; Maternal mortality; borreliosis; tick borne relapsing fever