title: [Relapsing (recurrent) disease caused by Borrelia miyamotoi].
abstract: OBJECTIVE
  To clarify the clinical, laboratory, and epidemiological characteristics of relapsing Ixodes tick-borne borreliosis (ITB) caused by Borrelia miyamotoi.
  
  
  METHODS
  Retrospective clinical observation was made in 79 inpatients of the Republican Infectious Diseases Hospital (Udmurt Republic), who had been diagnosed with B. miyamotoi-caused disease verified by real-time polymerase chain reaction. The latter and enzyme immunoassay ruled out possible vector-borne coinfections (ITB caused by B. burgdorferi sensu lato; tick-borne encephalitis; anaplasmosis; and ehrlichiosis).
  
  
  RESULTS
  The recurrent course of the disease was observed in 8 (10%) of the 79 patients. The relapsing fever curve was noted in 6 of the 8 patients; 4 patients had 2 episodes of fever and 2 patients had 3 episodes; the wave-like continuous type of fever cannot enable one to estimate the specific number of episodes in 2 more cases. Relapses occurred in all the 8 patients before antibiotic treatment. Febrile syndrome (weakness, headache, chill, fever, sweating, dizziness, nausea, vomiting, myalgia, and arthralgia) was leading in patients with relapses. These patients were less frequently observed to have signs of organ dysfunctions than those with one episode of fever. The values of clinical and biochemical blood tests and urinalyses were normal and near-normal in the majority of patients on hospital admission.
  
  
  CONCLUSIONS
  Relapsing B. miyamotoi infection cases detected in the directed study proved to be unrecognized by practical health authorities during the first and sometimes second episodes of fever. This indicates that the prevalence of this disease is essentially underestimated and there is a need to increase physicians' alertness and awareness and to introduce adequate diagnostic methods.
authors.affiliation: Izhevsk State Medical Academy, Ministry of Health of Russia, Izhevsk, Republic of Udmurtia, Russia.
authors.forename: D S
authors.initials: DS
authors.lastname: Sarksyan
authors.affiliation: Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia.
authors.forename: V V
authors.initials: VV
authors.lastname: Maleev
authors.affiliation: Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia.
authors.forename: A E
authors.initials: AE
authors.lastname: Platonov
authors.affiliation: Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia.
authors.forename: O V
authors.initials: OV
authors.lastname: Platonova
authors.affiliation: Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia.
authors.forename: L S
authors.initials: LS
authors.lastname: Karan
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001898:Borrelia / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D018884:Ixodes / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012061:Relapsing Fever / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012426:Russia / Q000453:epidemiology; D013984:Tick Infestations / Q000453:epidemiology*