Background: Tick borne relapsing fever (TBRF) is a spirochete infection caused by Borrelia species and is transmitted most commonly by soft ticks of the genus Ornithodoros. TBRF is an acute infectious disease characterized mainly by recurring episodes of fever which are often accompanied by other signs and symptoms such as headache, gastrointestinal complaints and hematological abnormalities. TBRF is encountered worldwide and is increasingly diagnosed among tourists and immigrants from endemic regions.
Objective: To characterize pediatric TBRF in comparison to adult TBRF.
Methods: Data from the medical records of all patients diagnosed with TBRF in the Hadassah Medical Centers or Shaare Zedek Medical Center, in Jerusalem, Israel, from 1/1/2004 to 31/07/2018 were collected and analyzed. Pediatric (
Results: During the study period, 92 patients were diagnosed with TBRF. The average age (±SD) at presentation was 21.3 (±10.9) years, of whom 21 (22.8%) were children. Children were evaluated in the ED after longer periods of fever compared to adolescents and adults: 15.6 (±10.5) VS 7.9 (±9.9) days (p<0.01), had 2.2 (±1.3) VS 0.6 (±0.8) relapses of fever at presentation and most complained of gastrointestinal symptoms (66.7% VS 33.8%; P<0.001). Children had a lower neutrophil count (4.8±2.7 *109/liter VS 7±2.9 *109/liter; P<0.01), lower C- reactive protein levels (8.1±4.3 mg/dl VS 15.6±10.1 mg/dl; P<0.01) and less thrombocytopenia (23.8% VS 59.2%; P<0.01).
Conclusions: Children exhibited a distinct and statistically different course of TBRF than adolescents and adults, characterized by longer periods before presentation, with more episodes of fever and lower levels of inflammatory markers. Even in endemic countries, the diagnosis of pediatric borreliosis requires a high index of suspicion due to the differences in its presentation.
