Volume 97, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We report two cases of louse-borne relapsing fever observed at our Institution in June 2016. Both patients were young asylum seekers from Africa who had recently arrived in Milan, Italy. Notably, direct microscopic examination of peripheral blood smears was repeatedly negative for the presence of spirochetes and the diagnosis, supported by clinical and epidemiologic evidence, required molecular confirmation by polymerase chain reaction amplification of DNA extracted from blood and sequencing of the amplified products.


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  1. Sparrow H, , 1958. Étude du foyer Éthiopien de fièvre récurrente. Bull Org Mon Santé 19: 673710. [Google Scholar]
  2. Bryceson ADM, Parry EHO, Perine PL, Warrell DA, Vukotich D, Leithead CS, , 1970. Louse-borne relapsing fever. A clinical and laboratory study of 62 cases in Ethiopia and a reconsideration of the literature. QJM 153: 129170. [Google Scholar]
  3. Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H, , 2015. Louse-borne relapsing fever (Borrelia recurrentis) in asylum seekers from Eritrea, the Netherlands, July 2015. Euro Surveill 20: 21196. [Google Scholar]
  4. Ciervo A, Mancini F, di Bernardo F, Giammanco A, Vitale G, Dones P, Fasciana T, Quartaro P, Mazzola G, Rezza G, , 2016. Louseborne relapsing fever in young migrants, Sicily, Italy, July–September 2015. Emerg Infect Dis 22: 152153. [Google Scholar]
  5. Lucchini A, 2016. Louseborne relapsing fever among east African refugees, Italy, 2015. Emerg Infect Dis 22: 298301. [Google Scholar]
  6. Goldenberger D, Claas GJ, Bloch-Infanger C, Breidthardt T, Suter B, Martinez M, Neumayr A, Blaich A, Egli A, Osthoff M, , 2015. Louse-borne relapsing fever (Borrelia recurrentis) in an Eritrean refugee arriving in Switzerland, August 2015. Euro Surveill 20: 21204. [Google Scholar]
  7. Costescu Strachinaru D-I, Cambier J, Kandet-Yattara H, Konopnicki D, , 2016. Relapsing fever in asylum seekers from Somalia arriving in Belgium in August 2015. Acta Clin Belg 71: 353355. [Google Scholar]
  8. Hoch M, 2015. Louse-borne relapsing fever (Borrelia recurrentis) diagnosed in 15 refugees from northeast Africa: epidemiology and preventive control measures, Bavaria, Germany, July to October 2015. Euro Surveill 20: 30046. [Google Scholar]
  9. Selmaier M, 2016. 25 Fälle von Läuserückfallfieber bei Flüchtlingen aus Ostafrika. (Louse-borne-relapsing fever in refugees from the Horn of Africa: a case series of 25 patients). Dtsch Med Wochenschr 141: e133e142 (article in German). [Google Scholar]
  10. Antinori S, 2016. Louse-borne relapsing fever (Borrelia recurrentis) in a Somali refugee arriving in Italy: a re-emerging infection in Europe? PLoS Negl Trop Dis 10: e0004522. [Google Scholar]
  11. Zammarchi L, 2016. Louse-borne relapsing fever with meningeal involvement in an immigrant from Somalia to Italy, October 2015. Vector Borne Zoonotic Dis 16: 352355. [Google Scholar]
  12. Keller C, Zumblick M, Streubel K, Eickmann M, Muller D, Kerwat M, Becker S, Gress T, , 2016. Hemorrhagic diathesis in Borrelia recurrentis infection imported to Germany. Emerg Infect Dis 22: 917919. [Google Scholar]
  13. Osthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D, , 2016. Louse-borne relapsing fever- report of four cases in Switzerland, June–December 2015. BMC Infect Dis 16: 210. [Google Scholar]
  14. Darcis G, Hayette M-P, Bontems S, Sauvage A-S, Meuris C, Van Esbroeck M, Leonard P, , 2016. Louse-borne relapsing fever in a refugee from Somalia arriving in Belgium. J Travel Med 23: 13. [Google Scholar]
  15. Colomba C, Scarlata F, Di Carlo P, Giammanco A, Fasciana T, Trizzino M, Cascio A, , 2016. Fourth case of louse-borne relapsing fever in young migrant, Sicily, Italy, December 2015. Mini review article. Public Health 139: 2226. [Google Scholar]
  16. Benz R, Maier S, , 2016. Unexpected cause of high fever in the blood film. Blood 127: 2264. [Google Scholar]
  17. von Both U, Alberer M, , 2016. Borrelia recurrentis infection. N Engl J Med 375: e5. [Google Scholar]
  18. Hytonen J, Khawaja T, Gronroos JO, Jalava A, Meri S, Oksi J, , 2017. Louse-borne relapsing fever in Finland in two asylum seekers from Somalia. APMIS 125: 5962. [Google Scholar]
  19. Jochum J, Tannich E, Tappe D, Schmiedel S, , 2017. A Somali refugee with fever and abnormal blood smear. Internist 58: 287292 (article in German). [Google Scholar]
  20. Grecchi C, Zanotti P, Pontarelli A, Chiari E, Tomasoni LR, Gulletta M, Barbui A, Caligaris S, Matteelli A, Castelli F, , 2017. Louse-borne relapsing fever in a refugee from Mali. Infection 45: 373376. [Google Scholar]
  21. Relman DA, , 1993. Universal bacterial 16S rDNA amplification and sequencing. Persing DH, Smith TF, Tenover FC, White TJ, eds., Diagnostic Molecular Microbiology: Principles and Applications. Rochester, Minnesota: Mayo Foundation, 489–495.
  22. Vial L, Diatta G, Tall A, Ba el H, Bouganali H, Durand P, Sokhna C, Rogier C, Renaud F, Trape JF, , 2006. Incidence of tick-borne relapsing fever in west Africa: longitudinal study. Lancet 368: 3743. [Google Scholar]
  23. Oliver MR, Liles WC, Spach DW, , 1996. Relapsing fever. Wild Environ Med 1: 4655. [Google Scholar]
  24. Igwe CU, Duru LA, Ukwamedua H, Ikaraoha CI, , 2007. Louse-borne relapsing fever and malaria co-infection in Ethiopia. Trop Doct 37: 121122. [Google Scholar]
  25. Wacker C, Prkno A, Brunkhorst FM, Schlattman P, , 2013. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 13: 426435. [Google Scholar]
  26. Shehabi Y, 2014. Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial. Am J Respir Crit Care Med 190: 11021110. [Google Scholar]
  27. Poulakou G, Bassetti M, Timsit J-F, , 2016. Critically ill migrants with infection: diagnostic considerations for intensive care physicians in Europe. Intensive Care Med 42: 245248. [Google Scholar]
  28. Alp E, Erdem H, Rello J, , 2016. Management of septic shock and severe infections in migrants and returning travellers requiring critical care. Eur J Clin Microbiol Infect Dis 35: 527533. [Google Scholar]

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  • Received : 18 Apr 2017
  • Accepted : 21 Aug 2017
  • Published online : 25 Sep 2017

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