Louse-borne relapsing fever (LBRF), caused by Borrelia recurrentis and transmitted by the body louse (Pediculus humanus), is a neglected infectious disease that has been responsible for huge outbreaks in the past but has virtually disappeared from Europe since the end of World War II.1,2 War, famine, overcrowding, and poor living conditions are recognized risk factors favoring the re-emergence of this disease.
From June to December 2015, around 50 cases of LBRF were described among asylum seekers from Eastern Africa arriving to Europe with reports from Germany, Italy, Belgium, Switzerland, the Netherlands, and Finland.3–19 The latest report of imported LBRF in Europe regards a patient observed in Italy in June 2016 and coming from Mali.20 In all published instances described as yet, migrants had stationed in overcrowded refugee camps in Libya before arriving to Italy after having crossed the Mediterranean Sea, with the exception of two patients who were probably infected in Turin, Italy, while sheltered in the same asylum as other individuals with the disease.5
We report herein two additional cases of LBRF in refugees from Somalia and Sudan who were admitted to our Department of Infectious Diseases in Milan, Italy, in June 2016. We describe their clinical presentation, the difficulties encountered in diagnosing the disease, and finally we review all cases of LBRF imported to Europe thus far.
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