Skip directly to site content Skip directly to search


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search

		Submit


Tickborne Diseases of the United States


Facebook
        Twitter
        LinkedIn
        Syndicate





Hard Tick Relapsing Fever					minus icon
                Contents
			HomeTick IDOverview of Tickborne DiseasesLyme DiseaseTickborne Relapsing Fever (TBRF)Hard Tick Relapsing FeverAnaplasmosisEhrlichiosisRocky Mountain Spotted FeverRickettsia parkeri RickettsiosisTularemiaBabesiosisHeartland and Bourbon Virus DiseasesColorado Tick FeverPowassan Virus DiseaseTickborne Diseases AbroadTick Bites/PreventionLyme Disease Prophylaxis After Tick Bite					Related Pages
										Agent*Borrelia miyamotoi*Where FoundOccurs in the upper midwestern, northeastern, and mid-Atlantic states, where it is transmitted by *Ixodes scapularis*ticks, and in Pacific coastal states, where it is transmitted by *I. pacificus* ticks. Unlike Lyme disease, which most commonly occurs in June and July, hard tick relapsing fever occurs most commonly in July and August.Borrelia miyamotoiIncubation Period3 days to 6 weeks, exact range unknownSigns And SymptomsInfection with *B. miyamotoi*most frequently presents as a self-resolving acute febrile illness, but the spectrum of illness varies from subclinical to severe. Severe manifestations (e.g., meningoencephalitis) appear to be more common in people with immunocompromising conditions. Symptoms may include:
Fever
Chills
Relapsing fever (10-40% of cases)
Fatigue
Arthralgia/myalgiaGeneral Laboratory FindingsLeukopenia
Thrombocytopenia
Elevated hepatic transaminases
ProteinuriaLaboratory DiagnosisDiagnosis relies on signs and symptoms coupled with:
Polymerase chain reaction (PCR) assays that detect *B. miyamotoi*DNA in blood or cerebrospinal fluid; or
Serologic assaysNotably, serologic tests are most often negative during the acute presentation and are therefore of limited utility in diagnosis, though paired acute and convalescent tests can confirm a recent infection. Some serologic and PCR tests can cross-react with other *Borrelia*species, making travel and tick exposure history important to distinguish between these entities.TreatmentThere are no randomized controlled trials that evaluate treatment regimens, but in published case series, patients were successfully treated with antimicrobial regimens effective for Lyme disease. A 2-week course of doxycycline or amoxicillin is appropriate for outpatient treatment of most patients, including young children. For persons with severe illness requiring hospitalization (e.g., meningoencephalitis), IV antibiotics such as ceftriaxone are appropriate initial therapy. When treating patients with immunocompromising conditions for suspected *B. miyamotoi*infection, consultation with an infectious disease specialist is advised.
*B. miyamotoi* symptoms typically improve within 24-72 hours following administration of appropriate antibiotics. The Jarisch-Herxheimer reaction has been described in a minority of treated patients.ReferencesBoden K, Lobenstein S, Hermann B, Margos G, Fingerle V. Borrelia miyamotoi–Associated Neuroborreliosis in Immunocompromised Person. *Emerg Infect Dis.* 2016;22(9):1617-1620.
Chowdri HR, Gugliotta JL, Berardi VP, et al. *Borrelia miyamotoi* infection presenting as human granulocytic anaplasmosis: a case report. *Ann Intern Med.* 2013;159(1):21-7.
Gugliotta JL, Goethert HK, Berardi VP, Telford SR 3rd. Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. *N Engl J Med.* 2013 Jan 17;368(3):240-5.
Jiang B, Jia N, Jiang J, Zheng Y, Chu Y, Jiang R, et al. Borrelia miyamotoi Infections in Humans and Ticks, Northeastern China. *Emerg Infect Dis.* 2018;24(2):236-241.
Jobe DA, Lovrich SD, Oldenburg DG, et al. *Borrelia miyamotoi* infection in patients from Upper Midwestern United States, 2014-2015. *Emerg Infect Dis.* 2016;22(8):1471-3.
Krause PJ, Schwab J, Narasimhan S, et al. Hard tick relapsing fever caused by *Borrelia miyamotoi* in a child. *Pediatr Infect Dis J.* 2016;35(12):1352-1354.
Krause PJ, Carroll M, Fedorova N, Brancato J, Dumouchel C, Akosa F, Narasimhan S, Fikrig E, Lane RS. Human Borrelia miyamotoi infection in California: Serodiagnosis is complicated by multiple endemic Borrelia species. *PLoS One.* 2018;13(2):e0191725.
Molloy PJ, Telford SR 3rd, Chowdri HR, et al. *Borrelia miyamotoi* disease in the northeastern United States: a case series. *Ann Intern Med.* 2015;163(2):91-8.
Wroblewski D, Gebhardt L, Prusinski MA, et al. Detection of *Borrelia miyamotoi* and other tick-borne pathogens in human clinical specimens and *Ixodes scapularis* ticks in New York State, 2012-2015. *Ticks Tick Borne Dis.* 2017;8(3):407-411.Top of Page
									PrevTickborne Relapsi...
			NextAnaplasmosis
							
					
						Page last reviewed:  August 5, 2022					Content source: 	Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD) homeTickborne Diseases of the United StatesTick IDOverview of Tickborne DiseasesLyme DiseaseTickborne Relapsing Fever (TBRF)Hard Tick Relapsing FeverAnaplasmosisEhrlichiosisRocky Mountain Spotted Fever*Rickettsia parkeri*RickettsiosisTularemiaBabesiosisHeartland and Bourbon Virus DiseasesColorado Tick FeverPowassan Virus DiseaseTickborne Diseases AbroadTick Bites/PreventionLyme Disease Prophylaxis After Tick Bite


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue