Untreated, the fever breaks within 6 days and the patient experiences drenching sweats. Fever returns 8 days later, and subsequent episodes are milder. On average, a patient experiences 3-5 recurrences of the illness. Infants and the elderly may become severely ill and require hospitalization, but deaths are rare. A rapid and specific diagnosis is made by observing the bacteria in a sample of blood under the microscope.
Organisms are most likely to be seen in blood drawn during a febrile episode.
Western immunoblot confirms the diagnosis. Either tetracycline or erythromycin for 5-10 days is effective. Rare treatment failures have occurred using doxycycline. Severely ill patients may require intravenous antibiotic treatment and hospitalization. CTF has also been transmitted by blood transfusions.