These carriers tend to remain in remote areas. The incidence of this disease is unknown, due mainly to the frequency with which the diagnosis is missed. Peak incidence of cases is mid-summer.
Most people are never aware that they have been bitten by a tick.
The disease begins with abrupt onset of fever with chills and drenching sweats. The initial phase is followed by about eight days without a fever, but then the symptoms begin again. There are usually 3-5 relapses, with the severity of the symptoms decreasing with each acute phase. Treatment consists of 5-10 days of antibiotic treatment, usually with tetracycline or erythromycin. Penicillin should not be used because it increases the rate of relapses.