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What is Tick-Borne Relapsing Fever (TBRF)?

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Tick-Borne Relapsing Fever (TBRF) is a bacterial infection caused by Borrelia species transmitted through the bite of soft ticks (Ornithodoros species). Unlike Lyme disease, which is caused by Borrelia burgdorferi and spread by hard ticks, TBRF is characterized by recurrent episodes of high fever, chills, muscle aches, and fatigue that come and go in cycles.

TBRF is most commonly found in the western United States, Mexico, and parts of Africa, where soft ticks live in rodent-infested cabins, caves, and rural areas. The infection can be severe if left untreated, but early antibiotic therapy is highly effective.

How Is TBRF Transmitted?

TBRF is transmitted through the bite of soft ticks (Ornithodoros species), which are different from the hard-bodied ticks that spread Lyme disease.

Soft ticks feed quickly (in less than 30 minutes), often at night, making tick bites harder to notice.
Unlike Lyme disease ticks, soft ticks do not attach for long periods—they feed and drop off unnoticed.
Soft ticks are commonly found in rodent-infested buildings, particularly cabins, barns, and caves.

TBRF transmission can occur within seconds of a tick bite, making prompt tick removal less effective as a prevention strategy compared to Lyme disease.

What Are the Symptoms of TBRF?

TBRF symptoms appear suddenly about 3–18 days after infection and follow a relapsing pattern, where fever episodes last 3–5 days, disappear, and return several times.

Primary Symptoms:

High fever (up to 106°F or 41°C) – Recurs every few days.
Chills and sweats – Intense cold shivering followed by sweating.
Severe headache – Often mistaken for flu or meningitis.
Muscle and joint pain – Resembles symptoms of Lyme disease.
Nausea, vomiting, and abdominal pain – Common in severe cases.

Neurological and Severe Symptoms (in untreated cases):

Seizures and altered mental state – Suggests brain involvement.
Jaundice (yellow skin and eyes) – Due to liver involvement.
Bleeding disorders – Nosebleeds, bruising, and low platelet count.
Eye pain and vision problems – Linked to inflammation.

TBRF follows a pattern of recurring fevers, caused by Borrelia bacteria changing their surface proteins, allowing them to evade the immune system and trigger new fever cycles.

How Is TBRF Diagnosed?

TBRF is diagnosed based on symptoms, travel history, and laboratory tests. Since the disease is often misdiagnosed as flu, malaria, or meningitis, specific testing is crucial.

Diagnostic Tests for TBRF:

Test Type

What It Detects

Best Use Case

Limitations

Blood Smear (Microscopy)

Borrelia bacteria in the bloodstream

Best for confirming active infection

Requires expert analysis

PCR (Polymerase Chain Reaction)

Borrelia DNA in blood

Early and accurate detection

Bacteria may not always be in the sample

Serologic Testing (ELISA, Western Blot)

Antibodies against Borrelia

Identifies past or ongoing infection

May not detect early infections

Since TBRF bacteria appear in the blood only during fever episodes, timing of blood samples is critical for detection.

How Is TBRF Treated?

TBRF is highly treatable with antibiotics, but early treatment is essential to prevent complications.

First-Line Treatments:

Doxycycline (100 mg twice daily for 7–10 days) – Most commonly used.
Tetracycline, Erythromycin, or Chloramphenicol – Alternatives for patients who cannot take doxycycline.
IV antibiotics (Ceftriaxone or Penicillin G) – For severe or neurological cases.

Jarisch-Herxheimer Reaction:

Many patients experience a sudden worsening of symptoms within 2–4 hours after starting antibiotics, known as the Jarisch-Herxheimer reaction.
Symptoms include fever, chills, sweating, rapid heartbeat, and low blood pressure.
This reaction resolves within 24 hours but may require fluids and fever management.

Because TBRF relapses naturally, untreated patients may experience up to 10 fever cycles before their immune system clears the infection. Antibiotics shorten the illness and prevent complications.

TBRF vs. Lyme Disease – What’s the Difference?

Feature

Tick-Borne Relapsing Fever (TBRF)

Lyme Disease

Cause

Borrelia hermsii, Borrelia turicatae, Borrelia parkeri

Borrelia burgdorferi

Tick Vector

Soft ticks (Ornithodoros)

Hard ticks (Ixodes scapularis)

Tick Feeding Time

Less than 30 minutes

24–48 hours

Symptoms

High fever, headache, relapsing illness

Flu-like symptoms, joint pain, bullseye rash

Rash Presence

Rare

Common (bullseye rash in 70–80% of cases)

Testing Methods

Blood smear, PCR, serology

Serology, PCR, Western Blot

Treatment

Doxycycline, tetracycline

Doxycycline, amoxicillin (early); IV antibiotics (late)

While both are caused by Borrelia species, TBRF and Lyme disease differ in transmission, symptoms, and detection methods.

How Can TBRF Be Prevented?

Since soft ticks are found in rodent-infested areas, prevention focuses on avoiding tick exposure in high-risk locations.

Prevention Strategies:

Avoid sleeping in rodent-infested cabins, barns, or caves.
Seal cracks and gaps in homes to prevent tick and rodent entry.
Use bed nets and insect repellents in tick-prone regions.
Wear protective clothing if spending time in rustic settings.

Unlike Lyme disease, TBRF ticks do not attach for long periods, so daily tick checks are less effective for prevention.

Final Thoughts

Tick-Borne Relapsing Fever (TBRF) is a serious but treatable tick-borne illness characterized by recurring high fevers.

Unlike Lyme disease, TBRF is spread by soft ticks, which bite quickly and often go unnoticed. Early detection and antibiotic treatment are crucial to prevent complications.

If you experience recurrent fevers after potential tick exposure, consider comprehensive testing at AcuDart Health for accurate diagnosis and timely treatment. Learn more about high-precision tick-borne disease testing.

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AcuDart Tick-Borne Disease Screening Test Panel

$499.00

$596.00

Tick-borne diseases like Lyme disease, Tick-Borne Relapsing Fever (TBRF), Babesiosis, and Bartonellosis share overlapping symptoms, making diagnosis difficult without comprehensive testing. Because these infections can mimic each other, relying on a single test for one disease may lead to missed or delayed diagnoses. That’s why AcuDart offers the most accurate and reliable tick-borne disease testing available.

Unlike standard tests from commercial labs like LabCorp or Quest, which typically screen for just one or two species per disease, the AcuDart Tick-Borne Disease Test Panel is designed for maximum accuracy and coverage. It detects 19 species across four major tick-borne diseases, making it the most comprehensive tick panel on the market. Whether you're experiencing persistent symptoms or have been exposed to ticks, AcuDart's tick-borne disease panel provides the most thorough and precise testing to help you get the right diagnosis and treatment faster.

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