Epistaxis and thrombocytopenia as major presentations of louse borne relapsing fever: Hospital-based study

Abstract

Background Louse-borne relapsing fever (LBRF) remains a cause of sporadic illness and occasional outbreaks in Ethiopia and other east African countries in overcrowded and unhygienic settings. In this article, we present clinical profiles and treatment outcome of patients treated as confirmed or probable cases of LBRF at Jimma Medical Center (JMC) in southwest Ethiopia. Methods Patients treated as confirmed or probable cases of LBRF at JMC during a period of May–July 2022 were prospectively followed during their course of hospital stay. All patients were evaluated with blood film for hemoparasites, complete blood count, and liver enzymes on hospital presentation. They were followed with daily clinical evaluation during their hospital stay. Result Thirty-six patients were treated as cases of LBRF. All patients except one were from Jimma Main Prison in Jimma Town, Ethiopia. All the patients were male with mean age of 28.7 years (SD = 12.7). The diagnosis of LBRF was confirmed by detection of B. recurrentis in blood film of 14 (38.9%) of the patients; the rest were treated as presumptive case of LBRF. Fever, reported by all patients, and an acute onset epistaxis, 30 (83.3%), were the major reasons for healthcare visits. Twenty-two (61.1%) patients were having thrombocytopenia with a platelet count < 150,000/μL; nine (25%) of which had severe forms (<50,000/μL). All patients were treated with oral doxycycline and discharged with improvement after a mean length of hospital stay of 4.25 days (SD = 0.77), range 2–6 days. Public health emergency was activated within two days of the first cases and helped in delousing all the cases and their contacts. Conclusion LBRF remains a public health problem in Ethiopia in settings with poor personal hygiene. Patients with LBRF may present with severe thrombocytopenia and life-threatening bleeding. Early detection and treatment initiation prevents outbreak propagation and improves treatment outcome.

The Need to Establish and Sustain Public Health Emergency Operation Centers for Managing Infectious Disease Outbreaks: Lesson From Response to Louse-Borne Relapsing Fever Outbreak in Jimma, Ethiopia

“…Other blood work-ups showed thrombocytopenia and elevated aspartate aminotransferase levels. 11 Presentation of this cluster of cases alerted the ED to review the reasons for the visit to the ED in the previous 10 days. This retrospective action led to the identification of 1 patient who presented from Jimma Main Prison to the ED with 5 days history of acute febrile illness (AFI).…”

“…There were no fever recrudescence, the occurrence of shock, JHR, or other complications. 11 The coordination and communication platform established due to COVID-19 has played a crucial role for the public health measures undertaken during the current LBRF outbreak. Treatment was given to the index cases and their close contacts.…”

“…For instance, Ethiopia faced difficulties in sustaining malaria control measures, 9 and experienced pockets of cholera outbreaks, 10 and a surge in the number of cases of relapsing fever since the onset of the pandemic despite the remarkable progress witnessed in controlling common infectious disease over the past few decades. 11…”

“…For instance, Ethiopia faced difficulties in sustaining malaria control measures, 9 and experienced pockets of cholera outbreaks, 10 and a surge in the number of cases of relapsing fever since the onset of the pandemic despite the remarkable progress witnessed in controlling common infectious disease over the past few decades. 11 Relapsing fever (RF) is an old disease already eradicated from most part of the world with recently reported cases being limited mainly to East African countries. 12 It is a vector-borne disease, the control of which needs interventions aimed to improving environmental sanitation and vector control.…”