Kamran Aziz, Syed Dilawar Abbas Rizvi, Muhammad Naqeeb, Tariq Shakoor.
Tick borne relapsing fever.
Pak Armed Forces Med J Jan ;55(3):268-9.

A young AFNS officer developed high grade fever, vomiting and generalized body aches while she was availing her leaves in Rawalakot, Azad Kashmir. There were no cough, dysuria, diarrhoea or skin rashes. Apart from symptomatic treatment, she was treated with tablet ofloxacin by a general practioner without any improvement. Seven days after the onset of disease she was admitted to CMH Gilgit with temperature, 1030F and vomiting. Physical examination was unremarkable apart from just palpable spleen and liver. Her blood picture, urinalysis, X ray chest, serum urea electrolytes, liver functions and widal test were not contributory. Blood slides for MP were repeatedly negative. She was empirically treated with a course of tablet chloroquine but fever persisted as such. On third day of her admission, two small erythematous indurated lesions were noted on her arm. She clearly remembered the appearance of the lesions overnight four days prior to the onset of fever; however neither she noticed any insect nor she considered it to be related to her disease. Keeping relapsing fever in mind, blood samples were taken during spike of fever for spirochetes (Borellia) and it was found to be positive (fig). She was accordingly treated with Capsule tetracycline. Her fever settled within two days and then she remained symptom free.

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