{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:47:59Z","timestamp":1792003679688,"version":"4.4.0"},"reference-count":104,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>\n                    Louse-borne relapsing fever (LBRF) is a classical epidemic disease, which in the past was associated with war, famine, poverty, forced migration, and crowding under poor hygienic conditions around the world. The disease\u2019s causative pathogen, the spirochete bacterium\n                    <jats:italic>Borrelia recurrentis<\/jats:italic>\n                    , is confined to humans and transmitted by a single vector, the human body louse\n                    <jats:italic>Pediculus humanus corporis<\/jats:italic>\n                    . Since the disease was at its peak before the days of modern medicine, many of its aspects have never been formally studied and to date remain incompletely understood. In order to shed light on some of these aspects, we have systematically reviewed the accessible literature on LBRF since the recognition of its mode of transmission in 1907, and summarized the existing data on mortality, Jarisch\u2013Herxheimer reaction (JHR), and impact on pregnancy.\n                  <\/jats:p>\n                  <jats:p>Publications were identified by using a predefined search strategy of electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of LBRF published in English, French, German, and Spanish since 1907 were included. Data extraction followed a predefined protocol and included a grading system to judge the certainty of the diagnosis of reported cases.<\/jats:p>\n                  <jats:p>The high mortality rates often found in literature are confined to extreme scenarios. The case fatality rate (CFR) of untreated cases is on average significantly lower than frequently assumed. In recent years, a rise in the overall CFRs is documented, for which reasons remain unknown.<\/jats:p>\n                  <jats:p>Lacking standardized criteria, a clear diagnostic threshold defining antibiotic treatment-induced JHR does not exist. This explains the wide range of occurrence rates found in literature. Pre-antibiotic era data suggest the existence of a JHR-like reaction also in cases treated with arsenicals and even in untreated cases.<\/jats:p>\n                  <jats:p>LBRF-related adverse outcomes are observed in 3 out of 4 pregnancies.<\/jats:p>","DOI":"10.1371\/journal.pntd.0008656","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T13:30:29Z","timestamp":1615469429000},"page":"e0008656","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Louse-borne relapsing fever\u2014A systematic review and analysis of the literature: Part 2\u2014Mortality, Jarisch\u2013Herxheimer reaction, impact on pregnancy"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4638-3820","authenticated-orcid":true,"given":"Pascal","family":"Kahlig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Neumayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Paris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"pntd.0008656.ref001","volume-title":"Borrelia; Strains, Vectors, Human and Animal Borreliosis","author":"O. Felsenfeld","year":"1971"},{"issue":"4","key":"pntd.0008656.ref002","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.cll.2015.07.001","article-title":"Relapsing Fever Borreliae: A Global Review","volume":"35","author":"SJ Cutler","year":"2015","journal-title":"Clin Lab Med"},{"key":"pntd.0008656.ref003","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1017\/S0950268819000116","article-title":"Louse-borne relapsing fever (Borrelia recurrentis infection)","volume":"147","author":"DA Warrell","year":"2019","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pntd.0008656.ref004","first-page":"129","article-title":"A clinical and laboratory study of 62 cases in ethiopia and a reconsideration of the literature","volume":"39","author":"ADM Bryceson","year":"1970","journal-title":"QJM"},{"issue":"4","key":"pntd.0008656.ref005","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5694\/j.1326-5377.1928.tb13135.x","article-title":"The Louse-Borne Type of Relapsing Fever as Prevalent in the Anglo-Egyptian Sudan, 1926-and 1927","volume":"1","author":"GEG Beveridge","year":"1928","journal-title":"Med J Aust"},{"issue":"2","key":"pntd.0008656.ref006","first-page":"66","article-title":"Louse-borne relapsing fever. A clinical and an epidemiological study of 389 patients in Asella Hospital, Ethiopia","volume":"45","author":"G Borgnolo","year":"1993","journal-title":"Trop Geogr Med"},{"issue":"1","key":"pntd.0008656.ref007","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/00365549509018969","article-title":"Treatment of louse-borne relapsing fever with low dose penicillin or tetracycline: a clinical trial","volume":"27","author":"T Seboxa","year":"1995","journal-title":"Scand J Infect Dis"},{"issue":"9","key":"pntd.0008656.ref008","first-page":"338","article-title":"Relapsing Fever in Bulandshahr District","volume":"48","author":"R Steen","year":"1913","journal-title":"Ind Med Gaz"},{"issue":"5","key":"pntd.0008656.ref009","doi-asserted-by":"crossref","first-page":"e0004522","DOI":"10.1371\/journal.pntd.0004522","article-title":"Louse-Borne Relapsing Fever (Borrelia recurrentis) in a Somali Refugee Arriving in Italy: A Re-emerging Infection in Europe?","volume":"10","author":"S Antinori","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0008656.ref010","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1580\/1080-6032(1996)007[0046:RF]2.3.CO;2","article-title":"Relapsing fever","volume":"7","author":"MR Oliver","year":"1996","journal-title":"Wilderness Environ Med"},{"issue":"2","key":"pntd.0008656.ref011","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1080\/00034983.1939.11685062","article-title":"The Epidemiology of Relapsing Fever in the Anglo-Egyptian Sudan","volume":"33","author":"R. Kirk","year":"1939","journal-title":"Ann Trop Med Parasitol"},{"issue":"1","key":"pntd.0008656.ref012","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0035-9203(47)90209-5","article-title":"An epidemic of louse-borne relapsing fever in Kenya","volume":"41","author":"PC Garnham","year":"1947","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0008656.ref013","first-page":"295","volume-title":"Relapsing Fever and other Borrelia Diseases. 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Herxheimer","year":"1902","journal-title":"Dtsch Med Wochenschr"},{"key":"pntd.0008656.ref017","first-page":"721","article-title":"Therapeutische Versuche bei Syphilis","volume":"45","author":"A. Jarisch","year":"1895","journal-title":"Wien Med Wochenschr"},{"issue":"1","key":"pntd.0008656.ref018","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4269\/ajtmh.16-0434","article-title":"The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis","volume":"96","author":"T. 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A report of 41 cases","volume":"54","author":"SL Chang","year":"1938","journal-title":"Chin Med J"},{"key":"pntd.0008656.ref048","first-page":"1","article-title":"Relapsing fever","volume":"21","author":"AH El Ramley","year":"1946","journal-title":"J Egypt Public Health Assoc"},{"issue":"1","key":"pntd.0008656.ref049","first-page":"69","article-title":"Epidemiological Study on Relapsing Fever in North Africa (1943\u20131945)","volume":"1","author":"M Gaud","year":"1948","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pntd.0008656.ref050","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/0035-9203(77)90206-1","article-title":"Louse-borne relapsing fever: I. 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