Sam R. Telford, III, ScD; Philip J. Molloy, MD; Victor P. Berardi
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0472.
Telford SR, Molloy PJ, Berardi VP. Borrelia miyamotoi. Ann Intern Med. 2015;163:963-964. doi: 10.7326/L15-5187
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Published: Ann Intern Med. 2015;163(12):963-964.
TO THE EDITOR:
We agree with Krause and Barbour (1) that our article provides important new information on the epidemiology, clinical presentation, and diagnosis of this newly recognized zoonosis and wish to comment on our use of the name “Borrelia miyamotoi disease (BMD)” and their suggestion that it be called “hard tick–borne relapsing fever (HTBRF).” We do not agree with their designation. Relapsing fever transmitted by soft ticks or body lice is classically a spectacular acute disease, and we note prior literature descriptions, such as, “There are few if any other diseases that are characterized by two or more episodes of high fever separated by weeklong periods of well-being … The first fever episode ends by crisis, which is characterized by rigors, hyperpyrexia, and elevations of pulse and blood pressure over approximately 15-30 minutes. This phase is followed by a few to several hours of profuse diaphoresis, falling temperature, and hypotension” (2). The fact that our cases of BMD were generally treated in a timely fashion would not have prevented us from identifying a clinical pattern of high fever, crisis, and diaphoresis for the first attack. Borrelia miyamotoi disease seems to be a milder condition than relapsing fever (it would not be mistaken for malaria), and a distinction should thus be made that underscores this fact to caregivers, who would tend to be confused by the taxonomy-based dichotomy between hard tick– and soft tick–transmitted relapsing fevers. Even though B. miyamotoi is genetically a relapsing fever spirochete, that it must cause a relapsing fever is not axiomatic.
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