Volume 26, Number 10—October 2020
Dispatch
Tickborne Relapsing Fever, Jerusalem, Israel, 2004–2018
Table
Characteristics of persons with tickborne relapsing fever, Jerusalem, Israel, 2004–2018*
Variable | Children and adolescents, n = 30 | Adults, n = 62 | Total, n = 92 | p value |
---|---|---|---|---|
Age, y† | ||||
Mean (95% CI) | 11.65 (10.3–13.1) | 25.97 (23.5–28.5) | 21.3 (21.23–21.37) | <0.01 |
Median (range) |
12 (3–18) |
22.5 (19–70) |
19 (3–70) |
|
Sex, no. (%) | ||||
M | 21 (70.0) | 54 (87.1) | 75 (81.5) | 0.09 |
F |
9 (30) |
8 (12.9) |
17 (18.5) |
|
Hospitalization, d | ||||
Mean (95% CI) | 2.57 (1.82–3.32) | 2.66 (2.31–3.01) | 2.63 (2.62–2.64) | 0.39 |
Median (range) |
2 |
2 |
2 |
|
Mean no. ED visits (95% CI) | 1.26 (1.12–1.4) | 1.21 (0.99–1.43) | 1.231 (1.12–1.34) | 0.6 |
ICU admission, no. (%) | 0 | 2 (3.2) | 2 (2.2) | 0.45 |
Treatment with doxycycline, no. (%) | 25 (83.3) | 61 (98.4) | 86 (93.5) | 0.09 |
Jarisch–Herxheimer reaction, no. (%) |
4 (13.3) |
15 (24.19) |
19 (20.7) |
0.35 |
Exposure history | ||||
Cave visits, no. (%) | 24 (80.0) | 52 (83.9) | 76 (82.6) | 0.82 |
Known tick bite, no. (%) |
9 (30.0) |
21 (33.8) |
30 (32.6) |
0.88 |
Mean incubation period, d, (95% CI) |
8.41 (6.22–10.6) |
9.4 (7.06–11.74) |
9.1 (9.05–9.15) |
0.61 |
Fever | ||||
Mean duration before ED visit, d (95% CI) | 12.4 (8.53–16.27) | 10 (7.31–12.7) | 9.76 (9.69–9.85) | 0.13 |
>1 Relapse of fever, no. (%) | 12 (40.0) | 7 (11.3) | 19 (20.6) | <0.01 |
No. fever episodes at diagnosis | ||||
1 | 6 | 31 | <0.01 | |
2 | 10 | 20 | ||
3 | 2 | 4 | ||
4 | 6 | 4 | ||
5 | 4 | 0 | ||
Missing information |
2 |
3 |
||
Signs and symptoms, no. (%) | ||||
Gastrointestinal | 16 (53.3) | 22 (35.5) | 38 (41.3) | 0.1 |
Respiratory | 1 (3.3) | 5 (8.1) | 6 (6.5) | 0.39 |
Myalgia | 8 (26.7) | 22 (35.5) | 30 (32.6) | 0.4 |
Malaise | 11 (36.7) | 24 (38.7) | 35 (38.0) | 0.85 |
CNS symptoms | 19 (63.3) | 32 (51.6) | 51 (55.4) | 0.29 |
History of shivering | 6 (20.0) | 19 (30.6) | 25 (27.2) | 0.29 |
Organomegaly | 5 (16.7) | 12 (19.4) | 17 (18.5) | 0.76 |
Rash | 6 (20.0) | 7 (11.3) | 13 (14.1) | 0.26 |
CNS signs | 4 (13.3) | 2 (3.2) | 6 (6.5) | 0.07 |
Bite mark, no. (%) |
11 (36.7) |
17 (27.4) |
28 (30.4) |
0.36 |
Laboratory results‡ | ||||
Leukocytes, mean 109/L (95% CI) | 8.65 (7.71–9.59) | 9.74 (7.32–12.16) | 9.37 (9.35–9.39) | 0.13 |
PMN, mean 109/L (95% CI) | 5.16 (4.22–6.1) | 7.12 (5.34–8.89) | 6.45 (9.43–6.47) | <0.01 |
PMN %, mean (95% CI) | 0.58 (0.51–0.64) | 0.72 (0.54–0.9) | 0.674 (0.67–0.68) | <0.01 |
Lymphocytes, mean, 109/L (± SD) | 1.85 (1.39–2.31) | 1.23 (0.92–1.54) | 1.442 (1.44–1.45) | <0.01 |
PLT, mean 109/L (95% CI) | 174.2 (146–203) | 136.93 (102.85–171.02) | 149.64 (149.13–150.15) | 0.04 |
PLT <150,000, no. (%) | 12 (40) | 35 (56.5) | 47 (51.1) | 0.2 |
Hemoglobin, mean g/dL (95% CI) | 11.98 (11.3–12.7) | 13.35 (10.03–16.67) | 12.88 (12.87–12.89) | <0.01 |
CRP, median mg/dL (IQR) | 7.93 (6.35–9.5) | 16.87 (12.67–21.07) | 12.2 (5.5–17.8) | <0.01 |
ESR, median mm/h (IQR)§ | 53.92 (40.76–67.09) | 53.96 (40.53–67.39) | 50 (30–75) | 0.99 |
Hyponatremia, no. (%) | 9 (30.0) | 17 (27.4) | 26 (28.2) | 0.8 |
Elevated creatinine level, no. (%)¶ | 2 (6.7) | 13 (21) | 15 (16.3) | 0.08 |
Elevated liver enzymes, no. (%)# | 0 | 8 (12.9) | 8 (8.7) | 0.04 |
*CNS, central nervous system; CRP, C-reactive protein; ED, emergency department; ESR, erythrocyte sedimentation rate; ICU, intensive care unit; IQR, interquartile range; PLT, platelets; PMN, polymorphonuclear.
†Number of persons in each group were as follows: 2–5 y: 3; 6–9 y: 5; 10–13 y: 10; 14–17 y: 12; 14–17 y: 12; 18–22 y: 31; 23–29 y: 16; 30–45 y: 10; and 46–70 y: 5.
‡Reference ranges: Platelets (109/L), 150,000-400,000; C-reactive protein (mg/dL), <0.5; ESR (mm/h) <20.
§Children, n = 13; adults, n = 26.
¶Elevated creatinine levels in comparison to age-adjusted reference (11).
#Elevated aspartate transaminase and/or alanine aminotransferase in comparison to age-adjusted reference (11).
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1These authors contributed equally to this article.