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      Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study

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          Abstract

          Background

          Louse- borne relapsing fever is an acute febrile illness caused by Borrelia recurrentis and is transmitted by body lice, Pediculus humanus corporis. The disease has occurred as epidemic in different parts of the country.Therefore, the aim of this retrospective study was conducted to assess the LBRF profile for the last four years.

          Methods

          A retrospective study was conducted on patients with LBRF admitted from 2009–2012 at Felegehiwot referral hospital. The diagnosis was based on both clinical and laboratory methods. Patients with strong clinical suspicion of LBRF and positive for Borrelia species in their blood was diagnosed as LBRF cases. Data was collected from all patients with LBRF- like symptoms in their registration book. Data was checked for completeness, coded and analysed using SPSS version 16. P < 0.05 was considered significant for comparison.

          Results

          Of the 4559 patients admitted with LBRF- like symptoms, 4178 (91.6%) were males and 381 (8.4%) were females. Most of the patients (74.2%) were within age groups 11–20 years. The majority of patients (94.4%) were from urban residence. The overall prevalence of LBRF was 225 (4.9%) and the highest prevalence 171 (5.1%) was observed in age groups of 11–20 years. The association between seasonal variation and prevalence of LBRF showed that more patients with positive for Borrelia species were recorded in dry 27 (9.7%) than wet 198 (4.6%) seasons (P < 0.001). Finally, a trend in prevalence of LBRF for the last four years showed that the highest numbers of cases were documented in 2010.

          Conclusion

          The overall prevalence of LBRF was high and the highest prevalence was observed in young age groups. Moreover, most of the patients with LBRF were from urban dwellers. Therefore, health education should be delivered towards LBRF prevention in the city.

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          Most cited references8

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          The body louse as a vector of reemerging human diseases.

          The body louse, Pediculus humanus humanus, is a strict human parasite, living and multiplying in clothing. Louse infestation is associated with cold weather and a lack of hygiene. Three pathogenic bacteria are transmitted by the body louse. Borrelia recurrentis is a spirochete, the agent of relapsing fever, recently cultured on axenic medium. Historically, massive outbreaks have occurred in Eurasia and Africa, but currently the disease is found only in Ethiopia and neighboring countries. Bartonella quintana is now recognized as an agent of bacillary angiomatosis bacteremia, trench fever, endocarditis, and chronic lymphadenopathy among the homeless. Rickettsia prowazekii is the agent of epidemic typhus. The most recent outbreak (and the largest since World War II) was observed in Burundi. A small outbreak was also reported in Russia in 1997. Louse infestation appears to become more prevalent worldwide, associated with a decline in social and hygienic conditions provoked by civil unrest and economic instability.
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            Relapsing fever--a forgotten disease revealed.

            S J Cutler (2010)
            Borrelial relapsing fever was once a major worldwide epidemic disease that made a significant impact on Livingstone during his epic travels through Africa and throughout Europe. Indeed, the term 'relapsing fever' was first used to describe clinical cases of this disease in Edinburgh. During the last century, we have witnessed the demise of the louse-borne infection, largely through improving standards of living resulting in a reduction in body lice, the vector for Borrelia recurrentis [louse-borne relapsing fever (LBRF)]. The tick-borne zoonotic form of the disease persists in endemic foci around the world [tick-borne relapsing fever (TBRF)]. Indeed, TBRF is reportedly the most common bacterial infection from Senegal and listed within the top ten causes of mortality in children under five in Tanzania. In Ethiopia, LBRF is again within the top ten causes of hospital admission, associated with significant morbidity and mortality. Despite these figures, many now regard relapsing fever as an unusual tropical disease. Certainly, recent cases have been imported following travel from endemic zones. More surprisingly, cases have been reported following family reunions in Colorado, USA. A further case was reported from the Mt Wilson observatory in Los Angeles, USA. In many regions, the infection is zoonotic with natural reservoirs in several vertebrate species. In West Africa, infection is again primarily zoonotic. Whether those species found predominantly in East Africa are zoonoses or are infections of humans alone is still debated, however, the life cycle may be determined by the feeding preferences of their arthropod vectors.
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              Human louse-transmitted infectious diseases.

              Several of the infectious diseases associated with human lice are life-threatening, including epidemic typhus, relapsing fever, and trench fever, which are caused by Rickettsia prowazekii, Borrelia recurrentis, and Bartonella quintana, respectively. Although these diseases have been known for several centuries, they remain a major public health concern in populations living in poor-hygiene conditions because of war, social disruption, severe poverty, or gaps in public health management. Poor-hygiene conditions favour a higher prevalence of body lice, which are the main vectors for these diseases. Trench fever has been reported in both developing and developed countries in populations living in poor conditions, such as homeless individuals. In contrast, outbreaks of epidemic typhus and epidemic relapsing fever have occurred in jails and refugee camps in developing countries. However, reports of a significantly high seroprevalence for epidemic typhus and epidemic relapsing fever in the homeless populations of developed countries suggest that these populations remain at high risk for outbreaks of these diseases. Additionally, experimental laboratory studies have demonstrated that the body louse can transmit other emerging or re-emerging pathogens, such as Acinetobacter baumannii and Yersinia pestis. Therefore, a strict survey of louse-borne diseases and the implementation of efficient delousing strategies in these populations should be public health priorities. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
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                Author and article information

                Contributors
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central
                1756-0500
                2014
                17 April 2014
                : 7
                : 250
                Affiliations
                [1 ]Department of Medical Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
                [2 ]Felegehiwot referral hospital, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
                Article
                1756-0500-7-250
                10.1186/1756-0500-7-250
                4065083
                24742342
                ce31e453-9333-4111-938c-223e70b06ec7
                Copyright © 2014 Yimer et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 September 2013
                : 11 April 2014
                Categories
                Research Article

                Medicine
                louse- borne relapsing fever,bahir dar city,ethiopia
                Medicine
                louse- borne relapsing fever, bahir dar city, ethiopia

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