TBRF can occur in most of the western portion of the US (west of the Mississippi River) with most cases occurring west of the Rocky Mountains. Travelers to these endemic states commonly get the disease as well. A high percentage of cases occur among people vacationing in rodent-infested cabins in wooded and mountainous areas.

Tick-borne Relapsing Fever (TBRF) is caused by bacterial spirochete species including Borelliahermsii, Borelliaparkerii, or Borelliaturicatae, with Borelliahermsii being the most common causative agent. The bacteria are transmitted by the bite of soft tick Ornithodoros species. These ticks feed primarily at night. The bite of the tick is usually painless and they feed for only 15 to 30 minutes before dropping off. This makes it difficult to detect the ticks on one’s body. The Ornithodoros soft ticks generally feed on small mammals and rodents including mice, chipmunks, squirrels, rats and rabbits, and in the absence of these hosts they will feed on other warm-blooded mammals including humans.

The agent of tickborne relapsing fever, Borrelia hermsi, is carried by soft ticks of the western United States. It is characterized by cycles of high fever and is treated with antibiotics.


Tick-borne relapsing fever (TBRF) is a rare infection linked to sleeping in rustic cabins, particularly cabins in mountainous areas of the western United States. The main symptoms of TBRF are high fever (e.g., 103° F), headache, muscle and joint aches. Symptoms can reoccur, producing a telltale pattern of fever lasting roughly 3 days, followed by 7 days without fever, followed by another 3 days of fever. Without antibiotic treatment, this process can repeat several times.


A definitive diagnosis of TBRF is made by detecting Borrelia spirochetes in the patient’s smears of blood, bone marrow or cerebrospinal fluid. The best time to detect spirochetes in patient blood samples is when the patient is febrile (feverish).


Symptoms of TBRF often resolve on their own, but treatment with antibiotics can help them resolve much faster. Antibiotics used to treat TBRF include erythromycin, tetracycline, chloramphenicol, and penicillin. The current recommended duration of antibiotic therapy is 7 days. Erythromycin or penicillin antibiotics are recommended for use by young children or pregnant women.

You need to remove the tick as soon as possible. Call your doctor if you are unable to remove the entire tick from your skin.

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