The Symptoms in Detail
The Temperature Curve.—This is the chief point in the clinical diagnosis of relapsing fever. The onset of the first febrile accession is abrupt and the temperature rapidly rises to 104°F. or higher. After a continued high temperature for three or four days the fever drops by crisis, which is at times productive of collapse. Following an apyrexial period of four to eight days we have a second febrile accession, and there may be several of these wave-like alternations of fever and apyrexia.
The Nervous System.—Very marked frontal headache is a striking feature and the pains in back and limbs may be of great severity. Cranial nerve involvement has been noted. There may be apathy, but on the whole the mind is clear.
The Digestive System.—Anorexia and vomiting are features of the febrile periods to cease in the fever-free periods. In some types bilious vomiting may be marked.
The Circulatory and the Respiratory System.—The pulse rate is much accelerated, and there may be some praecordial distress. A bronchial catarrh is frequently present in the first febrile paroxysm.
The Liver and Spleen.—Splenic tenderness and moderate enlargement are fairly constant features. The liver may suffer severely in the so-called bilious typhoid and marked jaundice may ensue with a typhoid state.
The Blood Examination.—This is the most important point in diagnosis. The spirochaetes, which are only found in the peripheral circulation during fever periods, are not so numerous in tropical relapsing fevers as in the European forms. When spirochaetes are scarce it is more satisfactory to examine Romanowsky-stained specimens, especially with the Giemsa staining. The spirochaetes show a varying number of undulations. There is no chromatin staining in the line of the spirochaetes. The disease when severe shows a well-marked polymorphonuclear leucocytosis, with at times an increase of large mononuclears. This latter, however, may be connected with malaria or amoebiasis.
Diagnosis
The disease most likely to be confused with relapsing fever is malaria and for this differentiation the finding of the parasites of either disease is of first importance.
The blood of a suspected case even during the apyrexial period should be injected into a mouse or white rat (guinea pigs are refractory to infection). Spirochaetes should appear in the blood of the mouse in about twenty-two hours and persist for about two days. Relapses occur but recovery is the rule.