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Abstract

KEY POINTS • A broad differential should be maintained in the returning traveller with fever, and a detailed travel, social and exposure history elicited to help guide appropriate diagnostics. • Spirochetes seen in routine peripheral blood or malaria smears are pathognomonic for tick-borne or louse-borne relapsing fever caused by Borrelia species. • In North America, tick-borne relapsing fever is endemic to British Columbia and the western United States, and is transmitted by Ornithodoros soft ticks. • Patients should be closely monitored for the Jarisch– Herxheimer reaction after initiation of effective therapy for all forms of relapsing fever.