Fourth case of louse-borne relapsing fever in Young Migrant, Sicily, Italy, December 2015. Mini Review Article

- Louse-borne relapsing fever (LBRF) is a vector-borne disease caused by infection with Borrelia recurrentis.
- In the first half of the twentieth century, major outbreaks of LBRF occurred in Eastern Europe.
- LBRF can be severe and death occurs in 10%-40% of cases in the absence of appropriate treatment.
- The aim of our paper is to review all cases of LBRF reported in migrants arrived in Europe in the last 10 years.

ObjectivesCurrently louse-borne relapsing fever (LBRF) is primarily found in limited endemic foci in Ethiopia, Somalia and Sudan; no case of imported LBRF has been reported in Europe in the 9 years prior to 2015. The aim of our paper is to describe a new case of imported LBRF detected in Sicily, Italy, and to review all cases reported in migrants arrived in Europe in the last 10 years.Study designMini review of all published cases of louse-borne relapsing fever in Europe in the last 10 years.MethodsA computerized search without language restriction was conducted using PubMed combining the terms '(louse-borne relapsing fever or LBRF or recurrentis) and (refugee or Europe or migrant)' without limits. Furthermore, the 'Ahead-of-Print Articles' of the top 10 journals (ranked by Impact factor - Web of Science) of Infectious diseases and of Epidemiology were checked.ResultsOur search identified 26 cases of LBRF between July and October 2015 in migrants recently arrived in Europe: 8 had been described in Italy; 1 in Switzerland; 2 in the Netherlands; 15 in Germany. We describe data regarding the clinical characteristics, diagnostic methods, therapy and outcome of these patients and of the new case.ConclusionsLBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.