Relapsing Fever

Figure 1. A 41-year-old woman presented with a four-week history of recurring fever (temperature, 40.5°C), headache, and diffuse myalgias. She was one of three family members in whom relapsing fever developed after they vacationed in a rustic, rodent-infested cabin in northeast Washington State. A Wright's-stained peripheral-blood smear contains two borrelia spirochetes (arrows). The patient was treated with 100 mg of doxycycline orally twice a day and had no further symptoms.