In the case of our patient, the rapid anti- through his stay, he experienced an “insect bite” to the leg, gen test was negative and no malaria parasites were seen on the which became pruritic and red. [...] After establishing infection in the host, Borrelia species are capable of altering their surface antigens, which Borrelia • Lyme borreliosis leads to the repeated cycles of spirochetemia and immune sys- • Tick-borne relapsing fever tem stimulation.1 The initial incubation period is 7 days (range • Louse-borne relapsing fever 2–14 d), followed by the first episode of fever and associated • Hard ti. [...] Between 1990 and 2011, 483 cases of firm the diagnosis, by the British Columbia Centre for Disease tick-borne relapsing fever were reported in the western US, and Control. [...] Once Diagnosis Borrelia infection was confirmed by the laboratory, we con- Identification of spirochetes in a peripheral blood smear is highly cluded that the “worm” removed from the patient’s leg had suggestive of relapsing fever, although there are rare instances of probably been a fly larva (myiasis), and was not likely associated other spirochetes being detected in Giemsa smears. [...] As per the Canadian guidelines,10 malaria approval of the version to be published, and agreed to be account- should always be ruled out in febrile patients who have travelled able for all aspects of the work.
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