Domínguez, María CarmenVergara, SalvadorGómez, María CarmenRoldán, María Esther2023-02-082023-02-082020http://hdl.handle.net/10668/15395Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994-2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Borrelia hispanicaJarisch-Herxheimer reactionSpainarthropodborne diseasebacteriaendemic borreliosistick-borne relapsing fevervector-borne infectionszoonosesBorreliaHeadacheHumansRelapsing FeverSeasonsSpainresearch article32308194open access10.3201/eid2605.1907451080-6059PMC7181924https://wwwnc.cdc.gov/eid/article/26/5/pdfs/19-0745.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181924/pdf