Tick-Borne Relapsing Fever in the White Mountains, Arizona, USA, 2013-2018

Neema Mafi, Hayley D. Yaglom, Craig Levy, Anissa Taylor, Catherine O'Grady, Heather Venkat, Kenneth K. Komatsu, Brentin Roller, Maria T. Seville, Shimon Kusne, John Leander Po, Shannon Thorn, Neil M. Ampel

Research output: Contribution to journalArticle


Tick-borne relapsing fever (TBRF) is a bacterial infection transmitted by tick bites that occurs in several different parts of the world, including the western United States. We describe 6 cases of TBRF acquired in the White Mountains of Arizona, USA, and diagnosed during 2013-2018. All but 1 case-patient had recurrent fever, and some had marked laboratory abnormalities, including leukopenia, thrombocytopenia, hyperbilirubinemia, and elevated aminotransaminases. One patient had uveitis. Diagnosis was delayed in 5 of the cases; all case-patients responded to therapy with doxycycline. Two patients had Jarisch-Herxheimer reactions. The White Mountains of Arizona have not been previously considered a region of high incidence for TBRF. These 6 cases likely represent a larger number of cases that might have been undiagnosed. Clinicians should be aware of TBRF in patients who reside, recreate, or travel to this area and especially for those who sleep overnight in cabins there.

Original languageEnglish (US)
Pages (from-to)649-653
Number of pages5
JournalEmerging infectious diseases
Issue number4
StatePublished - Apr 1 2019


  • Arizona
  • bacteria
  • bacterial infections
  • Borrelia hermsii
  • public health
  • relapsing fever
  • TBRF
  • tick-borne relapsing fever
  • tickborne diseases
  • ticks
  • United States
  • vector-borne infections
  • White Mountains
  • zoonoses

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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    Mafi, N., Yaglom, H. D., Levy, C., Taylor, A., O'Grady, C., Venkat, H., Komatsu, K. K., Roller, B., Seville, M. T., Kusne, S., Po, J. L., Thorn, S., & Ampel, N. M. (2019). Tick-Borne Relapsing Fever in the White Mountains, Arizona, USA, 2013-2018. Emerging infectious diseases, 25(4), 649-653. https://doi.org/10.3201/eid2504.181369