Factors Influencing Disease Outcomes in Relapsing Fever Patients: Insights from Ethiopia

Factors Influencing Disease Outcomes in Relapsing Fever Patients: Insights from Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Influencing Disease Outcomes in Relapsing Fever Patients: Insights from Ethiopia Seblewongel Birhanemskel Haileselassie, Molla Asnake Kebede, Missgana Worku Belete, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5544669/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Relapsing fever (RF) is a recurrent febrile illness caused by various Borrelia spirochetes, with humans as the only known reservoirs. Despite recurring epidemics and high mortality rates in East Africa, limited research focuses on RF compared to other infectious diseases. This study aims to assess the clinical characteristics, outcomes, and associated factors with disease outcome among RF patients admitted to Yekatit-12 Hospital Medical College. Methods An institutional based retrospective cross sectional study was done and the study period was from April 2023 to June 2023. Data were analyzed using SPSS version 7 (2020), and results were disseminated accordingly. Results A total of 119 confirmed RF cases were identified, with a mean age of 24.1 ± 7.4 years. All cases were male, with an average symptom duration of 4.5 ± 2.86 days. Most patients were street dwellers or daily laborers. The majority received combination therapy, with ceftriaxone and doxycycline as the treatments of choice. The incidence of Jarisch-Herxheimer Reaction (JHR) was 36.1%, and the case fatality rate was 45.4%. Factors significantly associated with poor outcomes included JHR (p = 0.023, AOR = 2.8, 95% CI: 1.09–7.64), mechanical ventilation use (p < 0.001, AOR = 2.7, 95% CI: 1.05–7.1), longer symptom duration (p = 0.021, AOR = 3.1, 95% CI: 1.24–7.9), and multi-organ failure (p = 0.002, AOR = 3.8, 95% CI: 1.23–11.6). Conclusion This study highlights the significant burden of relapsing fever among younger, predominantly male laborers, with severe complications contributing to high mortality. It underscores the importance of early detection, prompt treatment, and targeted public health strategies to improve outcomes. Relapsing fever Jarisch-Herxheimer Reaction (JHR) Clinical characteristics Case fatality rate Figures Figure 1 Figure 2 Figure 3 Background Louse-borne relapsing fever (LBRF) is a vector-borne disease that is typically characterized by the acute onset of febrile disease with a higher rate of subsequent febrile relapses in untreated patients. [ 1 , 2 ] Humans are the only known reservoirs for Borrelia recurrentis. The bacteria is transmitted from human to human by the body louse species known as Pediculus humanus which thrives well in poor hygienic conditions. [ 1 , 3 ] Relapsing fever (RF) was once a disease of global epidemic importance as it was widely distributed in all parts of the world including Europe and North America intimately associated with poverty and overcrowding [ 4 , 5 , 6 , 7 ] In severe cases, neurological involvement, myocarditis, acute respiratory distress syndrome, hepatic failure, spleen rupture and disseminated intravascular coagulation leading to intracranial, massive gastrointestinal, pulmonary, or peripartum hemorrhage may occur. [ 2 , 3 , 8 ] Relapsing fever has high mortality rates if untreated, with Louse-Borne Relapsing Fever (LBRF) ranging from 10–70% and Tick-Borne Relapsing Fever (TBRF) at 4–10%, largely influenced by coexisting conditions such as malnutrition, dehydration, or malaria. Mortality is most common during the first fever episode. With timely antibiotic treatment, mortality decreases to 2–5% for LBRF and < 2% for TBRF. However, co-infections like dysentery, salmonellosis, typhoid, typhus, tuberculosis, bacterial pneumonia, visceral leishmaniasis, and malaria can significantly increase mortality. [ 8 , 12 , 21 ] Relapsing fever is diagnosed by identifying spirochetes in a peripheral blood smear during febrile episodes. This can be done using dark-field microscopy or by examining a stained thick or thin blood film under a microscope. For confirmation, polymerase chain reaction (PCR) targeting the 16S rRNA gene may also be employed. [ 1 , 8 , 9 ] Although Louse-Borne Relapsing Fever (LBRF) cases have significantly declined worldwide following reduced body louse infestations since the 1940s, it remains a major public health issue and a leading cause of hospitalization and death in East African countries, particularly in Ethiopia. In Ethiopia, the endemic form is predominantly LBRF, while the Tick-Borne Relapsing Fever (TBRF) is less recognized. However, TBRF is endemic in the country, with occasional outbreaks, especially during the rainy season . [ 3 , 9 , 16 , 27 ] During a 2016 outbreak in the Arsi Zone, Ethiopia, the case-fatality rate for relapsing fever was 13%. Among children, reported case-fatalities range from 1.9–5.5%. In a study of 154 children under 15 years in Ethiopia, the overall case-fatality rate was 2.4%, significantly lower than the rate observed in adults ( 13.2% ). [ 3 , 11 , 14 ] Although the prevalence of body louse infestations drastically dropped after the 1940s, LBRF cases persist as the main public health issue and a leading cause of hospitalization and mortality in East African nations, particularly in Ethiopia Occasionally is found in neighboring countries, such as Eritrea, Sudan, and Somalia. [ 13 , 14 , 23 ] Despite recurring epidemics and the high mortality rates associated with relapsing fever (RF) in East Africa, particularly in Ethiopia, where mortality can reach up to 15% with treatment and 70% without treatment, research in the region has primarily focused on the other. Limited attention has been given to disease outcomes and their associated factors. In Ethiopia, comprehensive studies examining these critical aspects are lacking, underscoring the importance of addressing this gap to better understand the persistently high mortality rates. This study aims to identify the clinical characteristics and determinants influencing disease outcomes, thereby contributing to a deeper understanding of the factors driving mortality. Furthermore, ongoing challenges in Ethiopia, such as inflation and civil unrest, are expected to exacerbate the epidemic potential of RF. This underscores the importance of this research in informing emergency preparedness and response strategies to mitigate the impact of future epidemics. METHODS AND MATERIALS Study area The study was conducted in Yekatit 12 Hospital Medical College among all patients diagnosed with relapsing fever from September 1, 2014 – February 28 2015 EC. Yekatit12 Hospital Medical College,, Addis Ababa.. It includes 17 HC a catchments area and gives service for all available facilities the included subbcities are showen in the Fig. 1 . Later established as a medical college in 2003E.C. gives courses in multiple undergraduate and postgraduate programs. It has been providing service to a larger community not only in Addis Ababa but also including a larger population in the Oromia region around Addis Ababa. It serves around 230,000 people annually both in the emergency and outpatient department. Currently, the hospital has a staff of around 1500 in various units. For better data management and use, the hospital implemented EHR in 2012 E.C. The institution have its own accreted laboratory which do diagnostic tests including blood film. Ethiopian seasons summer so called ( Kiremt or Meher ) in Ethiopia runs from (June to Augest this is monsoon season so heavy rains and thunderstorms are regular occurance, Autumn (Belg) in Ethiopia runs from (September, October and November) are the harvest season, Winter (Bega) is from (December to Feburary) are dry season with frost in morning specially in January, Spring (Tseday) In Ethiopia runs from (March, April and May) these months experience occasional showers, May is the hottest mobth in Ethiopia. [ 26 ] Population The source population consisted of all patients admitted to Yekatit 12 Medical College with a diagnosis of relapsing fever. The study population included all patients diagnosed with relapsing fever at Yekatit 12 Medical College from September 1, 2021 – February 28, 2023 GC. All patients aged > 14 years with a confirmed diagnosis of relapsing fever with blood film were included. Patients whose diagnosis was not confirmed through blood film, those who were referred but whose outcomes were not traced, were excluded from the study. Study design and period An institutional based retrospective cross sectional study was done and the study period was from April 2023 to June 2023 Study variables. In this study, the dependent variable is the outcome of patients diagnosed with relapsing fever. The independent variables include a variety of factors such as comorbidities, age, sex, the season in which the patient presented, the duration of illness, Jarisch-Herxheimer (JHR) reaction, medications received, length of ICU stay, length of hospital stay, mechanical ventilation (MV) support, substance use, occurrence of multiorgan failure, systolic blood pressure (SBP), platelet count, seasonal variation, and the presence of organ failure. These variables will be analyzed to determine their impact on the clinical outcomes of patients with relapsing fever. Data collection tool and procedures To collect data, a structured questionnaire was developed in English, designed to extract pertinent clinical information from patients' medical records. The tool was adapted from similar studies with some modification to ensure relevance and comprehensiveness. [ 7 , 13 , 24 , 15 ] The questionnaire was organized into multiple sections to capture all necessary data. Laboratory investigations, including complete blood count (CBC), liver function tests (LFTs), and coagulation profiles (e.g., INR, aPTT), were also collected. Diagnostic procedures were recorded, including blood film. The treatment provided to each patient was documented in detail, including the type of treatment (pharmacological), blood transfusions, and medications administered. Finally, the length of symptom before standard treatment commenced were also recorded. The data collection process began by identifying eligible patients who met the inclusion criteria: those aged 14 years or older, diagnosed with relapsing fever during the study period. Data collectors retrieved patient charts identified through log books and the Health Management Information System (HMIS) registries. The questionnaire was then filled out using the available information within the medical charts. Operational definition Mass Sleeping: Sleeping in a shared or public space with more than 6 individuals in close proximity. [ 2 ]. Homelessness: A person who lives outside a traditional home and sleeps in a public space, such as on the street, in shelters, or in temporary housing situations. [ 3 ]. Characterization: The clinical presentation of patients with relapsing fever, including complications that arise either due to treatment or as a result of the relapsing fever itself [ 14 ]. JHR Reaction (Jarisch-Herxheimer Reaction): A reaction that occurs within 4 hours of initiating antibiotic treatment, where patients exhibit symptoms such as rigors, myalgias, a further rise in body temperature, increased respiratory rate, and hypotension [ 28 ]. AKI (Acute Kidney Injury): Defined according to KDIGO guidelines as an increase in serum creatinine by > 0.3 mg/dL within 48 hours, or an increase in serum creatinine to > 1.5 times baseline, with the increase either known or presumed to have occurred within the prior seven days, or urine output < 0.5 mg/dL/hr for six hours [ 29 ]. ARDS (Acute Respiratory Distress Syndrome): Diagnosed according to The Berlin Definition [ 30 ]. Hypoglycemia: Diagnosed using Whipple’s triad [ 31 ]. Liver Failure: Severe acute liver injury with encephalopathy and impaired synthetic function (INR > 1.5) in a patient without pre-existing liver disease or cirrhosis [ 32 ]. Thrombocytopenia: Classified as Mild = 100,000–149,000, Moderate = 50,000–99,000, and Severe = < 50,000 platelets, according to Harrison’s Standard Textbook of Medicine [ 25 ]. Anemia: Defined by the World Health Organization (WHO) as a hemoglobin level < 130 g/L (13 g/dL) for men and < 120 g/L (12 g/dL) for women. Anemia is further classified as mild (11–11.9), moderate (8–10.9), or severe (< 8) [ 25 ]. A case of relapsing fever: The patient presented with symptoms consistent with relapsing fever, and the diagnosis was confirmed through microscopic examination of peripheral blood, where the presence of spirochetes was identified using Giemsa or Wright staining. [ 32 ] Outcome measurement The outcome in this study refers to the final clinical status of patients diagnosed with relapsing fever during the study period. Two primary categories were used to assess the outcome: Discharged with Improvement and Died. Patients categorized as "Discharged with Improvement" were those who exhibited clinical improvement in their symptoms, such as resolution of fever, normalization of vital signs, and recovery of organ function, and were subsequently discharged from the hospital following treatment. On the other hand, patients who succumbed to during at admition at any cause, were classified under the "Died" category. This outcome reflects the mortality associated with the disease and its complications, providing valuable insights into the severity of relapsing fever and the effectiveness of the clinical interventions. Data quality assurance A pilot study by pretesting the data collection tools was conducted in St paul Millennium Medical College 5% of the total sample size to detect any weakness in the organization and structuring of the research instruments. Following the pre-test, improvements to the tools was made as necessary. Training was given to data collectors and supervisors on the purpose of the investigation and the significance of obtaining the data. The supervisors checked the filled questionnaire for completeness. Data processing and analysis The collected data was coded and entered into EPI INFO software version 7.2.1 (2018) and Epi Data version 2(2007) and was imported to SPSS version 27(2020) for cleaning and analysis. During analysis errors related to the inconsistency of data was checked and corrected during data cleaning. Finally, Descriptive statistics were generated through frequency, tables and graphs, while binary logistic regression was conducted to calculate odds ratios with 95% confidence level and p-values, testing the association between dependent and independent variables; a P- value < 0.2 was used for bi-variate analysis, and < 0.05 for multivariate analysis to declare statistical significance. Results Socio-demographic Characteristics During the study period, 119 laboratory-confirmed cases of relapsing fever were identified. The majority of patients, 79 (66.3%), were in the age group of 15–25 years, with a mean age of 24.1 ± 7.4 years, underscoring the disease's predominance among younger populations. All patients were male, and 50 (42.01%) were daily laborers (Table 1 ). Regarding referral pathways, 69 (58%) cases were referred from health centers. In terms of care-seeking behavior, 49.1% of patients presented within 2–5 days of symptom onset, while only 11 (9.2%) sought care within the first day of illness (Table 1 ). Table 1 Sociodemographic and Referral Characteristics of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Variables Category Frequency Percent (%) Sex Male 119 100.0 Age (years) 15–25 79 66.3 25–35 33 27.7 > 35 7 5.8 Occupation Government employee 3 2.5 Daily laborer 50 42.01 Unemployed 47 39.9 Prisoners 11 9.2 Unknown 8 6.7 Referral center Health center 69 58.0 Self-referred 40 33.6 Charity center 10 8.4 Duration of illness 10 days 3 2.5 Unknown 13 10.9 Clinical Presentation of Patients with Relapsing Fever Fever was the most common presenting symptom, reported in 85.5% of cases, often accompanied by nonspecific acute febrile illness (AFI)-like symptoms such as chills and rigors (67.2%). Shortness of breath or rapid breathing was noted in 54.6% of patients, while abdominal pain, nausea/vomiting, and jaundice were observed in 30.3%, 56.3%, and 36.1% of cases, respectively. Altered mental status was reported in 46.2% of patients, with one individual presenting with seizures. Additionally, 22.7% of patients experienced bleeding complications, including epistaxis, upper gastrointestinal bleeding (UGIB), and gum bleeding (Fig. 1 ). The two most common risk factors identified were residing in mass sleeping houses (37%) and homelessness (39.5%), aligning with the nature of the disease and the socioeconomic challenges faced by this patient group. Seasonal variability was evident, with the majority of cases (64.6%) occurring during the rainy seasons of summer and autumn (Table 2 ) . No patients in the study were found to have comorbidities such as diabetes mellitus (DM), hypertension (HTN), renal failure (RF), or cardiac illnesses, which aligns with the age demographic of the patient population. However, substance use disorders were identified in 38 patients (31.9%), including alcohol consumption, khat chewing, cigarette smoking, and inhalation of "mastish" (Table 2 ). Table 2 Risk factors and clinical findings of patients with relapsing fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Variables Category Frequency Percent (%) Risk factors Mass sleeping houses 44 37.0 Homelessness 46 39.5 Charity center 8 6.7 Prisons 11 9.2 Others 9 7.6 Season Summer 53 44.5 Autumn 24 20.1 Winter 30 25.2 Spring 12 10.1 Substance use Yes 38 31.9 No 81 68.1 Among patients diagnosed with relapsing fever during the study period, the majority exhibited abnormal vital signs upon presentation. Tachycardia was observed in 100 patients (84%), tachypnea in 91 patients (76.5%), and hypotension in 65.5%. Temperature measurements were available for 33 patients, of whom 27.3% had documented fever. All patients were confirmed to have Borrelia species infections through laboratory testing, conducted either at the referral center or at the study hospital (Table 3 ). Table 3 Clinical Characteristics of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Variable Category Frequency Percent (n = 119) Respiratory Rate 12–20 breaths/min 28 23.5% > 20 breaths/min 91 76.5% Pulse Rate 100 beats/min 100 84.0% Systolic Blood Pressure 90 mmHg 41 34.5% Temperature (n = 33) Hypothermic 2 6.1% Normal 22 66.7% Febrile 9 27.3% Diagnosis Blood Film 119 100% On physical examination, 43 patients (36.1%) presented with icteric sclera. Chest examination revealed findings in 83 patients (68.9%), with bilateral coarse crepitations noted in 58 patients (48.7%). Abdominal examination abnormalities were identified in 22 patients (18.5%), including right upper quadrant (RUQ) pain (5%), hepatosplenomegaly (HSM, 5%), hepatomegaly (3.4%), and splenomegaly (5%). Additionally, 55 patients (46.2%) exhibited altered mental status with a Glasgow Coma Scale (GCS) score of less than 14, including 7 patients (5.9%) who presented in a coma (Table 4 ). Table 4 Presenting Signs of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Sign Incidence Percent (n = 119) HEENT Icteric sclera 43 36.1% Dehydration signs 3 2.5% Bleeding gums 7 5.8% Pale conjunctiva 10 8.4% Icteric sclera and pale conjunctiva 3 2.5% Subconjunctival hemorrhage 1 0.8% Chest Crepitations 58 48.7% Transmitted sounds 2 1.7% Decreased air entry 16 13.4% Gasping 7 5.9% Abdomen Tenderness 6 5.0% Hepatomegaly 6 5.0% Splenomegaly 4 3.4% Hepatosplenomegaly 6 5.0% GCS < 8 7 5.9% 8 to 13 16 13.4% 13 to 14 32 26.9% COTPPT 64 53.8% Laboratory Findings All patients underwent complete blood count (CBC) and blood film analysis. At presentation, mild anemia was observed in 65 patients (54.6%), while severe anemia was present in 5 patients (4.2%). Leukocytosis was identified in 41.2% of patients, with 74% showing a left shift in their white blood cell differential. Thrombocytopenia was prevalent, with only 2 patients exhibiting a normal platelet count. Severe thrombocytopenia was seen in 81.8% of cases, including 42 patients with platelet counts below 20,000 and 17 patients with counts below 10,000, potentially requiring transfusion of fresh frozen plasma and platelets (Table 5 ). Organ function tests were performed on 107 patients. Elevated aspartate aminotransferase (AST) levels (> 2x the normal laboratory cutoff) were found in 63 patients (58%), while alanine aminotransferase (ALT) levels were similarly elevated in 21 cases (19.6%). Few patients exhibited significant abnormalities in alkaline phosphatase levels. Additionally, elevated creatinine levels were observed in 50 patients (46.7%) at the time of presentation (Table 5 ). Table 5 Laboratory Findings of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Laboratory Parameter Incidence Percentage (n = 119) Hemoglobin at Admission Mild 65 54.6% Moderate 19 15.9% Severe 5 4.2% Normal 30 25.2% White Blood Cell Count (WBC) Leukocytosis 49 41.2% Leukopenia 13 10.9% Normal 57 47.9% Neutrophils Increased 89 74.8% Normal 6 5.0% Neutropenic 24 20.2% Lymphocytes Lymphocytosis 5 4.2% Normal 103 86.6% Decreased 11 9.2% Platelet Count Thrombocytosis 2 1.7% Normal 2 1.7% Mild Thrombocytopenia 0 0.0% Moderate 18 15.1% Severe 97 81.5% Aspartate Aminotransferase (AST) Normal 12 11.2% 2x Normal 63 58.9% Alanine Aminotransferase (ALT) Normal 48 44.9% 2x Normal 21 19.6% Alkaline Phosphatase (Alk P) Normal 53 49.5% 2x Normal 17 15.9% Creatinine High 50 46.7% Normal 57 53.3% Management and Complications The majority of patients treated at the hospital received Ceftriaxone (80.7%), followed by oral doxycycline to 76 patients (63.9%). A smaller proportion (2.5%) were treated with Meropenem, while none received tetracycline. Penicillin was used as a first-line treatment in 33.6% of cases (40 patients), primarily for those referred from other health centers (Table 6 ). In this study, supportive treatments were administered to patients diagnosed with relapsing fever. Among the 119 patients, 4.2% (n = 5) required blood transfusions, while 16.8% (n = 20) received fresh frozen plasma. Platelet transfusions were the most common supportive treatment, given to 48.7% (n = 58) of patients. Mechanical ventilation was used for 40.3% (n = 48) of the patients, and 50.4% (n = 60) received vasopressors. These treatments reflect the severity and clinical management of complications associated with relapsing fever in the study population. (Table 7 )/ Combination therapy was the preferred approach, administered to 83% of patients. Among monotherapy cases, Ceftriaxone was the most frequently used (17%). The most common drug combination was Ceftriaxone with doxycycline, utilized in 16% of cases, followed by Cefepime with doxycycline, which was used for 11 patients. ( Fig. 2 ). Table 6 Treatment Modalities Used for Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Drugs Incidence Percentage (n = 119) Ceftriaxone 96 80.7% Metronidazole 12 10.1% Doxycycline 76 63.9% Cefepime 48 40.3% Ceftazidime 4 3.4% Ciprofloxacin 10 8.4% Meropenem 3 2.5% Azithromycin 11 9.2% Penicillin 43 36.1% Tetracycline 0 0.0% Table 7 Supportive Management Used for Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23). Supportive Treatment Incidence Percentage (n = 119) Blood Transfusion 5 4.2% Fresh Frozen Plasma 20 16.8% Platelet Transfusion 58 48.7% Mechanical Ventilator 48 40.3% Vasopressors 60 50.4% Complications Of the total patients, 105 (88.2%) developed complications. Acute Respiratory Distress Syndrome (ARDS) was the most common complication, affecting 69.7% of patients (83). Anemia was observed in 77.3% of cases, followed by shock, which was seen in 60.5% of patients (72) ( Table 8 ) .. Juvenile Hemorrhagic Retinopathy (JHR) was also a significant complication, affecting 36.1% of patients. Notably, all patients who developed JHR were those who had received penicillin as part of their treatment, and they were all referred from other health centers ( Table 8 ) . . Table 8 Complications in Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2024) Complications Incidence Percentage ARDS 83 69.74% Shock 72 60.5% Liver dysfunction 50 42.0% Renal failure 50 42.01% CNS complications 55 46.2% Anemia 89 74.7% JHR 43 36.1% Management Outcome In this study, 54 patients (45.4%, 95% CI: 36–54%) died (Fig. 3 ), and 7 patients (5.9%) with relapsing fever absconded from the emergency room after less than 24 hours of stay, without receiving complete and proper management ( Fig. 3 ) . The primary cause of death was multi-organ failure, which accounted for 64.8% of fatalities. Respiratory failure was the second leading cause of death, responsible for 14 (11.7%) of the deaths ( Table 9 ) . Table 9 Causes of Death in Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23). Cause of Death Frequency Percentage (n = 54) Respiratory failure 14 25.9% Multiorgan failure 35 64.81% Intracranial hemorrhage / Raised intracranial pressure 5 9.2% Total 54 100% Factors Associated with Mortality In this study, several factors were found to be significantly associated with the outcome of relapsing fever at a 25% confidence level. These factors included age, duration of symptoms, platelet count less than 50,000, multiple organ failure, Jarisch-Herxheimer reaction (JHR), substance use, and mechanical ventilation (MV). However, in the final multivariable logistic regression analysis, duration of symptoms, multiple organ failure, JHR, and mechanical ventilatory support were identified as independently associated with mortality. Specifically, after adjusting for other covariates, patients who required mechanical ventilation were about three times more likely to die [AOR: 2.74; 95% CI: 1.05–7.1] compared to those who did not require ventilatory support. Similarly, patients who developed Jarisch-Herxheimer reaction had approximately three times higher odds of death [AOR: 2.89; 95% CI: 1.09–7.64] than those who did not experience this reaction. Additionally, the odds of death were about three times higher for patients who delayed seeking healthcare for more than five days [AOR: 3.1; 95% CI: 1.24–7.98] compared to those who visited healthcare facilities within five days of symptom onset. Furthermore, patients who developed multiple organ failure had a significantly higher mortality risk, with odds of death about four times greater [AOR: 3.8; 95% CI: 1.23–11.6] than those without multiple organ failure. (Table 10 ) Table 10 Factors Associated with Mortality of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23). Variable Category Outcome COR P-value AOR Age 15–20 Died: 19 (51.4%) 3.1 (0.86, 11.6) 0.083 2.6 (0.56, 12.9) 21–30 Died: 31 (47.0%) 2.6 (0.77, 9.0) 0.120 1.5 (0.35, 6.34) > 30 Died: 4 (25.0%) 1 - 1 Duration of Symptoms 5 days Died: 27 (61.4%) 2.82 (1.30, 6.1) 0.021 3.1 (1.24, 7.9)* SBP (mmHg) 90 Died: 16 (39.0%) 1 - - Platelet Count (thousands) 50 Died: 6 (27.3%) 1 - 1 Jarisch-Herxheimer Reaction (JHR) Present Died: 25 (59.5%) 2.43 (1.12, 5.2) 0.023 2.8 (1.09, 7.64)* Absent Died: 29 (37.7%) 1 - 1 Multiple Organ Failure Yes Died: 45 (54.9%) 3.78 (1.58, 9.0) 0.002 3.8 (1.23, 11.6)* No Died: 9 (24.3%) 1 - 1 Mechanical Ventilation Yes Died: 32 (66.7%) 4.45 (2.03, 9.74) < 0.001 2.7 (1.05, 7.1) No Died: 22 (31.0%) 1 - 1 Substance Use Yes Died: 21 (55.3%) 1.79 (0.82, 3.91) 0.138 1.96 (0.73, 5.2) No Died: 33 (40.7%) 1 - 1 Note : Significant at a p-value < 0.05 level; AOR: adjusted odds ratio; COR: crude odds ratio; MV: mechanical ventilation; JHR: Jarisch-Herxheimer reaction. Discussion This study focused on managing patients with relapsing fever (RF), emphasizing clinical characteristics and factors influencing outcomes. Its uniqueness lies in addressing a topic previously unexplored in Ethiopia. The rising number of cases, fueled by forced migration, urbanization, instability, and interpersonal conflicts nationwide, highlights the urgency of this issue. Addis Ababa, as the primary destination for migrants, faces increased risks of disease transmission due to overcrowding, homelessness, and low socioeconomic conditions. The median age of patients in this study was 24.1 (± 7.4), aligning with findings from studies in Jimma, Arsi, Hossana, and Gondar, which reported that most cases affected individuals aged 15–25 years. This indicates that RF predominantly impacts the youth, the nation’s primary labor force, likely due to high unemployment, low socioeconomic status, and migration caused by conflict and instability [ 9 , 13 , 14 , 15 ] . Consistent with prior studies, the sex distribution revealed male predominance, with all patients in this study being male. A case-control study conducted in Arada in 2018 also found that 100% of identified cases were male. [ 3 ] This could be attributed to males' higher exposure to high-risk living conditions, such as migration for daily labor. However, since females also experience similar conditions, their lower incidence might be linked to better knowledge, awareness, and self-care practices, warranting further research into knowledge, attitude, and practice (KAP) among patients. Regarding occupational status, this study found that 81.9% of cases involved daily laborers and unemployed individuals, with less than 2.5% being civil servants. This aligns with studies in Arsi and Hossana, where daily laborers and farmers accounted for the majority of cases, while civil servants comprised less than 3% [ 9 , 14 , 16 ] interestingly, one healthcare professional contracted RF following patient contact, highlighting the occupational risk of healthcare exposure. Being a tertiary hospital, the majority of cases (58%) were referrals from health centers. The mean symptom duration was 4.5 (± 2.86) days, compared to 3.6 (± 0.7) days in Hossana [ 16 ] . A significant association was found between symptom duration and poor outcomes, with prolonged symptoms increasing mortality risk (AOR = 3.1, 95% CI: 1.24–7.9, p = 0.021). Fever was the most common presenting symptom, observed in 85.5% of patients, followed by chills and rigors (67.22%) and respiratory symptoms (54.6%). Severe symptoms, such as bleeding disorders (22.68%), altered mentation (46.21%), and jaundice (36.13%), were also prevalent. These findings are consistent with previous studies, though variations in prevalence were noted [ 9 , 14 , 16 ] . The two most common risk factors were mass sleeping houses (37%) and living on the streets (39.5%), reflecting the disease's socio-economic nature. Seasonal variability showed that most cases occurred during the wet season (64.5%), likely due to overcrowding in shelters during cold and wet weather. This contrasts with studies in Bahir Dar and Jimma, which found higher RF prevalence during dry seasons, possibly due to increased migration during that period [ 13 , 15 , 18 ]. Substance use disorder was noted in 31.8% of patients, while comorbidities were absent, likely due to the younger age group studied. Most patients presented with deranged vital signs, including tachycardia (76.5%), tachypnea (84%), and hypotension (65.5%), reflecting the severity of cases seen at referral centers. Laboratory findings revealed a high incidence of severe thrombocytopenia (81.8%) and anemia, consistent with the literature on RF's hematological impact. Organ dysfunction, particularly elevated creatinine and liver enzyme levels, was also common [ 21 ]. Treatment primarily involved ceftriaxone (80.7%) and doxycycline (63.95%), with a notable shift toward broader-spectrum antibiotics due to the complexity of cases. The study highlighted a high incidence of complications, such as acute respiratory distress syndrome (ARDS) in 70.6% of patients, anemia (77.3%), and shock (60.5%). Nearly 40% of patients required mechanical ventilation, underscoring the resource-intensive management required in severe RF cases. The mean hospital stay was 7.5 (± 7.4) days, with ICU and ER stays averaging 3.21 (± 4.6) and 1.86 (± 3.31) days, respectively. Jarisch-Herxheimer reaction (JHR) occurred in 36.1% of cases, significantly affecting mortality (AOR = 2.89, 95% CI: 1.09–7.64, p = 0.02). This aligns with reports from Gondar (46.5%) and Hossana (75.5%), although incidence rates var [ 9 , 14 , 16 , 21 ]. Mortality in this study was exceptionally high (45.4%) compared to studies in Jimma (6%) and Gondar (4.2%) [ 9 , 14 , 15 , 16 ]. This study identified critical factors associated with mortality in patients with relapsing fever. The findings underscore the impact of delayed healthcare-seeking behavior, the occurrence of Jarisch-Herxheimer reaction (JHR), the presence of multiple organ failure, and the need for mechanical ventilatory support on patient outcomes. Patients who delayed seeking medical attention for more than five days were significantly more likely to succumb to the disease compared to those who sought care earlier. This aligns with previous studies indicating that delays in treatment lead to disease progression and increased risk of severe complications, particularly in resource-limited settings where access to timely and adequate care may be constraines [ 33 ]. Early diagnosis and prompt initiation of antibiotic therapy remain paramount in reducing disease severity and improving survival rates. The Jarisch-Herxheimer reaction, a common complication during the treatment of relapsing fever, was found to be independently associated with mortality. This finding is consistent with prior evidence showing that the inflammatory cascade triggered by the rapid lysis of spirochetes can lead to significant hemodynamic instability and organ dysfunction, thereby increasing the risk of death [ 34 , 35 ]. Improved recognition and management of JHR, including the use of corticosteroids and supportive measures, may help mitigate its impact on mortality [ 36] . Multiple organ failure emerged as a critical determinant of poor prognosis, with affected patients facing significantly higher odds of mortality. This finding mirrors observations in other studies highlighting the role of systemic complications in driving adverse outcomes in infectious diseases [ 37]. The association between organ dysfunction and mortality underscores the need for robust critical care support and early intervention to prevent progression to multi-organ involvement. Mechanical ventilatory support was another independent predictor of mortality, reflecting the severe clinical deterioration in patients requiring such interventions. While mechanical ventilation is often life-saving, its necessity signals the presence of critical illness, as reported in studies of severe infections and sepsis [ 38 ]. Strategies to prevent respiratory failure, such as early respiratory monitoring and interventions, may help improve patient outcomes. Overall, these findings highlight the importance of early detection, timely intervention, and comprehensive management of complications in patients with relapsing fever. Future studies should explore the potential benefits of targeted interventions, such as early corticosteroid administration to mitigate JHR, and enhanced critical care resources to manage severe cases. Moreover, public health efforts to improve awareness of relapsing fever and address barriers to early healthcare access are crucial in reducing mortality in endemic regions. Conclusion This study provides valuable insights into the clinical and sociodemographic characteristics of relapsing fever patients, highlighting the disease's impact on younger, predominantly male populations, especially those engaged in labor-intensive occupations. The high incidence of severe clinical manifestations, including fever, chills, bleeding complications, and altered mental status, emphasizes the need for early detection and prompt medical intervention. The findings also underscore the critical role of timely supportive care, including the management of complications such as multi-organ failure and respiratory distress, in improving patient outcomes. Despite advances in treatment, the mortality rate remains significant, with factors such as delayed presentation, multiple organ failure, and mechanical ventilation being closely associated with poor prognosis. These results suggest the need for targeted public health strategies, especially for high-risk populations, including those residing in mass sleeping areas or engaging in substance use. Further research is necessary to explore the underlying mechanisms of relapse and identify more effective therapeutic options to reduce mortality. Abbreviations and Acronyms ALT Alanine Aminotransferase ARDS Acute Respiratory Distress Syndrome AST Aspartate Aminotransferase BI Borrelia Index CAF Chloramphenicol Cr Creatinine DIC Disseminated Intravascular Coagulopathy Hgb Hemoglobin INR International Normalized Ratio JHR Jarisch–Herxheimer Reaction LBRF Louse-Borne Relapsing Fever PCR Polymerase Chain Reaction RF Relapsing Fever Rrna Reverse RNA UOP Urine Output Ethics Declarations Declarations Authors' Contributions SHB: Conceptualization, investigation, data collection, methodology, and writing. MAK: Conceptualization, investigation, data collection, methodology, and writing. MWB: Statistical analysis, validation, and writing, review and editing. ABW: Validation and writing, review and editing. GDB: Validation and writing, review and editing RSA: Validation and writing, review and editing SBG: Validation and writing, review and editing ETA: Validation and writing, review and editing Ethical Approval Ethical approval for this study was obtained from the Institutional Review Boards (IRBs) of Yekatit 12 Hospital Medical. The research was conducted in accordance with the Declaration of Helsinki. Strict measures were implemented to protect privacy and maintain confidentiality, ensuring that no personal identifiers, including names, were recorded in the data. Consent for Publication and Consent for Participation Not applicable. Competing Interests The authors declare no competing interests. Privacy and Confidentiality To protect participant privacy, all data were anonymized using coded identifiers, and no personal identifiers were collected. Collected data were securely stored and accessible only to authorized researchers. Clinical trial number Not applicable.’ Availability of Data and Materials The datasets used and/or analyzed during the course of this study are available from the corresponding author upon reasonable request. Funding This study was supported by funding from the Yekatit 12 Hospital Medical College. The funding did not cover the publication fees. ACKNOWLEDGEMENT First and foremost, I would like to extend my sincere thanks to Yekatit 12 Hospital Medical College, Department of Internal Medicine, for incorporating research into the curriculum and providing the opportunity for us to engage in and develop our research ideas. References Barbour AG. Relapsing fever. In: Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw Hill; pp. 1421–5. Sintayehu Y, Asmamaw A, Yemanu T, Birhan M. Relapsing fever outbreak investigation in Beyeda district, northwest Ethiopia: a case-control study. EthiopJHealth Biomed Sci. 2022;12(2):16–8. Taye DG, Wondimagegn A. submitted for the school of graduates of Addis Ababa University in partial fulfillment for the degree of master of public health in filed epidemology. Versalovic J. Manual of clinical microbiology. Volume 1. American Society for Microbiology; 2011. Lucchini A, Lipani F, Costa C, Scarvaglieri M, Balbiano R, Carosella S, et al. Louseborne Relapsing Fever among East African Refugees, Italy, 2015. Emerg Infect Dis. 2016;22(2):298–301. Osthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D. Louse-borne relapsing fever – report of four cases in Switzerland, June-December 2015. BMC Infect Dis. 2016;16(1):210. Antinori S, Mediannikov O, Corbellino M, Raoult D. Louse-borne relapsing fever among East African refugees in Europe. Travel Med Infect Dis. 2016;14(2):110–4. BRYCESON ADM, PARRY EHO, PERINE PL, WARRELL DA, LOUSE-BORNE RELAPSING VUKOTICHDLEITHEADCS. FEVER: A Clinical and Laboratory Study of 62 Cases in Ethiopia and a Reconsideration of the Literature1. QJM Int J Med. 1970;39(1):129–70. Nordmann T, Feldt T, Bosselmann M, Tufa TB, Lemma G, Holtfreter M, et al. The outbreak of Louse-Borne Relapsing Fever among Urban Dwellers in Arsi Zone, Central Ethiopia, from July to November 2016. Am J Trop Med Hyg. 2018;98(6):1599–602. Guerrier G, Doherty T. Comparison of antibiotic regimens for treating louse-borne relapsing fever: a meta-analysis. Trans R Soc Trop Med Hyg. 2011;105(9):483–90. Rebaudet S, Parola P. Epidemiology of relapsing fever borreliosis in Europe. FEMS Immunol Med Microbiol. 2006;48(1):11–5. Osthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D. Louse-borne relapsing fever – report of four cases in Switzerland, June-December 2015. BMC Infect Dis. 2016;16(1):210. Yimer M, Mulu W, Ayalew W, Abera B. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study. BMC Res Notes. 2014;7(1):250. Nordmann T, Feldt T, Bosselmann M, Tufa TB, Lemma G, Holtfreter M, et al. The outbreak of Louse-Borne Relapsing Fever among Urban Dwellers in Arsi Zone, Central Ethiopia, from July to November 2016. Am J Trop Med Hyg. 2018;98(6):1599–602. Legesse W, Gebre-Selassie S. Louse-Borne Relapsing Fever Profile at Jimma Hospital, Ethiopia: a retrospective study. Ethiop J Educ Sci. 2008;1(1):59–64. Eguale T, Abate G, Balcha F. RELEASING FEVER IN HOSSANA, ETHIOPIA: CLINICAL AND EPIDEMIOLOGIC STUDY. 12(2):104–5. Yimer M, Mulu W, Ayalew W, Abera B. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study. BMC Res Notes. 2014;7(1):250. Mitiku K, Mengistu G. Relapsing fever in Gonder, Ethiopia. East Afr Med J. 2002;79(2):85–7. Yimer M, Knowledge. Attitude and Practices of High-Risk Populations on Louse-Borne Relapsing Fever in Bahir Dar City, North-West Ethiopia. Sci J Public Health. 2014;2(1):15. Ramos JM, Malmierca E, Reyes F, Wolde W, Galata A, Tesfamariam A, et al. Characteristics of louse-borne relapsing fever in Ethiopian children and adults. Ann Trop Med Parasitol. 2004 Mar;98(2):191–6. Warrell DA. Louse-borne relapsing fever ( Borrelia recurrentis infection). Epidemiol Infect. 2019;147:e106. Ramos JM, Malmierca E, Reyes F, Tesfamariam A. Results of a 10-year survey of louse-borne relapsing fever in southern Ethiopia: a decline in endemicity. Annals Trop Med Parasitol. 2008 Jul;102(5):467–9. Sangaré AK, Doumbo OK, Raoult D. Management and Treatment of Human Lice. Biomed Res Int. 2016;2016:1–12. Cutler SJ, Abdissa A, Trape JF. New concepts for the old challenge of African relapsing fever borreliosis. Clin Microbiol Infect. 2009;15(5):400–6. Anaemia. (2024) World Health Organization. https://www.who.int/data/nutrition/nlis/info/anaemia (Accessed: 07 February 2021). Treasures E. (2024) Ethiopian treasures, Ethiopian Climate and Seasons. http://www.ethiopiantreasures.co.uk/pages/climate.htm (Accessed: 07 February 2021). Mekonen E, Kiros K et al. Ethiopian standard treatment guideline, FMHACA, 2024: (p 189 – 90). Glick J, Klein T. Jarisch-Herxheimer Reaction: A Review of the Pathophysiology and Clinical Management. Clin Infect Dis. 2011;53(1):e21–5. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Supplements. 2012;2(1):1–138. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Camporota L. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307(23):2526–33. Lee WM. Acute liver failure. Lancet. 2008;372(9639):1817–28. Centers for Disease Control and Prevention (CDC). (2018). Relapsing Fever (Borrelia spp.). https://www.cdc.gov/relapsingfever/ Debes AK, Waller JA, Kendi C. Healthcare delays in relapsing fever and impact on patient outcomes. Int J Infect Dis. 2019;89:23–30. Zein ZA, Louse Borne Relapsing Fever (LBRF): Mortality and Frequency of Jarisch-Herxheimer Reaction. Journal of the Royal Society of Health, Schwarzer R. (2021). Goubau PF. Relapsing fevers. A review. Ann Soc Belg Med Trop. 1984;64:335–64. [PubMed] [Google Scholar]. Corticosteroids in severe. Jarisch-Herxheimer reaction: a systematic review. Clin Infect Dis, 72(5), 1023–32. Melkert PW. Mortality in high risk patients with tick-borne relapsing fever analysed by the Borrelia-index. East Afr Med J. 1991;68(11):875–9. pmid:1800081. Peña G, Lozano L, Camacho A. Mechanical ventilation in critical care: mortality trends in infectious diseases. Ann Intensiv Care. 2019;9(1):45–52. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5544669","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415263856,"identity":"d8444765-d7db-40f5-bdf0-23e34197a56c","order_by":0,"name":"Seblewongel Birhanemskel Haileselassie","email":"","orcid":"","institution":"Ethioistanbul hospital","correspondingAuthor":false,"prefix":"","firstName":"Seblewongel","middleName":"Birhanemskel","lastName":"Haileselassie","suffix":""},{"id":415263857,"identity":"b7f57fd2-8ed7-49ef-8166-3c474ca55516","order_by":1,"name":"Molla Asnake Kebede","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFAC5sYDYJqHgf33jwqQAHMDAS2MDTAtDNIMZ0BaGEnRwtgGEcGrQbe9seHAj5q6PP6ewweMC+fVRvO3A7X8qNiGU4vZmYMNB3uOHS6WONuWkDxz2/HcGYcZGxh7ztzGreVGYsMBHrYDiQ3neQwO8G47ltsA1MLM2IZfy8E//+oS55/n/9jAO+dY7nxitBzmbWNO3HC2h5mZt6EmdwNBLUC/HJbtO5y48cwxM8YZxw7kbgRqOYjXL8ebDz58860ucd6Z5GcMH2rqcuedP3zwwY8K3FrQwWEweYBo9UBQR4riUTAKRsEoGCEAAI0xaUMgoOzyAAAAAElFTkSuQmCC","orcid":"","institution":"Mizan-Tepi university","correspondingAuthor":true,"prefix":"","firstName":"Molla","middleName":"Asnake","lastName":"Kebede","suffix":""},{"id":415263858,"identity":"a03182b7-de94-48aa-8da2-d58a89d24b7f","order_by":2,"name":"Missgana Worku Belete","email":"","orcid":"","institution":"Mizan -Tepi university","correspondingAuthor":false,"prefix":"","firstName":"Missgana","middleName":"Worku","lastName":"Belete","suffix":""},{"id":415263859,"identity":"5503b8bb-1701-4756-a718-71994fd7e7a3","order_by":3,"name":"Adugnaw Bogale Worku","email":"","orcid":"","institution":"Mizan - Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Adugnaw","middleName":"Bogale","lastName":"Worku","suffix":""},{"id":415263860,"identity":"497cce96-0711-4859-9540-da0598aba682","order_by":4,"name":"Girma Daniel Bushiso","email":"","orcid":"","institution":"Mizan-Tepi university","correspondingAuthor":false,"prefix":"","firstName":"Girma","middleName":"Daniel","lastName":"Bushiso","suffix":""},{"id":415263861,"identity":"6f94ed50-34f4-41fe-9180-a86b344c2c17","order_by":5,"name":"Rediet Solomon Arega","email":"","orcid":"","institution":"Eka kotebe General hospital","correspondingAuthor":false,"prefix":"","firstName":"Rediet","middleName":"Solomon","lastName":"Arega","suffix":""},{"id":415263862,"identity":"17ffbe5a-df8a-497a-a791-2193d46c7ce6","order_by":6,"name":"Selam Bogale Gissa","email":"","orcid":"","institution":"Eka kotebe General hospital","correspondingAuthor":false,"prefix":"","firstName":"Selam","middleName":"Bogale","lastName":"Gissa","suffix":""},{"id":415263863,"identity":"bbb084f3-bf19-4bb2-ad09-84d0cca1ca8d","order_by":7,"name":"Elias Tabit Ahmed","email":"","orcid":"","institution":"Mizan -Tepi university","correspondingAuthor":false,"prefix":"","firstName":"Elias","middleName":"Tabit","lastName":"Ahmed","suffix":""},{"id":415263864,"identity":"7aef43d5-9fbf-495e-aa57-64fdbaa1c43e","order_by":8,"name":"Alemayehu Beharu Tekle","email":"","orcid":"","institution":"mizan tepi university","correspondingAuthor":false,"prefix":"","firstName":"Alemayehu","middleName":"Beharu","lastName":"Tekle","suffix":""}],"badges":[],"createdAt":"2024-11-28 19:08:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5544669/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5544669/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94916022,"identity":"6f7e3c9b-0a15-4db5-9bf3-b53380d508af","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":140343,"visible":true,"origin":"","legend":"","description":"","filename":"LastRF.docx","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/f751b41dab57bd315db3463d.docx"},{"id":94916021,"identity":"88b178bf-c75e-4392-a640-cd9d9cc24386","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10040,"visible":true,"origin":"","legend":"","description":"","filename":"5ec7d70a3eec4b99a73833ae2d75f667.json","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/e7a1ef98f402fd6f548fe727.json"},{"id":94916019,"identity":"92283c16-b44c-4b98-b6a7-1a767ca747ed","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":146947,"visible":true,"origin":"","legend":"","description":"","filename":"5ec7d70a3eec4b99a73833ae2d75f6671enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/7ea7a4d195d67159e76212b3.xml"},{"id":94916020,"identity":"86b22d8b-86cd-45d0-8948-eaf65794a017","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10517,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/0081e3c5d03904e4df10b1b4.png"},{"id":94916017,"identity":"1edbba9c-81c3-4ea7-bbbf-3ba6cb8d7735","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":42929,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/fb30b8f323037bd3ef3f6d95.png"},{"id":94916024,"identity":"70c69175-3d6e-46b7-9360-e1cb28cf5839","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7904,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/20729256a3b0d2b8052bc1bf.png"},{"id":94916025,"identity":"b7f2e438-d061-4f20-b7a3-1d7b1e112408","added_by":"auto","created_at":"2025-11-01 11:45:02","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144626,"visible":true,"origin":"","legend":"","description":"","filename":"5ec7d70a3eec4b99a73833ae2d75f6671structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/6356b14af4f8f07e99ac80d2.xml"},{"id":94916029,"identity":"084b8d67-b8c4-43c7-99ad-439f25fd045b","added_by":"auto","created_at":"2025-11-01 11:45:06","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159635,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/3d54596793de0d5267052d06.html"},{"id":94916014,"identity":"ec5c42a3-c817-44c5-9204-a1c162ea8400","added_by":"auto","created_at":"2025-11-01 11:45:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22969,"visible":true,"origin":"","legend":"\u003cp\u003ePresenting symptoms of patients with relapsing fever at Yekatit 12 Hospital Medical College, Addis Ababa, 2024\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/f22811c1fab4f37de3f83822.png"},{"id":94916023,"identity":"abc7e358-c0ca-45a0-89ee-ece80cfa2184","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":232198,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eUtilization of Combination Drug Therapy in Relapsing Fever Patients at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23).\u003c/u\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/d5aa2289c09e365e7376d630.jpeg"},{"id":94916018,"identity":"3d3d0602-e603-4e8b-bdba-ded79498e2eb","added_by":"auto","created_at":"2025-11-01 11:45:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18824,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eManagement Outcome of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23).\u003c/u\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/538f67e355359da8ccdb6ea6.png"},{"id":101754238,"identity":"333162a5-6bba-43b3-b090-7d084b81314e","added_by":"auto","created_at":"2026-02-03 10:42:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1777020,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5544669/v1/700dae4a-ec1b-4a77-8fdc-fc1e58681038.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Influencing Disease Outcomes in Relapsing Fever Patients: Insights from Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eLouse-borne relapsing fever (LBRF) is a vector-borne disease that is typically characterized by the acute onset of febrile disease with a higher rate of subsequent febrile relapses in untreated patients. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Humans are the only known reservoirs for Borrelia recurrentis. The bacteria is transmitted from human to human by the body louse species known as Pediculus humanus which thrives well in poor hygienic conditions. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Relapsing fever (RF) was once a disease of global epidemic importance as it was widely distributed in all parts of the world including Europe and North America intimately associated with poverty and overcrowding \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e In severe cases, neurological involvement, myocarditis, acute respiratory distress syndrome, hepatic failure, spleen rupture and disseminated intravascular coagulation leading to intracranial, massive gastrointestinal, pulmonary, or peripartum hemorrhage may occur. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRelapsing fever has high mortality rates if untreated, with Louse-Borne Relapsing Fever (LBRF) ranging from 10\u0026ndash;70% and Tick-Borne Relapsing Fever (TBRF) at 4\u0026ndash;10%, largely influenced by coexisting conditions such as malnutrition, dehydration, or malaria. Mortality is most common during the first fever episode. With timely antibiotic treatment, mortality decreases to 2\u0026ndash;5% for LBRF and \u0026lt;\u0026thinsp;2% for TBRF. However, co-infections like dysentery, salmonellosis, typhoid, typhus, tuberculosis, bacterial pneumonia, visceral leishmaniasis, and malaria can significantly increase mortality. \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRelapsing fever is diagnosed by identifying spirochetes in a peripheral blood smear during febrile episodes. This can be done using dark-field microscopy or by examining a stained thick or thin blood film under a microscope. For confirmation, polymerase chain reaction (PCR) targeting the 16S rRNA gene may also be employed. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough Louse-Borne Relapsing Fever (LBRF) cases have significantly declined worldwide following reduced body louse infestations since the 1940s, it remains a major public health issue and a leading cause of hospitalization and death in East African countries, particularly in Ethiopia. In Ethiopia, the endemic form is predominantly LBRF, while the Tick-Borne Relapsing Fever (TBRF) is less recognized. However, TBRF is endemic in the country, with occasional outbreaks, especially during the rainy season .\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e During a 2016 outbreak in the Arsi Zone, Ethiopia, the case-fatality rate for relapsing fever was 13%. Among children, reported case-fatalities range from 1.9\u0026ndash;5.5%. In a study of 154 children under 15 years in Ethiopia, the overall case-fatality rate was 2.4%, significantly lower than the rate observed in adults \u003cb\u003e(\u003c/b\u003e13.2%\u003cb\u003e).\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough the prevalence of body louse infestations drastically dropped after the 1940s, LBRF cases persist as the main public health issue and a leading cause of hospitalization and mortality in East African nations, particularly in Ethiopia Occasionally is found in neighboring countries, such as Eritrea, Sudan, and Somalia. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite recurring epidemics and the high mortality rates associated with relapsing fever (RF) in East Africa, particularly in Ethiopia, where mortality can reach up to 15% with treatment and 70% without treatment, research in the region has primarily focused on the other. Limited attention has been given to disease outcomes and their associated factors. In Ethiopia, comprehensive studies examining these critical aspects are lacking, underscoring the importance of addressing this gap to better understand the persistently high mortality rates. This study aims to identify the clinical characteristics and determinants influencing disease outcomes, thereby contributing to a deeper understanding of the factors driving mortality. Furthermore, ongoing challenges in Ethiopia, such as inflation and civil unrest, are expected to exacerbate the epidemic potential of RF. This underscores the importance of this research in informing emergency preparedness and response strategies to mitigate the impact of future epidemics.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study was conducted in Yekatit 12 Hospital Medical College among all patients diagnosed with relapsing fever from September 1, 2014 \u0026ndash; February 28 2015 EC. Yekatit12 Hospital Medical College,, Addis Ababa.. It includes 17 HC a catchments area and gives service for all available facilities the included subbcities are showen in the Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Later established as a medical college in 2003E.C. gives courses in multiple undergraduate and postgraduate programs. It has been providing service to a larger community not only in Addis Ababa but also including a larger population in the Oromia region around Addis Ababa. It serves around 230,000 people annually both in the emergency and outpatient department. Currently, the hospital has a staff of around 1500 in various units. For better data management and use, the hospital implemented EHR in 2012 E.C. The institution have its own accreted laboratory which do diagnostic tests including blood film. Ethiopian seasons summer so called ( Kiremt or Meher ) in Ethiopia runs from (June to Augest this is monsoon season so heavy rains and thunderstorms are regular occurance, Autumn (Belg) in Ethiopia runs from (September, October and November) are the harvest season, Winter (Bega) is from (December to Feburary) are dry season with frost in morning specially in January, Spring (Tseday) In Ethiopia runs from (March, April and May) these months experience occasional showers, May is the hottest mobth in Ethiopia. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe source population consisted of all patients admitted to Yekatit 12 Medical College with a diagnosis of relapsing fever. The study population included all patients diagnosed with relapsing fever at Yekatit 12 Medical College from September 1, 2021 \u0026ndash; February 28, 2023 GC. All patients aged\u0026thinsp;\u0026gt;\u0026thinsp;14 years with a confirmed diagnosis of relapsing fever with blood film were included. Patients whose diagnosis was not confirmed through blood film, those who were referred but whose outcomes were not traced, were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudy design and period\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAn institutional based retrospective cross sectional study was done and the study period was from April 2023 to June 2023\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy variables.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn this study, the dependent variable is the outcome of patients diagnosed with relapsing fever. The independent variables include a variety of factors such as comorbidities, age, sex, the season in which the patient presented, the duration of illness, Jarisch-Herxheimer (JHR) reaction, medications received, length of ICU stay, length of hospital stay, mechanical ventilation (MV) support, substance use, occurrence of multiorgan failure, systolic blood pressure (SBP), platelet count, seasonal variation, and the presence of organ failure. These variables will be analyzed to determine their impact on the clinical outcomes of patients with relapsing fever.\u003c/p\u003e\n\u003ch3\u003eData collection tool and procedures\u003c/h3\u003e\n\u003cp\u003eTo collect data, a structured questionnaire was developed in English, designed to extract pertinent clinical information from patients' medical records. The tool was adapted from similar studies with some modification to ensure relevance and comprehensiveness. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e The questionnaire was organized into multiple sections to capture all necessary data. Laboratory investigations, including complete blood count (CBC), liver function tests (LFTs), and coagulation profiles (e.g., INR, aPTT), were also collected. Diagnostic procedures were recorded, including blood film. The treatment provided to each patient was documented in detail, including the type of treatment (pharmacological), blood transfusions, and medications administered. Finally, the length of symptom before standard treatment commenced were also recorded.\u003c/p\u003e \u003cp\u003eThe data collection process began by identifying eligible patients who met the inclusion criteria: those aged 14 years or older, diagnosed with relapsing fever during the study period. Data collectors retrieved patient charts identified through log books and the Health Management Information System (HMIS) registries. The questionnaire was then filled out using the available information within the medical charts.\u003c/p\u003e\n\u003ch3\u003eOperational definition\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMass Sleeping: Sleeping in a shared or public space with more than 6 individuals in close proximity. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHomelessness: A person who lives outside a traditional home and sleeps in a public space, such as on the street, in shelters, or in temporary housing situations. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eCharacterization: The clinical presentation of patients with relapsing fever, including complications that arise either due to treatment or as a result of the relapsing fever itself \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eJHR Reaction (Jarisch-Herxheimer Reaction): A reaction that occurs within 4 hours of initiating antibiotic treatment, where patients exhibit symptoms such as rigors, myalgias, a further rise in body temperature, increased respiratory rate, and hypotension \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAKI (Acute Kidney Injury): Defined according to KDIGO guidelines as an increase in serum creatinine by \u0026gt;\u0026thinsp;0.3 mg/dL within 48 hours, or an increase in serum creatinine to \u0026gt;\u0026thinsp;1.5 times baseline, with the increase either known or presumed to have occurred within the prior seven days, or urine output\u0026thinsp;\u0026lt;\u0026thinsp;0.5 mg/dL/hr for six hours \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eARDS (Acute Respiratory Distress Syndrome): Diagnosed according to The Berlin Definition \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHypoglycemia: Diagnosed using Whipple\u0026rsquo;s triad \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eLiver Failure: Severe acute liver injury with encephalopathy and impaired synthetic function (INR\u0026thinsp;\u0026gt;\u0026thinsp;1.5) in a patient without pre-existing liver disease or cirrhosis \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThrombocytopenia: Classified as Mild\u0026thinsp;=\u0026thinsp;100,000\u0026ndash;149,000, Moderate\u0026thinsp;=\u0026thinsp;50,000\u0026ndash;99,000, and Severe\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;50,000 platelets, according to Harrison\u0026rsquo;s Standard Textbook of Medicine \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAnemia: Defined by the World Health Organization (WHO) as a hemoglobin level\u0026thinsp;\u0026lt;\u0026thinsp;130 g/L (13 g/dL) for men and \u0026lt;\u0026thinsp;120 g/L (12 g/dL) for women. Anemia is further classified as mild (11\u0026ndash;11.9), moderate (8\u0026ndash;10.9), or severe (\u0026lt;\u0026thinsp;8) \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA case of relapsing fever: The patient presented with symptoms consistent with relapsing fever, and the diagnosis was confirmed through microscopic examination of peripheral blood, where the presence of spirochetes was identified using Giemsa or Wright staining. \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measurement\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe outcome in this study refers to the final clinical status of patients diagnosed with relapsing fever during the study period. Two primary categories were used to assess the outcome: Discharged with Improvement \u003cb\u003eand\u003c/b\u003e Died. Patients categorized as \"Discharged with Improvement\" were those who exhibited clinical improvement in their symptoms, such as resolution of fever, normalization of vital signs, and recovery of organ function, and were subsequently discharged from the hospital following treatment. On the other hand, patients who succumbed to during at admition at any cause, were classified under the \"Died\" category. This outcome reflects the mortality associated with the disease and its complications, providing valuable insights into the severity of relapsing fever and the effectiveness of the clinical interventions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData quality assurance\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA pilot study by pretesting the data collection tools was conducted in St paul Millennium Medical College 5% of the total sample size to detect any weakness in the organization and structuring of the research instruments. Following the pre-test, improvements to the tools was made as necessary. Training was given to data collectors and supervisors on the purpose of the investigation and the significance of obtaining the data. The supervisors checked the filled questionnaire for completeness.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData processing and analysis\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe collected data was coded and entered into EPI INFO software version 7.2.1 (2018) and Epi Data version 2(2007) and was imported to SPSS version 27(2020) for cleaning and analysis. During analysis errors related to the inconsistency of data was checked and corrected during data cleaning. Finally, Descriptive statistics were generated through frequency, tables and graphs, while binary logistic regression was conducted to calculate odds ratios with 95% confidence level and p-values, testing the association between dependent and independent variables; a P- value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 was used for bi-variate analysis, and \u0026lt;\u0026thinsp;0.05 for multivariate analysis to declare statistical significance.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":" \u003cdiv id=\"Sec11\" type=\"Results\" class=\"Section2\"\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e \u003cp\u003eDuring the study period, 119 laboratory-confirmed cases of relapsing fever were identified. The majority of patients, 79 (66.3%), were in the age group of 15\u0026ndash;25 years, with a mean age of 24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 years, underscoring the disease's predominance among younger populations. All patients were male, and 50 (42.01%) were daily laborers (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Regarding referral pathways, 69 (58%) cases were referred from health centers. In terms of care-seeking behavior, 49.1% of patients presented within 2\u0026ndash;5 days of symptom onset, while only 11 (9.2%) sought care within the first day of illness (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSociodemographic and Referral Characteristics of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrisoners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eReferral center\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-referred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharity center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eDuration of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClinical Presentation of Patients with Relapsing Fever\u003c/h2\u003e \u003cp\u003eFever was the most common presenting symptom, reported in 85.5% of cases, often accompanied by nonspecific acute febrile illness (AFI)-like symptoms such as chills and rigors (67.2%). Shortness of breath or rapid breathing was noted in 54.6% of patients, while abdominal pain, nausea/vomiting, and jaundice were observed in 30.3%, 56.3%, and 36.1% of cases, respectively. Altered mental status was reported in 46.2% of patients, with one individual presenting with seizures. Additionally, 22.7% of patients experienced bleeding complications, including epistaxis, upper gastrointestinal bleeding (UGIB), and gum bleeding (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe two most common risk factors identified were residing in mass sleeping houses (37%) and homelessness (39.5%), aligning with the nature of the disease and the socioeconomic challenges faced by this patient group. Seasonal variability was evident, with the majority of cases (64.6%) occurring during the rainy seasons of summer and autumn (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. No patients in the study were found to have comorbidities such as diabetes mellitus (DM), hypertension (HTN), renal failure (RF), or cardiac illnesses, which aligns with the age demographic of the patient population. However, substance use disorders were identified in 38 patients (31.9%), including alcohol consumption, khat chewing, cigarette smoking, and inhalation of \"mastish\" (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRisk factors and clinical findings of patients with relapsing fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eRisk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMass sleeping houses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomelessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharity center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrisons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSeason\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAutumn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWinter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSubstance use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong patients diagnosed with relapsing fever during the study period, the majority exhibited abnormal vital signs upon presentation. Tachycardia was observed in 100 patients (84%), tachypnea in 91 patients (76.5%), and hypotension in 65.5%. Temperature measurements were available for 33 patients, of whom 27.3% had documented fever. All patients were confirmed to have \u003cem\u003eBorrelia\u003c/em\u003e species infections through laboratory testing, conducted either at the referral center or at the study hospital (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eClinical Characteristics of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRespiratory Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;20 breaths/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 breaths/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePulse Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60 beats/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 to 100 beats/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100 beats/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSystolic Blood Pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90 mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90 mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTemperature (n\u0026thinsp;=\u0026thinsp;33)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypothermic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFebrile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlood Film\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn physical examination, 43 patients (36.1%) presented with icteric sclera. Chest examination revealed findings in 83 patients (68.9%), with bilateral coarse crepitations noted in 58 patients (48.7%). Abdominal examination abnormalities were identified in 22 patients (18.5%), including right upper quadrant (RUQ) pain (5%), hepatosplenomegaly (HSM, 5%), hepatomegaly (3.4%), and splenomegaly (5%). Additionally, 55 patients (46.2%) exhibited altered mental status with a Glasgow Coma Scale (GCS) score of less than 14, including 7 patients (5.9%) who presented in a coma (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePresenting Signs of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHEENT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIcteric sclera\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDehydration signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding gums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePale conjunctiva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIcteric sclera and pale conjunctiva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubconjunctival hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrepitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransmitted sounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased air entry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGasping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbdomen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTenderness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSplenomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatosplenomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGCS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 to 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13 to 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOTPPT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory Findings\u003c/h2\u003e \u003cp\u003eAll patients underwent complete blood count (CBC) and blood film analysis. At presentation, mild anemia was observed in 65 patients (54.6%), while severe anemia was present in 5 patients (4.2%). Leukocytosis was identified in 41.2% of patients, with 74% showing a left shift in their white blood cell differential. Thrombocytopenia was prevalent, with only 2 patients exhibiting a normal platelet count. Severe thrombocytopenia was seen in 81.8% of cases, including 42 patients with platelet counts below 20,000 and 17 patients with counts below 10,000, potentially requiring transfusion of fresh frozen plasma and platelets (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Organ function tests were performed on 107 patients. Elevated aspartate aminotransferase (AST) levels (\u0026gt;\u0026thinsp;2x the normal laboratory cutoff) were found in 63 patients (58%), while alanine aminotransferase (ALT) levels were similarly elevated in 21 cases (19.6%). Few patients exhibited significant abnormalities in alkaline phosphatase levels. Additionally, elevated creatinine levels were observed in 50 patients (46.7%) at the time of presentation (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLaboratory Findings of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory Parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin at Admission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhite Blood Cell Count (WBC)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeutrophils\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutropenic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphocytes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelet Count\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild Thrombocytopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAspartate Aminotransferase (AST)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlanine Aminotransferase (ALT)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlkaline Phosphatase (Alk P)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2x Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCreatinine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eManagement and Complications\u003c/h2\u003e \u003cp\u003eThe majority of patients treated at the hospital received Ceftriaxone (80.7%), followed by oral doxycycline to 76 patients (63.9%). A smaller proportion (2.5%) were treated with Meropenem, while none received tetracycline. Penicillin was used as a first-line treatment in 33.6% of cases (40 patients), primarily for those referred from other health centers (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In this study, supportive treatments were administered to patients diagnosed with relapsing fever. Among the 119 patients, 4.2% (n\u0026thinsp;=\u0026thinsp;5) required blood transfusions, while 16.8% (n\u0026thinsp;=\u0026thinsp;20) received fresh frozen plasma. Platelet transfusions were the most common supportive treatment, given to 48.7% (n\u0026thinsp;=\u0026thinsp;58) of patients. Mechanical ventilation was used for 40.3% (n\u0026thinsp;=\u0026thinsp;48) of the patients, and 50.4% (n\u0026thinsp;=\u0026thinsp;60) received vasopressors. These treatments reflect the severity and clinical management of complications associated with relapsing fever in the study population. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)/ Combination therapy was the preferred approach, administered to 83% of patients. Among monotherapy cases, Ceftriaxone was the most frequently used (17%). The most common drug combination was Ceftriaxone with doxycycline, utilized in 16% of cases, followed by Cefepime with doxycycline, which was used for 11 patients. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTreatment Modalities Used for Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetronidazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoxycycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftazidime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetracycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSupportive Management Used for Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa, (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupportive Treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh Frozen Plasma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet Transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical Ventilator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComplications\u003c/h2\u003e \u003cp\u003eOf the total patients, 105 (88.2%) developed complications. Acute Respiratory Distress Syndrome (ARDS) was the most common complication, affecting 69.7% of patients (83). Anemia was observed in 77.3% of cases, followed by shock, which was seen in 60.5% of patients (72) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.. Juvenile Hemorrhagic Retinopathy (JHR) was also a significant complication, affecting 36.1% of patients. Notably, all patients who developed JHR were those who had received penicillin as part of their treatment, and they were all referred from other health centers \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. .\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eComplications in Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2024)\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.01%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCNS complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eManagement Outcome\u003c/h2\u003e \u003cp\u003eIn this study, 54 patients (45.4%, 95% CI: 36\u0026ndash;54%) died (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and 7 patients (5.9%) with relapsing fever absconded from the emergency room after less than 24 hours of stay, without receiving complete and proper management \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The primary cause of death was multi-organ failure, which accounted for 64.8% of fatalities. Respiratory failure was the second leading cause of death, responsible for 14 (11.7%) of the deaths \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCauses of Death in Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of Death\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiorgan failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.81%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntracranial hemorrhage / Raised intracranial pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Mortality\u003c/h2\u003e \u003cp\u003eIn this study, several factors were found to be significantly associated with the outcome of relapsing fever at a 25% confidence level. These factors included age, duration of symptoms, platelet count less than 50,000, multiple organ failure, Jarisch-Herxheimer reaction (JHR), substance use, and mechanical ventilation (MV). However, in the final multivariable logistic regression analysis, duration of symptoms, multiple organ failure, JHR, and mechanical ventilatory support were identified as independently associated with mortality. Specifically, after adjusting for other covariates, patients who required mechanical ventilation were about three times more likely to die [AOR: 2.74; 95% CI: 1.05\u0026ndash;7.1] compared to those who did not require ventilatory support. Similarly, patients who developed Jarisch-Herxheimer reaction had approximately three times higher odds of death [AOR: 2.89; 95% CI: 1.09\u0026ndash;7.64] than those who did not experience this reaction. Additionally, the odds of death were about three times higher for patients who delayed seeking healthcare for more than five days [AOR: 3.1; 95% CI: 1.24\u0026ndash;7.98] compared to those who visited healthcare facilities within five days of symptom onset. Furthermore, patients who developed multiple organ failure had a significantly higher mortality risk, with odds of death about four times greater [AOR: 3.8; 95% CI: 1.23\u0026ndash;11.6] than those without multiple organ failure. (Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFactors Associated with Mortality of Patients with Relapsing Fever at Yekatit 12 Hospital Medical College, Addis Ababa (2022 and 23).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 19 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1 (0.86, 11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6 (0.56, 12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 31 (47.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6 (0.77, 9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5 (0.35, 6.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 4 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 27 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 27 (61.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.82 (1.30, 6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.1 (1.24, 7.9)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 38 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.48 (0.68, 3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 16 (39.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlatelet Count (thousands)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 48 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.61 (0.94, 7.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6 (0.73, 9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 6 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eJarisch-Herxheimer Reaction (JHR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 25 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.43 (1.12, 5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.8 (1.09, 7.64)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 29 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple Organ Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 45 (54.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.78 (1.58, 9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8 (1.23, 11.6)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 9 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMechanical Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 32 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.45 (2.03, 9.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.7 (1.05, 7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 22 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubstance Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 21 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.79 (0.82, 3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.96 (0.73, 5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied: 33 (40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003cem\u003eSignificant at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level; AOR: adjusted odds ratio; COR: crude odds ratio; MV: mechanical ventilation; JHR: Jarisch-Herxheimer reaction.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study focused on managing patients with relapsing fever (RF), emphasizing clinical characteristics and factors influencing outcomes. Its uniqueness lies in addressing a topic previously unexplored in Ethiopia. The rising number of cases, fueled by forced migration, urbanization, instability, and interpersonal conflicts nationwide, highlights the urgency of this issue. Addis Ababa, as the primary destination for migrants, faces increased risks of disease transmission due to overcrowding, homelessness, and low socioeconomic conditions.\u003c/p\u003e \u003cp\u003eThe median age of patients in this study was 24.1 (\u0026plusmn;\u0026thinsp;7.4), aligning with findings from studies in Jimma, Arsi, Hossana, and Gondar, which reported that most cases affected individuals aged 15\u0026ndash;25 years. This indicates that RF predominantly impacts the youth, the nation\u0026rsquo;s primary labor force, likely due to high unemployment, low socioeconomic status, and migration caused by conflict and instability \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConsistent with prior studies, the sex distribution revealed male predominance, with all patients in this study being male. A case-control study conducted in Arada in 2018 also found that 100% of identified cases were male. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e This could be attributed to males' higher exposure to high-risk living conditions, such as migration for daily labor. However, since females also experience similar conditions, their lower incidence might be linked to better knowledge, awareness, and self-care practices, warranting further research into knowledge, attitude, and practice (KAP) among patients.\u003c/p\u003e \u003cp\u003eRegarding occupational status, this study found that 81.9% of cases involved daily laborers and unemployed individuals, with less than 2.5% being civil servants. This aligns with studies in Arsi and Hossana, where daily laborers and farmers accounted for the majority of cases, while civil servants comprised less than 3% \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e interestingly, one healthcare professional contracted RF following patient contact, highlighting the occupational risk of healthcare exposure.\u003c/p\u003e \u003cp\u003eBeing a tertiary hospital, the majority of cases (58%) were referrals from health centers. The mean symptom duration was 4.5 (\u0026plusmn;\u0026thinsp;2.86) days, compared to 3.6 (\u0026plusmn;\u0026thinsp;0.7) days in Hossana \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. A significant association was found between symptom duration and poor outcomes, with prolonged symptoms increasing mortality risk (AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI: 1.24\u0026ndash;7.9, p\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e \u003cp\u003eFever was the most common presenting symptom, observed in 85.5% of patients, followed by chills and rigors (67.22%) and respiratory symptoms (54.6%). Severe symptoms, such as bleeding disorders (22.68%), altered mentation (46.21%), and jaundice (36.13%), were also prevalent. These findings are consistent with previous studies, though variations in prevalence were noted \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eThe two most common risk factors were mass sleeping houses (37%) and living on the streets (39.5%), reflecting the disease's socio-economic nature. Seasonal variability showed that most cases occurred during the wet season (64.5%), likely due to overcrowding in shelters during cold and wet weather. This contrasts with studies in Bahir Dar and Jimma, which found higher RF prevalence during dry seasons, possibly due to increased migration during that period \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSubstance use disorder was noted in 31.8% of patients, while comorbidities were absent, likely due to the younger age group studied. Most patients presented with deranged vital signs, including tachycardia (76.5%), tachypnea (84%), and hypotension (65.5%), reflecting the severity of cases seen at referral centers.\u003c/p\u003e \u003cp\u003eLaboratory findings revealed a high incidence of severe thrombocytopenia (81.8%) and anemia, consistent with the literature on RF's hematological impact. Organ dysfunction, particularly elevated creatinine and liver enzyme levels, was also common \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTreatment primarily involved ceftriaxone (80.7%) and doxycycline (63.95%), with a notable shift toward broader-spectrum antibiotics due to the complexity of cases. The study highlighted a high incidence of complications, such as acute respiratory distress syndrome (ARDS) in 70.6% of patients, anemia (77.3%), and shock (60.5%). Nearly 40% of patients required mechanical ventilation, underscoring the resource-intensive management required in severe RF cases.\u003c/p\u003e \u003cp\u003eThe mean hospital stay was 7.5 (\u0026plusmn;\u0026thinsp;7.4) days, with ICU and ER stays averaging 3.21 (\u0026plusmn;\u0026thinsp;4.6) and 1.86 (\u0026plusmn;\u0026thinsp;3.31) days, respectively. Jarisch-Herxheimer reaction (JHR) occurred in 36.1% of cases, significantly affecting mortality (AOR\u0026thinsp;=\u0026thinsp;2.89, 95% CI: 1.09\u0026ndash;7.64, p\u0026thinsp;=\u0026thinsp;0.02). This aligns with reports from Gondar (46.5%) and Hossana (75.5%), although incidence rates var \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/sup\u003e Mortality in this study was exceptionally high (45.4%) compared to studies in Jimma (6%) and Gondar (4.2%) \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study identified critical factors associated with mortality in patients with relapsing fever. The findings underscore the impact of delayed healthcare-seeking behavior, the occurrence of Jarisch-Herxheimer reaction (JHR), the presence of multiple organ failure, and the need for mechanical ventilatory support on patient outcomes.\u003c/p\u003e \u003cp\u003ePatients who delayed seeking medical attention for more than five days were significantly more likely to succumb to the disease compared to those who sought care earlier. This aligns with previous studies indicating that delays in treatment lead to disease progression and increased risk of severe complications, particularly in resource-limited settings where access to timely and adequate care may be constraines \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/sup\u003e Early diagnosis and prompt initiation of antibiotic therapy remain paramount in reducing disease severity and improving survival rates.\u003c/p\u003e \u003cp\u003eThe Jarisch-Herxheimer reaction, a common complication during the treatment of relapsing fever, was found to be independently associated with mortality. This finding is consistent with prior evidence showing that the inflammatory cascade triggered by the rapid lysis of spirochetes can lead to significant hemodynamic instability and organ dysfunction, thereby increasing the risk of death \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/sup\u003e Improved recognition and management of JHR, including the use of corticosteroids and supportive measures, may help mitigate its impact on mortality \u003csup\u003e\u003cb\u003e[ 36]\u003c/b\u003e\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eMultiple organ failure emerged as a critical determinant of poor prognosis, with affected patients facing significantly higher odds of mortality. This finding mirrors observations in other studies highlighting the role of systemic complications in driving adverse outcomes in infectious diseases \u003csup\u003e\u003cb\u003e[ 37].\u003c/b\u003e\u003c/sup\u003e The association between organ dysfunction and mortality underscores the need for robust critical care support and early intervention to prevent progression to multi-organ involvement.\u003c/p\u003e \u003cp\u003eMechanical ventilatory support was another independent predictor of mortality, reflecting the severe clinical deterioration in patients requiring such interventions. While mechanical ventilation is often life-saving, its necessity signals the presence of critical illness, as reported in studies of severe infections and sepsis \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/sup\u003e Strategies to prevent respiratory failure, such as early respiratory monitoring and interventions, may help improve patient outcomes.\u003c/p\u003e \u003cp\u003eOverall, these findings highlight the importance of early detection, timely intervention, and comprehensive management of complications in patients with relapsing fever. Future studies should explore the potential benefits of targeted interventions, such as early corticosteroid administration to mitigate JHR, and enhanced critical care resources to manage severe cases. Moreover, public health efforts to improve awareness of relapsing fever and address barriers to early healthcare access are crucial in reducing mortality in endemic regions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into the clinical and sociodemographic characteristics of relapsing fever patients, highlighting the disease's impact on younger, predominantly male populations, especially those engaged in labor-intensive occupations. The high incidence of severe clinical manifestations, including fever, chills, bleeding complications, and altered mental status, emphasizes the need for early detection and prompt medical intervention. The findings also underscore the critical role of timely supportive care, including the management of complications such as multi-organ failure and respiratory distress, in improving patient outcomes. Despite advances in treatment, the mortality rate remains significant, with factors such as delayed presentation, multiple organ failure, and mechanical ventilation being closely associated with poor prognosis. These results suggest the need for targeted public health strategies, especially for high-risk populations, including those residing in mass sleeping areas or engaging in substance use. Further research is necessary to explore the underlying mechanisms of relapse and identify more effective therapeutic options to reduce mortality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv id=\"AGS1\" class=\"AbbreviationGroupSection\"\u003e \u003cdiv class=\"Heading\"\u003eand Acronyms\u003c/div\u003e \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Respiratory Distress Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBorrelia Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChloramphenicol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCr\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisseminated Intravascular Coagulopathy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHgb\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Normalized Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJarisch\u0026ndash;Herxheimer Reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLBRF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLouse-Borne Relapsing Fever\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolymerase Chain Reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRelapsing Fever\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRrna\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReverse RNA\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrine Output\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEthics Declarations\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSHB: Conceptualization, investigation, data collection, methodology, and writing.\u003c/p\u003e\n\u003cp\u003eMAK: Conceptualization, investigation, data collection, methodology, and writing.\u003c/p\u003e\n\u003cp\u003eMWB: Statistical analysis, validation, and writing, review and editing.\u003c/p\u003e\n\u003cp\u003eABW: Validation and writing, review and editing.\u003c/p\u003e\n\u003cp\u003eGDB: Validation and writing, review and editing\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;RSA: Validation and writing, review and editing\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SBG: Validation and writing, review and editing\u003c/p\u003e\n\u003cp\u003eETA: Validation and writing, review and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Boards (IRBs) of Yekatit 12 Hospital Medical. The research was conducted in accordance with the Declaration of Helsinki. Strict measures were implemented to protect privacy and maintain confidentiality, ensuring that no personal identifiers, including names, were recorded in the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication and Consent for Participation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrivacy and Confidentiality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo protect participant privacy, all data were anonymized using coded identifiers, and no personal identifiers were collected. Collected data were securely stored and accessible only to authorized researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.’\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the course of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by funding from the\u0026nbsp;Yekatit 12 Hospital Medical College. The funding did not cover the publication fees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst and foremost, I would like to extend my sincere thanks to Yekatit 12 Hospital Medical College, Department of Internal Medicine, for incorporating research into the curriculum and providing the opportunity for us to engage in and develop our research ideas.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarbour AG. Relapsing fever. In: Harrison\u0026rsquo;s Principles of Internal Medicine. 21st ed. New York: McGraw Hill; pp. 1421\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSintayehu Y, Asmamaw A, Yemanu T, Birhan M. Relapsing fever outbreak investigation in Beyeda district, northwest Ethiopia: a case-control study. EthiopJHealth Biomed Sci. 2022;12(2):16\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaye DG, Wondimagegn A. submitted for the school of graduates of Addis Ababa University in partial fulfillment for the degree of master of public health in filed epidemology.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVersalovic J. Manual of clinical microbiology. Volume 1. American Society for Microbiology; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucchini A, Lipani F, Costa C, Scarvaglieri M, Balbiano R, Carosella S, et al. Louseborne Relapsing Fever among East African Refugees, Italy, 2015. Emerg Infect Dis. 2016;22(2):298\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D. Louse-borne relapsing fever \u0026ndash; report of four cases in Switzerland, June-December 2015. BMC Infect Dis. 2016;16(1):210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntinori S, Mediannikov O, Corbellino M, Raoult D. Louse-borne relapsing fever among East African refugees in Europe. Travel Med Infect Dis. 2016;14(2):110\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBRYCESON ADM, PARRY EHO, PERINE PL, WARRELL DA, LOUSE-BORNE RELAPSING VUKOTICHDLEITHEADCS. FEVER: A Clinical and Laboratory Study of 62 Cases in Ethiopia and a Reconsideration of the Literature1. QJM Int J Med. 1970;39(1):129\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNordmann T, Feldt T, Bosselmann M, Tufa TB, Lemma G, Holtfreter M, et al. The outbreak of Louse-Borne Relapsing Fever among Urban Dwellers in Arsi Zone, Central Ethiopia, from July to November 2016. Am J Trop Med Hyg. 2018;98(6):1599\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuerrier G, Doherty T. Comparison of antibiotic regimens for treating louse-borne relapsing fever: a meta-analysis. Trans R Soc Trop Med Hyg. 2011;105(9):483\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRebaudet S, Parola P. Epidemiology of relapsing fever borreliosis in Europe. FEMS Immunol Med Microbiol. 2006;48(1):11\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D. Louse-borne relapsing fever \u0026ndash; report of four cases in Switzerland, June-December 2015. BMC Infect Dis. 2016;16(1):210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYimer M, Mulu W, Ayalew W, Abera B. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study. BMC Res Notes. 2014;7(1):250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNordmann T, Feldt T, Bosselmann M, Tufa TB, Lemma G, Holtfreter M, et al. The outbreak of Louse-Borne Relapsing Fever among Urban Dwellers in Arsi Zone, Central Ethiopia, from July to November 2016. Am J Trop Med Hyg. 2018;98(6):1599\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLegesse W, Gebre-Selassie S. Louse-Borne Relapsing Fever Profile at Jimma Hospital, Ethiopia: a retrospective study. Ethiop J Educ Sci. 2008;1(1):59\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEguale T, Abate G, Balcha F. RELEASING FEVER IN HOSSANA, ETHIOPIA: CLINICAL AND EPIDEMIOLOGIC STUDY. 12(2):104\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYimer M, Mulu W, Ayalew W, Abera B. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study. BMC Res Notes. 2014;7(1):250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitiku K, Mengistu G. Relapsing fever in Gonder, Ethiopia. East Afr Med J. 2002;79(2):85\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYimer M, Knowledge. Attitude and Practices of High-Risk Populations on Louse-Borne Relapsing Fever in Bahir Dar City, North-West Ethiopia. Sci J Public Health. 2014;2(1):15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamos JM, Malmierca E, Reyes F, Wolde W, Galata A, Tesfamariam A, et al. Characteristics of louse-borne relapsing fever in Ethiopian children and adults. Ann Trop Med Parasitol. 2004 Mar;98(2):191\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarrell DA. Louse-borne relapsing fever (\u003cem\u003eBorrelia recurrentis\u003c/em\u003e infection). Epidemiol Infect. 2019;147:e106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamos JM, Malmierca E, Reyes F, Tesfamariam A. Results of a 10-year survey of louse-borne relapsing fever in southern Ethiopia: a decline in endemicity. Annals Trop Med Parasitol. 2008 Jul;102(5):467\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSangar\u0026eacute; AK, Doumbo OK, Raoult D. Management and Treatment of Human Lice. Biomed Res Int. 2016;2016:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCutler SJ, Abdissa A, Trape JF. New concepts for the old challenge of African relapsing fever borreliosis. Clin Microbiol Infect. 2009;15(5):400\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnaemia. (2024) World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/data/nutrition/nlis/info/anaemia\u003c/span\u003e\u003cspan address=\"https://www.who.int/data/nutrition/nlis/info/anaemia\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (Accessed: 07 February 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTreasures E. (2024) Ethiopian treasures, Ethiopian Climate and Seasons. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ethiopiantreasures.co.uk/pages/climate.htm\u003c/span\u003e\u003cspan address=\"http://www.ethiopiantreasures.co.uk/pages/climate.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (Accessed: 07 February 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekonen E, Kiros K et al. Ethiopian standard treatment guideline, FMHACA, 2024: (p 189\u0026thinsp;\u0026ndash;\u0026thinsp;90).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlick J, Klein T. Jarisch-Herxheimer Reaction: A Review of the Pathophysiology and Clinical Management. Clin Infect Dis. 2011;53(1):e21\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Supplements. 2012;2(1):1\u0026ndash;138.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Camporota L. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307(23):2526\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee WM. Acute liver failure. Lancet. 2008;372(9639):1817\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (CDC). (2018). Relapsing Fever (Borrelia spp.). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/relapsingfever/\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/relapsingfever/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDebes AK, Waller JA, Kendi C. Healthcare delays in relapsing fever and impact on patient outcomes. Int J Infect Dis. 2019;89:23\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZein ZA, Louse Borne Relapsing Fever (LBRF): Mortality and Frequency of Jarisch-Herxheimer Reaction. Journal of the Royal Society of Health, Schwarzer R. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoubau PF. Relapsing fevers. A review. Ann Soc Belg Med Trop. 1984;64:335\u0026ndash;64. [PubMed] [Google Scholar].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorticosteroids in severe. Jarisch-Herxheimer reaction: a systematic review. Clin Infect Dis, 72(5), 1023\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelkert PW. Mortality in high risk patients with tick-borne relapsing fever analysed by the Borrelia-index. East Afr Med J. 1991;68(11):875\u0026ndash;9. pmid:1800081.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePe\u0026ntilde;a G, Lozano L, Camacho A. Mechanical ventilation in critical care: mortality trends in infectious diseases. Ann Intensiv Care. 2019;9(1):45\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Relapsing fever, Jarisch-Herxheimer Reaction (JHR), Clinical characteristics, Case fatality rate","lastPublishedDoi":"10.21203/rs.3.rs-5544669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5544669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRelapsing fever (RF) is a recurrent febrile illness caused by various \u003cem\u003eBorrelia\u003c/em\u003e spirochetes, with humans as the only known reservoirs. Despite recurring epidemics and high mortality rates in East Africa, limited research focuses on RF compared to other infectious diseases. This study aims to assess the clinical characteristics, outcomes, and associated factors with disease outcome among RF patients admitted to Yekatit-12 Hospital Medical College.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn institutional based retrospective cross sectional study was done and the study period was from April 2023 to June 2023. Data were analyzed using SPSS version 7 (2020), and results were disseminated accordingly.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 119 confirmed RF cases were identified, with a mean age of 24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 years. All cases were male, with an average symptom duration of 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86 days. Most patients were street dwellers or daily laborers. The majority received combination therapy, with ceftriaxone and doxycycline as the treatments of choice. The incidence of Jarisch-Herxheimer Reaction (JHR) was 36.1%, and the case fatality rate was 45.4%. Factors significantly associated with poor outcomes included JHR (p\u0026thinsp;=\u0026thinsp;0.023, AOR\u0026thinsp;=\u0026thinsp;2.8, 95% CI: 1.09\u0026ndash;7.64), mechanical ventilation use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, AOR\u0026thinsp;=\u0026thinsp;2.7, 95% CI: 1.05\u0026ndash;7.1), longer symptom duration (p\u0026thinsp;=\u0026thinsp;0.021, AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI: 1.24\u0026ndash;7.9), and multi-organ failure (p\u0026thinsp;=\u0026thinsp;0.002, AOR\u0026thinsp;=\u0026thinsp;3.8, 95% CI: 1.23\u0026ndash;11.6).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the significant burden of relapsing fever among younger, predominantly male laborers, with severe complications contributing to high mortality. It underscores the importance of early detection, prompt treatment, and targeted public health strategies to improve outcomes.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Disease Outcomes in Relapsing Fever Patients: Insights from Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-01 11:44:55","doi":"10.21203/rs.3.rs-5544669/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67098985-bb8b-4062-a040-6d08227c0605","owner":[],"postedDate":"November 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T04:09:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-01 11:44:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5544669","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5544669","identity":"rs-5544669","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}