Clinical Manifestations

After an incubation period of some 5 to 8 days, the disease manifests itself suddenly, with shivering, headache, body pains, and high temperature. Nausea and vomiting are occasionally present. The spleen and liver are enlarged and tender; bronchitis is present in 40 to 60 percent of cases and jaundice in 20 to 60 percent. In cases with a favorable outcome, there is a crisis of 1 to 2 hours or longer within 3 to 9 days, followed by a fall in temperature. Relapse, shorter and less severe than the primary attack, follows in 11 to 15 days. A diminishing proportion of patients suffer up to four relapses. Not all cases relapse, however, and in some epidemics no more than 50 percent of the patients suffer relapse. Death is due to liver damage, lobar pneumonia, subarachnoid hemorrhage, or rupture of the spleen.

The causal organisms are present in the blood during the febrile attacks, but absent in the intermissions. After one or more relapses, the active immunity produced by the patient is sufficient to prevent further invasion of the blood by the spirochetes. It is doubtful, however, that this represents a true end of the disease for the patient. Rather it would seem that an equilibrium is established between host and parasite, and like all equilibria is liable to disturbance.

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