184.2 📚 國考版

184.2.0.1 必背 — LBRF vs TBRF

	LBRF (B. recurrentis)	TBRF (multiple)
Vector	Body louse	Soft tick (Ornithodoros)
Transmission	Crushed louse, NOT bite	Tick bite (brief, night)
Setting	War, refugees, poverty	Cabin, cave, outdoor
Relapses	1-2	5-10
Mortality	10-40% untreated	1-5%
Tx	Single dose doxy/PCN	Doxy × 7-10d
Herxheimer	Severe (ICU)	Less severe

184.2.0.2 必背 — Smear visible

• Borrelia visible peripheral blood smear during fever — unique among bacteria

184.2.0.3 必背 — Antigenic Variation

• Vmp protein — multiple variants → relapsing pattern (immune escape)

184.2.0.4 必背 — Cabin / Cave + Fever

• Consider TBRF (B. hermsii) W USA

184.2.0.5 必背 — Refugee + Crowding + Fever

• Consider LBRF (B. recurrentis)

184.2.0.6 必背 — Treatment

• Doxycycline 100 bid × 7-10d (TBRF) or single dose (LBRF)
• Ceftriaxone IV for severe / CNS
• Jarisch-Herxheimer severe — pre-medicate, ICU

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