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Fig 1.

Assumed global distribution of TBRF and LBRF, 1950–1969 (Felsenfeld O. Borrelia; Strains, Vectors, Human and Animal Borreliosis. St. Louis: Warren H. Green; 1971[8]).

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Fig 2.

Microscopical detection of TBRF Borrelia in blood films.

Microscopic images of Giemsa-stained thin blood films (original magnifications ×1’000) showing TBRF Borrelia in a patient suffering from TBRF fever due to Borrelia persica (courtesy of Dr. Veronika Muigg).

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Table 1.

Overview of laboratory methods applied in TBRF and their advantages, disadvantages and use.

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Table 2.

Diagnostic grading system to judge the certainty of the correct diagnosis of TBRF.

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Fig 3.

Flow diagram of search and selection of eligible publications.

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Fig 4.

Number of TBRF case studies published from 1906 to 2020.

TBRF, tick borne relapsing fever.

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Fig 5.

Reported TBRF cases by country and causative Borrelia species.

B., Borrelia. Map created on www.mapchart.net.

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Fig 6.

Reported TBRF cases caused by unidentified Borrelia species.

TBRF, Tick borne relapsing fever. Map created on www.mapchart.net.

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Fig 7.

Reported presence of TBRF Borrelia species in ticks and animal hosts in America.

B., Borrelia. Map created on www.mapchart.net.

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Fig 8.

Reported presence of TBRF Borrelia species in ticks and animal hosts in Africa.

B., Borrelia. Map created on www.mapchart.net.

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Fig 9.

Reported presence of TBRF Borrelia species in ticks and animal hosts in Europe.

B., Borrelia. Map created on www.mapchart.net.

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Fig 10.

Reported presence of TBRF Borrelia species in ticks and animal hosts in Asia.

B., Borrelia. Map created on www.mapchart.net.

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Table 3.

Known and putative TBRF Borrelia spp. and their animal host(s) and transmitting tick species.

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Table 4.

Number of publications on TBRF cases by country where the infections were most likely acquired (n = 240 studies).

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Table 5.

Case analysis on TBRF in travelers.

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Fig 11.

Relative frequency of signs and symptoms (in %) related to TBRF (n = 152 studies).

TBRF, tick borne relapsing fever.

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Fig 12.

Number of relapsing fever episodes in studies on TBRF (n = 67 studies).

* Note: Since the number of relapsing fever episodes within single studies was mostly reported as median, an evaluation per case was not possible.

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Fig 13.

Abnormal laboratory findings related to TBRF (n = 65 studies).

ALAT, alanine aminotransferase; AP, alkaline phosphatase; ASAT, aspartate transaminase; CK, creatine kinase; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GGT, gamma-glutamyltransferase; LDH, lactate dehydrogenase; TBRF, tick borne relapsing fever.

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Fig 14.

Complications of TBRF (n = 47 studies).

ARDS, acute respiratory distress syndrome; DIC, disseminated intravascular coagulation; TBRF, tick borne relapsing fever.

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Table 6.

Diagnostic methods used to diagnose TBRF in 7,612 cases (n = 240 studies).

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Fig 15.

Use of different antimicrobial compounds/drugs to treat TBRF as reported from 1930 until today (n = 172 studies).

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Table 7.

Treatment specific frequency of JHR in TBRF (n = 65 studies).

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Table 8.

Case fatality analysis of TBRF (n = 17 studies).

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Table 9.

Summary of characteristics of TBRF compared to LBRF.

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