- 2 variants: Tick (B Hermsii) or Louse (B Recurrentis) borne
 
   
           
        
        
        
          
          
            
  
      
    
    
      
        
            - Tick Borne: mountainous US→ West/Southwest, plateau of Mexico, South America
- Louse Borne: Sudan, Ethiopia; Times of famine or war
 
   
           
        
        
        
          
          
            
  
      
        
        
        
        
          
            
                - Photophobia
- Joint aches
- Confusion
 
       
    
    
      
        
            - Fever x ~3d→ then fever free x 1w→ then recurrent fever
- Louse borne more severe than tick borne
 
   
           
        
        
        
          
          
            
  
      
    
    
      
        
            - Sometimes conj injection
- Non specific mac-pap rash
 
   
           
        
       
      
      
  
  
    
      - Organisms can be seen on peripheral smear