- 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