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They don’t just have persistent coughs: Instead their disease is a systemic experience, with brain fog, internal organ pain, bowel problems, tremors, relapsing fevers, more.

The spirochetes were similar to what he had studied as a graduate student: the cause of relapsing fever.

If spirochetes caused relapsing fever, perhaps other spirochetes were responsible for the mysterious new Lyme arthritis for which a cause was not known.

The situation is further complicated because Ixodes ticks transmit a host of other pathogens, such as Rickettsia, other bacteria, viruses and protozoa, leading to diseases including typhus, relapsing fever, babesiosis and meningoencephalitis.

Writing to a friend, he described the process whereby the thoughts sponsored by his “relapsing fever” brought this book into the world: