Acute sensorineural hearing loss and severe otalgia due to scrub typhus

Abstract

BackgroundScrub typhus is an acute febrile illness caused by Orientia tsutsugamushi.Case presentationsWe encountered a patient with sensorineural hearing loss complicating scrub typhus, and three patients with scrub typhus who complained of otalgia, which was sudden onset, severe, paroxysmal, intermittent yet persistent pain lasting for several seconds, appeared within 1 week after the onset of fever and rash. The acute sensorineural hearing loss and otalgia were resolved after antibiotic administration.ConclusionWhen patients in endemic areas present with fever and rash and have sensorineural hearing loss or otalgia without otoscopic abnormalities, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.

Scrub Typhus Meningitis in South India — A Retrospective Study

“…Microglial nodules suggested cortical invasion [34]. The involved cranial nerves are the optic [17], abducens, facial and cochlear [35] nerves. Peripheral nervous system involvement reported are mononeuritis multiplex [36], brachial plexus neuropathy [37], polyneuropathy [28], myelitis [30], [38] and Guillain-Barre syndrome (GBS) [25].…”

“…Facial nerve palsy has also been described with R. typhi and R. conorii infections [25]. There is a ∼19% incidence of ear symptoms in scrub typhus that includes sensorineural hearing loss, otalgia and tinnitus [35]. Direct central nervous system invasion and involvement of the cochlear division or a secondary immune mediated effect in the vasovasorum of the cochlear nerve has been hypothesised [35].…”

“…There is a ∼19% incidence of ear symptoms in scrub typhus that includes sensorineural hearing loss, otalgia and tinnitus [35]. Direct central nervous system invasion and involvement of the cochlear division or a secondary immune mediated effect in the vasovasorum of the cochlear nerve has been hypothesised [35]. Otalgia occurs in the first week, while sensorineural hearing loss and tinnitus occur during the second week [35].…”

“…Direct central nervous system invasion and involvement of the cochlear division or a secondary immune mediated effect in the vasovasorum of the cochlear nerve has been hypothesised [35]. Otalgia occurs in the first week, while sensorineural hearing loss and tinnitus occur during the second week [35]. Cochlear and retrocochlear damage has been proven histopathologically with demyelination and patchy neuritis having been noted in the 7 th and 8 th cranial nerves [9].…”

Scrub typhus meningitis: An under-recognized cause of aseptic meningitis in India

“…[9] Trigeminal neuralgia, acute sensori-neural hearing loss and facial palsy have also been reported. [10][11][12] The reported complications of the peripheral nervous system include mononeuritis multiplex, brachial plexus neuropathy, polyneuropathy and Guillain-Barre syndrome. [13][14][15] A pathognomonic eschar is a typical feature of scrub typhus and is of a high diagnostic value.…”