Mediterranean spotted fever and hearing impairment: a rare complication

Abstract

Mediterranean spotted fever (MSF) is caused by Rickettsia conorii and transmitted by the brown dog tick Rhipicephalus sanguineus. It is prevalent in southern Europe, Africa and central Asia. The disease usually has a benign course and is characterized by fever, myalgia and a characteristic papular rash with an inoculation eschar ('tache noir') at the site of the tick bite. Severe forms of disease can have cardiac, neurologic or renal involvement. Nervous system complications are unusual and may develop in the early phase of disease or as a delayed complication. Neurological symptoms include headache and alterations of the level of consciousness, and some cases of meningoenchefalitis and Guillain-Barrè syndrome have been also reported. Peripheral nerve involvement is reported only in a limited number of case reports. We describe a case of Rickettsia conorii that was complicated with hearing loss and did not respond to specific treatment. Hearing loss is a rare event, but clinicians should be aware of this complication.

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

“…Rickettsiae in general are neurotropic pathogens [ 36 ], but commonly cause vasculitis as the primary pathology [ 37 , 38 ]. There are reports of cranial nerve palsies caused by rickettsial infections that support our hypothesis [ 36 , 39 – 41 ]. History of rickettsial infections in Sri Lanka has two demarcated eras [ 42 ].…”

Bilateral Sensorineural Deafness in a Young Pregnant Female Presenting with a Fever: A Rare Complication of a Reemerging Disease—Spotted Fever Group Rickettsioses

“…Hearing impairment in rickettsiosis can be unilateral or bilateral, and it might resolve within days, months, or sometimes years [7]. When scrub typhus is concerned, nearly one-third of patients are susceptible to develop transient deafness which is considered as a clinical feature, favoring the diagnosis [7, 16, 17]. Since deafness associated with SF is considered rare, this case brings out useful insight into the disease.…”

“…This disease is endemic in the northern, southern, and Central America and characterized by a purpuric and vasculitic rash [2–4, 10]. Mediterranean spotted fever (MSF) is a more benign form of SFGR and is endemic to Southern Europe, North Africa, and Central Asia [2, 3, 5, 7]. This disease is characterized by a maculopapular rash.…”

“…Except for Rocky Mountain spotted fever (RMSF) the most severe form of SF, neurological manifestations are uncommon in SFGR unless severely complicated with multiorgan involvement [6, 7]. Sensorineural deafness is a rare manifestation where the eighth cranial nerve gets involved in complicated SF [6, 7]. Kularatne et al in one of the studies carried out in Sri Lanka describing neurological complications in SFGR reported a single patient with sensorineural deafness [6].…”

Epidemiology, Clinical Aspectes,laboratory Diagnosis and Treatment of Rickesial Diseases in the Mediterranean Area Durin Covid-19 Pandemic:a Review of the Literature

“…It was estimated that about 5–10% of MSF cases could be severe. Cases of severe respiratory distress syndrome, 57 cardiovascular symptoms (coronary ectasia, 58 myocarditis, 59 , 60 vasculitis 61 ) ocular symptoms, 62 – 65 neurological symptoms 66 , 67 (sensorineural hearing lost, 68 , 69 polyneuropathy, 70 , 71 encephalitis, 72 , 73 meningitis 74 , 75 ), acute pancreatitis, 76 splenic rupture, 77 acute renal failure, 73 hemophagocytic syndrome 78 – 80 and arthritis 81 , 82 have been reported.…”