Bell's palsy and sudden deafness associated with Rickettsia spp. infection in Sweden. A retrospective and prospective serological survey including PCR findings

Abstract

Background and purposeSixty patients with facial palsy and 67 with sudden deafness were retrospectively or prospectively examined for serological evidence of rickettsial infection; in six cases where cerebrospinal fluid was available, patients were also examined for presence of rickettsial DNA.MethodsRickettsial antibodies were detected in single or paired serum samples using immunofluorescence with Rickettsia helvetica as the antigen and in four cases also using western blot. Using PCR and subsequent direct cycle sequencing, the nucleotide sequences of the amplicons (17 kDa protein gene) in cerebrospinal fluid were analysed.ResultsFive out of 60 (8.3%) patients with facial palsy and eight of 67 (11.9%) with hearing loss showed confirmative serological evidence of infection with Rickettsia spp. An additional three and four patients in the facial palsy and hearing loss groups, respectively, showed evidence of having a recent or current infection or serological findings suggestive of infection. In four cases, the specificity of the reaction was confirmed by western blot. An additional 70 patients were seroreactive with IgG or IgM antibodies higher than or equal to the cut-off of 1:64, whereas 37 patients were seronegative. Only two of 127 patients had detectable antibodies to Borrelia spp. In three of six patients, rickettsial DNA was detected in the cerebrospinal fluid, where the obtained sequences (17 kDa) shared 100% similarity with the corresponding gene sequence of Rickettsia felis.ConclusionsThese results highlight the importance of considering Rickettsia spp. as a cause of neuritis, and perhaps as a primary cause of neuritis unrelated to neuroborreliosis.

Bilateral Facial Palsy: Post Vivax Malaria Scenario

“…9 , Rickettsial infection. 10 , varicella zoster virus reactivation. 11 However, our literature search did not reveal any report of bilateral Bell's palsy after malaria.…”

Gefahren der Übertragung von Krankheitserregern durch Schildzecken in Deutschland

“…Welche Rolle dieses Pathogen bei anderen Erkrankungen spielt, ist unklar. Diskutiert werden in diesem Zusammenhang unter anderem Fazialisparesen und plötzliche Taubheit [31]. Ähnliches gilt für die ebenfalls häufigen Rickettsienarten R. slovaca und R. raoultii, die mit der Tick-borne lymphadenopathy (TIBOLA) assoziiert werden.…”

Rickettsia felis identified in two fatal cases of acute meningoencephalitis

“…Typically, it presents as a mild, febrile illness that can be syndromically confused with many other undifferentiated fevers, especially in Africa and Asia, where diagnostic resources are limited. Neurological involvement has been reported in several cases in Mexico [9] and Sweden [10,11] but not deaths. In this report we describe the identification of R. felis from the cerebrospinal fluid (CSF) of two fatal cases of acute neurological disease in North Sulawesi, Indonesia.…”