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Shingu M, Fujishima C, Hara S, Nishioka H. Japanese spotted fever complicated by acute sensorineural hearing loss. J Infect Chemother 2024:S1341-321X(24)00104-1. [PMID: 38599283 DOI: 10.1016/j.jiac.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
Japanese spotted fever is an emerging rickettsiosis caused by Rickettsia japonica and is characterized by high fever, rash, and eschar formation. Other symptoms are often vague and nonspecific and include headaches, nausea, vomiting, and myalgia. We present a case of a 46-year-old woman with Japanese spotted fever, complicated by transient bilateral sensorineural hearing loss and presenting cutaneous IgM/IgG immune complex vasculitis. The patient was admitted with a history of several days of high fever, generalized skin erythema, and hearing impairment. Laboratory findings revealed thrombocytopenia and elevated liver enzyme and C-reactive protein levels. Pure-tone audiometry revealed bilateral sensorineural hearing loss, and a skin biopsy revealed leukocytoclastic vasculitis with deposition of C3 and IgM on the vessel walls. Under the tentative diagnosis of rickettsiosis, scrub typhus, or Japanese spotted fever, the patient was treated with minocycline, and her symptoms improved within approximately 10 days. A definitive diagnosis was made on the basis of a serological test showing increased antibody levels against Rickettsia japonica. Japanese spotted fever can cause transient sensorineural hearing loss, a rare complication that presents with cutaneous IgM/IgG immune complex vasculitis.
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Affiliation(s)
- Motohiro Shingu
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Chieko Fujishima
- Department of Dermatology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Shigeo Hara
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan.
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2
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Jatsho J. An unusual presentation of scrub typhus in a child: a case report. BMC Pediatr 2022; 22:77. [PMID: 35114958 PMCID: PMC8812046 DOI: 10.1186/s12887-022-03139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Scrub Typhus (ST) is an acute, febrile zoonotic disease caused by the bacterium Orientia tsutsugamushi which is endemic to the Asia-Pacific region. Infected adults rarely present with sensorineural hearing loss and otalgia. Though few cases of pediatric cases are known to present with otalgia, no pediatric cases of sensorineural deafness complicating ST have been reported to date. Case presentation A 5-year-old, previously healthy girl presented with a one-week history of high-grade intermittent fever, Headache and right ear pain with a recent onset of reduced hearing. She had a fever up to 39 °C, cervical lymphadenopathy, bilateral pleural effusion with diffuse infiltrations, and mild hepatosplenomegaly with no evidence of rash. Her initial examination was normal except for mildly enlarged tonsils. Unilateral right ear hearing loss was noted using Weber’s test. Evidence of progressive, mild anemia, and raised inflammatory markers was noted. Diagnosis of scrub typhus was confirmed by positive detection of Orentia tsutsugamushi IgM antibodies on rapid diagnostic test and the presence of chigger mite in the right external auditory canal on repeat examination. She responded dramatically to the empirical treatment of ceftriaxone and doxycycline. On follow-up, she did not have any residual hearing loss and her ear pain had resolved completely. Conclusion Acute onset hearing loss or severe otalgia with or without findings should be an important diagnostic clue for suspecting scrub typhus in patients who present with a history of fever especially in endemic areas.
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Affiliation(s)
- Jimba Jatsho
- Department of Pediatrics, Phuentsholing Hospital, Ministry of Health, Phuentsholing, Bhutan.
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3
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Mediterranean Spotted Fever: Current Knowledge and Recent Advances. Trop Med Infect Dis 2021; 6:tropicalmed6040172. [PMID: 34698275 PMCID: PMC8544691 DOI: 10.3390/tropicalmed6040172] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Mediterranean spotted fever (MSF) is an emerging tick-borne rickettsiosis of the spotted fever group (SFG), endemic in the Mediterranean basin. By virtue of technological innovations in molecular genetics, it has been determined that the causative agent of MSF is Rickettsia conorii subspecies conorii. The arthropod vector of this bacterium is the brown dog tick Rhipicephalus sanguineus. The true nature of the reservoir of R. conorii conorii has not been completely deciphered yet, although many authors theorize that the canine population, other mammals, and the ticks themselves could potentially contribute as reservoirs. Typical symptoms of MSF include fever, maculopapular rash, and a characteristic eschar (“tache noire”). Atypical clinical features and severe multi-organ complications may also be present. All of these manifestations arise from the disseminated infection of the endothelium by R. conorii conorii. Several methods exist for the diagnosis of MSF. Serological tests are widely used and molecular techniques have become increasingly available. Doxycycline remains the treatment of choice, while preventive measures are focused on modification of human behavior and vector control strategies. The purpose of this review is to summarize the current knowledge on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of MSF.
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Epidemiology, Clinical Aspects, Laboratory Diagnosis and Treatment of Rickettsial Diseases in the Mediterranean Area During COVID-19 Pandemic: A Review of the Literature. Mediterr J Hematol Infect Dis 2020; 12:e2020056. [PMID: 32952967 PMCID: PMC7485464 DOI: 10.4084/mjhid.2020.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/04/2020] [Indexed: 01/12/2023] Open
Abstract
The purpose of the present review is to give an update regarding the classification, epidemiology, clinical manifestation, diagnoses, and treatment of the Rickettsial diseases present in the Mediterranean area. We performed a comprehensive search, through electronic databases (Pubmed – MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles, reviews, and books). The availability of new diagnostic tools, including Polymerase Chain Reaction and nucleotide sequencing has significantly modified the classification of intracellular bacteria, including the order Rickettsiales with more and more new Rickettsia species recognized as human pathogens. Furthermore, emerging Rickettsia species have been found in several countries and are often associated with unique clinical pictures that may challenge the physician in the early detection of the diseases. Rickettsial infections include a wide spectrum of clinical presentations ranging from a benign to a potentially life treating disease that requires prompt recognition and proper management. Recently, due to the spread of SARS-CoV-2 infection, the differential diagnosis with COVID-19 is of crucial importance. The correct understanding of the clinical features, diagnostic tools, and proper treatment can assist clinicians in the management of Rickettsioses in the Mediterranean area.
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Stephens BE, Thi M, Alkhateb R, Agarwal A, Sharkey FE, Dayton C, Anstead GM. Case Report: Fulminant Murine Typhus Presenting with Status Epilepticus and Multi-Organ Failure: an Autopsy Case and a Review of the Neurologic Presentations of Murine Typhus. Am J Trop Med Hyg 2018; 99:306-309. [PMID: 29943716 DOI: 10.4269/ajtmh.18-0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Murine typhus (MT) is an important cause of febrile illness in endemic areas, and there is an epidemiologic resurgence of this infection currently transpiring in Texas and California. Fatal cases and severe neurological complications are rare. A fatal case of MT in a middle-aged man is reported with a course culminating in multi-organ failure and refractory status epilepticus. An autopsy revealed hemorrhagic pneumonia, acute tubular necrosis, and ischemic necrosis in the liver, adrenals, and brain. We have also reviewed the neurologic complications of MT.
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Affiliation(s)
- Benjamin E Stephens
- Department of Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Meilinh Thi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Rahaf Alkhateb
- Department of Pathology and Laboratory Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Apeksha Agarwal
- Department of Pathology and Laboratory Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Francis E Sharkey
- Department of Pathology and Laboratory Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Christopher Dayton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
| | - Gregory M Anstead
- Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, Texas.,Division of Infectious Diseases, Department of Medicine, Long School of Medicine at University of Texas Health, San Antonio, Texas
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Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis 2017; 17:273. [PMID: 28407761 PMCID: PMC5390359 DOI: 10.1186/s12879-017-2385-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- Caroline Theunissen
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium.
| | - Lieselotte Cnops
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Ralph Huits
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Emmanuel Bottieau
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
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Rossio R, Conalbi V, Castagna V, Recalcati S, Torri A, Coen M, Cassulini LR, Peyvandi F. Mediterranean spotted fever and hearing impairment: a rare complication. Int J Infect Dis 2015; 35:34-6. [DOI: 10.1016/j.ijid.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022] Open
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Parola P, Paddock CD, Socolovschi C, Labruna MB, Mediannikov O, Kernif T, Abdad MY, Stenos J, Bitam I, Fournier PE, Raoult D. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 2013; 26:657-702. [PMID: 24092850 PMCID: PMC3811236 DOI: 10.1128/cmr.00032-13] [Citation(s) in RCA: 916] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia. These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.
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Affiliation(s)
- Philippe Parola
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | | | - Cristina Socolovschi
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Marcelo B. Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia Universidade de São Paulo, Cidade Universitária, São Paulo, SP, Brazil
| | - Oleg Mediannikov
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Tahar Kernif
- Service d'Ecologie des Systèmes Vectoriels, Institut Pasteur d'Algérie, Algiers, Algeria
| | - Mohammad Yazid Abdad
- Division of Veterinary and Biomedical Science, Murdoch University, Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - John Stenos
- Division of Veterinary and Biomedical Science, Murdoch University, Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - Idir Bitam
- University of Boumerdes, Boumerdes, Algeria
| | - Pierre-Edouard Fournier
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Didier Raoult
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
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9
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Queirós J, Maia S, Seca M, Friande A, Araújo M, Meireles A. Atypical Cogan's Syndrome. Case Rep Ophthalmol Med 2013; 2013:476527. [PMID: 23691387 PMCID: PMC3638509 DOI: 10.1155/2013/476527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Cogan's syndrome is a rare clinical entity whose etiopathology is still unknown, and the treatment strategies are not clearly defined. Case. A 23-year-old male presented with symptoms of headache, peripheral facial palsy, persistent right hearing loss and bilateral papillitis. Workup excluded all infectious, granulomatous, neoplastic, and immune causes. The diagnosis of atypical Cogan's syndrome was established, and the patient was treated with systemic corticosteroids and later on with cyclophosphamide and methotrexate. There were improvement of visual symptoms and stabilisation of left hearing. Conclusion. Cogan's syndrome is a very rare disease with no specific biological tests for the diagnosis. The diagnostic exams are mostly important to exclude other etiologies. The atypical ocular and audiovestibular manifestations make the diagnosis difficult, delaying the institution of appropriate therapy which may result in profound bilateral deafness.
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Affiliation(s)
- João Queirós
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Sofia Maia
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Mariana Seca
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - António Friande
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Maria Araújo
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Angelina Meireles
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
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Mendes-Corrêa MCJ, Bittar RSM, Salmito N, Oiticica J. Pegylated interferon/ribavirin-associated sudden hearing loss in a patient with chronic hepatitis C in Brazil. Braz J Infect Dis 2011; 15:87-9. [PMID: 21412597 DOI: 10.1016/s1413-8670(11)70147-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 09/07/2010] [Indexed: 11/29/2022] Open
Abstract
Sudden hearing loss is defined as a sensorineural hearing loss, equal to or greater than 30 dB, at three or more consecutive frequencies, which takes place within 72 hours. Both peginterferon and ribavirin are well-known to be associated with significant adverse effects, but sudden hearing loss is uncommon. We report a 65-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon-alpha and ribavirin for chronic hepatitis C. Peginterferon and ribavirin may cause sudden hearing loss that may not recover after discontinuation of therapy. Immediate treatment for all possible etiologies is essential, along with targeted investigations and early referral for an ear, nose and throat specialist. Physicians should be aware of the possible ototoxic effects of peginterferon and ribavirin combination therapy requiring appropriate surveillance.
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Saporito L, Giammanco GM, Rubino R, Ingrassia D, Spicola D, Titone L, Colomba C. Severe Mediterranean spotted fever complicated by acute renal failure and herpetic oesophagitis. J Med Microbiol 2010; 59:990-992. [PMID: 20508004 DOI: 10.1099/jmm.0.015891-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. Recently, complicated cases have been more frequently reported, even in previously healthy patients. We describe a case of severe MSF complicated by acute renal failure and associated with herpetic oesophagitis. Acyclovir therapy resulted in remission of oesophageal symptoms within 48 h.
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Affiliation(s)
- Laura Saporito
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giovanni M Giammanco
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Microbiologia, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Raffaella Rubino
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Daniela Ingrassia
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Daria Spicola
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Lucina Titone
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Claudia Colomba
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Lin SY, Wang YL, Lin HF, Chen TC, Chen YH, Lu PL. Reversible hearing impairment: delayed complication of murine typhus or adverse reaction to azithromycin? J Med Microbiol 2010; 59:602-606. [DOI: 10.1099/jmm.0.013813-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Delayed and reversible hearing loss occurred in a 55-year-old male patient with murine typhus infection. The patient had the initial symptoms of headache, fever and chills, followed by the occurrence of bilateral hearing loss on day 9 from fever onset. Murine typhus was diagnosed with a high IgM titre by indirect immunofluorescence assay. After treatment with azithromycin and prednisolone, the fever and other symptoms subsided gradually and bilateral hearing loss improved 3 weeks later. Though an adverse reaction to azithromycin could not be ruled out, delayed onset of hearing loss was more likely a complication of murine typhus, mainly because the hearing loss did not occur during the azithromycin usage period. Although hearing loss due to murine typhus is rare, clinicians should be alert to the existence of such a delayed complication.
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Affiliation(s)
- Shang-Yi Lin
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Ya-Ling Wang
- Department of Pharmacology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Tun-Chieh Chen
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yen-Hsu Chen
- Tropical Medicine Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Po-Liang Lu
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Kang JI, Kim DM, Lee J. Acute sensorineural hearing loss and severe otalgia due to scrub typhus. BMC Infect Dis 2009; 9:173. [PMID: 19849842 PMCID: PMC2773783 DOI: 10.1186/1471-2334-9-173] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 10/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. CASE PRESENTATIONS We 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. CONCLUSION When 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.
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Affiliation(s)
- Ji-In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Chosun University, School of Medicine, Gwangju City, Republic of Korea.
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14
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Colomba C, Saporito L, Colletti P, Mazzola G, Rubino R, Pampinella D, Titone L. Atrial fibrillation in Mediterranean spotted fever. J Med Microbiol 2008; 57:1424-1426. [DOI: 10.1099/jmm.0.2008/002162-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, maculo-papular rash and a black eschar at the site of the tick bite (‘tache noir’). We describe the case of a 58-year-old man affected by MSF who developed atrial fibrillation. The patient presented himself to the hospital after 7 days of fever, malaise and severe headache. Cardiac auscultation revealed a chaotic heart rhythm and an electrocardiogram confirmed atrial fibrillation with a fast ventricular response. Diagnosis of MSF was made after the appearance of a maculo-papular skin rash, and treatment with oral doxycycline was started. An immunofluorescence antibody test confirmed R. conorii infection. The patient recovered after 7 days of treatment. Cardiac arrhythmia is a rare complication of MSF. Inflammation may play a role in the pathogenesis of atrial fibrillation. R. conorii is an intracellular bacterium which could trigger atrial fibrillation. Our patient was previously healthy and had no reported history of cardiac disease. This suggests that heart function should be monitored in MSF patients even in the absence of underlying risk factors.
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Affiliation(s)
- Claudia Colomba
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Laura Saporito
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Pietro Colletti
- Dipartimento di Patologie Emergenti, Clinica delle Malattie Infettive, Azienda Ospedaliera Universitaria Policlinico ‘Paolo Giaccone’, Via del Vespro 129, 90127 Palermo, Italy
| | - Giovanni Mazzola
- Dipartimento di Patologie Emergenti, Clinica delle Malattie Infettive, Azienda Ospedaliera Universitaria Policlinico ‘Paolo Giaccone’, Via del Vespro 129, 90127 Palermo, Italy
| | - Raffaella Rubino
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Diego Pampinella
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Lucina Titone
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy
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