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Bell’s palsy and sudden deafness associated with Rickettsia spp . infection in Sweden: A retrospective and prospective serological survey including PCR findings
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
Department of Otorhinolaryngology, Falu hospital, Sweden.
Department of Otorhinolaryngology, Falu hospital, Sweden.
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2014 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 21, no 2, 206-214 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE:

Sixty 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.

METHODS:

Rickettsial 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.

RESULTS:

Five 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.

CONCLUSIONS:

These results highlight the importance of considering Rickettsia spp. as a cause of neuritis, and perhaps as a primary cause of neuritis unrelated to neuroborreliosis.

Place, publisher, year, edition, pages
2014. Vol. 21, no 2, 206-214 p.
Keyword [en]
PCR, Bell's palsy, deafness, neuritis, serology, spotted fever rickettsia
National Category
Infectious Medicine
Research subject
Infectious Diseases; Microbiology; Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:uu:diva-205365DOI: 10.1111/ene.12218ISI: 000329547200008PubMedID: 23790098OAI: oai:DiVA.org:uu-205365DiVA: diva2:641360
Available from: 2013-08-16 Created: 2013-08-16 Last updated: 2017-12-06
In thesis
1. Studies of Spotted Fever Rickettsia - Distribution, Detection, Diagnosis and Clinical Context: With a Focus on Vectors and Patients in Sweden
Open this publication in new window or tab >>Studies of Spotted Fever Rickettsia - Distribution, Detection, Diagnosis and Clinical Context: With a Focus on Vectors and Patients in Sweden
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The spotted fever rickettsia, Rickettsia helvetica, is an endemic tick-borne bacteria in Sweden. It causes infections in humans, manifested as aneruptive fever, headache, arthralgia and myalgia, and sometimes an inoculation eschar or a rash. There have also been two known cases of human infections with R. felis in Sweden.

The present thesis starts by investigating dispersal of ticks and Rickettsia spp. by migrating birds flying from Africa to Europe. Almost 15,000 birds were searched and 734 ticks collected, mainly of the species Hyalomma marginatum complex. Almost half (48%) of the ticks were infected with Rickettsia spp., 96% of which was R. aeschlimannii, the remaining R. africae and undefined species.

The next study focused on questing ticks over a large area in Sweden and determining the prevalence of Rickettsia spp., Anaplasma spp. and Coxiella burnetii. Rickettsia spp. was found in 9.5-9.6% of the ticks and A. phagocytophilum in 0.7%; no C. burnetii was found.

The last three papers in the thesis focused on the clinical presentation of rickettsiosis, the symptoms associated with the infection in general and particularly in patients with neurological complications. A tick-exposed population in Sweden was investigated to gain a better understanding of symptoms due to rickettsioses, also in relation to co-infections with other tick-borne bacteria. Based on symptoms, it was not possible to distinguish what pathogen caused the infections. Most patients had erythema migrans, some had serological reactions to Rickettsia spp., Borrelia spp. or co-infections by Rickettsia spp., Borrelia spp. and/or Anaplasma spp. In the fourth and fifth papers, we found associations between antibodies against Rickettsia spp. and sudden deafness (in 10-24% of patients) and facial nerve paralysis (in 8.3-25% of patients). In three patients R. felis was detected in the cerebrospinal fluids.   

Briefly, the thesis helps to clarify our knowledge about tick dispersal, shows a narrower prevalence estimate of Rickettsia spp. in Swedish ticks, and illuminates symptoms of rickettsioses and co-infections with other tick-borne infections. It also shows that presence of erythema migrans may be explained by more than Lyme disease and indicates a possible association between rickettsiosis and sudden deafness and facial nerve paralysis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1195
Keyword
tick-borne infections, co-infections, ticks, Ixodes ricinus, zoonosis, Rickettsia helvetica, migrating birds, Bell’s pares, erythema migrans, Rickettsia aeschlimannii, sudden deafness, facial nerve paralysis, Hyalomma marginatum, Rickettsia africae, western blot, PCR, serology
National Category
Clinical Medicine Basic Medicine
Research subject
Clinical Bacteriology
Identifiers
urn:nbn:se:uu:diva-280667 (URN)978-91-554-9512-1 (ISBN)
Public defence
2016-05-04, Hörsalen, Klinisk Mikrobiologi, Akademiska sjukhuset, Ing D1, Dag Hammarskjöldsväg 17, Uppsala, 09:15 (Swedish)
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Supervisors
Available from: 2016-04-11 Created: 2016-03-14 Last updated: 2016-04-12

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Nilsson, KennethWallmenius, KatarinaPåhlson, Carl

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