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

Kariyawasam, A. G. T. A.; Palangasinghe, D R; Fonseka, C. L.; Silva, P U T De; Kanakkahewa, T. E.; Dahanayaka, N J

doi:10.1155/2019/5923146

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…While tractable tinnitus and deafness may occur in approximately 20% of scrub typhus patients, no studies have examined the underlying mechanisms [ 31 ]. One case of sensorineural hearing loss due to SFR has recently been reported [ 32 ]. A pregnant 33-year-old woman presented to an outpatient clinic with 5-day history of fever, myalgia, headache, and maculopapular rash.…”

Section: Clinical Neurological Profiles Of Scrub Typhus and Sfrmentioning

confidence: 99%

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses

2020

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Scrub typhus and spotted fever rickettsioses (SFR) are understudied, vector-borne diseases of global significance. Over 1 billion individuals are at risk for scrub typhus alone in an endemic region, spanning across eastern and southern Asia to Northern Australia. While highly treatable, diagnostic challenges make timely antibiotic intervention difficult for these diseases. Delayed therapy may lead to severe outcomes affecting multiple organs, including the central nervous system (CNS), where infection and associated neuroinflammation may be lethal or lead to lasting sequelae. Meningitis and encephalitis are prevalent in both scrub typhus and SFR. Additionally, case reports detailing focal neurological deficits have come to light, with attention to both acute and chronic sequelae of infection. Despite the increasing number of clinical reports outlining neurologic consequences of these diseases, relatively little research has examined underlying mechanisms of neuroinflammation. Animal models of scrub typhus have identified cerebral T-cell infiltration and vascular damage associated with endothelial infection and neuropathogenesis. Differential gene expression analysis of brain tissues during murine scrub typhus have revealed selective increases in CXCR3 ligands, proinflammatory and type-1 cytokines and chemokines, and cytotoxicity molecules, as well as alterations in the complement pathway. In SFR, microglial expansion and macrophage infiltration contribute to neurological disease progression. This narrative Review highlights clinical neurologic features of scrub typhus and SFR and evaluates our current understanding of basic research into neuroinflammation for both diseases in animal models. Further investigation into key mediators of neuropathogenesis may yield prognostic markers and treatment regimens for severe patients.

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Section: Clinical Neurological Profiles Of Scrub Typhus and Sfrmentioning

confidence: 99%

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses

2020

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“…A case of right blindness due to retinitis caused R. sibirica infection was reported [43]. A case of bilateral sensorineural deafness caused by R.conori was also noted [44]. Another case of bilateral sensorineural hearing loss was seen after scrub typhus infection which did not improve even after 2 years [34].…”

Section: Resultsmentioning

confidence: 99%

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Sengupta,

Mandal

et al. 2023

Preprint

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Background – Leptospirosis and Rickettsial infections including scrub typhus are murine typhus are bacterial zoonosis prevalent in different geographical locations. This systematic review aims to identify foetal outcome in pregnant woman diagnosed with Rickettsial infection including scrub typhus and leptospirosis along with its associated factors. Methods - A comprehensive search was done in MEDLINE/PubMed, Scopus, CENTRAL (Cochrane), Web of Science, PsycInfo, Academic Search Premier, CINAHL, and Embase using a defined search term. The selection criteria were studies having pregnant women with diagnosed leptospirosis and Rickettsial infections including scrub typhus. The studies were excluded based on - diagnosis not clear, animal study, in vitro study, no pregnant population, co-infection, other infection except those concerned, seroprevalence without any foetal outcome. Studies in language other than English were also excluded. The initial screening of titles and abstracts was conducted by two independent reviewers using the Rayyan Web interface. Discrepancies were resolved through discussion or consultation with a third reviewer. Full-text review was carried out by the two reviewers, with disagreements resolved similarly. Data extraction was performed in Microsoft Excel, aided by Zotero for reference management. The assessment of study quality utilized The Joanna Briggs Institute Critical Appraisal tools. Data synthesis and analysis included a narrative synthesis of findings. Main results – A total of 54 studies were included in the systematic review for analysis. Among the 54 studies included in the systematic review, 22 had data on only scrub typhus, 14 had data on only Rickettsial infection, 16 had data on leptospirosis and 2 studies had data on all three infections. A total of 176 cases of scrub typhus were included with foetal loss in 53 (30.11%) and neonatal death in 3 (1.7%). Among the 38 cases of Rickettsial infection, 4 (10.5%) had foetal loss. Out of the total 63 cases of leptospirosis 13 (20.6%) had foetal loss. There were 6 maternal deaths due to scrub typhus and one maternal death due to Rocky Mountain spotted fever. Conclusion – Leptospirosis and Rickettsial infections including scrub typhus are important causes of loss of pregnancy. Hence diagnosis and appropriate management of these cases in pregnancy is essential.

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“…46 Consequently, most cases of suspected spotted fever rickettsiosis are diagnosed serologically as R. conorii infections using homologous antigens. [11][12][13][14] However, at least one serological study used a cross-adsorption IFA protocol and concluded that exposure to more than one SFG rickettsiae may occur in Sri Lanka. 16 This observation is in agreement with descriptions of three cases of travel-acquired rickettsioses in tourists returning from Sri Lanka and India to Australia, France, and Japan, indicating that R. conorii is probably not the sole etiological agent in Sri Lanka, 19,44,47 We performed testing of ticks obtained in the vicinity of human dwellings and collected from peri-domestic animals to evaluate the presence of rickettsial agents posing potential risks to humans.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 Because antigen from African strains of Rickettsia conorii is commonly used for serodiagnostic tests in Sri Lanka, it is sometimes interpreted incorrectly as exposure to R. conorii, as this is a group-specific test. [11][12][13][14][15] However, testing of sera of pediatric patients against a panel of eight different SFG rickettsial antigens, and subsequent cross-adsorption and Western blot analysis suggested that exposure to different species of SFG Rickettsia occurs in Sri Lanka. 16 The descriptions of Sri Lankan patients with SFG rickettsioses includes some severe clinical manifestations, including the development of acute vasculitis, arthritis, and fern leaf skin necrosis.…”

Section: Introductionmentioning

confidence: 99%

Molecular Characterization of Rickettsial Agents in Ticks (Acari: Ixodidae) from Sri Lanka

Dasch

Eremeeva

Zambrano

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Because the majority of spotted fever group rickettsiae are transmitted to humans by tick bites, it is important to understand which ticks might play a role in transmission of rickettsial pathogens in Sri Lanka. The purpose of our study was to conduct molecular surveillance of 847 ticks collected in different locations in central Sri Lanka to determine which were infected with Rickettsia and Anaplasmataceae. Molecular methods were used to identify the ticks and the agents detected. Most ticks (Amblyomma, Haemaphysalis, and Rhipicephalus) were collected by flagging, and lower number was collected from dogs, cattle, pigs, a pangolin, and tortoises. Five spotted fever genotypes were identified: a Rickettsia africae-like agent in Amblyomma larvae, Rhipicephalus massiliae and a related genotype identified in association with the tropical type of Rhipicephalus sanguineus from dogs and Rhipicephalus haemaphysaloides from dogs and cattle, and Candidatus R. kellyi and another novel genotype (SL94) in R. haemaphysaloides. Twenty-three ticks were positive for Anaplasmataceae, including one Anaplasma and two Ehrlichia genotypes. Because the sequence database for both ticks and rickettsial agents from Sri Lanka and southern India is not extensive, additional molecular characterization of the tick species of Sri Lanka and their rickettsial agents is required to understand their pathogenic potential more completely. However, several of the agents we identified in this survey may well be pathogenic for humans and domestic animals, and should be considered as a part of epidemiological surveillance and patient management.

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

Cited by 4 publications

References 18 publications

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Molecular Characterization of Rickettsial Agents in Ticks (Acari: Ixodidae) from Sri Lanka

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