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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   R ickettsia 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   R ickettsia  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  I g G  or  I g M  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   B orrelia  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   R ickettsia   felis .    Conclusions  These results highlight the importance of considering   R ickettsia  spp. as a cause of neuritis, and perhaps as a primary cause of neuritis unrelated to neuroborreliosis.

european journal of neurology

B ell's palsy and sudden deafness associated with   R ickettsia  spp. infection in  S weden. A retrospective and prospective serological survey including  PCR  findings