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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
Author(s) -
Nilsson K.,
Wallménius K.,
Hartwig S.,
Norlander T.,
Påhlson C.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12218
Subject(s) - serology , medicine , neuroborreliosis , antibody , palsy , virology , borrelia burgdorferi , immunology , pathology , alternative medicine
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.