Scrub Typhus with Bilateral Sensorineural Hearing Loss: A Rare Presentation

Athulya Asokan; Athira V R; Sanal  K Thomas; Ajeesh Koshy

Athulya Asokan Assistant Professor, General Medicine, Government Medical College, Kottayam.
Athira V R Senior resident, General Medicine, Pushpagiri Institute of medical Sciences
Sanal K Thomas Senior resident, Neurology, Jubilee mission medical college
Ajeesh Koshy Assistant Professor , General Medicine , Pushpagiri Institute of medical Sciences

Keywords: Scrub Typhus, Orientia tsutsugamushi, Bilateral Sensorineural Hearing Loss, Vasculitis, Doxycycline

Abstract

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging infectious disease prevalent in Southeast Asia, including India. While commonly presenting with fever and systemic complications, neurological manifestations such as sudden bilateral sensorineural hearing loss (SNHL) are rare but increasingly recognised. We report a case of a 64-year-old female presenting with fever, myalgia, and bilateral SNHL, later diagnosed with scrub typhus. Diagnostic challenges arise due to the diverse clinical spectrum and nonspecific symptoms. The proposed mechanisms for hearing loss involve direct invasion of the central nervous system or vasculitis of the cochlear nerve. Heightened awareness among healthcare providers is crucial for timely diagnosis and management. Empirical treatment with doxycycline is recommended in endemic regions for suspected cases. This case emphasises the importance of considering scrub typhus in patients with acute febrile illness and otic symptoms, facilitating early intervention and improved outcomes.

How to cite this article:
Asokan A, Athira V R, Thomas S K, Koshy A.
Scrub Typhus with Bilateral Sensorineural
Hearing Loss: A Rare Presentation. J Commun
Dis. 2024;56(1):13-15.

References

Chakraborty S, Sarma N. Scrub typhus: an emerging threat. Indian J Dermatol. 2017 Sep-Oct;62(5):478-85.

[PubMed] [Google Scholar]

Choi YS, Song SY, Kim YD, Bae CH. A case of scrub typhus with bilateral sudden hearing loss. Korean J

Otorhinolaryngol Head Neck Surg. 2013;56(11):738. [Google Scholar]

Dixit J, Jadon RS, Ray A, Ranjan P, Vikram NK, Sood R. Scrub typhus with bilateral sensorineural hearing loss: a unique case report. J Vector Borne Dis. 2020;57(1):101- 3. [PubMed] [Google Scholar]

Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K. Rickettsial meningitis and encephalitis. Arch Intern Med. 1991;151(9):1753-7. [PubMed] [Google Scholar]

Stephen S, Sangeetha B, Ambroise S, Sarangapani K, Gunasekaran D, Hanifah M, Somasundaram S. Outbreak of scrub typhus in Puducherry & Tamil Nadu during cooler months. Indian J Med Res. 2015 Nov;142(5):591- 7. [PubMed] [Google Scholar]

Premaratna R, Chandrasena TG, Dassayake AS, Loftis AD, Dasch GA, de Silva HJ. Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin Infect Dis. 2006;42(1):e6-8. [PubMed]

[Google Scholar]

Sexton DJ. Acute hearing loss and rickettsial diseases. Clin Infect Dis. 2006;42(10):1506. [PubMed] [Google Scholar]

Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E. Scrub typhus among hospitalized patients with febrile illness in South India: magnitude and clinical predictors. J Infect. 2006;52(1):56-60. [PubMed] [Google Scholar]

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010 Jan;58:24-8. [PubMed] [Google Scholar]