Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
ENT Unit, General Hospital, Kandy, 20000, Sri Lanka.
BMC Infect Dis. 2018 Aug 22;18(1):418. doi: 10.1186/s12879-018-3338-8.
Over the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem.
All cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified.
There were 29 patients with mean age of 46 years (range 22-76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1-55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species.
On contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.
在过去的二十年中，耳内 tick 滋生（耳螨病）在斯里兰卡的丘陵中部地区很常见。极少数情况下，与耳螨病相关的孤立性单侧面神经麻痹被认为是毒素对神经的损害，这促使我们研究这个问题的临床流行病学和病因病理学。
2001 年至 2016 年，所有患有与耳螨病相关的孤立性单侧面神经麻痹的患者均在斯里兰卡康堤总医院耳鼻喉科诊所就诊，均纳入本研究。通过神经传导研究评估面神经麻痹，并鉴定采集的 tick。
共有 29 名患者，平均年龄为 46 岁（范围为 22-76 岁），男女比例为 1:1.9。前 12 例无特定治疗的患者恢复时间为 1-55 个月，其中 4 例出现轴索变性。最后 5 例患者接受多西环素治疗，4 周内恢复。他们对斑点热立克次体的免疫荧光抗体有强烈的血清转化，最后 1 例患者采集的 tick 通过 PCR 检测出立克次体 DNA 阳性。鉴定出的 tick 属于 Dermacentor、Amblyomma、Rhipicephalus 和 Hyalomma 种。
与流行的毒素理论相反，我们能够证明可治疗的立克次体病因病理学是导致斯里兰卡耳螨病相关下运动性面神经麻痹的原因。
