Acute Hearing Loss and Rickettsial Diseases

TotheEditor—Premaratna et al. [1] provided a timely reminder to clinicians in their report describing acute hearing loss due to scrub typhus. These authors, however, do not mention an important fact that is relevant for clinicians who practice in areas where other rickettsial diseases are prevalent. Acute hearing loss with or without other isolated cranial nerve abnormalities may occur in a variety of rickettsial diseases. For example, unilateral or bilateral deafness may occur in patients with Rocky Mountain spotted fever, Mediterranean spotted fever, and murine typhus [2–5]. The mechanism for hearing loss in patients with Rocky Mountain spotted fever has been assumed to be vasculitis-induced cochlear damage [3]. However, it is also possible that hearing impairment or selected other neurological complications of rickettsial infection could be immune mediated, because Guillian-Barré polyneuropathy has been described following infection with Rickettsia conorii and Rickettsia rickettsii [6, 7]. Potential conflicts of interest. D.J.S.: no conflicts.