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. 2018 Aug 22;18(1):418.
doi: 10.1186/s12879-018-3338-8.

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Senanayake A M Kularatne  1 , Ranjan Fernando  2 , Sinnadurai Selvaratnam  2 , Chandrasiri Narampanawa  2 , Kosala Weerakoon  3 , Sujanthe Wickramasinghe  4 , Manoji Pathirage  4 , Vajira Weerasinghe  5 , Anura Bandara  6 , Jayanthe Rajapakse  6
Affiliations

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Senanayake A M Kularatne et al. BMC Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Facial nerve palsy; Otoacariasis; Rickettsial; Sri Lanka; Tick bite.

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Conflict of interest statement

Ethics approval and consent to participate

Publication of this work was granted ethics clearance by the Ethics review committee, Faculty of Medicine, University of Peradeniya, Sri Lanka. All study participants were adults and informed written consent was obtained from all participants.

Consent for publication

Informed written consent for publishing the photographs (shown in Fig. 2) was directly obtained from the patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Dorsal view of ticks. a Rhipicephalus adult female, b Dermacentor adult female, c Hyalomma adult female, d Amblyomma adult female. Scale bars 1 mm
Fig. 2
Fig. 2
Intra-aural tick bite causing unilateral facial nerve palsy. Facial palsy of case 29, before (a) and after (b) treatment, c Tick attached to deep ear canal
See this image and copyright information in PMC

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