title: Mediterranean spotted fever and hearing impairment: a rare complication.
abstract: Mediterranean spotted fever (MSF) is caused by Rickettsia conorii and transmitted by the brown dog tick Rhipicephalus sanguineus. It is prevalent in southern Europe, Africa and central Asia. The disease usually has a benign course and is characterized by fever, myalgia and a characteristic papular rash with an inoculation eschar ('tache noir') at the site of the tick bite. Severe forms of disease can have cardiac, neurologic or renal involvement. Nervous system complications are unusual and may develop in the early phase of disease or as a delayed complication. Neurological symptoms include headache and alterations of the level of consciousness, and some cases of meningoenchefalitis and Guillain-Barrè syndrome have been also reported. Peripheral nerve involvement is reported only in a limited number of case reports. We describe a case of Rickettsia conorii that was complicated with hearing loss and did not respond to specific treatment. Hearing loss is a rare event, but clinicians should be aware of this complication.
authors.affiliation: U.O. Ematologia non tumorale e coagulopatie Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy. Electronic address: raffa.vale@tin.it.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rossio
authors.affiliation: Università degli Studi di Milano. Electronic address: valeria.conalbi@studenti.unimi.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Conalbi
authors.affiliation: Università degli Studi di Milano. Electronic address: V.castagna92@gmail.com.
authors.forename: Valentina
authors.initials: V
authors.lastname: Castagna
authors.affiliation: U.O. Dermatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. Electronic address: Sebastianorecalcati@hotmail.com.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Recalcati
authors.affiliation: U.O. Ematologia non tumorale e coagulopatie Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy. Electronic address: Adriana.torri@policlinico.mi.it.
authors.forename: Adriana
authors.initials: A
authors.lastname: Torri
authors.affiliation: I Divisione di Malattie Infettive A.O. L. Sacco, Milan, Italy. Electronic address: coen.massimo@hsacco.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Coen
authors.affiliation: U.O. Dermatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. Electronic address: lucia.restano@fastwebnet.it.
authors.forename: Lucia Restano
authors.initials: LR
authors.lastname: Cassulini
authors.affiliation: Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Luigi Villa Foundation, Milan, Italy. Electronic address: flora.peyvandi@unimi.it.
authors.forename: Flora
authors.initials: F
authors.lastname: Peyvandi
mesh_terms: D000368:Aged; D001907:Boutonneuse Fever / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D034381:Hearing Loss / Q000382:microbiology*; D006801:Humans; D008297:Male
keywords: Hearing loss; Mediterranean spotted fever; Neurological complication; Rickettsia conorii