Acute otitis media in typhoid fevers

Typhoid infections in Ukraine are not often complicated by acute inflammation of the middle ear, especially at present, when typhoid fevers have been practically eliminated and occur only in extremely rare cases in "declassed" individuals. In the last century, typhoid epidemics in our country occurred during the First World War and the Civil War, the Great Patriotic War, during periods of disasters for the population and famine in the country. It was during these periods that typhoid infections were especially severe and caused many complications.

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Otitis in typhoid fever

Typhoid fever is an infectious disease from the group of intestinal infections, characterized by ulcerative lesions of the lymphatic apparatus of the small intestine, cyclic course, bacteremia, symptoms of intoxication, skin rash. The causative agent is Salmonella typhi. The sources of infection are a sick person and a carrier. The pathogen is released into the environment with feces and urine. With typhoid fever, complications such as pneumonia, bedsores, mumps, meningitis, otitis, etc. can be observed.

Otitis most often occurs in the 4th-5th week from the onset of the disease, but can occur throughout the infectious process. Its frequency in the last century was 3-7% of all cases of typhoid fever. The infection penetrates the middle ear through the auditory tube during the formation of ulcers and crusts of typhoid genesis in the nasopharynx. The hematogenous route cannot be excluded either. There are several forms of otitis in typhoid fever - from mild to severe necrotic, in which there is destruction of the auditory ossicles and eardrum. The necrotic form is characterized by abundant growth of granulation tissue, osteitis and osteonecrosis, scanty discharge of pus, from which the typhoid pathogen is extremely rarely isolated. Typhoid infection, both in otitis in typhoid fever and in its absence, can cause damage to the ear labyrinth, resulting in varying degrees of hearing loss. The prognosis for the functions of the ear labyrinth, with the exception of its severe forms, is favorable.

Treatment of otitis in typhoid fever is typical for acute inflammation of the middle ear.

Prevention - preventive sanitation of the nasopharynx by irrigating it with various antiseptic solutions.

Otitis in relapsing fever

Relapsing fever is an infectious disease that occurs in the form of febrile attacks alternating with periods of apyrexia (normal body temperature). A distinction is made between epidemic louse-borne and endemic tick-borne relapsing fever. Foci of infection persist in a number of countries in Asia, America and Africa. The causative agent of relapsing fever is the thread-like spirochete of Obermeyer (strongorrelia recurrentis). The source of the infectious agent is a sick person. The carriers of the infectious agent are lice. Infection occurs as a result of damage to the louse's body and the penetration of the insect's hemolymph, containing spirochetes, into damaged areas of the skin and human blood. The infectious agent multiplies in organs rich in reticuloendothelial tissue. Its repeated entry into the blood in large quantities is accompanied by the mass death of spirochetes and the release of endotoxin, causing a general intoxication syndrome: fever, increased vascular permeability, hemodynamic disturbances, etc. Some pathogens remain in the central nervous system, bone marrow, spleen, and multiply again, forming a generation of pathogens with new antigenic properties. The entry of these pathogens causes a new attack, etc. During the attacks, each of which becomes less pronounced, antibodies are produced to several varieties of spirochetes, immunity increases, and clinical recovery occurs.

Otitis most often occurs at the height of the first attack, less often - the second, sometimes during subsequent attacks, the number of which is no more than 4-5, and even during the recovery period. The incidence of otitis in relapsing fever is low (0.5-1.5%), depending on the region and country. Symptoms are practically no different from the course of banal acute inflammation of the middle ear, except for the fact that with each new attack there is a synchronous exacerbation of otitis with the appearance of severe pain in the ear and an increase in purulent discharge.

Treatment of otitis in relapsing fever is typical for acute inflammation of the middle ear with the use of drugs from the tetracycline group or chloramphenicol until a stable decrease in body temperature, usually up to 5-7 days.

Otitis in typhus

Typhus is an infectious disease characterized by a cyclical course, fever, a peculiar rash, damage to the vascular and central nervous systems. Typhus is caused by Rickettsia prowazekii, which secrete a toxin in the body. The source of the infectious agents is a sick person, and the carrier is a body louse. Having entered the intestines of a louse while sucking the blood of a sick person, the rickettsia multiply. When such a louse sucks blood on a healthy person, it simultaneously defecates, and a large number of pathogens are released along with the feces, which are rubbed into the skin during the itching caused by the bites. Having entered the blood, the rickettsia multiply in the vascular endothelium and destroy it. Thrombovasculitis occurs, and subsequently - granulomatosis, especially characteristic of the vessels of the skin, central nervous system, and adrenal glands. An important role in the pathogenesis of the disease is played not only by the rickettsia themselves, but also by the exotoxin they secrete.

Symptoms are characterized, in addition to the general severe condition, by such signs as hyperemia of the face, neck, upper body, conjunctiva (the exotoxin of the typhus pathogen has a strong vasodilatory effect); on the transitional folds of the latter, characteristic point spots of red or dark red color with a cyanotic tint can be found (Chiari-Avtsyn symptom). The same formations can also occur on the mucous membrane of the soft palate and at the base of the uvula. When trying to stick out the tongue, its jerky movements are noted. On the 4th-6th day, one of the most important clinical signs of typhus appears - roseolous-petechial rash with typical localization on the flexor surfaces of the arms, back, inner thighs. It is during this period that the occurrence of otitis with typhus becomes most likely. Complications are possible with delayed or insufficiently effective treatment (pneumonia, meningoencephalitis, myocarditis, trophic ulcers, ulcerative nasopharyngitis, acute otitis, etc.).

Otitis in typhus usually occurs during the height of the disease, but can also be observed during the recovery period or as an exacerbation of existing chronic purulent otitis media. The incidence of otitis in typhus is 4-6% and increases sharply during typhus epidemics. Infection in the middle ear penetrates mainly through the tubes with the above-mentioned nasopharyngitis or hematogenously. A characteristic sign of otitis in typhus is the appearance of red spots and small-point hemorrhages on the surface of the eardrum, similar to skin rashes. Soon after the appearance of these signs on the eardrum, its spontaneous perforation occurs. Symptoms are typical of banal acute inflammation of the middle ear. The complications of otitis that arise are due to a general decrease in immunity caused by the underlying disease. At the height of the clinical picture of typhus, otitis signs are usually masked by a severe general condition and dysfunction of the central nervous system. During this period, typhus exotoxin can affect the receptor apparatus of the inner ear, causing dizziness, hearing loss and other signs of damage to the central nervous system, which, however, normalize upon recovery.

Treatment is local, as with banal purulent inflammation of the middle ear, with an emphasis on antibiotic therapy using drugs from the tetracycline or chloramphenicol group until a stable decrease in body temperature occurs, usually up to 2-3 days of normal temperature.