Acute otitis in typhus

Typhoid infections in Ukraine are not often complicated by acute inflammation of the middle ear, especially at the present time, when typhus is practically eliminated and arise only in extremely rare cases in "declassed" individuals. In the last century typhoid epidemics in our country arose during the First World and Civil wars, the Great Patriotic War, during periods of disasters of the population and famine in the country. It was during these periods that typhoid infections were particularly difficult and gave 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 flow, bacteremia, symptoms of intoxication, skin rash. The causative agent is Salmonella typhi. Sources of infection are a sick person and a carrier. The causative agent is excreted into the environment with feces and urine. With typhoid fever, complications such as pneumonia, bedsores, parotitis, meningitis, otitis media and many others can be observed. Other

Otitis occurs most often in the 4-5th week from the onset of the disease, but can occur during the entire infectious process. Its frequency in the last century was 3-7% of all cases of typhoid fever. Infection penetrates into the middle ear through the auditory tube during the formation of ulcers and crusts of typhoid genesis in the nasopharynx. It is also possible to exclude the hematogenous pathway. There are several forms of otitis in typhoid fever - from light to severe necrotic, in which the destruction of the auditory ossicles and the tympanic membrane occur. Necrotic form is characterized by abundant growth of granulation tissue, osteitis and osteonecrosis, poor pus, from which excretion of the typhoid fever is extremely rare. Typhoid infection in both typhoid fever and in its absence can cause damage to the ear maze, which results in a different degree of deafness. The prognosis for the functions of the ear maze, 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 applying irrigation with various antiseptic solutions.

Otitis with recurrent typhoid

Recurrent typhus is an infectious disease that occurs in the form of febrile seizures alternating with periods of apyrexia (normal body temperature). There are epidemic lousy and endemic tick-borne recurrent typhus. Foci of infection persist in several countries in Asia, America and Africa. The causative agent of recurrent typhus is the filamentous spirochete of Obermeyer (strongorrelia recurrentis). The source of the causative agent of infection is a sick person. Carrying out the causative agent are lice. Infection occurs as a result of damage to the body of the louse and the entry of the hemolymph of the insect containing spirochetes into damaged skin and human blood. The causative agent multiplies in organs that are rich in reticuloendothelial tissue. Re-entering it into the blood in large quantities is accompanied by mass death of the spirochetes and the release of endotoxin, which causes a general intoxication syndrome: fever, increased vascular permeability, hemodynamic disorders, etc. Some of the pathogens persist in the central nervous system, bone marrow, spleen, reproduce again, forming a generation of pathogens with new antigenic properties. The entry of these pathogens causes a new attack, etc. In the course of seizures, each of which is becoming less pronounced, antibodies to several species of spirochetes are developed, immunity increases, and clinical recovery begins.

Otitis occurs most often at the height of the first attack, less often in the second, sometimes during subsequent attacks, the number of which is no more than 4-5, and even in the period of convalescence. The incidence of otitis in recurrent typhoid is low (0.5-1.5%), depending on the region and country. Symptoms practically do not differ 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 with recurrent typhoid is typical for acute inflammation of the middle ear with the use of drugs of the tetracycline or levomycetin group until the body temperature drops steadily, usually up to 5-7 days.

Otitis with typhus

Typhus fever is an infectious disease characterized by a cyclic course, fever, a peculiar rash, a lesion of the vascular and central nervous systems. The causative agents of typhus are Riquettsia Provachek, which in the body secrete toxin. The source of infectious agents is a sick person, and the carrier is a louse. Having entered the intestine of a louse when sucking the blood of a sick person, rickettsia multiply. Such a louse, when sucking blood on a healthy person, causes defecation at the same time, and a large number of pathogens are excreted along with the feces, which are rubbed into the skin when itching occurs when biting. Once in the blood, the rickettsia multiply into the endothelium of the vessels and destroy it. There are thrombovasculitis, followed by granulomatosis, especially characteristic of the vessels of the skin, the central nervous system, the adrenal glands. An important role in the pathogenesis of the disease is played not only by the rickettsia itself, but also by the exotoxin released by them.

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

Otitis with typhus usually occurs during the height of the disease, but it can also occur in the period of convalescence or as an exacerbation of the existing chronic suppurative otitis media. The frequency of otitis in typhus is 4-6% and increases sharply in epidemics of typhus. Infection in the middle ear penetrates mainly through the tubes with nasopharyngitis, noted above or hematogenous way. A characteristic feature of otitis in typhus is the appearance on the surface of the tympanic membrane of red specks and small-dotted hemorrhages similar to rashes on the skin. Soon after the appearance of these signs on the tympanic membrane, its spontaneous perforation arises. Symptoms are typical for common acute inflammation of the middle ear. The resulting complications of otitis are caused by a general decrease in immunity caused by the underlying disease. At the height of the clinical picture of typhus, otiatric symptoms are usually masked by a severe general condition and impaired CNS functions. During this period, typhoid typhus exotoxin can affect the receptor apparatus of the inner ear, causing dizziness, hearing loss and other signs of CNS damage, which, however, normalize on recovery.

Treatment is local, as in banal purulent inflammation of the middle ear, with an emphasis on antibiotic therapy with the use of drugs of the tetracycline or levomycetin group until the body temperature drops steadily, usually up to 2-3 days of normal temperature.