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Bell's palsy and Cyclospora

Bell’s palsy, an idiopathic facial paralysis, is a common disease that causes important functional, aesthetic, and psychosocial disturbances in the patients (1). Bell’s palsy is characterized by the mouth sags, dribbling, taste impairment, and watery eye. The etiology of VIIth nerve palsy may be due to brainstem tumor, stroke, polio, cerebello-pontine angle lesions (acoustic neuroma, meningitis), otitis media, Ramsay Hunt Syndrome (herpeszoster oticus), cholesteatoma, parotid tumors, trauma, sarcoid, Guillain-Barre, leprosy, Lyme disease etc (2,3). But Bell’s palsy is idiopathic in nature. Cyclospora cayetanensis is a coccidian parasite that causes acute and chronic diarrhea in immunocompetent and immunocompromised patients (4,5,6,7,8) It has been reported the Bell’s palsy syndrome in a Cyclospora infected chronic diarrheal patient in this coccidian endemic area, Nepal. Tirth Raj Ghimire and colleagues reported case of Bell’s palsy following chronic Cyclospora infection. Although this syndrome in their study could have been coincidental, they have proposed that Cyclospora as another infectious trigger of Bell’s palsy (9). In this study, along Biliary disease, Guillain-Barre syndrome, Reiter syndrome, acalculus cholecystitis, pulmonary infection and low hemoglobin concentration in the absence of efficient immune system, another major syndrome, Bell’s palsy, has been reported as an extraintestinal complication of Cyclospora infection. In their study, the duration of facial involvement was about four months in their patient. Partial facial paralysis is usually resolved within several months. Likelihood of complete recovery after total paralysis varies from 20% to 90% (3). And the duration of diarrhea caused by Cyclospora was about 17 months. Careful review of the literature revealed that this occurrence is extremely rare. This could be due to an autoimmune basis similar to the occurrence of Guillain-Barre syndrome. Presence of sole Cyclospora in the patient's stool and recovery of his protracted diarrhea and facial paralysis after treatment with cotrimoxazole, the involvement of Cyclospora in chronic diarrheal patients to manifest Guillain-Barre syndrome, pulmonary infection, low hemoglobin concentration in various studies, the authors assume that Bell’s palsy was the result of the chronic Cyclospora infection in their patient.

References 1. Ying LI, Fan-rong LIANG, Shu-guang YU,et al: Efficacy of acupuncture and moxibustion in treating. CMJ, 117: 1502-1506, 2004

2. Hope RA, Longmore JM, Hodgetts TJ, et al: Oxford Handbook of Clinical Medicine, Oxford University Press, India, 1994

3. Thomas CL: Taber ’s Cyclopedic Medical Dictionary, 1993. ISBN: 0-8036-8313-8 (Davis FA)

4. Ghimire TR, Mishra PN: Intestinal parasites and hemoglobin concentration in the people of two different areas of Nepal. JNHRC 3: 1-7, 2005

5. Ghimire TR: Cyclosporiasis in HIV and Non-HIV patients: A study in Kanti Children’s Hospital, Maharajgunj and Sukra Raj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal. Dissertation: Master’s Degree in Zoology, Central Department of Zoology, Tribhuvan University, Kirtipur, Kathmandu, Nepal, 2004

6. Shlim DR, Cohen MT, Eaton M, et al: An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Am J Trop Med Hyg 45: 383-389, 1991

7. Outbreaks of diarrheal illness associated with cyanobacteria (blue-green algae)-like bodiesChicago and Nepal, 1989 and 1990. MMWR Morb Mortal Wkly Rep 40: 325-327, 1991

8. Ghimire TR, Mishra PN, Sherchand JB: The seasonal outbreaks of Cyclospora and Cryptosporidium in Kathmandu, Nepal. JNHRC 3(1): 39-48, 2005

9. Ghimire TR, Mishra PN, Sherchand JB, Ghimire LV: Bell’s Palsy and Cyclosporiasis: Causal or Coincidence? Nepal Journal of Neuroscience 4:86- 88, 2007 (http://neuroscience.org.np/neuro/issues/uploads/abstract_K3M0aH6IUP.pdf