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Tick-Borne Encephalitis


Presentation

  • Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreported.[ncbi.nlm.nih.gov]
  • With increasing foreign travel, TBE is likely to present more commonly in the U.K. and should be considered in any case of febrile illness with neurological complications following travel abroad.[ncbi.nlm.nih.gov]
  • We present four cases of patients who died because of TBE.[ncbi.nlm.nih.gov]
  • BACKGROUND: Host factors determining the clinical presentation of tick-borne encephalitis (TBE) are not fully elucidated.[ncbi.nlm.nih.gov]
  • Notably, the consequences of TBE present a larger burden than TBE itself. CONCLUSIONS: TBE presents a relatively high burden expressed in DALYs compared with estimates for other infectious diseases from the GBD 2010 study for Slovenia.[ncbi.nlm.nih.gov]
Fever
  • In these cases, fever can be the only leading manifestation. We report on four hospitalised children who had TBE and presented as fever without localising signs (FWLS) between 2000 and 2008 in an endemic area in Switzerland.[ncbi.nlm.nih.gov]
  • In approximately two-thirds of patients infected with the European TBE virus, only an early (viremic) phase is experienced; symptoms are nonspecific and may include fever, malaise, anorexia, muscle aches, headache, nausea, and/or vomiting.[cdc.gov]
  • Their pathogenesis ranges from mild illness to severe manifestations such as hemorrhagic fever and fatal encephalitis.[ncbi.nlm.nih.gov]
  • We describe severe tick-borne encephalitis (TBE) in a patient who had previously experienced West Nile fever, another flavivirus infection endemic in Hungary.[ncbi.nlm.nih.gov]
  • It may manifest as meningoencephalitis or a mild illness with fever.[patient.info]
Fatigue
  • In addition, the answers concerning tiredness/fatigue, poor concentration/attention, reduced initiative/motivation, balance disturbances, coordination problems, difficulties with short- and long-term memory, learning difficulties and problems with fine[ncbi.nlm.nih.gov]
  • Symptoms can last up to 8 days and include fever, headache, fatigue, muscle pain, nausea, and loss of appetite.[iamat.org]
  • Symptoms Fever, headache, fatigue, and malaise tend to occur and last for about five days. Following a short period of symptom-free time, more severe manifestations may develop including meningitis, encephalitis, myelitis, and cranial neuritis.[columbia-lyme.org]
  • TBE can for instance cause long-term memory issues, severe fatigue and loss of mobility. Symptoms The incubation period is usually 4 – 14 days, but can be up to a month. The first symptoms are typically fever, headache, muscle-ache and fatigue.[vaccination.org.uk]
  • Tick-borne encephalitis can affect the central nervous system and causes symptoms similar to Lyme disease: headache, fatigue and muscle pain.[stuttgartcitizen.com]
Malaise
  • In approximately two-thirds of patients infected with the European TBE virus, only an early (viremic) phase is experienced; symptoms are nonspecific and may include fever, malaise, anorexia, muscle aches, headache, nausea, and/or vomiting.[cdc.gov]
  • Symptoms Fever, headache, fatigue, and malaise tend to occur and last for about five days. Following a short period of symptom-free time, more severe manifestations may develop including meningitis, encephalitis, myelitis, and cranial neuritis.[columbia-lyme.org]
  • The earliest symptom of Lyme disease is a rash that looks like a bull’s-eye at the site of the tick bite, and can progress to flu-like symptoms, including muscle soreness, headache, fever and malaise.[stuttgartcitizen.com]
  • This phase is characterized by aggravated headaches, ophtalmoplegia, vomiting, malaise, meningeal symptoms, cranial nerve paralysis and paresis of the limbs. An acute stage of tick-borne encephalitis lasts 1 to 3 weeks.[diesse.it]
  • Non specific symptoms of mild fever, malaise, headache, nausea, vomiting and myalgias may be present as first manifestation of the disease and spontaneously resolve within 1 week. After another week the patient may develop neurological symptoms.[en.wikipedia.org]
Hyposmia
  • We present a case of hyposmia following administration of a tick-borne encephalitis (TBE) vaccine. The olfactory impairment did not recover during 1-year follow up.[ncbi.nlm.nih.gov]
Severe Clinical Course
  • TBE cases with concomitant myelitis tend to have a more severe clinical course and more likelihood of needing intensive care support. They should therefore be identified early in order to be prepared for life threatening respiratory complications.[ncbi.nlm.nih.gov]
  • The authors present the case report of 75-years old female subject, who suffered from the uncommon severe clinical course of TBE--with the development of consciousness impairment, tetraplegia, and dyspnoea (demanding ventilatory support).[ncbi.nlm.nih.gov]
Vomiting
  • All infected patients had similar clinical and laboratory symptoms and signs, including fever, headache, generalized body aches, arthralgia, anorexia, vomiting, leucopenia, thrombocytopenia, elevated liver enzymes (serum glutamic oxalacetic and serum[ncbi.nlm.nih.gov]
  • In approximately two-thirds of patients infected with the European TBE virus, only an early (viremic) phase is experienced; symptoms are nonspecific and may include fever, malaise, anorexia, muscle aches, headache, nausea, and/or vomiting.[cdc.gov]
  • Case report A 43-year-old man from the Black Forest area, Germany, who had not had TBE vaccination developed symptoms of gastroenteritis with fever (diarrhoea, nausea and vomiting) lasting for approximately 1 week.[dx.doi.org]
  • For example: Meningitis: high fever, headache, nausea, vomiting, photophobia, vertigo.[patient.info]
Nausea
  • In approximately two-thirds of patients infected with the European TBE virus, only an early (viremic) phase is experienced; symptoms are nonspecific and may include fever, malaise, anorexia, muscle aches, headache, nausea, and/or vomiting.[cdc.gov]
  • Sufferers may also complain of nausea, muscle pain, lethargy and general discomfort. Some patients may go on to develop encephalitis, which can cause paralysis and can be fatal in some cases.[heathrowmedical.com]
  • Sufferers may also complain of nausea, muscle pain, lethargy and general discomfort. Some patients may go on to develop Encephalitis, which can cause paralysis and can be fatal in some cases.[londontravelclinic.co.uk]
  • Case report A 43-year-old man from the Black Forest area, Germany, who had not had TBE vaccination developed symptoms of gastroenteritis with fever (diarrhoea, nausea and vomiting) lasting for approximately 1 week.[dx.doi.org]
  • For example: Meningitis: high fever, headache, nausea, vomiting, photophobia, vertigo.[patient.info]
Arthralgia
  • All infected patients had similar clinical and laboratory symptoms and signs, including fever, headache, generalized body aches, arthralgia, anorexia, vomiting, leucopenia, thrombocytopenia, elevated liver enzymes (serum glutamic oxalacetic and serum[ncbi.nlm.nih.gov]
Headache
  • In approximately two-thirds of patients infected with the European TBE virus, only an early (viremic) phase is experienced; symptoms are nonspecific and may include fever, malaise, anorexia, muscle aches, headache, nausea, and/or vomiting.[cdc.gov]
  • Foremost, FWLS characterised by a biphasic fever course and accompanied by headache in patients in a reduced general condition. Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreported.[ncbi.nlm.nih.gov]
  • All infected patients had similar clinical and laboratory symptoms and signs, including fever, headache, generalized body aches, arthralgia, anorexia, vomiting, leucopenia, thrombocytopenia, elevated liver enzymes (serum glutamic oxalacetic and serum[ncbi.nlm.nih.gov]
  • The control group (CG) consisted of 18 patients hospitalized because of headaches and had lumbar puncture performed. The NF-κB was measured by human inhibitory subunit of NF-κB ELISA Kit during acute and convalescent period.[ncbi.nlm.nih.gov]
  • In some of these reports it was also suggested that there is an abortive form of TBE virus infection, which is manifested only by a febrile headache without meningeal involvement (i.e., the initial phase of illness without subsequent CNS involvement)[ncbi.nlm.nih.gov]
Confusion
  • ., drowsiness, confusion, sensory disturbances, and/or motor abnormalities such as paralysis), or meningoencephalitis.[cdc.gov]
  • In certain individuals the infection can spread to the brain leading to seizures, confusion and paralysis.[ealingtravelclinic.co.uk]
  • TBE should not be confused with Lyme disease (Lyme borreliosis), which is also transmitted by tick bites. Vaccination People who spend a lot of time in areas with a known risk of TBE infection should consider vaccination against TBE.[fhi.no]
  • Tick-borne encephalitis is a rare infection that can cause fever, headache, vomiting, weakness, confusion, seizures, and memory loss. Long-term neurologic problems may occur.[hpepublichealth.ca]
Neck Stiffness
  • The disease typically begins as a flu-like illness, including fever, headache, and vomiting, followed by the development of neurologic symptoms, including neck stiffness, dizziness, tremors, drowsiness, delirium, and coma.[redplanet.travel]
  • A third of patients go on to phase 2 with higher and more prolonged fever than phase 1, with new symptoms and signs of central and / or peripheral neuronal involvement such as headaches, insomnia, confusion, or vomiting, neck stiffness, muscle pain and[fhi.no]
Neglect
  • However, the neglect of its expansion and scarce analyses of the dynamics have made the overall disease burden and the risk distribution of the disease being unclear in mainland China.[ncbi.nlm.nih.gov]
Learning Difficulties
  • In addition, the answers concerning tiredness/fatigue, poor concentration/attention, reduced initiative/motivation, balance disturbances, coordination problems, difficulties with short- and long-term memory, learning difficulties and problems with fine[ncbi.nlm.nih.gov]

Workup

Pericardial Effusion
  • Cardiac involvement was demonstrated by pericardial effusion, elevated serum concentration of troponin-I and cardiac arrhythmia. Co-infections with enteroviruses, Borrelia burgdorferi or the agent of human granulocytic ehrlichiosis were excluded.[ncbi.nlm.nih.gov]
Hyponatremia
  • In VMG hyponatremia was diagnosed in 7 (9.7%) patients. In the age group CONCLUSIONS: (1) Hyponatremia is a common disorder in TBE and is more frequent than in other viral types of meningitis, especially in young patients ([ncbi.nlm.nih.gov]

Treatment

  • No specific antiviral treatment is currently available for TBE; indeed, supportive treatment as well as intensive care and assisted ventilation in severe forms may be needed.[ncbi.nlm.nih.gov]
  • This phase IV, open-label clinical trial investigated whether allergies and SIT treatment influenced immune responses to routine vaccination.[ncbi.nlm.nih.gov]
  • The medicines will usually be tested against another treatment called a control. This will either be a dummy treatment (a placebo) or a standard treatment already in use.[nhs.uk]
  • No effective antiviral or immunomodulating therapy is available for TBE; therefore the treatment is symptomatic.[ncbi.nlm.nih.gov]
  • No specific treatment for TBE is known. It can be successfully prevented by active immunization.[ncbi.nlm.nih.gov]

Prognosis

  • The long-term prognosis is unfavorable in about 40% to 50% of patients who sustain sequelae for months to years, mainly in terms of pareses, ataxia, and other gait disturbances. No specific treatment for TBE is known.[ncbi.nlm.nih.gov]
  • The severity of clinical symptoms at the first presentation correlated well with long-term prognosis. Patients with only “mild” symptoms at the onset mostly had a good prognosis and vice versa.[omicsonline.org]
  • Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations.[ncbi.nlm.nih.gov]
  • This information can be used to classify clinical presentation and estimate infection-associated complications and individual prognosis.[ncbi.nlm.nih.gov]
  • Tickborne Encephalitis in an Area of High Endemicity in Lithuania: Disease Severity and Long-Term Prognosis. Clinical Infectious Diseases 2002; 35(6):650-658. Fulltext (DOI) Pubmed View record in Web of Science II.[openarchive.ki.se]

Etiology

  • A systematic study was carried out in cooperation between the Department of Neurology of the University of Florence and the Istituto Superiore di Sanità (Rome), in order to understand a possible role of arboviruses as etiologic agents of meningoencephalitis[ncbi.nlm.nih.gov]
  • Günther G, Haglund M, Lindquist L, Forsgren M, Sköldenberg B (1997) Tick-bone encephalitis in Sweden in relation to aseptic meningo-encephalitis of other etiology: a prospective study of clinical course and outcome. J Neurol 244: 230-238.[omicsonline.org]

Epidemiology

  • In this study, we described epidemiological characteristics of 2117 reported human TBE cases from 2006 to 2013 in mainland China.[ncbi.nlm.nih.gov]
  • The conference agenda was divided into six sessions: 'National Implementation of EU notifiable disease status', 'Virology', 'Epidemiology and Risk areas & Poster Walk Epidemiological Update', 'Clinic', 'Environmental Factors' and 'New Findings and Diagnosis[ncbi.nlm.nih.gov]
  • THE PURPOSE OF THE STUDY: to present epidemiological features and clinical manifestations of TBE in patients residing in Grodno region.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Virology, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China. 2 Department of Virology, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China. qincf@bmi.ac.cn.[ncbi.nlm.nih.gov]
  • Antiviral Res 57: 129–146 PubMed CrossRef Google Scholar Günther G, Haglund M (2005) Tick-Borne Encephalopathies: Epidemiology, Diagnosis, Treatment and Prevention.[dx.doi.org]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Magnetic resonance imaging (MRI) changes in tick-borne encephalitis (TBE) are non-specific and the pathophysiological mechanisms leading to their formation remain unclear.[ncbi.nlm.nih.gov]

Prevention

  • Enhanced surveillance and intervention for human TBE in the high-risk regions, particularly on the forest areas in north-eastern China, is necessary to prevent human infections. Copyright 2017 The Authors. Published by Elsevier GmbH..[ncbi.nlm.nih.gov]
  • There is no treatment, and prevention with the vaccine is the only intervention currently available. To evaluate vaccines for preventing TBE in terms of effectiveness and adverse effects.[ncbi.nlm.nih.gov]
  • There is no effective antiviral treatment for TBE, but the disease may be effectively prevented by vaccination. 2017 EAN.[ncbi.nlm.nih.gov]
  • Prevention includes non-specific (tick-bite prevention, tick checks) and specific prophylaxis in the form of a vaccination. Tick-borne encephalitis vaccines are very effective and available in many disease endemic areas and in travel clinics.[en.wikipedia.org]
  • Transplacental transfer of antibody after vaccination has been observed and could provide protection to unvaccinated newborns preventing or alleviating the potential devastating impact of this disease.[ncbi.nlm.nih.gov]

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