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Neurological complications of tick borne encephalitis: the experience of 89 patients studied and literature review

Neurological Sciences volume 35, pages 15–21 (2014)Cite this article

Abstract

Tick borne encephalitis (TBE) is an acute febrile syndrome that can be complicated with neurological symptoms ranging from mild meningitis to severe encephalomyelitis. The causative agent is a virus belonging to the family of flaviviruses. We have collected a series of 89 patients and compared the clinical course with the main data of the literature of TBE. This review in addition describes the clinical manifestations associated with TBE infections, the main molecular-biological properties of these viruses, and the different factors that define the incidence and severity of disease who are frequently situated in the age group young/adult with a social harm and functional non-negligible. This review also contains diagnostic elements and neuropathological features typical of this infection and a brief summary of vaccination against TBE.

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References

  1. Schneider H (1931) Uber epidemische acute Meningite serosa. Wien Klin Wochenschr 44:350–352

    Google Scholar 

  2. Kunz C, Heinz FX (2003) Tick borne encephalitis. Vaccine 21:S1–S2

    PubMed  Article  Google Scholar 

  3. Lindquist L, Vapalahti O (2009) Tick-borne encephalitis. Lancet 371:1861–1871

    Article  Google Scholar 

  4. WHO/EURO (2004) WHO regional office for Europe: their distribution and burden on public health. WHO regional office for Europe (WHO/EURO), Copenhagen, Denmark, pp 37–53. http://www.euro.who.int/document/e82481.pdf. Accessed 8 Dec 2007

  5. Heinz FX, Allison SL (2003) Flavivirus structure and membrane fusion. Adv Virus Res 59:63–97

    CAS  PubMed  Google Scholar 

  6. Suss J (2003) Epidemiology and ecology of TBE relevant to the production of effective vaccines. Vaccine 21:S19–S35

    PubMed  Article  Google Scholar 

  7. Gritsun TS, Nuttall PA, Gould EA (2003) Tick borne flaviviruses. Adv Virus Res 59:63–97

    Google Scholar 

  8. Parola P, Raoult D (2001) Ticks and tick-borne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis 32:897–928

    CAS  PubMed  Article  Google Scholar 

  9. Krausler J (1981) 23 years of TBE in district of Neunkirchen (Austria). In: Kunz C (ed) Tick borne encephalitis. Faculats, Wien, pp 6–12

    Google Scholar 

  10. Suss J, Schrader C, Falk U, Wohanka N (2004) Tick borne encephalitis (TBE) in Germany: epidemiological data, development of risk areas and virus prevalence in field collected ticks removed from humans. Int J Med Microbiol 293:S69–S79

    Google Scholar 

  11. Alekseev AN, Chunikhin SP (1990) Transmission of the tick-borne encephalitis virus by ixodid ticks in the experiment (mechanisms, terms, species and sexual distinctions. Parazitologiia 24:177–185

    CAS  PubMed  Google Scholar 

  12. Kaiser R (1999) The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994–98: a prospective study of 656 patients. Brain 122(Pt 11):2067–2078

    PubMed  Article  Google Scholar 

  13. Fauser S, Stich O, Rauer S (2007) Unusual case of tick borne encephalitis with isolated myeloradiculitis. J Neurol Neurosurg Psychiatry 78:909–910

    PubMed  Article  Google Scholar 

  14. Gunther G, Haglund M, Linquist L, Forsgren M, Skoldenberg B (1997) Tick borne encephalitis in Sweden in relation to aseptic meningoencephalitis of other etiology: a prospective study of clinical course and outcome. J Neurol 244:230–238

    CAS  PubMed  Article  Google Scholar 

  15. Mickiene A, Laiskonis A, Günther G, Vene S, Lundkvist A, Lindquist L (2002) Tick borne encephalitis in an area of high endemicity in Lithuania: disease severity and long term prognosis. Clin Infect Dis 35:650–658

    PubMed  Article  Google Scholar 

  16. Furlan SL, Strle F (1995) Thrombocytopenia a common finding in the initial phase of tick borne encephalitis. Infection 23:203–206

    Article  Google Scholar 

  17. Kaiser R, Vollmer H, Schmidtke K, Rauer S, Berger W, Gores D (1997) Follow-up and prognosis of early summer meningoencephalitis. Nervenarzt 68:324–330

    CAS  PubMed  Article  Google Scholar 

  18. Schellinger PD, Schmutzhard E, Fiebach JB, Pfausler B, Maier H, Schwab S (2000) Poliomyelitic-like illness in central European encephalitis. Neurology 55:299–302

    CAS  PubMed  Article  Google Scholar 

  19. Pikelj F, Tomaciz M, Maticic M, Socan M, Muzlovic I (1995) Severe form of tick borne meningoencephalitis in Slovenia. J Infect 31:83–85

    Google Scholar 

  20. Kleiter I, Steinbrcher A, Flugel D et al (2006) Autonomic involvement in tick borne encephalitis (TBE): report of five cases. Eur J Med Res 11:261–265

    PubMed  Google Scholar 

  21. Beer S, Brune N, Kesserling J (1999) Detection of anterior horn lesions by MRI in Central European tick-borne encephalomyelitis. J Neurol 246(12):1169–1171

    Google Scholar 

  22. Zambito Marsala S, Francavilla E, Gioulis M, Candeago RM, Mondardini V, Gentile M et al (2012) Isolated polio-like syndrome after tick-borne encephalitis presenting with acute hyperckemia. Neurol Sci 33(3):669–672. doi:10.1007/s10072-011-0834-7

    PubMed  Article  Google Scholar 

  23. Kaiser R (1996) Tick-borne encephalitis in south western Germany. Infection 24:398–399

    CAS  PubMed  Article  Google Scholar 

  24. Tomazic J, Pikelj F, Schwartz B et al (1996) The clinical features of tick-borne encephalitis in Slovenia. A study of 492 cases in 1994. Antibiot Monit 12:115–120

    Google Scholar 

  25. Haglund M, Forsgren M, Lindh G, Lindquist L (1996) A 10-year follow-up study of tick-borne encephalitis in the Stockholm area and a review of the literature: need for a vaccination strategy. Scand J Infect Dis 28:217–224

    CAS  PubMed  Article  Google Scholar 

  26. Duniewicz M, Mertenova J, Moravcova E et al (1975) Central European tick-borne encephalitis from 1969 to 1972 in Central Bohemia. Infection 3:223–228

    CAS  PubMed  Article  Google Scholar 

  27. Falisevac J, Beus I (1981) Clinical manifestations of tick-borne encephalitis in Croatia. In: Kunz C (ed) Tick-borne encephalitis. Facultas, Vienna, Austria, pp 13–19

    Google Scholar 

  28. Jezyna C, Zajac W, Pancewicz S (1984) Epidemiologic and clinical studies of patients with tick-borne encephalitis from northeastern Poland. Zentralbl Bakteriol Mikrobiol Hyg 178:510–521

    CAS  Google Scholar 

  29. Wahlberg P, Carlsson SA, Granlund H et al (2006) TBE in Aland Islands 1959–2005: Kumlinge disease. Scand J Infect Dis 38:1057–1062

    PubMed  Article  Google Scholar 

  30. Ackermann R, Kruger K, Roggendorf M et al (1986) Spread of early-summer meningoencephalitis in the Federal Republic of Germany. Dtsch Med Wochenschr 111:927–933

    CAS  PubMed  Article  Google Scholar 

  31. Holmgren B, Forsgren M (1990) Epidemiology of tick-borne encephalitis in Sweden 1956–1989: a study of 1116 cases. Scand J Infect Dis 22:287–295

    CAS  PubMed  Article  Google Scholar 

  32. Grubbauer H, Dornbusch H, Spork D, Zobel G, Trop M, Zenz W (1992) Tick-borne encephalitis in a 3-month-old child. Eur J Pediatr 151:743–744

    CAS  PubMed  Article  Google Scholar 

  33. Harasek G (1974) Tick-borne encephalitis in children. Dtsch Med Wochenschr 99:1965–1970

    CAS  PubMed  Article  Google Scholar 

  34. Oksi J, Viljanen MK, Kalimo H, Peltonen R, Martilla R, Salomaa P et al (1993) Fatal encephalitis caused by concomitant infection with tick-borne encephalitis virus and Borrelia burgdorferi. Clin Infect Dis 16:392–396

    CAS  PubMed  Article  Google Scholar 

  35. Puchhammer-Stockl E, Kunz C, Mandl CW, Heinz FX (1995) Identification of tick-borne encephalitis virus ribonucleic acid in tick suspensions and in clinical specimens by a reverse transcription-nested polymerase chain reaction assay. Clin Diagn Virol 4:321–326

    CAS  PubMed  Article  Google Scholar 

  36. Holzmann H (2003) Diagnosis of tick-borne encephalitis. Vaccine 21:S36–S40

    PubMed  Article  Google Scholar 

  37. Kaiser R (1999) The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994–98. A prospective study of 656 patients. Brain 122:2067–2078

    PubMed  Article  Google Scholar 

  38. Grygorczuck S, Mierzynska D, Zdrodowoska A et al (2006) Tick borne encephalitis in north-eastern Poland in 1997–2001: a retrospective study. Scand J Infect Dis 38:904–909

    Article  Google Scholar 

  39. Lorenzl S, Pfister H, Padovan C, Yousry T (1996) MRI abnormalities in tick-borne encephalitis. Lancet 347:698–699

    CAS  PubMed  Article  Google Scholar 

  40. Marjelund S, Tikkakoski T, Tuieku S et al (2004) Magnetic resonance imaging findings and outcome in severe tick-borne encephalitis. Report of four cases and review of literature. Acta Radiol 45:88–94

    CAS  PubMed  Article  Google Scholar 

  41. Alkadhi H, Kollias SS (2000) MRI in tick-borne encephalitis. Neuroradiology 42:753–755

    CAS  PubMed  Article  Google Scholar 

  42. Kalita J, Misra UK (2000) Comparison of CT scan and MRI findings in the diagnosis of Japanese encephalitis. J Neurol Sci 174:3–8

    CAS  PubMed  Article  Google Scholar 

  43. Cerna F, Mehrad B, Luby JP et al (1999) St Louis encephalitis and the substantia nigra: MR imaging evaluation. Am J Neuroradiol 20:1281–1283

    CAS  PubMed  Google Scholar 

  44. Bender A, Schulte-Altedorneburg G, Walther EU, Pfister H-W (2005) Severe tick-borne encephalitis with simultaneous brain stem, bithalamic, and spinal cord involvement documented by MRI. J Neurol Neurosurg Psychiatry 76:135–137

    CAS  PubMed  Article  Google Scholar 

  45. Enzinger C, Melish B, Reischl A, Simbrunner J, Fazekas F (2009) Polyradiculitis as a predominant symptom of tick-borne encephalitis virus infection. Arch Neurol 66(7):904–905

    PubMed  Article  Google Scholar 

  46. Jeren T, Vince A (1988) Cytologic and immunoenzymatic findings in CSF from patients with tick-borne encephalitis. Acta Cytol 42:330–334

    Article  Google Scholar 

  47. Gunther G, Haglund M, Lindquist L, Skoldenberg B, Forsgren M (1997) Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long term follow-up related to clinical course and outcome. Clin Diagn Virol 8:17–29

    CAS  PubMed  Article  Google Scholar 

  48. Venturi G, Mel R, Marchi A et al (2006) Humoral immunity and correlation between ELISA, haemagglutination inhibition and neutralization tests after vaccination against TBE virus in children. J Virol Methods 134(1–2):136–139

    Article  Google Scholar 

  49. Baldovin T, Mel R, Bertoncello C, Carpenè G, Soppelsa F, Giliberti A, Baldo V (2012) Persistence of immunity to tick-borne encephalitis after vaccination and natural infection. J Med Virol 84(8):1274–1278

    CAS  PubMed  Article  Google Scholar 

  50. World Health Organization (WHO) (2011) Vaccines against tick-borne encephalitis: WHO position paper. Wkly Epidemiol Rec 86:241–256

    Google Scholar 

  51. Prevention of TBE, European Centre for Disease Prevention and Control (ECDC). http://ecdc.europa.eu/en/healthtopics/tick_borne_diseases/tick_borne_encephalitis/key_messages/Pages/prevention.aspx. Accessed 3 Jan 2013

  52. Amicizia D, Domnich A, Panatto D, Lai PL, Cristina ML, Avio U, Gasparini R (2013) Epidemiology of tick-borne encephalitis (TBE) in Europe and its prevention by available vaccines. Hum Vaccin Immunother 9(5):1163–1171

    PubMed  Article  Google Scholar 

  53. Hofmann H (1995) After vaccination for tick-borne encephalitis must onset of neurologic disorders be expected? Wien Klin Wochenschr 107:509–515

    CAS  PubMed  Google Scholar 

  54. Scholz E, Wietholter H (1987) Postvaccinal neuritis following prophylactic vaccination against early-summer meningo-encephalitis. Dtsch Med Wochenschr 112:544–546

    CAS  PubMed  Article  Google Scholar 

  55. Hainz U, Jenewein B, Asch E, Pfeiffer KP, Berger P, Grubeck-Loebenstein B (2005) Insufficient protection for healthy elderly adults by tetanus and TBE vaccines. Vaccine 23:3232–3235

    PubMed  Article  Google Scholar 

  56. Ehrlich HJ, Pavlova BG, Fritsch S et al (2003) Randomized, phase II dose-finding studies of a modified tick-borne encephalitis vaccine: evaluation of safety and immunogenicity. Vaccine 22:217–223

    CAS  PubMed  Article  Google Scholar 

  57. Zent O, Banzhoff A, Hilbert AK, Meriste S, Sluzewski W, Wittermann Ch (2003) Safety, immunogenicity and tolerability of a new pediatric tick-borne encephalitis (TBE) vaccine, free of protein-derived stabilizer. Vaccine 21:3584–3592

    CAS  PubMed  Article  Google Scholar 

  58. Pavlova BG, Loew-Baselli A, Fritsch S et al (2003) Tolerability of modified tick-borne encephalitis vaccine FSME-IMMUN “NEW” in children: results of post-marketing surveillance. Vaccine 21:742–745

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Department of Neurology, San Martino Hospital, Belluno, Italy

    Sandro Zambito Marsala, Manuela Gioulis & Corrado Marchini

  2. Department of Neurology, Santorso Hospital, Vicenza (VI), Italy

    Michele Pistacchi

  3. Department of Health Service and Public Health, San Martino Hospital, Belluno, Italy

    Rosanna Mel

  4. Department of Infectious Diseases, San Martino Hospital, Belluno, Italy

    Ermenegildo Francavilla

Authors
  1. Sandro Zambito Marsala
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  2. Michele Pistacchi
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  3. Manuela Gioulis
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  4. Rosanna Mel
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  5. Corrado Marchini
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  6. Ermenegildo Francavilla
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Correspondence to Sandro Zambito Marsala.

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Zambito Marsala, S., Pistacchi, M., Gioulis, M. et al. Neurological complications of tick borne encephalitis: the experience of 89 patients studied and literature review. Neurol Sci 35, 15–21 (2014). https://doi.org/10.1007/s10072-013-1565-8

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  • DOI: https://doi.org/10.1007/s10072-013-1565-8

Keywords

  • Tick borne encephalitis
  • Flavivirus
  • Polio like paralysis
  • Viral meningitis
  • Myeloradiculitis syndrome
  • Biphasic fever