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Tick-Borne Encephalopathies

Epidemiology, Diagnosis, Treatment and Prevention

CNS Drugs volume 19, pages 1009–1032 (2005)Cite this article

Abstract

Tick-borne encephalopathies constitute a broad range of infectious diseases affecting the brain and other parts of the CNS. The causative agents are both viral and bacterial. This review focuses on the current most important tick-borne human diseases: tick-borne encephalitis (TBE; including Powassan encephalitis) and Lyme borreliosis. Rocky Mountain spotted fever (RMSF) and Colorado tick fever (CTF), less common tick-borne diseases associated with encephalopathy, are also discussed.

TBE is the most important flaviviral infection of the CNS in Europe and Russia, with 10 000–12 000 people diagnosed annually. The lethality of TBE in Europe is 0.5% and a post-encephalitic syndrome is seen in over 40% of affected patients, often producing a pronounced impairment in quality of life. There is no specific treatment for TBE. Two vaccines are available to prevent infection. Although these have a good protection rate and good efficacy, there are few data on long-term immunity.

Lyme borreliosis is the most prevalent tick-borne disease in Europe and North America, with >50 000 cases annually. Localised early disease can be treated with oral phenoxymethylpenicillin (penicillin V), doxycycline or amoxicillin. The later manifestations of meningitis, arthritis or acrodermatitis can be treated with oral doxycycline, oral amoxicillin or intravenous ceftriaxone; intravenous benzylpenicillin (penicillin G) or cefotaxime can be used as alternatives. The current use of vaccines against Lyme borreliosis in North America is under discussion, as the LYMErix™ vaccine has been withdrawn from the market because of possible adverse effects, for example, arthritis.

RMSF and CTF appear only in North America. RMSF is an important rickettsial disease and is effectively treated with doxycycline. There is no treatment or preventative measure available for CTF.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Infectious Diseases, Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    Göran Günther

  2. Clinic of Infectious Diseases, County Hospital, Kalmar, Sweden

    Mats Haglund

  3. Research Institute of Zoonotic Ecology and Epidemiology (RIZEE), Färjestaden, Sweden

    Mats Haglund

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  1. Göran Günther
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Correspondence to Göran Günther.

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Günther, G., Haglund, M. Tick-Borne Encephalopathies. CNS Drugs 19, 1009–1032 (2005). https://doi.org/10.2165/00023210-200519120-00004

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Keywords

  • Lyme Borreliosis
  • Japanese Encephalitis
  • Tick Bite
  • Oral Amoxicillin
  • Oral Doxycycline