Summary
In middle and eastern European countries, tick-borne encephalitis (TBE) is one of the most important human infections of the central nervous system. TBE virus (TBEV) is mainly transmitted by tick bites and in very rare cases by unpasteurized milk. The incubation period is on an average 7–10 days. A biphasic course of illness with a prodromal period occurs in about two third of patients. In European countries, TBE presents as meningitis in about 50 % of patients, as meningoencephalitis in 40 %, and as meningoencephalomyelitis in 10 %. The severity of TBE increases with age, in children and adolescents, meningitis is the predominant form of the disease. Long-term prognosis is unfavorable in about 40–50 % of patients who suffer from sequelae for months to years, mainly in terms of pareses, ataxia, and other gait disturbances. No specific treatment for TBE is known so far, but TBE can be successfully prevented by active immunization.
Zusammenfassung
Die Frühsommer-Meningoenzephalitis (FSME) ist in Mittel- und Osteuropa eine der wichtigsten Virusinfektionen des Nervensystems. Jährlich erkranken weltweit mehr als 10.000 Personen an einer FSME. Das Virus wird hauptsächlich durch Zecken und gelegentlich auch durch unpasteurisierte Ziegenmilch übertragen. Etwa ein Drittel der Patienten bemerkt allerdings keinen Zeckenstich, die Infektion führt in einem von drei Fällen auch zur Erkrankung. Die durchschnittliche Inkubationszeit beträgt 7–10 Tage, eine fieberhafte Prodromalphase findet sich bei zwei Drittel der Patienten. In Europa manifestiert sich die Erkrankung zu etwa 50 % als Meningitis, zu 40 % als Enzephalitis und in ca. 10 % zusätzlich als Myelitis. Die Erkrankungsschwere korreliert mit dem Alter, ältere Menschen haben einen deutlich ungünstigeren Verlauf als Kinder und Jugendliche. Etwa 40–50 % der Betroffenen leiden unter Langzeitfolgen über Monate bis Jahre. Im Vordergrund stehen Lähmungen der Extremitäten und Atmung sowie Gleichgewichtsstörungen. Die Diagnose wird gesichert durch den Nachweis FSME-spezifischer IgM- und IgG-Antikörper im Serum und eine Pleozytose im Liquor. Es existiert keine kausale Therapie, jedoch eine hochwirksame Aktivimpfung gegen FSME.
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Kaiser, R. Tick-borne encephalitis: Clinical findings and prognosis in adults. Wien Med Wochenschr 162, 239–243 (2012). https://doi.org/10.1007/s10354-012-0105-0
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DOI: https://doi.org/10.1007/s10354-012-0105-0