1/5. Double infection with tick borne encephalitis virus and borrelia burgdorferi sensu lato.The limited information on co-infection with borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus was a stimulus for presentation of two patients with well-defined double infection of the central nervous system. TBE virus and B. burgdorferi sensu lato infections are searched for in all patients with lymphocytic meningitis and/or meningoencephalitis admitted to our department. During the last ten years we identified two patients who had ELISA IgM and IgG antibodies to TBE virus in serum and a positive PCR result for TBE virus in cerebrospinal fluid as well as B. burgdorferi sensu lato isolated from cerebrospinal fluid. Intrathecal production of borrelial antibodies was not proven in either of the two patients. These findings show that in patients with acute lymphocytic meningitis originating in regions endemic for Lyme borreliosis and TBE, the possibility of concomitant infection should be considered.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/5. An abortive form of tick-borne encephalitis (TBE)--a rare clinical manifestation of infection with TBE virus.Tick-borne encephalitis (TBE) is one of the most important human infections of the central nervous system (CNS) and is endemic in several European countries, including a large part of slovenia. In at least two-thirds of patients who develop CNS involvement, the disease has a characteristic biphasic course. Seroepidemiological studies on TBE virus infection in endemic areas of various European countries have demonstrated that asymptomatic infections are common. 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) and that it represents more than half of the cases of clinically manifested infection with TBE virus. The aim of this report was to evaluate patients who presented with the initial phase of TBE and monitor them for the appearance of the second, encephalitic phase of the disease. In 56/205 (27.3%) patients with febrile illness occurring after a tick bite, infection with TBE virus was demonstrated by the appearance of specific IgM and IgG antibodies against TBE virus during a follow-up period of 6 weeks. All 56 patients were diagnosed during the initial phase of TBE, however, only 1/56 (1.8%) had an isolated initial phase of TBE without subsequent CNS involvement, whereas 55/56 (98.2%) patients developed a clinically biphasic course of illness with CSF abnormalities (pleocytosis) during the second phase of the disease. Detailed epidemiological, clinical and laboratory characteristics of this patient with an abortive form of TBE virus infection are presented. The results of our study support the view that the abortive form of central European TBE is a rare clinical manifestation of TBE virus infection.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/5. Autonomic involvement in tick-borne encephalitis (TBE): report of five cases.BACKGROUND: Tick-borne encephalitis (TBE) is a viral infection of the CNS with significant acute and long-term morbidity. Dysfunction of the autonomic nervous system may be a potentially harmful complication of TBE. MATERIAL AND methods: In a retrospective case series, 5 patients with acute TBE were evaluated for clinical signs of autonomic dysfunction and subject to autonomic testing. heart rate variability (HRV) with 6 per minute deep breathing was performed between day 9 to 31 after onset of meningitis. Follow-up data were available in three cases. RESULTS: All patients showed clinical signs of autonomic dysfunction, including upper and lower gastrointestinal tract symptoms, orthostatic hypotension, and urinary retention. A reduced HRV was observed in 4 patients, with sustained sinus tachycardia in 2 of them. The minimum of the HRV was reached 9 to 20 days after onset of meningitis. In one patient, normalization of the HRV occurred within 3 months. CONCLUSION: Acute TBE can be associated with autonomic dysfunction including reduced HRV and tachycardia. prospective studies are needed to analyze the incidence of autonomic dysfunction in TBE, and to clarify which patients have the highest risk for autonomic failure.- - - - - - - - - - ranking = 0.33799722464763keywords = nervous system (Clic here for more details about this article) |
4/5. Another possible precipitating factor in multiple sclerosis: the exposure to organic solvents.Recent clinical observations seem to indicate that a possible correlation may exist between the appearance of inflammatory diseases of the nervous system and exposure to organic solvents. In certain cases the patients could not be distinguished, either from the clinical or laboratory point of view, from typical cases of multiple sclerosis. These observations raise the problem of a possible action of organic solvents on the immunological responses, already described in different pathological conditions as a further possible precipitating factor in MS.- - - - - - - - - - ranking = 0.33799722464763keywords = nervous system (Clic here for more details about this article) |
5/5. Clinical value of specific intrathecal production of antibodies.The production of intrathecal antibodies is considered a highly specific marker for an infection of the central nervous system (CNS), e.g. borreliosis or tick-borne encephalitis (TBE). To investigate the validity of this assumption, we examined records of patients who had been hospitalized between 1989 and 1995, who were tested for borreliosis (n = 8003) and TBE (n = 904) and whose cerebrospinal fluid (CSF) had subsequently tested positive for intrathecal production of antibodies. The time period between the beginning of the symptoms and the time of the CSF examination ranged from one day to six weeks. Seventy-seven patients showed a production of intrathecal antibodies against borrelia burgdorferi. Three of these patients were false positives with no history and no clinical signs of neuroborreliosis. In two cases, this was due to a non-specific cross-reaction caused by a preceding infection with syphilis. The third false positive was possibly caused by an earlier administration of immunoglobulins. Three patients showed a production of intrathecal antibodies against TBE virus. Two of these patients were false positives. In one case, we suspect that the production of intrathecal antibodies was caused by a non-specific immune reaction during an acute neuroborreliosis. One year earlier, the patient had contact with TBE virus through a vaccination against TBE. The cause of the second false positive is unclear, the clinical findings, acute encephalitis and the serological analysis suggest a cross-reaction with a virus similar to TBE. A specific intrathecal production of antibodies is not a proof for an infection of the CNS. In unclear cases, one should carry out a Western blot analysis or, if one suspects a case of TBE, a neutralization test.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |