1/37. Tick-borne encephalitis (TBE) in italy: report of the first clinical case. Previous studies on the clinical features of meningoencephalitis in italy did not help to indicate the nature of the causative agents. On the other hand during the past decade nine arboviruses were isolated in italy, some of which are yet to prove pathogenic for man. A systematic study was carried out in cooperation between the Department of neurology of the University of Florence and the Istituto Superiore di Sanita (rome), in order to understand a possible role of arboviruses as etiologic agents of meningoencephalitis in italy; in this preliminary communication the first clinical case of Tick-Borne Encephalitis (TBE) virus infection is described. ( info) |
2/37. Poliomyelitic-like illness in central European encephalitis. Central European encephalitis (CEE) may be accompanied by myeloradiculitic symptoms in up to 5% of patients. The authors report six patients with a myelitic form of CEE mimicking acute poliomyelitis with bulbar and arm predominance and a poor prognosis. Three patients died. Of the survivors, only one can perform most activities of daily living, but still needs assisted ventilation at night. autopsy in one patient showed severe cervicothoracic inflammation with changes almost exclusively in anterior horn cells and roots, as typically seen in poliomyelitis. ( info) |
3/37. Myopericarditis associated with central European tick-borne encephalitis. The case of an 11-year-old child with acute myopericarditis associated with central European tick-borne encephalitis is presented. 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. Recovery was uneventful. CONCLUSION: Central European tick-borne encephalitis can be complicated by cardiac involvement. ( info) |
4/37. MRI in tick-borne encephalitis. The tick-borne encephalitis (TBE) virus gives rise to epidemic encephalitis. Mild forms usually manifest as influenza-like episodes or are clinically silent. MRI is usually normal in TBE. We describe severe TBE in a patient who presented with fever and altered mental status after a tick bite and a specific antibody response to TBE. MRI revealed pronounced signal abnormalities in the basal ganglia and thalamus, without contrast enhancement. These findings coincide well with neuropathological studies of severe nerve cell degeneration with inflammatory cell infiltrates, neuronophagia and reactive astrocytosis in the deep grey matter. We review the literature and discuss the relevant differential diagnosis. ( info) |
5/37. First documented case of infection with the tick-borne encephalitis virus in Vorarlberg, austria. The present study provides evidence and documentation of the first case of infection with the tick-borne encephalitis (TBE) virus acquired in the federal state of Vorarlberg (austria). The area in which the viral infection was discovered lies in the vicinity of Ludesch in the Illvalley (Bludenz district). In order to investigate the current state of immunity to TBE in the Vorarlberg community, a total of 218 representative sera samples taken from donors resident in the districts of this state were investigated for antibody titers (IgG) of TBE. 38% of the samples had antibody titers representative of sufficient patient immunity, with the highest immunity (63%) in persons aged 20-40 years. Donors living in urban areas had a higher percentage of immunity (43%) than those living in rural areas (33%). Further, men were more immune to infection (43%) than women (33%). The lowest level of immunity (18%) to TBE was found in the Bregenzerwald communities. Based on this report, wider criteria for administering TBE vaccines to patients from the Illvalley should be applied, in particular among the elderly and those living in rural areas. ( info) |
6/37. Outbreak of Powassan encephalitis--maine and vermont, 1999-2001. Powassan (POW) virus, a North American tickborne flavivirus related to the Eastern Hemisphere's tickborne encephalitis viruses, was first isolated from a patient with encephalitis in 1958. During 1958-1998, 27 human POW encephalitis cases were reported from canada and the northeastern united states. During September 1999-July 2001, four maine and vermont residents with encephalitis were found to be infected with POW virus. These persons were tested for other arbovirus infections found in the northeast after testing for west nile virus (WNV) infection was negative. This report describes these four cases, summarizes the results of ecologic investigations, and discusses a potential association between ticks that infest medium-sized mammals and the risk for human exposure to POW virus. The findings underscore the need for personal protective measures to prevent tick bites and continued encephalitis surveillance. ( info) |
7/37. 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. ( info) |
8/37. 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. ( info) |
9/37. An uncommon severe clinical course of European tick-borne encephalitis. Tick-borne encephalitis (TBE) is the major European arbovirosis. Man is often infected by the tick bite; laboratory infections as well as infections after consumption of nonpasteurized milk have occasionally been reported. TBE typically takes a biphasic course. After an incubation period (7-14 days usually), the prodromal symptoms occur. The first stage of the disease lasts 1-8 days. After an afebrile asymptomatic interval of approximately 1-week the second stage develops, in which TBE may manifest as isolated meningitis, meningoencephalitis, meningoencephalomyelitis and/or radiculitis. The mortality rate is 0-3.3%. There is high frequency of sequelae. patients who have suffered from a TBE infection are immune for the rest of their lives. At present there is no effective antiviral therapy and management is strictly supportive. Active immunization against TBE is recommended for all subjects living in and travelling to areas of risk. Passive immunization is recommended only within 48 hours after a tick bite. 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). Her state was complicated by the transient left side faciobrachial motor Jackson's convulsions, blood pressure instability, heart arrhythmia, respiratory infection, anemia, and by the development of critical illness neuropathy. Although she made slow progress during treatment, she died on the 114th day because of suspected aspiration. ( info) |
10/37. Tick-borne encephalitis in a 3-month-old child. Tick-borne encephalitis has not been reported in infants younger than 12 months of age. We report a 3.5-month-old child with a serologically proven tick-borne encephalitis. The infant had a history of a tick bite 3.5 weeks before the first symptoms of encephalitis appeared. The family lives in an endemic area of the disease. There were no prodromal signs and the course of the disease was monophasic. In an endemic area, prophylactic treatment with hyperimmunoglobulin after a tick bite should be considered even in very young infants, but in most children active immunization is probably not necessary because of infrequent exposure. Active immunization is still recommended after the 1st year of life. ( info) |