Comparison of the Epidemiological and Clinical Features of Tick-Borne Encephalitis in Children and Adults

Abstract

The aim of this prospective study was to compare epidemiological data and clinical features in children and adults with tick-borne encephalitis (TBE). Patients with aseptic meningitis diagnosed at the University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia, from June to August 1997, in whom the diagnosis of TBE was ascertained by the presence of serum IgM antibodies against TBE virus, who were serologically negative for Borrelia burgdorferi sensu lato and had a negative PCR CSF result on enteroviral infection, were included in the study. Out of 213 patients with aseptic meningitis, 80 (37.56%) fulfilled inclusion criteria. There were 20 children and 60 adults. In both groups males predominated. Virtually all patients had headache and fever, and more than 50% suffered from vomiting. The majority of patients in both groups recalled a tick bite, had a biphasic course of the illness, and was found to have obviously expressed meningeal signs. In both groups the median CSF leukocyte count was somewhat lower than 100 x 10(6)/l with a predominance of lymphocytes. Children were more often given antibiotics during the initial phase of TBE than adults (p = 0.0095). Several other statistically significant distinctions (p < 0.05) were found including the frequency of fatigue, malaise, vertigo, photophobia, myalgias, arthralgias, as well as elevated CSF albumin and protein concentration, elevated albumin quotient and IgG quotient; all these findings were more often present in adults. In addition a longer duration of fever, more frequent need for anti-edematous treatment and longer hospitalization were found in adults. Direct comparison of clinical and epidemiological characteristics of TBE in children and adults revealed differences in several clinical and laboratory features and corroborates the previous conclusion that TBE in childhood is a milder illness than TBE in adults.

Pediatric tick-borne infections of the central nervous system in an endemic region of Sweden: a prospective evaluation of clinical manifestations

“…The present study adopting wide inclusion criteria strongly indicate that children with tick-borne CNS infections, foremost TBE, often present with diffuse symptoms and nonspecific findings (e.g., headache, temperature, malaise/ fatigue), which is in accordance with earlier retrospective data [8]. The biphasic course as a hallmark of TBE reported for both children and adults [11,13,16,21] was not evident in our study, further illustrating the diagnostic difficulties. In NB, the diagnostic challenge seems to be less pronounced since, as earlier described [3,4,18,19,22], isolated headache was a major complaint and approximately half of the children presented with facial nerve palsy.…”

Antibody persistence after two vaccinations with either FSME-IMMUN® Junior or ENCEPUR® Children followed by third vaccination with FSME-IMMUN® Junior

“…1,2 Although TBE in children is generally considered a milder illness than among adults, there have been a number of severe cases reported in the pediatric population. [3][4][5][6] Despite strong evidence that TBE vaccines protect children and adolescents against clinical TBE, vaccine formulations and immunization strategies capable of ensuring optimal protection of the pediatric population combined with an acceptable tolerability profile are under continuous evaluation. 7 In Europe, two pediatric TBE vaccines are currently available on the market: FSME-IMMUN ® Junior (Baxter AG),…”

Tick-borne encephalitis in Slovenia (1953-2013): the 60th anniversary

“…V zadnjih letih so opazovali kar pri eni tretjini otrok s KME žariščne spremembe v EEG ali vsaj asimetrijo. Vendar pa je nekajletno proučevanje kliničnega poteka KME pri otrocih (38) in odraslih bolnikih pokazalo, da poteka bolezen pri otrocih blažje kot pri odraslih (39) in da zlasti hudo poteka okužba pri odraslih, starih nad 60 let (40). Zanimivi sta tudi raziskavi o poteku bolezni in morebitnih posledicah po preboleli bolezni.…”