Recovery and sequelae in 523 adults and children with tick-borne encephalitis in Germany

Nygren, Teresa; Pilic, Antonia; Böhmer, Merle M.; Wagner-Wiening, Christiane; Wichmann, Ole; Hellenbrand, Wiebke

doi:10.1007/s15010-023-02023-w

Cited by 11 publications

(3 citation statements)

References 23 publications

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“…Best outcomes were observed in the youngest aetiological group, those with TBE, in which only 20% had residual symptoms (mild to moderate). This appears a much better prognosis compared to that recently reported from Germany [21]. This probably primarily reflects the fact that prognosis in TBE clearly worsens with increasing age and in the German study 66% of the included adult patients were >50 years of age whereas 60% of the TBE cases in the current cohort were <44 years of age.…”

Section: Discussioncontrasting

confidence: 44%

Adult-Onset Encephalitis over Twelve Years in Easternmost Finland

Sipilä

2024

Neuroepidemiology

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Introduction: The epidemiology of encephalitis varies by region and time. Available Finnish data are outdated and there are no data from eastern parts of the country nor concerning the occurrence autoimmune encephalitides. Material and methods: Patients with encephalitis were identified from mandatory administrative registries in North Karelia Central Hospital. The diagnoses were verified, and data extracted by reviewing the patient records. Study period was 2010-2021. Only patients >16 years of age were included. Results: 51 patients with a clinical encephalitis were identified (55 % men) identified with a median age of 65 years [interquartile range (IQR) 45, 73; total age range 16-88 years] indicating a crude incidence of 3.1/100,000 person-years for the entire study period. A specific aetiology could be identified in 31 cases (61 %) with Tick-borne encephalitis (TBE) being the most common one (20 % of all 51 cases), followed by Herpes simplex virus type 1 (HSV-1, 16 %) and Varicella Zoster virus (VZV, 14 %). Autoimmune aetiology was confirmed in 10 %. TBE was most often found in the youngest age group (16-52 years of age) and the herpes viruses in the oldest group (71 years or older). A specific cause was most often identified in the oldest patients (78 %). TBE patients were younger than patients with VZV (p=0.0009) or HSV-1 (p=0.0057) but there was no difference when they were compared to patients with autoimmune (p=0.27) or unknown (p=0.074) aetiology. At presentation, there were differences in the occurrence of some clinical signs and symptoms between aetiologies but nothing specific. Eight patients (16 %) were immunosuppressed. Inpatient seizures occurred in 10 patients (20 %). In these cases, the etiology was HSV-1 in 50 % and TBE or VZV in none. A full recovery was observed in 51 % of all patients while three patients (6 %) had died of the encephalitis while in hospital or shortly after discharge. Conclusions: Adult-onset encephalitis was more common and the patients older in easternmost Finland than previously reported in other parts of the country. TBE, HSV-1 and VZV are the most commonly identified specific aetiologies whereas a fifth of the cases are probably caused by autoimmunity. Prognosis depended on aetiology but was very good in the majority of cases

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Section: Discussioncontrasting

confidence: 44%

Adult-Onset Encephalitis over Twelve Years in Easternmost Finland

Sipilä

2024

Neuroepidemiology

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“…Overall, while the mortality rate of European TBE is low, the associated morbidity is significant [21,79]. In a recent review of 523 TBE paediatric and adult cases, full recovery was noted in 94.9% and 63.8% of children and adults, respectively [143]. In 2016, the Swedish institute for disease control and prevention performed a retrospective study analysing long-term outcomes in 96 TBE patients (median age 59 years), 2-15 years post mild to severe CNS disease.…”

Section: Long-term Neurological Effects and Impact On Quality Of Lifementioning

confidence: 99%

Tick-Borne Encephalitis (TBE): From Tick to Pathology

Worku

2023

JCM

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Tick-borne encephalitis (TBE) is a viral arthropod infection, endemic to large parts of Europe and Asia, and is characterised by neurological involvement, which can range from mild to severe, and in 33–60% of cases, it leads to a post-encephalitis syndrome and long-term morbidity. While TBE virus, now identified as Orthoflavivirus encephalitidis, was originally isolated in 1937, the pathogenesis of TBE is not fully appreciated with the mode of transmission (blood, tick, alimentary), viral strain, host immune response, and age, likely helping to shape the disease phenotype that we explore in this review. Importantly, the incidence of TBE is increasing, and due to global warming, its epidemiology is evolving, with new foci of transmission reported across Europe and in the UK. As such, a better understanding of the symptomatology, diagnostics, treatment, and prevention of TBE is required to inform healthcare professionals going forward, which this review addresses in detail. To this end, the need for robust national surveillance data and randomised control trial data regarding the use of various antivirals (e.g., Galidesivir and 7-deaza-2′-CMA), monoclonal antibodies, and glucocorticoids is required to improve the management and outcomes of TBE.

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“…In Germany, the heterogeneous geographical distribution of TBEV endemic areas and incidence of TBE cases is characterized by a north-to-south gradient, with most human cases occurring in the southern federal states of Bavaria and Baden-Württemberg [8]. Clinical manifestations of TBEV infection range from asymptomatic infection over mild febrile illness to severe meningoencephalitis or encephalomyelitis with substantial potential for long-term sequelae such as post-encephalitic or paralytic syndromes [9,10]. Cases with involvement of the CNS usually have a biphasic course with a first viraemic phase characterized by a non-specific febrile illness followed by a symptom-free interval of a few days before the second phase with acute neurological…”

Section: Introductionmentioning

confidence: 99%

Results of Tick-Borne Encephalitis Virus (TBEV) Diagnostics in an Endemic Area in Southern Germany, 2007 to 2022

Steininger,

Ensser,

Knöll

et al. 2023

Viruses

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Tick-borne encephalitis virus (TBEV) is the most important tick-transmitted neurotropic flavivirus in Europe and Asia. Our analysis aimed to investigate the contribution of TBEV-specific antibody detection by serological assays and TBEV RNA detection by real-time PCR to the diagnosis of tick-borne encephalitis (TBE). We analyzed data from 3713 patients from 16 years of laboratory TBEV diagnostics in an endemic area in Southern Germany. During this period, 126 cases of TBE were diagnosed. TBEV-specific IgM ELISA tests showed a high clinical sensitivity (96.8%) and a very high clinical specificity (99.7%). In immunocompetent patients, TBE was reliably diagnosed by detection of TBEV IgM antibodies in serum. Intrathecal TBEV IgG antibody synthesis was detected in 46 of 84 (55%) cases by analysis of paired serum and cerebrospinal fluid (CSF) samples. None of the 87 immunocompetent TBE patients tested had detectable TBEV RNA in serum or CSF. In contrast, in two TBE patients without TBEV-specific antibodies, diagnosis could only be made by the detection of TBEV RNA in CSF. Both patients had previously been treated with the B cell-depleting antibody rituximab. Therefore, in patients with CNS infection and humoral immunodeficiency, it is necessary to include TBEV PCR in the diagnostic approach.

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Recovery and sequelae in 523 adults and children with tick-borne encephalitis in Germany

Cited by 11 publications

References 23 publications

Adult-Onset Encephalitis over Twelve Years in Easternmost Finland

Adult-Onset Encephalitis over Twelve Years in Easternmost Finland

Tick-Borne Encephalitis (TBE): From Tick to Pathology

Results of Tick-Borne Encephalitis Virus (TBEV) Diagnostics in an Endemic Area in Southern Germany, 2007 to 2022

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