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Tick-borne encephalitis in Europe: a brief update on epidemiology, diagnosis, prevention, and treatment

Published:January 21, 2019DOI:https://doi.org/10.1016/j.ejim.2019.01.004

      Highlights

      • Tick-borne encephalitis (TBE) is an emerging health threat that is spreading in many parts of Europe.
      • TBE is an important cause of CNS infection with a significant incidence of permanent sequelae.
      • No specific antiviral treatment is currently available for TBE.
      • Awareness and effective vaccination are fundamental to prevent TBE morbidity and mortality.

      Abstract

      Tick-borne encephalitis (TBE) is an emerging health threat that is spreading in many parts of Europe. The mix of socio-economical, ecological and climatic factors as well as the presence of more susceptible hosts is actively contributing to the increasing number of TBE reported cases. TBE is an important cause of central nervous system (CNS) infection that can result in long-term neurological sequelae and even death. Diagnosis of TBE relays mainly on high clinical suspicion confirmed by serological and molecular assays both on serum and cerebrospinal fluid (CSF) with an ancillary role for neuroimaging in supporting the diagnosis. No specific antiviral treatment is currently available for TBE; indeed, supportive treatment as well as intensive care and assisted ventilation in severe forms may be needed. Because of limited option for TBE treatment, of crucial importance is effective vaccination to prevent disease-related morbidity and mortality.
      Due to expanding proportion of subject possibly exposed to TBE (and new populations such as: unaware travellers to TBE-endemic areas and immunocompromised patients), we performed a comprehensive review of TBE epidemiology, clinical presentation, current available diagnostic tools and treatment.
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      References

        • Růžek D.
        • Dobler G.
        • Donoso Mantke O.
        Tick-borne encephalitis: pathogenesis and clinical implications.
        Travel Med Infect Dis. 2010 Jul; 8: 223-232
        • Mandl C.W.
        Steps of the tick-borne encephalitis virus replication cycle that affect neuropathogenesis.
        Virus Res. 2005 Aug; 111: 161-174
        • Lindenbach B.D.
        • Rice C.A.
        Flaviviridae: the viruses and their replication.
        in: Knipe D.M. Howley P.M. Fields virology. 4th edition. Lippincott Williams & Wilkins, London, New York and Tokyo2001: 991-1041
        • Burke and Monath
        Neurotropic Viral Infections: Volume 1: Neurotropic RNA Viruses.
        Springer, 2001
        • Lindquist L.
        • Vapalahti O.
        Tick-borne encephalitis.
        Lancet. 2008 May 31; 371: 1861-1871
        • Tomazic J.
        • Poljak M.
        • Popovic P.
        • Maticic M.
        • Beovic B.
        • Avsic-Zupanc T.
        • et al.
        Tick-borne encephalitis: possibly a fatal disease in its acute stage. PCR amplification of TBE RNA from postmortem brain tissue.
        Infection. 1997 Jan-Feb; 25: 41-43
        • Valarcher J.F.
        • Hägglund S.
        • Juremalm M.
        • Blomqvist G.
        • Renström L.
        • Zohari S.
        • et al.
        Tick-borne encephalitis.
        Rev Sci Tech. 2015 Aug; 34: 453-466
        • Jemeršić L.
        • Dežđek D.
        • Brnić D.
        • Prpić J.
        • Janicki Z.
        • Keros T.
        • et al.
        Detection and genetic characterization of tick-borne encephalitis virus (TBEV) derived from ticks removed from red foxes (Vulpes vulpes) and isolated from spleen samples of red deer (Cervus elaphus) in Croatia.
        Ticks Tick Borne Dis. 2014 Feb; 5: 7-13
        • Gallia F.
        • Rampas J.
        • Hollender L.
        Laboratory infection caused by tick-borne encephalitis virus.
        Cas Lek Cesk. 1949; 88: 224-229
        • Daniel M.
        • Danielová V.
        • Fialová A.
        • Malý M.
        • Kříž B.
        • Nuttall P.A.
        Increased relative risk of tick-borne encephalitis in warmer weather.
        Front Cell Infect Microbiol. 2018 Mar 22; 8: 90
        • Yoshii K.
        • Song J.Y.
        • Park S.B.
        • Yang J.
        • Schmitt H.J.
        Tick-borne encephalitis in Japan, Republic of Korea and China.
        Emerg Microbes Infect. 2017 Sep 20; 6e82
        • Randolph S.E.
        Human activities predominate in determining changing incidence of tick-borne encephalitis in Europe.
        Euro Surveill. 2010; 15: 24-31
        • Velay A.
        • Solis M.
        • Kack-Kack W.
        • Gantner P.
        • Maquart M.
        • Martinot M.
        • et al.
        A new hot spot for tick-borne encephalitis (TBE): a marked increase of TBE cases in France in 2016.
        Ticks Tick Borne Dis. 2018 Jan; 9: 120-125
        • de Graaf J.A.
        • Reimerink J.H.
        • Voorn G.P.
        • Bij de Vaate E.A.
        • de Vries A.
        • Rockx B.
        • et al.
        First human case of tick-borne encephalitis virus infection acquired in the Netherlands, July 2016.
        Euro Surveill. 2016 Aug 18; 21
        • Meltzer E.
        • Paran Y.
        • Lustig Y.
        • Stienlauf S.
        • Weinberger M.
        • Schwartz E.
        Travel-related tick-borne encephalitis, Israel, 2006-2014.
        Emerg Infect Dis. 2017 Jan; 23: 119-121
        • Haditsch M.
        • Kunze U.
        Tick-borne encephalitis: a disease neglected by travel medicine.
        Travel Med Infect Dis. 2013 Sep-Oct; 11: 295-300
        • Steffen R.
        Epidemiology of tick-borne encephalitis (TBE) in international travellers to Western/Central Europe and conclusions on vaccination recommendations.
        J Travel Med. 2016 Apr 17; 23
        • Mehlhorn H.
        • Mehlhorn T.
        • Müller M.
        • Vogt M.
        • Rissland J.
        Tick survey for prevalent pathogens in peri-urban recreation sites in Saarland and Rhineland-Palatinate (Germany).
        Parasitol Res. 2016 Mar; 115: 1167-1172
        • Biernat B.
        • Karbowiak G.
        • Werszko J.
        • Stańczak J.
        Prevalence of tick-borne encephalitis virus (TBEV) RNA in Dermacentor reticulatus ticks from natural and urban environment, Poland.
        Exp Appl Acarol. 2014 Dec; 64: 543-551
        • European Centre for Disease Prevention and Control
        Epidemiological Situation of Tick-Borne Encephalitis in the European Union and European Free Trade Association Countries.
        ECDC, Stockholm2012
        • Zajkowska J.
        • Czupryna P.
        • Pancewicz S.
        • Adamczyk-Przychodzeń A.
        • Kondrusik M.
        • Grygorczuk S.
        • Moniuszko A.
        Fatal outcome of tick-borne encephalitis - a case series.
        Neurol Neurochir Pol. 2011 Jul-Aug; 45: 402-406
        • Kaiser R.
        The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994-98: a prospective study of 656 patients.
        Brain. 1999 Nov; 122: 2067-2078
        • Gritsun T.S.
        • Lashkevich V.A.
        • Gould E.A.
        Tick-borne encephalitis.
        Antiviral Res. 2003; 57: 129-146
      1. Mandell, Douglas, and Bennett's principles and practice of infectious diseases / [edited by] John E. Bennett, Raphael Dolin, Martin J. Blaser. – Eighth edition.

        • Chrdle A.
        • Chmelík V.
        • Růžek D.
        Tick-borne encephalitis: what travelers should know when visiting an endemic country.
        Hum Vaccin Immunother. 2016; 12: 2694-2699
        • Taba P.
        • Schmutzhard E.
        • Forsberg P.
        • Lutsar I.
        • Ljøstad U.
        • Mygland Å.
        • et al.
        EAN consensus review on prevention, diagnosis and management of tick-borne encephalitis.
        Eur J Neurol. 2017 Oct; 24: 1214-e61
        • Ternovoi V.A.
        • Kurzhukov G.P.
        • Sokolov Y.V.
        • et al.
        Tick-borne encephalitis with hemorrhagic syndrome, Novosibirsk region, Russia, 1999.
        Emerg Infect Dis. 2003; 9: 743-746
        • Günther G.
        • Haglund M.
        • Lindquist L.
        • et al.
        Tick-borne encephalitis in Sweden in relation to aseptic meningoencephalitis of other etiology: a prospective study of clinical course and outcome.
        J Neurol. 1997; 244: 230
        • Veje M.
        • Nolskog P.
        • Petzold M.
        • Bergström T.
        • Lindén T.
        • Peker Y.
        • et al.
        Tick-borne encephalitis sequelae at long-term follow-up: a self-reported case-control study.
        Acta Neurol Scand. 2016 Dec; 134: 434-441
        • Czupryna P.
        • Grygorczuk S.
        • Krawczuk K.
        • Pancewicz S.
        • Zajkowska J.
        • Dunaj J.
        • et al.
        Sequelae of tick-borne encephalitis in retrospective analysis of 1072 patients.
        Epidemiol Infect. 2018 Oct; 146: 1663-1670
        • Bogovič P.
        • Stupica D.
        • Rojko T.
        • Lotrič-Furlan S.
        • Avšič-Županc T.
        • Kastrin A.
        • et al.
        The long-term outcome of tick-borne encephalitis in Central Europe.
        Ticks Tick Borne Dis. 2018 Feb; 9: 369-378
        • Mickiene A.
        • Laiskonis A.
        • Günther G.
        • Vene S.
        • Lundkvist A.
        • Lindquist L.
        Tick-borne encephalitis in an area of high endemicity in Lithuania: disease severity and long-term prognosis.
        Clin Infect Dis. 2002; 35: 650-658
        • Puchhammer-Stöckl E.
        • Kunz C.
        • Mandl C.W.
        • Heinz F.X.
        Identifi cation of tick-borne encephalitis virus ribonucleic acid in tick suspensions and in clinical specimens by a reverse transcription-nested polymerase chain reaction assay.
        Clin Diagn Virol. 1995; 4: 321-326
        • Jääskeläinen A.
        • Han X.
        • Niedrig M.
        • Vaheri A.
        • Vapalahti O.
        Diagnosis of tick-borne encephalitis with μ-capture IgM-EIA based on secreted recombinant antigen produced in insect cells.
        J Clin Microbiol. 2003; 41: 4336-4342
        • Gritsun T.S.
        • Frolova T.V.
        • Zhankov A.I.
        • et al.
        Characterization of a Siberian virus isolated from a patient with progressive chronic tick-borne encephalitis.
        J Virol. 2003; 77: 25-36
        • Günther G.
        • Haglund M.
        • Lindquist L.
        • Sköldenberg B.
        • Forsgren M.
        Intrathecal IgM, IgA and Igb antibody response in tick-borne encephalitis. Long-term follow-up related to clinical course and outcome.
        Clin Diagn Virol. 1997; 8: 17-29
        • Nakayasu M.
        Development of a serodiagnostic IgM-ELISA for tick-borne encephalitis virus using subviral particles with strep-tag.
        Ticks Tick Borne Dis. Sep 2018; 9: 1391-1394
        • Vilibic-Cavlek T.
        • Barbic L.
        • Stevanovic V.
        • Petrovic G.
        Mlinaric-Galinovic G. IgG Avidity: an important serologic marker for the diagnosis of tick-borne encephalitis virus infection.
        Pol J Microbiol. 2016; 65: 119-121
        • Remoli M.E.
        • Marchi A.
        • Fortuna C.
        • Benedetti E.
        • Minelli G.
        • Fiorentini C.
        • et al.
        Anti-tick-borne encephalitis (TBE) virus neutralizing antibodies dynamics in natural infections versus vaccination.
        Pathog Dis. 2015 Mar; 73: 1-3
        • Zawadzki Radosław
        • et al.
        Evaluation of imaging methods in tick-borne encephalitis.
        Pol J Radiol. 2017; 82: 742-747
        • Gelpi E.
        • Preusser M.
        • Laggner U.
        • et al.
        Inflammatory response in human tick-borne encephalitis: analysis of postmortem brain tissue.
        J Neurovirol. 2006; 12: 322-327
        • Holzmann H.
        Diagnosis of tick-borne encephalitis.
        Vaccine. 2003; 1: 36-40
        • Schellinger P.D.
        • Schmutzhard E.
        • et al.
        Poliomyelitic-like illness in central European encephalitis.
        Neurology. 2000; 55: 299-302
        • Hertzell K.B.
        • Pauksens K.
        • Rombo L.
        • Knight A.
        • Vene S.
        • Askling H.H.
        Tick-borne encephalitis (TBE) vaccine to medically immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study.
        Vaccine. 2016 Jan 27; 34: 650-655
        • Eyer L.
        • Valdés J.J.
        • Gil V.A.
        • Nencka R.
        • Hřebabecký H.
        • Šála M.
        • et al.
        Nucleoside inhibitors of tick-borne encephalitis virus.
        Antimicrob Agents Chemother. 2015 Sep; 59: 5483-5493
        • Czupryna P.
        • Moniuszko-Malinowska A.
        • Grygorczuk S.
        • Pancewicz S.
        • Dunaj J.
        • Król M.
        • et al.
        Effect of a single dose of mannitol on hydration status and electrolyte concentrations in patients with tick-borne encephalitis.
        J Int Med Res. 2018; ([Aug 20:300060518790175])
        • Lindgren E.
        • Gustafson R.
        Tick-borne encephalitis in Sweden and climate change.
        Lancet. 2001; 358: 16e8
        • Rezza G.
        • Farchi F.
        • Pezzotti P.
        • Ruscio M.
        • Lo Presti A.
        • Ciccozzi M.
        • et al.
        TBE virology group. Tick-borne encephalitis in north-East Italy: a 14-year retrospective study, January 2000 to December 2013.
        Euro Surveill. 2015; 20
        • Lukan M.
        • Bullova E.
        • Petko B.
        Climate warming and tickborne encephalitis, Slovakia.
        Emerg Infect Dis. 2010; 16: 524e6
        • Banzhoff A.
        • Bröker M.
        • Zent O.
        Protection against tick-borne encephalitis (TBE) for people living in and travelling to TBEendemic areas.
        Travel Med Infect Dis. 2008; 6: 331e41
        • Gao X.
        • Nasci R.
        • Liang G.
        The neglected arboviral infections in mainland China.
        PLoS Negl Trop Dis. 2010; 4: e624