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Early summer meningo encephalitis, encephalitis, tick
English: tick-borne encephalitis, TBE
Please also note our appropriate topic: Tick bite
The TBE virus, like Borelliosis, is transmitted by ticks. The TBE virus occurs particularly in southern Germany, but recently it is increasingly spreading to the north.
Early summer meningoencephalitis (TBE) is an inflammation of the brain and / or meninges caused by the TBE virus, which belongs to the flavivirus family.
Occasionally the spinal cord is involved (meningo-encephalo-myelitis).
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In Europe, the virus is usually transmitted to humans through the bite of infected ticks (most commonly Ixodes ricinus, Ixodes persulcatus). The bloodsuckers only become active at temperatures around 10 degrees and mainly in spring and early summer. However, infection in November is still possible!
Ticks are mainly found in forests in tall grass and bushes. Their main hosts are small mammals such as mice (main reservoir), but also birds and deer. The viruses in the tick's salivary glands are washed into the bloodstream with the saliva during the act of sucking.
However, not every tick bite triggers an infection with the TBE virus. The longer a tick sucks, the greater the likelihood that humans will also become infected. Forcibly removing ticks from the skin also increases the risk that the pathogen will literally be “squeezed” into the bloodstream.
In rare cases, the TBE virus can also be transmitted through infected raw milk products from goats and sheep, which is particularly important in Eastern European countries.
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A direct infection from person to person is not possible.
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Epidemiology
TBE occurs only in certain regions. In many European countries, especially Austria, Eastern Europe and Eastern Siberia, there are TBE - transmitting ticks.
The risk areas (two illnesses per year or five illnesses in five years) in Germany, around 90% of TBE cases are southern Germany, the Bavarian Forest, the Black Forest and the Lake Constance region; the Odenwald is also affected.
In these areas around 1-5% of ticks are carriers of the TBE virus. An updated list of the annually changing High risk areas (over 25 cases of illness in five years) can be found on the website of the Robert Koch Institute (www.rki.de).
Since the mandatory notification was introduced in 2001, almost 300 cases of illness have been registered in Germany each year. This means that early summer meningoencephalitis is much rarer than that which is also transmitted by ticks Lyme disease. It should be noted, however, that due to the low involvement of the nervous system (10%), many cases of the disease are undiagnosed.
$config[ads_text3] not foundChildren are less likely to become infected than adults, and the course is usually milder. Nevertheless one can Meningitis in children also arise from a TBE infection.
It used to be said that early summer meningoenzepahlitis (TBE) mainly occurred in southern Germany. Due to climate change and the mild winters that accompany it, more and more TBE cases are also occurring in northern and central Germany.
The majority of Bavaria and Baden-Württemberg are defined risk areas according to the Robert Koch Institute. Individual districts in Thuringia, Hesse, Rhineland-Palatinate and Saarland also belong to the risk areas.
In addition, there are individual counties throughout Germany in which TBE diseases have occurred more frequently, but formally these do not fall under the definition of a risk area according to the Robert Koch Institute. Ultimately, you should be aware that it is not only decisive whether you live in a risk area. For example, you can get infected with the virus from a tick bite during a one-time vacation in Bavaria. Even in risk areas, however, not all ticks carry the TBE virus. However, the risk of getting infected with the disease from a tick bite should not be underestimated.
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The incubation period is the time between infection and the onset of a disease.
In the case of a TBE infection, the incubation time describes the period between the tick bite and the first symptoms. It can be between two and 30 days. On average, the first symptoms appear after 10 days. Usually these are flu-like symptoms.
This does not always have to indicate an infection with the TBE virus. It can also be Lyme disease, an infection with Borrelia. Even in risk areas, not all ticks carry the TBE virus. And even if the virus is passed on to humans, not all patients become ill. It is therefore important to watch yourself closely for 4 weeks after the tick bite.
In the event of abnormalities, a doctor should always be consulted.
After an incubation period of 2 to 30 days, most patients develop flu-like symptoms with a slight fever and headache and body aches. In the majority of patients, the disease is then over.
In 10 percent of cases, a second phase of the disease occurs after a period without symptoms. In this phase of the disease, the central nervous system is attacked by the pathogen. It is characterized by a high fever and headache. If there is an inflammation of the brain and the spinal cord membranes (Meningoencephalitis), then numerous neurological deficits such as paralysis and sensory disorders can occur. Disturbances in consciousness, which can lead to a coma, are also possible. With such a severe course, the patient must be treated in an intensive care unit.
The disease does not break out in every person who has been infected with the TBE virus by a tick bite. Around a third of those infected develop early summer meningoencephalitis (TBE).
The first symptoms usually appear after 10 days; but can also develop after 4 weeks. The first signs of TBE are similar to those of a flu-like infection. Those affected complain of fever and headache and body aches.
Gastrointestinal complaints are also occasionally reported. You should also know that some patients go through this first phase completely without symptoms. Usually the disease is over in most patients. Only 10 percent have a second phase of illness after a symptom-free interval. In the second phase of the disease, the virus attacks the central nervous system. The patients have a high fever. The other symptoms depend on which parts of the central nervous system are infected by the virus.
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The early summer meningoencephalitis (TBE) runs in two phases (biphasic course).
Also read our topic: Meningoencephalitis
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The word encephalitis is made up of the ancient Greek word for brain and the medical ending -itis, which stands for inflammation. Encephalitis is an inflammation of the brain.
In meningoencephalitis, not only the brain tissue but also the meninges are affected by the inflammation. The disease is initially characterized by a high fever and headache. In the early stages, encephalitis can therefore easily be mistaken for a flu-like infection. In the course of the disease, dizziness, nausea and vomiting also occur.
In the worst case, impaired consciousness occurs. This can range from drowsiness to a coma. Muscle paralysis can also occur as a result of damage to the nerve cells in the brain. If the respiratory muscles are paralyzed, the patient must be artificially ventilated. This is also the case with severe impaired consciousness. Depending on the severity of the disease, treatment in an intensive care unit may be necessary.
Read more about this under: Encephalitis
The abbreviation TBE stands for early summer meningoencephalitis. Meningoencephalitis is the medical term for inflammation of the brain (Encephalon) and meninges (Meninges). In case of meningitis (meningitis) only the meninges are affected by the inflammation. The brain tissue itself, i.e. the nerve cells, have not suffered any damage so far. After an infection with the TBE virus, the virus attacks the central nervous system in the second phase of the disease. If the disease is limited to the meninges, it is called meningitis. In the course of the disease, meningoencephalitis can always develop, the inflammation spreading from the meninges to the underlying brain tissue.
You can find more information about this at: Meningitis
To confirm the diagnosis, antibodies against the TBE virus are detected in the blood or cerebrospinal fluid (liquor) using the ELISA method.
A lumbar puncture is performed to obtain cerebral fluid.
To remove it, a hollow needle is used between the 3rd and 4th or the 4th and 5th lumbar vertebrae into a space below the spinal cord containing nerve water (lumbar puncture). It then drips through this needle into sterile tubes. Its appearance alone can give clues to the type of disease and possible pathogens: In the case of purulent meningitis it is cloudy to purulent, in viral meningitis / encephalitis it is clear to at most a little cloudy. In addition to the liquor (nerve fluid), blood is always taken and examined and both findings are compared with one another.
The examination of the nerve water is called liquor diagnostics.
The infection can be detected by detecting current antibodies (IgM), which the body's own immune system builds against the TBE virus as a defense.
However, our immune system only produces these antibodies at the beginning of the second phase of the disease. It should also be noted that a vaccination against the TBE virus leads to measurable antibody levels in the blood.
According to the Robert Koch Institute, only a TBE virus infection with detection of IgM and IgG antibodies in the serum may be considered such.
In the first phase of the disease, the TBE virus can be detected by creating a cell culture or by detecting the virus genetic material (DNA) using nRT-PCR (nested reverse transcriptase polymerase chain reaction).
As the medical ending -itis suggests, early summer meningoencephalitis (TBE) is an inflammatory disease. Therefore, in most patents, increased inflammation parameters can also be detected in the blood. Inflammation parameters are several laboratory values that indicate inflammation in the blood. On the one hand, the blood count shows a significantly increased number of white blood cells (leukocyte count).
The C-reactive protein (CRP) is also increased. This is a protein that is made in the liver. It is increasingly produced when there is inflammation and is therefore a very good marker for determining whether there is inflammation in the body.
A special test in the laboratory (ELISA test) can also be used to detect specific antibodies against the TBE virus. This is conclusive for the diagnosis. The antibodies are produced by the body's own immune system after contact with the virus. Unfortunately, it often takes until the second phase of the disease before the antibodies can be detected. However, you can not only examine the blood, but also nerve fluid (liquor), which is taken from the spinal canal by means of a lumbar puncture, for these antibodies. There are now also special procedures (PCR and Western blot) that try to detect the virus directly in the blood or in the nerve water.
The best therapy for early summer meningoencephalitis is prevention. On the one hand, there is a vaccination and, on the other hand, certain rules of conduct that reduce the risk of infection with the TBE virus (exposure prophylaxis).
If the disease has already broken out, no specific therapy is possible because there are no drugs against the TBE virus. In general, however, the prognosis is good even without treatment: 70 - 90% of diseases heal without consequences, especially in children and adolescents. Bed rest, pain relievers (analgesics), antipyretic drugs (antipyretics) and stimulus shielding are useful. In severe cases, intensive medical treatment is necessary, which ensures all vital functions, adequate fluid intake and nutrition.
In 10-30% of cases, neurological disorders may persist, such as memory or concentration disorders (cognitive deficits), balance disorders (ataxia), hearing disorders, but also seizure disorders (epilepsy) and paralysis (paresis). TBE is fatal in 1-2% of cases involving the brain.
This question can be answered with a clear no. TBE is a disease that is triggered by viruses. Antibiotics are very good for treating bacterial infections. Unfortunately, antibiotics are ineffective against viruses. While Lyme disease can be treated well with antibiotics, there is no causal therapy for TBE. That is precisely why vaccination against the virus is important. Read more about this under: Vaccination against TBE
The rehabilitation measures as part of follow-up treatment, which can be carried out as an inpatient in a rehabilitation clinic (rehab) or on an outpatient basis in a corresponding rehabilitation center, depend on the existing deficits.
There are various exercise groups and computer-aided training for memory disorders and poor concentration.
Balance disorders can be improved through appropriate physiotherapeutic measures, speech disorders through speech therapy training.
Because hearing disorders can occur more frequently, a hearing test should be carried out four to six weeks after the illness in order to be able to initiate early ENT treatment with a hearing aid or cochlear implant.
Active immunization (this means that the body makes antibodies against the virus itself, as opposed to passive immunization, where antibodies are injected) against the TBE virus consists of injecting inactivated viruses into a muscle that are not able to replicate.
For the basic immunization, three vaccinations are necessary, of which the second is given after three months and the third after about a year (booster).
A booster vaccination (vaccinations for adults) is recommended for people who live in endemic areas (i.e. in areas where ticks are often infected with the virus) after three to five years according to the recommendation of the Robert Koch Institute.
See also matching: Vaccination against meningitis
There is also a quick schedule for people who have decided at short notice to go to an endemic area (risk area).
The vaccine is given in two or three doses over a period of three weeks. For those who decide very quickly, it also makes sense to give the first vaccination shortly before departure.
The vaccination for children is available from the first year of life.
The following recommendations exist for exposure prophylaxis (protection against tick bites):
After a full vaccination, 99% of those vaccinated have complete protection against the TBE virus. Usually three vaccinations are necessary for this. A booster vaccination is recommended every 3-5 years. Efficacy has been demonstrated in clinical studies for these vaccination schedules. You should therefore take regular booster vaccinations. If the vaccinations have been carried out correctly and up-to-date, there can be virtually no infection with the TBE virus.
If a tick is infected with the TBE virus, the virus lives in the tick's saliva. A tick bite can then spread the virus into the wound and thus into the blood of the person stung. However, meningoencephalitis does not always break out. In two thirds of patients, the immune system can protect the body from the onset of the disease.
There is no known human-to-human transmission. So you can only get infected with the disease through a tick bite. Contact with an infected patient is not contagious.
Yes, in rare cases TBE can be fatal. The numbers are very different. Ultimately, it is assumed that around 1 percent of those affected will not survive the disease. You have to know that there is no causal therapy for TBE. You only treat the symptoms that are relevant. In the case of severe progress with respiratory paralysis and impaired consciousness, this must be done in an intensive care unit.
Actually, Lyme disease and TBE do not have much in common, so one should rather ask what the similarities between TBE and Lyme disease are. This question is easy to answer. Both diseases are diseases that can be transmitted to humans through a tick bite.
