Materiały źródłowe

• #1 Tick-Borne Encephalitis (TBE): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/tbe

  Tick-borne encephalitis (TBE) is a virus spread by tick bites in parts of Europe and Asia. It can cause flu-like symptoms or serious neurological complications, like muscle weakness, confusion, paralysis and seizures. […] Most people have no symptoms or flu-like symptoms, but some develop neurological conditions that can cause severe complications, like weakness and paralysis. […] Symptoms of TBE can happen in two phases. Initial symptoms start within about a week of getting bitten by a tick. They include: Fever, Headache, Body aches, Fatigue, Nausea, Loss of appetite. […] A few days to a week later and sometimes, weeks after the initial symptoms get better some people develop neurological symptoms, including: Fever, Vomiting, Sensitivity to light (photophobia), Confusion or altered mental state, Muscle weakness, Stiff neck, Facial paralysis, Seizures.

• #1 Tick-borne Encephalitis: Symptoms, Diagnosis, and Treatment | Tick-borne Encephalitis Virus | CDC

  https://www.cdc.gov/tick-borne-encephalitis/symptoms-diagnosis-treatment/index.html

  Many people infected with tick-borne encephalitis virus do not have symptoms. For people with symptoms, the time from tick bite to feeling sick (incubation period) is usually about 7 to 14 days, but can range from about 4 to 28 days. […] Severe disease often occurs including inflammation of the brain (encephalitis) or the membranes around the brain and spinal cord (meningitis). […] Initial symptoms can include fever, headache, vomiting, and weakness. […] A few days later, severe symptoms can develop including confusion, loss of coordination, difficulty speaking, weakness of the arms or legs, and seizures. […] Sometimes initial symptoms last a few days and completely resolve, but then about a week later the more severe symptoms develop. This is referred to as a biphasic illness.

• #1 Factsheet about tick-borne encephalitis (TBE)

  https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet

  Tick-borne encephalitis (TBE) is most often manifested as a two-phased illness. The first phase is associated with symptoms like fever, fatigue, headache, muscular ache and nausea. The second phase involves the neurological system with symptoms of meningitis (inflammation of the membrane that surrounds the brain and spinal cord) and/or encephalitis (inflammation of the brain). […] Approximately two-thirds of human TBE virus infections are non-symptomatic. In clinical cases, TBE often has a biphasic course. The first viraemic phase lasts approximately five (range 2-10) days, and is associated with non-specific symptoms (fever, fatigue, headache, myalgia, nausea). This phase is followed by an asymptomatic interval lasting seven (range 1-33) days that precedes the second phase, when the central nervous system is involved (meningitis, meningoencephalitis, myelitis, paralysis, radiculitis).

• #1 Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4419106/

  Tick-borne encephalitis is an infection of central nervous system caused by tick-borne encephalitis virus transmitted to humans predominantly by tick bites. Clinical spectrum of the disease ranges from mild meningitis to severe meningoencephalitis with or without paralysis. A post-encephalitic syndrome, causing long-lasting morbidity that often affects the quality of life develops in up to 50% of patients after acute tick-borne encephalitis. Clinical course and outcome vary by subtype of tick-borne encephalitis virus (the disease caused by the European subtype has milder course and better outcome than the disease caused by Siberian and Far-Easter subtypes), age of patients (increasing age is associated with less favorable outcome), and host genetic factors. The majority of patients with monophasic course of the disease has central nervous system involvement (meningitis, meningoencephalitis), while a small fraction has a febrile illness with headache but no meningitis (i.e., the initial phase of TBE not followed by the second, meningoencephalitic phase of the disease), named abortive form of TBE or febrile headache. The initial phase correlate with viremia and usually presents with non-specific symptoms such as moderate fever, headache, body pain (myalgia and arthralgia), fatigue, general malaise, anorexia, nausea, and others. This phase lasts for 2 to 7 d and is followed by amelioration or even an asymptomatic interval that usually lasts for about 1 wk (1-21 d). Than the second phase appears: in approximately 50% of adult patients it presents as meningitis, in about 40% as meningoencephalitis, and in around 10% as meningoencephalomyelitis. Meningitis typically manifests with high fever, headache, nausea and vomiting; many patients have photophobia, and some vertigo. Encephalitis can be manifested by impaired consciousness ranging from somnolence to stupor and, in rare cases, coma. Other manifestations comprise personality changes, behavioral disorders, concentration and cognitive function disturbances, tongue fasciculations and tremor of extremities; very rarely focal or generalized seizures, delirium and psychosis develop. Flaccid pareses, that are a typical characteristic of meningoencephalomyelitis, usually arise during the febrile phase of the disease, and are occasionally preceded by severe pain in the affected muscle groups. The upper extremities are more often affected than the lower extremities and the proximal segments more frequently than the distal ones. Patients with pareses of respiratory muscles rather commonly require artificial ventilatory support. Involvement of the central portions of the brainstem and medulla oblongata are associated with poor prognosis. Myelitis usually occur with encephalitis, and only very rarely as the only manifestation of TBE. Data on this manifestation of TBE are limited. It manifests with moderate fever, headache, fatigue, and other symptoms of initial phase of the disease that are not followed by nervous system involvement. The fever typically endures for several days, and the outcome of the disease is excellent. In Central Europe the majority of patients with the initial phase of TBE develop the second, central nervous system phase of the disease. In patients with TBE the involvement of cranial nerves has been reported. Published data suggests that cranial nerve involvement is rare and mainly asymmetrical, that its occurrence varies with the severity of clinical presentation of TBE, and that in most cases it has a favorable outcome. TBE may cause long-lasting morbidity which often has an impact on patients quality of life and, sometimes, necessitates an alteration of lifestyle. Many nonspecific neurological/neuropsychiatric symptoms and residual neurological dysfunctions have been reported in some prospective and several retrospective studies, but findings are hard to compare due to diverse study designs, distinct definitions, and variable follow-up times. Published data suggest that 40% to 50% of patients after acute TBE develop a post-encephalitic syndrome. The most frequently reported symptoms have been cognitive disorders, neuropsychiatric complaints (such as apathy, irritability, memory and concentration disorders, altered sleep pattern), headache, hearing loss and/or tinnitus, disturbances of vision, balance and coordination disorders, and flaccid paresis or paralysis. Long-lasting sequelae are identified in up to 50% of adult patients. The disease caused by the European TBEV subtype usually has a biphasic course, with a severe neurologic deficit in approximately 10% of patients, and a case-fatality rate of less than 2%. Infections with Far Eastern TBEV subtype often cause an illness with a gradual onset, more severe course, higher rates of severe neurologic sequelae, and a fatality rate of 20%-40%. The predominant form of TBE in children and adolescents is meningitis. A summary of 8 studies on 1169 children with TBE, published from 1963 to 2005, showed that meningitis was present in 802 (69%), meningoencephalitis in 356 (30%), and meningoencephalomyelitis in 11 (1%) patients. Twenty out of 945 patients (2.1%) had long-term neurologic sequelae.

• #1 TBE IN ADULTS | Bavarian Nordic

  https://bnvaccines.com/en-EE/disease-area/tbe-adults

  The initial phase is followed by an asymptomatic interval that usually lasts for about 1 week (range: 1–21 days). Second disease phase-symptoms can occur in 20-30% of patients and can include: Meningitis typically manifests with high fever, headache, nausea and vomiting; many patients have photophobia, and some vertigo. Encephalitis may be manifested by impaired consciousness ranging from somnolence to stupor and, in rare cases, coma. Patients aged over ~40 years are more likely to develop the encephalitic form of the disease. Risk factors include age, comorbidities and immunosuppression. In patients aged over 60 years, TBE increasingly takes a severe course, leading to paralysis and the highest case-fatality rate.

• #1 Tick-borne encephalitis

  https://www.ecdc.europa.eu/en/tick-borne-encephalitis

  Tick-borne encephalitis (TBE) is an infectious disease that affects the central nervous system and is transmitted by the bite of infected ticks. Symptoms appear, on average, within seven days and occur in two phases. The first phase includes fever, tiredness, headache, muscle pain and nausea. The second phase affects the nervous system, showing symptoms such as meningitis (inflammation around the brain and spinal cord) and/or encephalitis (inflammation of the brain). […] The severity of the disease depends largely on the type of virus. There are three virus subtypes: European subtype: its mortality rate is between 0.5% and 2%, and up to 10% of people infected suffer long-term or permanent neurological problems. Far Eastern subtype: its mortality rate is up to 35% and has a higher rate of severe long-term or permanent neurological problems. Siberian subtype: its mortality rate is between 1% and 3% and patients tend to develop chronic or long-term disease. […] Meningitis, encephalitis or meningomyelitis (inflammation of the spinal cord and enveloping membranes) require hospitalisation and supportive care depending on the severity of the syndrome.

• #1 Tick-borne encephalitis virus: Infectious substances pathogen safety data sheet – Canada.ca

  https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/tick-borne-encephalitis-virus.html

  TBEV-FE tends to cause more severe disease; the mortality rate is estimated to be 5-40%Footnote 9,Footnote 10 and up to 60% of recovered patients have neurologic sequelaeFootnote 2. […] Mortality rates are estimated to be 6-8% for TBEV-Sib, and 1-2% for TBEV-EuFootnote 2,Footnote 5. […] Fatalities are rare in childrenFootnote 5,Footnote 7.

• #1

  https://link.springer.com/article/10.1007/s13365-020-00856-x

  The aim of our study was to compare the course of TBE in children and adults. TBE symptoms in children were milder compared with adults, with meningitis in 97% of cases. In adults, meningoencephalitis and meningoencephalomyelitis made up 49.26% of cases. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. […] TBE in children has a milder course than in adults. The most common clinical form of the disease is meningitis. In children, non-specific symptoms such as fever, headache, fatigue and exhaustion appear more frequently. […] The disease caused by European TBEV generally has a milder course and better outcome in children than in adults. […] The presentation of TBE in children is milder than in adults. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. There were no differences in cerebrospinal fluid pleocytosis between children and adults with TBE, whereas the protein concentration was higher in adults on admission. Sequelae after TBE are less frequent in children than in adults. Dexamethasone usage prolongs the disease but does not influence sequelae development.

• #1 Tick-Borne Encephalitis: Symptoms, Treatment, Prevention, Outlook

  https://www.healthline.com/health/tick-borne-encephalitis

  Serious symptoms can include: stiff neck, severe headache, sensitivity to lights or sounds, drowsiness, altered mental status, confusion, slurred speech, seizures, tremors, loss of movement in part of the body. […] Most people with TBE will recover. But, up to one-third of people with TBE may experience long-term complications. […] Long-term complications can include: cognitive disorders, memory and concentration disorders, vision, balance, and coordination disorders, hearing loss or tinnitus, paralysis. […] The risk of incomplete recovery is higher for people with more severe disease during the initial phase of TBE. Also, research suggests adults older than 60 have a higher risk of more severe disease.

• #1 TickAlert | Tick-borne encephalitis | Symptoms

  https://tickalert.org/tick-borne-encephalitis-symptoms

  The long-term consequences of TBE can be serious. Although most people with TBE recover fully, some patients infected with TBE will suffer severe complications with their brain, nerves and spinal cord. Long-term complications associated with TBE can include: Ataxia a group of disorders that affect co-ordination, balance and speech, Seizures, Paralysis, Loss of consciousness.

• #1 TBE patients’ lasting problems | University of Gothenburg

  https://www.gu.se/en/news/tbe-patients-lasting-problems

  Impaired memory, reduced motivation, and declining motor skills. These are some of the problems that may persist several years after people contract tick-borne encephalitis, a University of Gothenburg thesis shows. […] Ninety-two former TBE patients were interviewed in median five and a half years after contracting the disease. It emerged that the interviewees had significantly more problems in terms of memory, concentration, initiative, and motivation than a control group. Other difficulties were those caused by persistent impairment of their fine motor skills, balance, and coordination, and headaches. […] Fatigue, another significant problem, was studied through polysomnography in 22 previous TBE patients and 20 controls. Despite equivalent sleep patterns and similar proportions of people with sleep apnea, the former TBE patients suffered from more fatigue and greater impact on daily life. […] Of those who are of working age, many find it difficult to work. They cant concentrate, their multitasking ability has decreased, they dont get started on tasks, and they get extremely tired. Whats more, a lot of them have motor problems to do with balance and fine motor function.

• #1 Progressive Course of Chronic Tick-Borne Encephalitis Manifesting as Amyotrophic Lateral Sclerosis-like Syndrome 35 Years after the Acute Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9405949/

  The chronic form of tick-borne encephalitis (TBE) is understudied and seems to be linked exclusively to Siberian and Far Eastern TBE virus (TBEV) subtypes. […] The disease manifested as an ALS-like syndrome with bulbar signs, progressive muscle weakness and atrophy, decreased reflexes, and eventual respiratory failure and death. […] Depending on the course of the disease, chronic TBE may present as various combinations of periods of progression and stabilization, including primary progressive, relapsing, and secondary progressive forms. […] Based on clinical symptoms, chronic TBE can be represented by a hyperkinetic syndrome with or without Kozhevnikovs epilepsy or an amyotrophic/poliomyelitic form, including ALS-like syndromes. […] Several decades after the disease, presumably after a significant overstrain, the patient developed severe impairment of cerebral functions with bulbar symptoms resembling ALS-like syndrome.

• #1 Progressive Course of Chronic Tick-Borne Encephalitis Manifesting as Amyotrophic Lateral Sclerosis-like Syndrome 35 Years after the Acute Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9405949/

  The presented case history of a patient with actively progressing bulbar dysfunctions has some similarities to the bulbar form of amyotrophic lateral sclerosis (ALS). […] The defining feature of this clinical case is an extremely long period between the acute disease and the reactivation and relapse of the persistent TBEV infection. […] To the best of our knowledge, this is the first laboratory-confirmed case of progressive TBE with an asymptomatic period lasting as long as 35 years.

• #1 Factsheet about tick-borne encephalitis (TBE)

  https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet

  The European subtype is associated with milder disease, with 20-30% of patients experiencing the second phase, mortality rates of 0.5-2%, and severe neurological sequelae in up to 10% of patients. In children, the second phase of illness is usually limited to meningitis, whereas adults older than 40 years are at increased risk of developing encephalitis, with higher mortality and long-lasting sequelae in those over the age of 60. […] The far eastern subtype is associated with more severe disease: monophasic illness, with no asymptomatic interval preceding the onset of neurological disease, mortality rates of up to 35%, and higher rates of severe neurological sequelae. […] The Siberian subtype is associated with a less severe disease (fatality rate of 13%), with a tendency for patients to develop chronic or extremely prolonged infections.

• #2 Tick-borne encephalitis – Wikipedia

  https://en.wikipedia.org/wiki/Tick-borne_encephalitis

  Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The disease most often manifests as meningitis, encephalitis or meningoencephalitis. Myelitis and spinal paralysis also occur. In about one third of cases sequelae, predominantly cognitive dysfunction, persist for a year or more. […] The disease is most often biphasic. After an incubation period of approximately one week (range: 4-28 days) from exposure (tick bite) non-specific symptoms occur. These symptoms are fever, malaise, headache, nausea, vomiting and myalgias that persist for about 5 days. Then, after approximately one week without symptoms, some of the infected develop neurological symptoms, i.e. meningitis, encephalitis or meningoencephalitis. Myelitis also occurs with or without encephalitis.

• #2

  https://www.gov.uk/guidance/tick-borne-encephalitis-epidemiology-diagnosis-and-prevention

  Tick-borne encephalitis (TBE) is a viral infection that causes minimal or no symptoms in the majority of people. In rare cases, the virus can attack the central nervous system and can result in long-term neurological symptoms or (very rarely) death. […] The average incubation period of TBE is 7 days, but may be up to 28 days. The incubation period for foodborne infection is usually shorter, around 4 days. Approximately two-thirds of human TBE virus infections are asymptomatic. In symptomatic cases, it is often biphasic, with an initial viraemic phase lasting approximately 5 days (range 2 to 10), and is associated with non-specific symptoms (fever, fatigue, headache, myalgia, nausea). This phase is usually followed by an asymptomatic interval and apparent recovery, lasting 7 days (range 1 to 33). The second phase begins approximately 7 days after initial resolution of symptoms (range 1 to 33 days) and involves the central nervous system. Typical presentations are meningitis, meningoencephalitis, myelitis, paralysis, or radiculitis.

• #2 Clinical Signs and Symptoms of Tick-borne Encephalitis | Tick-borne Encephalitis Virus | CDC

  https://www.cdc.gov/tick-borne-encephalitis/hcp/clinical-signs/index.html

  Tick-borne encephalitis (TBE) can present as an acute febrile illness or neuroinvasive disease, with varying degrees of severity depending on viral subtype and patient risk factors. […] TBE can present as a biphasic illness, particularly with the European subtype of the virus. […] Acute neuroinvasive disease (i.e., aseptic meningitis, encephalitis, or meningoencephalomyelitis) is the most commonly recognized clinical manifestation of TBE virus infection. Milder forms of the disease (e.g., febrile illness) also occur. […] TBE can present as a biphasic illness, particularly with the European subtype of the virus, as follows: First phase: a nonspecific febrile illness that might be accompanied by symptoms such as headache, malaise, myalgia, anorexia, nausea, and/or vomiting. This phase usually lasts for several days and is followed by an afebrile and relatively asymptomatic period, typically of about one week’s duration.

• #2 TickAlert | Tick-borne encephalitis | Symptoms

  https://tickalert.org/tick-borne-encephalitis-symptoms

  TBE is an infection of the central nervous system that affects the brain, spinal cord and membranes around them. For most people infected with the TBE virus, there are no symptoms. But if there are, they usually appear in two phases. […] In the first phase, people have flu-like symptoms including muscle pain, headache, fatigue and a peak temperature between 37.5C and 39C for 2 to 7 days. Then, there is a period of 2 to 10 days with no symptoms or mild symptoms, which is followed by the second phase. […] With some people, the second phase can be serious. The second phase targets the brain, presenting as meningitis and/or encephalitis. These symptoms may include a higher fever, headache, nausea, vomiting and vertigo. […] In severe cases, permanent paralysis can occur and, in very rare cases, people may die.

• #2 Tick-Borne Encephalitis (TBE): From Tick to Pathology

  https://www.mdpi.com/2077-0383/12/21/6859

  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. […] Where symptoms occur, however, there is a risk of central nervous system (CNS) involvement manifesting as encephalitis/meningitis/myelopathy, with the risks of long-term neuropsychiatric sequelae present in survivors. […] Overall, 5% of survivors will suffer permanent paresis, and approximately 33–60% will suffer a post-encephalitic syndrome that may last for years after TBE recovery. […] The first phase of European TBE is characterised by viraemia and typically lasts 2–7 days. At this time, patients present with a flu-like illness, including fever, headache, myalgia, and, in a minority, diarrhoea and abdominal pain, with a spectrum of illness reported.

• #2 Tick-Borne Encephalitis

  https://www.encephalitis.info/types-of-encephalitis/infectious-encephalitis/tick-borne-encephalitis/

  Most people, who are infected with the TBE virus, show no symptoms at all. In those that do have symptoms (2-30%), they typically appear about one-two weeks after the bite. From those with initial symptoms, one third will develop neurological symptoms. […] In the European type of TBE there are normally two phases to the illness. The first phase consists of flu-like illness with symptoms such as fever, headache and generalised body aches. It lasts around five days. There is then about a week with no symptoms, which is followed by the second phase of the illness, when the brain or nerves are involved. The severity of the second phase varies between patients. Some people have a very mild illness whilst others may have a severe illness. Older people tend to get a more severe illness than younger people or children.

• #2 Factsheet about tick-borne encephalitis (TBE)

  https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet

  Tick-borne encephalitis (TBE) is most often manifested as a two-phased illness. The first phase is associated with symptoms like fever, fatigue, headache, muscular ache and nausea. The second phase involves the neurological system with symptoms of meningitis (inflammation of the membrane that surrounds the brain and spinal cord) and/or encephalitis (inflammation of the brain). […] Approximately two-thirds of human TBE virus infections are non-symptomatic. In clinical cases, TBE often has a biphasic course. The first viraemic phase lasts approximately five (range 2-10) days, and is associated with non-specific symptoms (fever, fatigue, headache, myalgia, nausea). This phase is followed by an asymptomatic interval lasting seven (range 1-33) days that precedes the second phase, when the central nervous system is involved (meningitis, meningoencephalitis, myelitis, paralysis, radiculitis).

• #2 Tick-Borne Encephalitis

  https://www.encephalitis.info/types-of-encephalitis/infectious-encephalitis/tick-borne-encephalitis/

  The symptoms in the second stage are similar to other causes of encephalitis and meningitis (inflammation of the lining of the brain). These include neck stiffness, headache, nausea, impaired consciousness (from drowsiness to coma), poor coordination, tremor, personality changes and psychosis. Some patients will also get muscle pain or limb weakness (most often in the arms). In severe cases the muscles that control the breathing are affected and people may die.

• #2 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  Tick-borne encephalitis (TBE) is an infection of the central nervous system (CNS) caused by the tick-borne encephalitis virus (TBEV) being transmitted by ticks in several central, eastern, and northern European countries. The severity of the disease is broad, ranging from fever and headache to death, with a relatively high proportion of patients needing intensive care unit (ICU) treatment. Most patients develop meningitis or meningoencephalitis, some present with additional spinal involvement. At hospital discharge, many patients suffer persisting signs like ataxia and tremor; symptoms such as headache or decreased concentration are also described. In addition, follow-up studies have shown that 16–50% of patients suffer from long-lasting sequelae. […] A total of 1045 patients with TBE were recruited for genetic investigations; 555 cases were eligible for clinical description, with ages ranging from 11 months to 88 years (median of 50 years). Most patients had a biphasic course of disease (65.1%), with various symptoms or signs, including fever, fatigue, malaise, headache, body pain, pharyngitis, and gastrointestinal symptoms. A clinical diagnosis was assigned to 553 of 555 patients; 207 (37.3%) had meningitis, 241 (43.4%) moderate meningoencephalitis, 32 (5.8%) severe meningoencephalitis, 15 (2.7%) meningomyelitis, 46 (8.3%) meningoencephalomyelitis with moderate encephalitis, and 13 (2.3%) meningoencephalomyelitis with severe encephalitis.

• #2 Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4419106/

  Tick-borne encephalitis is an infection of central nervous system caused by tick-borne encephalitis virus transmitted to humans predominantly by tick bites. Clinical spectrum of the disease ranges from mild meningitis to severe meningoencephalitis with or without paralysis. A post-encephalitic syndrome, causing long-lasting morbidity that often affects the quality of life develops in up to 50% of patients after acute tick-borne encephalitis. Clinical course and outcome vary by subtype of tick-borne encephalitis virus (the disease caused by the European subtype has milder course and better outcome than the disease caused by Siberian and Far-Easter subtypes), age of patients (increasing age is associated with less favorable outcome), and host genetic factors. The majority of patients with monophasic course of the disease has central nervous system involvement (meningitis, meningoencephalitis), while a small fraction has a febrile illness with headache but no meningitis (i.e., the initial phase of TBE not followed by the second, meningoencephalitic phase of the disease), named abortive form of TBE or febrile headache. The initial phase correlate with viremia and usually presents with non-specific symptoms such as moderate fever, headache, body pain (myalgia and arthralgia), fatigue, general malaise, anorexia, nausea, and others. This phase lasts for 2 to 7 d and is followed by amelioration or even an asymptomatic interval that usually lasts for about 1 wk (1-21 d). Than the second phase appears: in approximately 50% of adult patients it presents as meningitis, in about 40% as meningoencephalitis, and in around 10% as meningoencephalomyelitis. Meningitis typically manifests with high fever, headache, nausea and vomiting; many patients have photophobia, and some vertigo. Encephalitis can be manifested by impaired consciousness ranging from somnolence to stupor and, in rare cases, coma. Other manifestations comprise personality changes, behavioral disorders, concentration and cognitive function disturbances, tongue fasciculations and tremor of extremities; very rarely focal or generalized seizures, delirium and psychosis develop. Flaccid pareses, that are a typical characteristic of meningoencephalomyelitis, usually arise during the febrile phase of the disease, and are occasionally preceded by severe pain in the affected muscle groups. The upper extremities are more often affected than the lower extremities and the proximal segments more frequently than the distal ones. Patients with pareses of respiratory muscles rather commonly require artificial ventilatory support. Involvement of the central portions of the brainstem and medulla oblongata are associated with poor prognosis. Myelitis usually occur with encephalitis, and only very rarely as the only manifestation of TBE. Data on this manifestation of TBE are limited. It manifests with moderate fever, headache, fatigue, and other symptoms of initial phase of the disease that are not followed by nervous system involvement. The fever typically endures for several days, and the outcome of the disease is excellent. In Central Europe the majority of patients with the initial phase of TBE develop the second, central nervous system phase of the disease. In patients with TBE the involvement of cranial nerves has been reported. Published data suggests that cranial nerve involvement is rare and mainly asymmetrical, that its occurrence varies with the severity of clinical presentation of TBE, and that in most cases it has a favorable outcome. TBE may cause long-lasting morbidity which often has an impact on patients quality of life and, sometimes, necessitates an alteration of lifestyle. Many nonspecific neurological/neuropsychiatric symptoms and residual neurological dysfunctions have been reported in some prospective and several retrospective studies, but findings are hard to compare due to diverse study designs, distinct definitions, and variable follow-up times. Published data suggest that 40% to 50% of patients after acute TBE develop a post-encephalitic syndrome. The most frequently reported symptoms have been cognitive disorders, neuropsychiatric complaints (such as apathy, irritability, memory and concentration disorders, altered sleep pattern), headache, hearing loss and/or tinnitus, disturbances of vision, balance and coordination disorders, and flaccid paresis or paralysis. Long-lasting sequelae are identified in up to 50% of adult patients. The disease caused by the European TBEV subtype usually has a biphasic course, with a severe neurologic deficit in approximately 10% of patients, and a case-fatality rate of less than 2%. Infections with Far Eastern TBEV subtype often cause an illness with a gradual onset, more severe course, higher rates of severe neurologic sequelae, and a fatality rate of 20%-40%. The predominant form of TBE in children and adolescents is meningitis. A summary of 8 studies on 1169 children with TBE, published from 1963 to 2005, showed that meningitis was present in 802 (69%), meningoencephalitis in 356 (30%), and meningoencephalomyelitis in 11 (1%) patients. Twenty out of 945 patients (2.1%) had long-term neurologic sequelae.

• #2 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  Tick-borne encephalitis (TBE) virus is a major cause of central nervous system infections in endemic countries. Here, we present clinical and laboratory characteristics of a large international cohort of patients with confirmed TBE using a uniform clinical protocol. A detailed description of clinical signs and symptoms was recorded. The obtained information enabled a reliable classification in 553 of 555 patients: 207 (37.3%) had meningitis, 273 (49.2%) meningoencephalitis, 15 (2.7%) meningomyelitis, and 58 (10.5%) meningoencephalomyelitis; 41 (7.4%) patients had a peripheral paresis of extremities, 13 (2.3%) a central paresis of extremities, and 25 (4.5%) had single or multiple cranial nerve palsies. Five (0.9%) patients died during acute illness. Outcome at discharge was recorded in 298 patients. Of 176 (59.1%) patients with incomplete recovery, 80 (27%) displayed persisting symptoms or signs without recovery expectation. This study provides further evidence that TBE is a severe disease with a large proportion of patients with incomplete recovery.

• #2 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  In total, 56 (10.1%) patients had pareses of extremities, of whom 41 (7.4%) had peripheral pareses of extremities, 13 (2.3%) central pareses of extremities, and 2 had unknown peripheral or central pareses of extremities. A detailed distribution of pareses of extremities is shown in Table 2. Twenty-five (4.5%) patients had cranial nerve palsy. Nineteen of them had a single cranial nerve palsy, and six had multiple cranial nerve palsies. […] We recorded the outcome at the discharge of 298 patients; 117 (39%) had a complete recovery, 176 (59%) an incomplete recovery, and 5 (2%) died. Symptoms and signs of 121 patients discharged with incomplete recovery were recorded; 36 (30%) had mild subjective symptoms, 28 (23%) had severe subjective symptoms, and 57 (47%) had objective signs, of whom 25 (20.5%) had one objective sign, 25 (20.5%) had two objective signs, and 7 (6%) had three or more objective signs. Headache (93% of patients) was a predominant subjective symptom, followed by decreased concentration (47%). Objective signs included tremor (31%), ataxia (22%), and pareses of extremities (16%).

• #2 Factsheet about tick-borne encephalitis (TBE)

  https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet

  The European subtype is associated with milder disease, with 20-30% of patients experiencing the second phase, mortality rates of 0.5-2%, and severe neurological sequelae in up to 10% of patients. In children, the second phase of illness is usually limited to meningitis, whereas adults older than 40 years are at increased risk of developing encephalitis, with higher mortality and long-lasting sequelae in those over the age of 60. […] The far eastern subtype is associated with more severe disease: monophasic illness, with no asymptomatic interval preceding the onset of neurological disease, mortality rates of up to 35%, and higher rates of severe neurological sequelae. […] The Siberian subtype is associated with a less severe disease (fatality rate of 13%), with a tendency for patients to develop chronic or extremely prolonged infections.

• #2 Tick-borne encephalitis in children | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/09/clinical-review/tick-borne-encephalitis-children

  The majority develop meningitis, characterised by non-specific symptoms such as high fever, headache and nausea/vomiting. The proportion of children with a biphasic course varies considerably across studies, and the first phase is often interpreted as an upper respiratory infection. […] Neck stiffness is the most common clinical finding, but there may be no objective signs of infection in the central nervous system. Severe neurological findings such as reduced level of consciousness, ataxia, paresis and generalised seizures, can occur but are rare in children with meningoencephalitis. […] Child deaths caused by the European subtype of the TBE virus are extremely rare, and severe neurological sequelae are less common in children than in adults. However, the risk of long-term cognitive dysfunction is a concern. In a Swedish follow-up study, half of the children experienced residual problems, including headaches, cognitive problems, irritability and fatigue four years after the illness. […] The need for outpatient follow-up will depend on the individual clinical presentation as well as any pathological findings in EEG or MRI scans.

• #2 Tick-borne encephalitis (TBE) | Hôpital de La Tour

  https://www.la-tour.ch/en/tick-borne-encephalitis-tbe

  Although a central nervous system infection can be cured, many patients suffer long-term neurological sequelae. Some 30-50% suffer from residual symptoms such as chronic fatigue, headaches, muscle pain and cognitive impairment. In some cases, more serious sequelae may persist, such as severe cognitive impairment or chronic respiratory paralysis representing a major life-threatening risk.

• #2 Tick-Borne Encephalitis (TBE): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/tbe

  The main complications of TBE are swelling of your brain (encephalitis) and the membrane around your brain and spinal cord (meningitis). These cause the second stage of TBE symptoms and can lead to permanent: Paralysis, Memory loss, Balance and coordination issues, Speech and language issues. […] If you’ve been diagnosed with TBE, you could develop neurological symptoms as many as 20 days after your initial symptoms get better. […] The mortality (death) rate of European and Siberian TBE is less than 3%. For Far Eastern TBE, it’s as high as 35%. […] Go to the emergency room if you have symptoms of severe illness, including: High fever (over 103 degrees Fahrenheit/40 degrees Celsius), Severe headache, Confusion or altered mental state, Difficulty breathing, Extreme weakness, Paralysis, Seizures.

• #2 Clinical Signs and Symptoms of Tick-borne Encephalitis | Tick-borne Encephalitis Virus | CDC

  https://www.cdc.gov/tick-borne-encephalitis/hcp/clinical-signs/index.html

  Second phase: a clinical illness with central nervous system involvement. Depending on specific presentation, findings can include meningeal signs, altered mental status, cognitive dysfunction, ataxia, rigidity, seizures, tremors, cranial nerve palsies, and limb paresis. […] Infections with the Far Eastern TBE virus subtype are generally more severe than infections with the other two subtypes. […] Disease severity is highest in older persons. […] The case fatality and frequency of neurologic sequelae vary by viral subtype. With the European subtype, the case fatality is about 12%, with the Siberian subtype about 68%, and with the Far Eastern subtype about 20%. Frequencies of sequelae ranging from 10-50% have been reported from different areas. Chronic and progressive forms of disease have been reported, particularly after infection with the Siberian subtype.

• #2 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  This is the first multicenter report on clinical findings of TBE patients from six highly endemic European countries. We confirm the high rates of patients with encephalitic disease caused by TBEV in European countries, as previously described by single-center studies or national studies. The analysis of patient characteristics confirmed higher age as a risk factor for severe disease. Older age groups had a higher risk for meningoencephalitis and meningoencephalomyelitis. Further, pre-existing comorbidities were identified as risk factors for meningoencephalitis and meningoencephalomyelitis. A significant proportion of patients (10.1%) developed paresis of extremities, which was consistent with previous publications suggesting a rate from 0.7% to 15.1%. […] More than half of the patients were discharged with incomplete recovery (176/298 patients, 59%). This included a high proportion (80/298 patients, 27%) with no expectation of complete recovery at discharge according to the clinician’s assessment. Previous publications also describe high numbers of patients with sequelae after TBE infection. Most impressively, TBE causes pareses of extremities in 10.1% of patients, with incomplete recovery of paresis at discharge. This impairment is a major factor for loss of function and loss of life quality and attributes to the high burden of TBE disease.

• #2

  https://link.springer.com/article/10.1007/s13365-020-00856-x

  The aim of our study was to compare the course of TBE in children and adults. TBE symptoms in children were milder compared with adults, with meningitis in 97% of cases. In adults, meningoencephalitis and meningoencephalomyelitis made up 49.26% of cases. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. […] TBE in children has a milder course than in adults. The most common clinical form of the disease is meningitis. In children, non-specific symptoms such as fever, headache, fatigue and exhaustion appear more frequently. […] The disease caused by European TBEV generally has a milder course and better outcome in children than in adults. […] The presentation of TBE in children is milder than in adults. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. There were no differences in cerebrospinal fluid pleocytosis between children and adults with TBE, whereas the protein concentration was higher in adults on admission. Sequelae after TBE are less frequent in children than in adults. Dexamethasone usage prolongs the disease but does not influence sequelae development.

• #2 TBE Risks | TicoVac® (Tick-Borne Encephalitis Vaccine) | Safety Info

  https://ticovac.pfizerpro.com/clinical-information/risk-factors

  Disorders that affect coordination, balance, and speech. […] Cognitive changes leading to memory loss, inability to concentrate, and mood change. […] Muscle weakness or permanent paralysis. […] Temporary or long-term loss of consciousness. […] In very rare cases, death may occur. […] Vaccination is an effective prevention method for TBE. […] TBE is a rare viral infection for which there is no effective cure. There is currently no specific treatment for TBE, only management of symptoms.

• #3 TBE IN ADULTS | Bavarian Nordic

  https://bnvaccines.com/en-EE/disease-area/tbe-adults

  TBE is a serious disease that can lead to permanent brain damage or even death. Up to 2 out of 100 people infected with TBE die. […] The majority of tick-borne encephalitis virus (TBEV) infections are asymptomatic, but it remains difficult to ascertain the proportion who are asymptomatic due to underdiagnosis. It is estimated that 1 in 3 of infected persons develop symptoms for TBE. The incubation period of TBE is usually 7–14 days (range: 2–28 days), with a shorter incubation period of 3–4 days reported for alimentary transmission. Case-fatality rates of greater than 20% are reported, although the severity of the disease appears to be associated with the viral subtype involved: ≥20% for the Far-Eastern subtype, 6–8% for the Siberian subtype, 1–2% for the European subtype. In ≤40% of encephalitic cases, the disease results in permanent central nervous system (CNS) sequelae, including various neuropsychiatric and cognitive complaints characteristic of postencephalitic syndrome. In fatal cases, characteristic neuropathological changes include polioencephalomyelitis.

• #3 Clinical Signs and Symptoms of Tick-borne Encephalitis | Tick-borne Encephalitis Virus | CDC

  https://www.cdc.gov/tick-borne-encephalitis/hcp/clinical-signs/index.html

  Tick-borne encephalitis (TBE) can present as an acute febrile illness or neuroinvasive disease, with varying degrees of severity depending on viral subtype and patient risk factors. […] TBE can present as a biphasic illness, particularly with the European subtype of the virus. […] Acute neuroinvasive disease (i.e., aseptic meningitis, encephalitis, or meningoencephalomyelitis) is the most commonly recognized clinical manifestation of TBE virus infection. Milder forms of the disease (e.g., febrile illness) also occur. […] TBE can present as a biphasic illness, particularly with the European subtype of the virus, as follows: First phase: a nonspecific febrile illness that might be accompanied by symptoms such as headache, malaise, myalgia, anorexia, nausea, and/or vomiting. This phase usually lasts for several days and is followed by an afebrile and relatively asymptomatic period, typically of about one week’s duration.

• #3 Clinical Signs and Symptoms of Tick-borne Encephalitis | Tick-borne Encephalitis Virus | CDC

  https://www.cdc.gov/tick-borne-encephalitis/hcp/clinical-signs/index.html

  Second phase: a clinical illness with central nervous system involvement. Depending on specific presentation, findings can include meningeal signs, altered mental status, cognitive dysfunction, ataxia, rigidity, seizures, tremors, cranial nerve palsies, and limb paresis. […] Infections with the Far Eastern TBE virus subtype are generally more severe than infections with the other two subtypes. […] Disease severity is highest in older persons. […] The case fatality and frequency of neurologic sequelae vary by viral subtype. With the European subtype, the case fatality is about 12%, with the Siberian subtype about 68%, and with the Far Eastern subtype about 20%. Frequencies of sequelae ranging from 10-50% have been reported from different areas. Chronic and progressive forms of disease have been reported, particularly after infection with the Siberian subtype.

• #3 Tick-Borne Encephalitis: Symptoms, Treatment, Prevention, Outlook

  https://www.healthline.com/health/tick-borne-encephalitis

  Serious symptoms can include: stiff neck, severe headache, sensitivity to lights or sounds, drowsiness, altered mental status, confusion, slurred speech, seizures, tremors, loss of movement in part of the body. […] Most people with TBE will recover. But, up to one-third of people with TBE may experience long-term complications. […] Long-term complications can include: cognitive disorders, memory and concentration disorders, vision, balance, and coordination disorders, hearing loss or tinnitus, paralysis. […] The risk of incomplete recovery is higher for people with more severe disease during the initial phase of TBE. Also, research suggests adults older than 60 have a higher risk of more severe disease.

• #3 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  In total, 56 (10.1%) patients had pareses of extremities, of whom 41 (7.4%) had peripheral pareses of extremities, 13 (2.3%) central pareses of extremities, and 2 had unknown peripheral or central pareses of extremities. A detailed distribution of pareses of extremities is shown in Table 2. Twenty-five (4.5%) patients had cranial nerve palsy. Nineteen of them had a single cranial nerve palsy, and six had multiple cranial nerve palsies. […] We recorded the outcome at the discharge of 298 patients; 117 (39%) had a complete recovery, 176 (59%) an incomplete recovery, and 5 (2%) died. Symptoms and signs of 121 patients discharged with incomplete recovery were recorded; 36 (30%) had mild subjective symptoms, 28 (23%) had severe subjective symptoms, and 57 (47%) had objective signs, of whom 25 (20.5%) had one objective sign, 25 (20.5%) had two objective signs, and 7 (6%) had three or more objective signs. Headache (93% of patients) was a predominant subjective symptom, followed by decreased concentration (47%). Objective signs included tremor (31%), ataxia (22%), and pareses of extremities (16%).

• #3 Tick-borne encephalitis virus: Infectious substances pathogen safety data sheet – Canada.ca

  https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/tick-borne-encephalitis-virus.html

  TBEV-FE tends to cause more severe disease; the mortality rate is estimated to be 5-40%Footnote 9,Footnote 10 and up to 60% of recovered patients have neurologic sequelaeFootnote 2. […] Mortality rates are estimated to be 6-8% for TBEV-Sib, and 1-2% for TBEV-EuFootnote 2,Footnote 5. […] Fatalities are rare in childrenFootnote 5,Footnote 7.

• #3

  https://www.gov.uk/guidance/tick-borne-encephalitis-epidemiology-diagnosis-and-prevention

  The European subtype is associated with milder disease, with 20 to 30% of patients experiencing the second phase, severe neurological sequelae in up to 10% of patients, and an overall mortality of 0.5 to 2%. In children, the second phase of illness is usually limited to meningitis, while adults older than 40 years are at increased risk of developing encephalitis. There is a higher likelihood of long-lasting sequelae, and a higher mortality, in those over the age of 60 years, the immunocompromised, or those with significant co-morbidities.

• #3 TBE patients’ lasting problems | University of Gothenburg

  https://www.gu.se/en/news/tbe-patients-lasting-problems

  Impaired memory, reduced motivation, and declining motor skills. These are some of the problems that may persist several years after people contract tick-borne encephalitis, a University of Gothenburg thesis shows. […] Ninety-two former TBE patients were interviewed in median five and a half years after contracting the disease. It emerged that the interviewees had significantly more problems in terms of memory, concentration, initiative, and motivation than a control group. Other difficulties were those caused by persistent impairment of their fine motor skills, balance, and coordination, and headaches. […] Fatigue, another significant problem, was studied through polysomnography in 22 previous TBE patients and 20 controls. Despite equivalent sleep patterns and similar proportions of people with sleep apnea, the former TBE patients suffered from more fatigue and greater impact on daily life. […] Of those who are of working age, many find it difficult to work. They cant concentrate, their multitasking ability has decreased, they dont get started on tasks, and they get extremely tired. Whats more, a lot of them have motor problems to do with balance and fine motor function.

• #3 Tick-borne encephalitis – Wikipedia

  https://en.wikipedia.org/wiki/Tick-borne_encephalitis

  Sequelae persist for a year or more in approximately one third of people who develop neurological disease. The most common long-term symptoms are headache, concentration difficulties, memory impairment and other symptoms of cognitive dysfunction. […] Mortality depends on the subtype of the virus. For the European subtype mortality rates are 0.5% to 2% for people who develop neurological disease.

• #4 Tick-borne encephalitis (FSME/TBE) – Vaccinatiecentrum.nl

  https://www.vaccinatiecentrum.nl/en/tick-borne-encephalitis-fsme-tbe/

  Stage 2 may include the following common symptoms: (High) fever; Severe headache; Impaired movement (ataxia); Muscle and joint pain; Intolerance to light; Paralysis and nerve damage; Reduced consciousness, drowsiness and disorientation; Cognitive impairment; Sleep disorders; Hearing problems; Swallowing and speech problems; Vision problems; Cramping; Vertigo; Nausea and vomiting; Abdominal pain, constipation and diarrhoea; Trembling of the arms and legs; Neck pain and stiffness; Imbalance; Personality and behavioural changes; sensory overload; Fatigue; Emotional lability, anxiety and depression; Autonomic dysregulation; In rare cases epilepsy, seizures and coma. […] Men and people aged over 50 are at higher risk of becoming seriously ill.

• #4 Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE): A European Multicentre Study from 2010 to 2017

  https://www.mdpi.com/2076-2607/9/7/1420

  In total, 56 (10.1%) patients had pareses of extremities, of whom 41 (7.4%) had peripheral pareses of extremities, 13 (2.3%) central pareses of extremities, and 2 had unknown peripheral or central pareses of extremities. A detailed distribution of pareses of extremities is shown in Table 2. Twenty-five (4.5%) patients had cranial nerve palsy. Nineteen of them had a single cranial nerve palsy, and six had multiple cranial nerve palsies. […] We recorded the outcome at the discharge of 298 patients; 117 (39%) had a complete recovery, 176 (59%) an incomplete recovery, and 5 (2%) died. Symptoms and signs of 121 patients discharged with incomplete recovery were recorded; 36 (30%) had mild subjective symptoms, 28 (23%) had severe subjective symptoms, and 57 (47%) had objective signs, of whom 25 (20.5%) had one objective sign, 25 (20.5%) had two objective signs, and 7 (6%) had three or more objective signs. Headache (93% of patients) was a predominant subjective symptom, followed by decreased concentration (47%). Objective signs included tremor (31%), ataxia (22%), and pareses of extremities (16%).

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