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Tick-borne encephalitis in Sweden in relation to aseptic meningo-encephalitis of other etiology: a prospective study of clinical course and outcome

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Abstract

A total of 149 patients with clinical symptoms of acute viral meningo-encephalitis were enrolled in this study from June 1991 to December 1993. Tick-borne encephalitis (TBE) was diagnosed in 85 of the 149 patients (males 54%, median age 42 years (range 15–78)). The initial clinical appearance of TBE was classified as mild (mainly meningeal; (n = 47), moderate (n = 31) or severe (n = 7), more or less encephalitic. The most common acute symptoms of encephalitis were ataxia (26%), altered consciousness (20%), decreased concentration or memory (9%), irritable response to light and sound (28%), tremor (9%) and dysphasia (9%). Spinal nerve paralysis (11%) occurred in all three clinical stages and did not correlate with the severity or duration of encephalitis. The duration of hospitalisation, the time on the sick-list and the time to recovery were significantly longer in TBE patients. All patients survived, but many patients with TBE suffered an extended period of neurological dysfunction. Of patients with TBE 80% (68/85) showed persisting symptoms of CNS dysfunction on follow-up at week 6, compared with 55% (35/64) of the patients with aseptic meningitis of other aetiology. The corresponding figures after 1 year were 40% (33/83) and 20% (13/ 64). One year after TBE 13 (28%) patients with initially mild, meningeal symptoms had decreased memory and decreased concentration capacity, dysphasia or ataxia. Spinal nerve paralysis persisted after 1 year in 5 of 9 patients with TBE. In conclusion, TBE in Sweden is associated with a significant morbidity and a post-TBE syndrome existed after 1 year in more than one third of the patients.

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References

  1. Aurelius E, Johansson B, Sköldenberg B, Forsgren M (1991) Encephalitis in immunocompetent patients due to herpes simplex virus type 1 or 2 as determined by PCR or type-specific antibody assays of cerebrospinal fluid. J Med Virol 27: 591–594

    Google Scholar 

  2. Aurelius E, Johansson B, Sköldenberg B, Staland Å, Forsgren M (1991) Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet 337: 189–192

    Article  CAS  Google Scholar 

  3. .Bednar B (1961) Tick-borne encephalitis with a protracted course. In: Bogaert L van, et al (eds) Encephalitides. Elsevier, Amsterdam, pp 17–22

    Google Scholar 

  4. Casas I, Powell L, Klapper PE, Cleator GM (1995) New method for the extraction of viral RNA and DNA from cerebrospinal fluid for use in the polymerase chain reaction assay. J Virol Methods 53: 25–36

    Article  CAS  Google Scholar 

  5. Fingerland A, Vortel V (1961) Tick encephalitis. In: Bogaert L van, et al (eds) Encephalitides. Elsevier, Amsterdam, pp 23–32

    Google Scholar 

  6. Forsgren M, Skoog E, Jeansson S, Olofsson S, Giesecke J (1994) Prevalence of antibodies to herpes simplex virus in pregnant women in Stockholm 1969, 1983 and 1989: implications for STD epidemiology. Int J STD AIDS 5: 113–116

    Article  CAS  Google Scholar 

  7. Glimåker M, Abebe A, Johansson B, Ehrnst A, Strannegård Ö (1992) Detection of enteroviral RNA by polymerase chain reaction in faecal samples from patients with aseptic meningitis. J Med Virol 38: 54–61

    Article  Google Scholar 

  8. Glimåker M, Johanssson B, Olcén P, Ehrnst A, Forsgren M (1993) Detection of enteroviral RNA by polymerase chain reaction in cerebrospinal fluid from patients with aseptic meningitis. Scand J Infect Dis 25: 547–557

    Article  Google Scholar 

  9. Grinschgl W, Kovac W, Seitelberger F (1961) Spring-summer-Encephalomye-litis in Austria. In: Bogaert L van, et al (eds) Encephalitides. Elsevier, Amsterdam, pp 3–16

    Google Scholar 

  10. Günther G, Haglund M, Lindquist L, Sköldenberg B, Forsgren M (1996) Intrathecal production of neopterin and β-2 microglobulin in tick-borne encephalitis (TBE) compared to meningoencephalitis of other etiology. Scand J Infect Dis 28: 131–138

    Article  Google Scholar 

  11. Gustafson R, Svenungsson B, Gardulf A, Stiernstedt G, Forsgren M (1990) Prevalence of tick-borne encephalitis and Lyme borreliosis in a defined Swedish population. Scand J Infect dis 22: 297–306

    Article  CAS  Google Scholar 

  12. Haglund M, Forsgren M, Lindh G, Lindquist L (1996) A 10-year follow-up study of tick-borne encephalitis in the Stockholm area and a review of the literature: need for a vaccination strategy. Scand J Infect Dis 28: 217–224

    Article  CAS  Google Scholar 

  13. Heinz F, Mandl C (1993) The molecular biology of tick-borne encephalitis virus. APMIS 101: 735–745

    Article  CAS  Google Scholar 

  14. Heinz F, Roggendorf M, Hofmann H, Kunz C, Deinhardt F (1981) Comparison of two different enzyme immunoassays for detection of immunoglobulin M antibodies against tick-borne encephalitis virus in serum and cerebrospinal fluid. J Clin Microbiol 14: 141–145

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Holmgren B, Forsgren M (1990) Epidemiology of tick-borne encephalitis in Sweden 1956–1989: a study of 1116 cases. Scand J Infect 22: 287–295

    Article  CAS  Google Scholar 

  16. Holmgren B, Lindahl J, Zeipel G von, Svedmyr A (1959) Tick-borne meningoencephalomyelitis in Sweden. Acta Med Scand 164: 507–522

    Article  CAS  Google Scholar 

  17. Jellinger K (1979) The histopathology of tick-borne encephalitis. In: Kunz C (ed) Tick-borne encephalitis. International symposium, Baden, Vienna, 19–20 October. Facultas, Vienna, pp 59–75

    Google Scholar 

  18. Kaiser R (1995) Tick-borne encephalitis in southern Germany. Lancet 445: 463

    Article  Google Scholar 

  19. Köhler H (1982) FSME-Combiquick-Reagenziensatz für die Diagnose der Frühsommer-Meningoenzephalitis. Labor Med 5: 449–450

    Google Scholar 

  20. KunzC (1992) Tick-borne encephalitis in Europe. Acta Leiden 2: 1–14

    Google Scholar 

  21. Mandl CW, Heinz FX, Stöckl E, Kunz C (1989) Genome sequence of tick-borne encephalitis virus (Western Subtype) and comparative analysis of non-structural proteins with other flaviviruses. Virology 173: 291–301

    Article  CAS  Google Scholar 

  22. Osetowska E (1970) Tick-borne encephalitides. In: Debre R, Celers J (eds) Clinical virology. The evaluation and management of human viral infections. Saunders, Philadelphia, pp 182–193

    Google Scholar 

  23. Pletnev AG, Yamshchikov VF, Blinov VM (1990) Nucleotide sequence of the genome and complete amino acid sequence of the polyprotein of tick-borne encephalitis virus. Virology 174: 250–263

    Article  CAS  Google Scholar 

  24. Puchhammer-Stockl E, Kunz C, Mandl CW, Heinz FX (1995) Identification of tick-borne encephalitis virus ribonucleid acid in tick suspensions and in clinical specimens by a reverse transcription-nested polymerase chain reaction assay. Clin Diagn Virol 4: 321–326

    Article  CAS  Google Scholar 

  25. Radsel-Medvescek A, Marolt-Gomiscek M, Povse-Trojar M, Gajsek-Zima M, Cvetko B (1980) Late sequelae after tick-borne meningoencephalitis in patients treated at the Hospital for Infectious Diseases, University Medical Centre of Ljubljana during the period 1974–1975. In: Vesenjak-Hirjan J, et al (eds) Arboviruses in the Mediterranean countries, Zbl. Bakt [Suppl 9]. Fischer, Stuttgart, pp 281–284

    Google Scholar 

  26. Samuelsson A, Skoog E, Forsgren M (1990) Aspects on the serodiagnosis of enterovirus infections by ELISA. Serodiagn Immunother Infect Dis 4: 395–406

    Article  Google Scholar 

  27. Sköldenberg B (1991) Herpes simplex encephalitis. Scand J Infect Dis 78: 40–46

    Google Scholar 

  28. Stiernstedt G, Granström M, Hederstedt B, Sköldenberg B (1985) Diagnosis of spirochetal meningitis by means of enzyme-linked immunosorbent assay and indirect immunofluorescence assay in serum and cerebrospinal fluid. J Clin Microbiol 21: 819–825

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Svedmyr A, Zeipel G von, Holmgren B, Lindahl J (1958) Tick-borne meningoencephalomyelitis in Sweden. Arch Virusforsch 8: 565–576

    Article  Google Scholar 

  30. Tibbling G, Link H, Öhman S (1977) Principles of albumin and IgG analysis in neurological disorders. I. Establishment of reference values. Scand J Clin Lab Invest 37: 385–390

    Article  CAS  Google Scholar 

  31. Wahlberg P, Saukku P, Brummer-Korvenkontio M (1989) Tick-borne viral encephalitis in Finland. The clinical features of Kumlinge disease during 1959–1987. J Intern Med 225: 173–177

    Article  CAS  Google Scholar 

  32. Zeipel G von (1959) Isolation of viruses of the Russian spring-summer encephalitis-louping ill group from Swedish ticks and from a human case of meningoencephalitis. Arch Virusforsch 9: 460–469

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases, Karolinska Institute at Danderyd Hospital, S-18288, Danderyd, Sweden

    Göran Günther & Birgit Sköldenberg

  2. Department of Infectious Diseases, Karolinska Institute at Huddinge Hospital, I 73, S-14186, Huddinge, Sweden

    Mats Haglund & Lars Lindquist

  3. Department of Clinical Virology, Karolinska Institute at Huddinge Hospital, F 68, S-14186, Huddinge, Sweden

    Marianne Forsgren

Authors
  1. Göran Günther
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  2. Mats Haglund
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  3. Lars Lindquist
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  4. Marianne Forsgren
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  5. Birgit Sköldenberg
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Günther, G., Haglund, M., Lindquist, L. et al. Tick-borne encephalitis in Sweden in relation to aseptic meningo-encephalitis of other etiology: a prospective study of clinical course and outcome. J Neurol 244, 230–238 (1997). https://doi.org/10.1007/s004150050077

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  • DOI: https://doi.org/10.1007/s004150050077

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