Abstract
Tick-borne encephalitis (TBE) and neuroborreliosis (NB) are well-known central nervous system (CNS) infections in children. Childhood tick-borne CNS infections are generally described as mild conditions. However, this view has recently been challenged, and the natural course, including potential sequelae, has been debated. If the diseases present with nonspecific symptoms and signs, some children may elude diagnosis. This study estimates the incidence of symptomatic tick-borne CNS infections in children under medical care and describes the spectrum of manifestations. One hundred twenty-four children with neurologic symptoms attending the Pediatric Emergency Department were included prospectively. Anti-TBE virus and anti-Borrelia serology results were analyzed together with inflammatory parameters in the blood and cerebrospinal fluid. Nearly one fourth of the children with neurologic symptoms were diagnosed with a tick-borne CNS infection (TBE, n = 10 [8%] and NB, n = 21 [16.8%]). In general, these children displayed an indistinct medical history and presented with nonspecific signs such as malaise/fatigue and headache. Diagnosis was based on analysis of acute and convalescent sera. Blood inflammatory parameters were nonspecific and did not contribute to the diagnostics. Conclusion: Pediatric tick-borne CNS infections are unexpectedly common and should be considered in children with unspecific and unexplained acute CNS-related symptoms.
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Arnez M, Avsic-Zupanc T (2009) Tick-borne encephalitis in children: an update on epidemiology and diagnosis. Expert Rev Anti Infect Ther 7(10):1251–1260. doi:10.1586/eri.09.99
Bogovic P, Lotric-Furlan S, Strle F (2010) What tick-borne encephalitis may look like: clinical signs and symptoms. Travel Med Infect Dis 8(4):246–250. doi:10.1016/j.tmaid.2010.05.011
Broekhuijsen-van Henten DM, Braun KP, Wolfs TF (2010) Clinical presentation of childhood neuroborreliosis; neurological examination may be normal. Arch Dis Child. doi:10.1136/adc.2009.176529
Christen HJ (1996) Lyme neuroborreliosis in children. Ann Med 28(3):235–240
Danielova V, Rudenko N, Daniel M, Holubova J, Materna J, Golovchenko M, Schwarzova L (2006) Extension of Ixodes ricinus ticks and agents of tick-borne diseases to mountain areas in the Czech Republic. Int J Med Microbiol 296(Suppl 40):48–53. doi:10.1016/j.ijmm.2006.02.007
Fritsch P, Gruber-Sedlmayr U, Pansi H, Zohrer B, Mutz I, Spork D, Zenz W (2008) Tick-borne encephalitis in Styrian children from 1981 to 2005: a retrospective study and a review of the literature. Acta Paediatr 97(5):535–538. doi:10.1111/j.1651-2227.2008.00763.x
Gunther G, Haglund M, Lindquist L, Skoldenberg B, Forsgren M (1997) Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long-term follow-up related to clinical course and outcome. Clin Diagn Virol 8(1):17–29
Hansson ME, Orvell C, Engman ML, Wide K, Lindquist L, Lidefelt KJ, Sundin M (2011) Tick-borne encephalitis in childhood: rare or missed? Pediatr Infect Dis J 30(4):355–357. doi:10.1097/INF.0b013e3181fe3b5a00006454-201104000-00021
Heinz FX, Holzmann H, Essl A, Kundi M (2007) Field effectiveness of vaccination against tick-borne encephalitis. Vaccine 25(43):7559–7567. doi:10.1016/j.vaccine.2007.08.024
Henningsson AJ, Malmvall BE, Ernerudh J, Matussek A, Forsberg P (2010) Neuroborreliosis—an epidemiological, clinical and healthcare cost study from an endemic area in the south-east of Sweden. Clin Microbiol Infect 16(8):1245–1251. doi:10.1111/j.1469-0691.2009.03059.x
Kaiser R (1999) The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994–98: a prospective study of 656 patients. Brain 122(Pt 11):2067–2078
Kunze U (2010) Tick-borne encephalitis: from childhood to golden age does increased mobility mean increased risk? Conference report of the 11th meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE). Vaccine 28(4):875–876. doi:10.1016/j.vaccine.2009.11.032
Lesnicar G, Poljak M, Seme K, Lesnicar J (2003) Pediatric tick-borne encephalitis in 371 cases from an endemic region in Slovenia, 1959 to 2000. Pediatr Infect Dis J 22(7):612–617. doi:10.1097/01.inf.0000073202.39700.a0
Lindquist L (2008) Tick-borne encephalitis (TBE) in childhood. Acta Paediatr 97(5):532–534. doi:10.1111/j.1651-2227.2008.00761.x
Lindquist L, Vapalahti O (2008) Tick-borne encephalitis. Lancet 371(9627):1861–1871. doi:10.1016/S0140-6736(08)60800-4
Logar M, Arnez M, Kolbl J, Avsic-Zupanc T, Strle F (2000) Comparison of the epidemiological and clinical features of tick-borne encephalitis in children and adults. Infection 28(2):74–77
Meyer PM, Zimmermann H, Goetschel P (2010) Tick-borne encephalitis presenting as fever without localising signs—a case series. Eur J Pediatr 169(6):767–769. doi:10.1007/s00431-009-1097-7
Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I (2010) EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 17(1):8–16. doi:10.1111/j.1468-1331.2009.02862.x, e11-14
Oymar K, Tveitnes D (2009) Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe. Scand J Infect Dis 41(2):88–94. doi:10.1080/00365540802593453
Parola P, Raoult D (2001) Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis 32(6):897–928. doi:10.1086/319347
Schmolck H, Maritz E, Kletzin I, Korinthenberg R (2005) Neurologic, neuropsychologic, and electroencephalographic findings after European tick-borne encephalitis in children. J Child Neurol 20(6):500–508
Skogman BH, Croner S, Nordwall M, Eknefelt M, Ernerudh J, Forsberg P (2008) Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatr Infect Dis J 27(12):1089–1094. doi:10.1097/INF.0b013e31817fd423
Stanek G, Strle F (2009) Lyme borreliosis: a European perspective on diagnosis and clinical management. Curr Opin Infect Dis 22(5):450–454. doi:10.1097/QCO.0b013e32832ee880
Suss J (2003) Epidemiology and ecology of TBE relevant to the production of effective vaccines. Vaccine 21(Suppl 1):S19–S35
Suss J (2008) Tick-borne encephalitis in Europe and beyond—the epidemiological situation as of 2007. Euro Surveill 13(26)
Zenz W, Pansi H, Zoehrer B, Mutz I, Holzmann H, Kraigher A, Berghold A, Spork D (2005) Tick-borne encephalitis in children in Styria and Slovenia between 1980 and 2003. Pediatr Infect Dis J 24(10):892–896
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This study was supported with unrestricted grants by Karolinska Institutet, the Stockholm County Council, and the Swedish Association of Persons with Neurological Disabilities.
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Sundin, M., Hansson, M.E.A., Engman, ML. et al. Pediatric tick-borne infections of the central nervous system in an endemic region of Sweden: a prospective evaluation of clinical manifestations. Eur J Pediatr 171, 347–352 (2012). https://doi.org/10.1007/s00431-011-1542-2
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DOI: https://doi.org/10.1007/s00431-011-1542-2