Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital Huddinge, Sweden.
Pediatr Infect Dis J. 2012 Jun;31(6):570-4. doi: 10.1097/INF.0b013e31824f23c0.
Neurologic sequelae, including cognitive deficits, after childhood tick-borne encephalitis (TBE) and neuroborreliosis (NB) are not well-characterized. These infections are among the most common affecting the central nervous system in children and can be difficult to diagnose due to vague symptomatology. The aim of this study was to investigate long-term (>1 year) consequences of pediatric TBE and NB as well as the value of markers for brain damage and genetic susceptibility.
From a previous prospective study, children diagnosed with TBE (n = 8) and NB (n = 12) as well as pediatric controls (n = 15) were followed up by clinical examination, semistructured interview and screening for cognitive dysfunction by the Five-to-Fifteen Questionnaire. The follow-up also included detection of serum autoantibodies against the neural proteins; glial fibrillary acidic protein and myelin basic protein, as well as genotyping of a 32 basepair deletion in the chemokine receptor type 5 gene.
Children diagnosed with TBE displayed significantly more long-term subjective complaints (ie, fatigue, headache and irritability) compared with the NB and control groups. Significantly higher frequency of disabilities was also detected by the Five-to-Fifteen Questionnaire in the TBE group. Both TBE and NB cause consequences (eg, prolonged convalescence, worries and financial loss) for the families. Markers for genetic susceptibility and brain damage had no prognostic values in this cohort.
Pediatric TBE results in long-lasting residual symptoms and neurologic deficits affecting daily life. Vigilance for TBE-related morbidity among pediatricians and long-term clinical follow-up with assessment of cognitive dysfunctions and appropriate interventions seems reasonable for these children.
儿童感染 tick-borne encephalitis（TBE）和 neuroborreliosis（NB）后可能出现神经后遗症，包括认知障碍，但这些后遗症的特征尚未完全明确。这两种感染是儿童中枢神经系统最常见的感染之一，由于症状模糊，诊断较为困难。本研究旨在调查儿童 TBE 和 NB 的长期（>1 年）后果，以及脑损伤标志物和遗传易感性的价值。
在一项前瞻性研究中，对诊断为 TBE（n=8）和 NB（n=12）的儿童以及儿科对照者（n=15）进行了临床检查、半结构化访谈和 Five-to-Fifteen Questionnaire 认知障碍筛查。随访还包括检测针对神经蛋白的血清自身抗体；神经胶质纤维酸性蛋白和髓鞘碱性蛋白，以及趋化因子受体 5 基因 32 个碱基缺失的基因分型。
与 NB 和对照组相比，诊断为 TBE 的儿童表现出明显更多的长期主观症状（即疲劳、头痛和易怒）。TBE 组通过 Five-to-Fifteen Questionnaire 还检测到明显更高的残疾频率。TBE 和 NB 都会给家庭带来后果（如康复时间延长、担忧和经济损失）。本队列中，遗传易感性和脑损伤标志物没有预后价值。
儿童 TBE 会导致长期持续的残留症状和影响日常生活的神经功能缺陷。儿科医生应警惕 TBE 相关发病率，并对这些儿童进行长期临床随访，评估认知功能障碍并进行适当干预，这似乎是合理的。
