Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Eur J Neurol. 2017 Oct;24(10):1214-e61. doi: 10.1111/ene.13356. Epub 2017 Aug 1.
Tick-borne encephalitis (TBE) is an infection of the central nervous system (CNS) caused by tick-borne encephalitis virus (TBEV) and transmitted by ticks, with a variety of clinical manifestations. The incidence of TBE in Europe is increasing due to an extended season of the infection and the enlargement of endemic areas. Our objectives are to provide recommendations on the prevention, diagnosis and management of TBE, based on evidence or consensus decisions.
For systematic evaluation, the literature was searched from 1970 to 2015 (including early online publications of 2016), and recommendations were based on evidence or consensus decisions of the Task Force when evidence-based data were not available.
Vaccination against TBE is recommended for all age groups above 1 year in highly endemic areas (≥5 cases/100 000/year), but also for individuals at risk in areas with a lower incidence. Travellers to endemic areas should be vaccinated if their visits will include extensive outdoor activities. Post-exposure prophylaxis after a tick bite is not recommended. A case of TBE is defined by the presence of clinical signs of meningitis, meningoencephalitis or meningoencephalomyelitis with cerebrospinal fluid (CSF) pleocytosis (>5 × 10 cells/l) and the presence of specific TBEV serum immunoglobulin M (IgM) and IgG antibodies, CSF IgM antibodies or TBEV IgG seroconversion. TBEV-specific polymerase chain reaction in blood is diagnostic in the first viremic phase but it is not sensitive in the second phase of TBE with clinical manifestations of CNS inflammation. Lumbar puncture should be performed in all patients with suspected CNS infection unless there are contraindications. Imaging of the brain and spinal cord has a low sensitivity and a low specificity, but it is useful for differential diagnosis. No effective antiviral or immunomodulating therapy is available for TBE; therefore the treatment is symptomatic. Patients with a potentially life threatening meningoencephalitis or meningoencephalomyelitis should be admitted to an intensive care unit. In the case of brain oedema, analgosedation should be deepened; osmotherapy and corticosteroids are not routinely recommended. If intracranial pressure is increased, therapeutic hypothermia or decompressive craniectomy might be considered. Seizures should be treated as any other symptomatic epileptic seizures.
Tick-borne encephalitis is a viral CNS infection that may result in long-term neurological sequelae. Since its incidence in Europe is increasing due to broadening of endemic areas and prolongation of the tick activity season, the health burden of TBE is enlarging. There is no effective antiviral treatment for TBE, but the disease may be effectively prevented by vaccination.
由蜱传播的脑炎病毒（TBEV）引起的中枢神经系统（CNS）感染即为蜱传脑炎（TBE），其临床表现多样。由于感染季节延长和流行地区扩大，欧洲 TBE 的发病率正在上升。我们的目标是根据证据或专家组的共识决定，就 TBE 的预防、诊断和管理提供建议。
为了进行系统评价，从 1970 年到 2015 年（包括 2016 年早期在线出版物）检索文献，当没有基于证据的数据时，建议基于专家组的证据或共识决定。
高度流行地区（≥5 例/100000/年）的所有 1 岁以上年龄组，以及发病率较低地区的高危个体，均推荐接种 TBE 疫苗。前往流行地区的旅行者如果要进行广泛的户外活动，应接种疫苗。不建议在蜱叮咬后进行暴露后预防。TBE 的确诊病例定义为出现脑膜炎、脑膜脑炎或脑膜脊髓炎的临床体征，伴有脑脊液（CSF）白细胞增多（>5×10 个细胞/l），以及存在特异性 TBEV 血清免疫球蛋白 M（IgM）和 IgG 抗体、CSF IgM 抗体或 TBEV IgG 血清转换。TBEV 特异性聚合酶链反应在血液中具有诊断价值，可用于病毒血症的第一阶段，但在表现为中枢神经系统炎症的 TBE 第二阶段不敏感。除非有禁忌证，否则应在所有疑似中枢神经系统感染的患者中进行腰椎穿刺。脑和脊髓成像的敏感性和特异性均较低，但对鉴别诊断有用。目前尚无有效的抗病毒或免疫调节治疗方法，因此治疗是对症的。有生命危险的脑膜脑炎或脑膜脊髓炎患者应入住重症监护病房。如果出现脑水肿，应加深镇痛镇静；不常规推荐使用渗透压治疗和皮质类固醇。如果颅内压升高，可考虑使用治疗性低温或去骨瓣减压术。癫痫发作应按任何其他症状性癫痫发作进行治疗。
TBE 是一种病毒性中枢神经系统感染，可能导致长期的神经后遗症。由于流行地区的扩大和蜱活动季节的延长，欧洲 TBE 的发病率正在上升，因此 TBE 的健康负担正在增加。目前尚无有效的 TBE 抗病毒治疗方法，但可通过疫苗接种有效预防该病。
