Gulin Jana, Neudauer Lučka Marija, Kejžar Nataša, Bajrović Fajko F, Collinet-Adler Stefan, Stupica Daša
Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
J Clin Med. 2024 Dec 25;14(1):45. doi: 10.3390/jcm14010045.
: In Slovenia, patients with suspected tick-borne encephalitis (TBE) were historically referred to infectious diseases (ID), but during the COVID-19 pandemic, there were increased referrals to neurology. This study compared the clinical management of TBE patients between ID specialists and neurologists and assessed patients' outcomes. : We retrospectively reviewed the clinical, laboratory, and imaging data of 318 adult patients with TBE managed by ID (n = 256; 80.5%) and neurology (n = 62; 19.5%) at a tertiary centre in Slovenia between March 2020 and September 2022 to explore variations in diagnostic and therapeutic approaches by specialty and to assess the severity and outcome of acute illness. : Patients referred to ID or neurology did not differ regarding their basic demographic and epidemiologic characteristics or basic laboratory parameters. However, patients referred to neurology more often presented with severe illness, including impaired consciousness and/or focal neurological signs (72.6% vs. 55.5%; < 0.001). ID specialists used head imaging before lumbar puncture (6.6% vs. 64.5%; < 0.001), performed microbiological tests other than for TBE (16.0% vs. 51.6%; < 0.001), and empirically prescribed antimicrobials less often than neurology (5.1% vs. 22.6%; < 0.001). When adjusting for age, sex, comorbidities, vaccination status, and the severity of acute illness, clinical outcomes were similar between the two groups of patients, but those with more severe acute illness had higher odds for incomplete recovery. : Differences in clinical presentation between ID and neurology referrals could only partially explain the narrower diagnostic and therapeutic approach used by ID, which, given the study design, was not associated with adverse outcomes. Additionally, in patients with clinical characteristics suggestive of TBE in endemic areas, tremor in the absence of other focal neurological signs or impaired consciousness may not necessitate head imaging before lumbar puncture. Future prospective studies could help to optimise the management of this clinical syndrome.
在斯洛文尼亚，疑似蜱传脑炎（TBE）的患者以往被转诊至传染病科（ID），但在新冠疫情期间，转诊至神经科的患者有所增加。本研究比较了ID专科医生和神经科医生对TBE患者的临床管理情况，并评估了患者的预后。我们回顾性分析了2020年3月至2022年9月期间在斯洛文尼亚一家三级中心由ID（n = 256；80.5%）和神经科（n = 62；19.5%）管理的318例成年TBE患者的临床、实验室和影像学数据，以探讨不同专科在诊断和治疗方法上的差异，并评估急性疾病的严重程度和预后。转诊至ID或神经科的患者在基本人口统计学和流行病学特征或基本实验室参数方面并无差异。然而，转诊至神经科的患者更常表现为重症疾病，包括意识障碍和/或局灶性神经体征（72.6%对55.5%；<0.001）。ID专科医生在腰椎穿刺前进行头部影像学检查的比例较低（6.6%对64.5%；<0.001），进行除TBE之外的微生物学检查的比例较低（16.0%对51.6%；<0.001），经验性使用抗菌药物的比例也低于神经科（5.1%对22.6%；<0.001）。在对年龄、性别、合并症、疫苗接种状况和急性疾病严重程度进行校正后，两组患者的临床结局相似，但急性疾病较严重的患者不完全恢复的几率更高。ID和神经科转诊患者在临床表现上的差异只能部分解释ID采用的诊断和治疗方法较为局限的原因，鉴于研究设计，这与不良结局并无关联。此外，在流行地区具有提示TBE临床特征的患者中，在没有其他局灶性神经体征或意识障碍的情况下出现震颤，可能无需在腰椎穿刺前进行头部影像学检查。未来的前瞻性研究可能有助于优化这种临床综合征的管理。
