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Zhang H, Wang Y, Chen C, Xing W, Xia W, Fu W, Liu A, Zhang C, Guan Q, Zhao Y, Sun G, Lu D, Dong Z, Li Z, Zhou Y, Zhang S, Du Y, Zheng C, Xu D. A novel rapid visual nucleic acid detection technique for tick-borne encephalitis virus by combining RT-recombinase-aided amplification and CRISPR/Cas13a coupled with a lateral flow dipstick. Int J Biol Macromol 2024; 275:133720. [PMID: 38987000 DOI: 10.1016/j.ijbiomac.2024.133720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
Tick-borne encephalitis virus (TBEV), a zoonotic pathogen, can cause severe neurological complications and fatal outcomes in humans. Early diagnosis of TBEV infection is crucial for clinical practice. Although serological assays are frequently employed for detection, the lack of antibodies in the early stages of infection and the cross-reactivity of antibodies limit their efficacy. Conventional molecular diagnostic methods such as RT-qPCR can achieve early and accurate identification but require specialized instrumentation and professionals, hindering their application in resource-limited areas. Our study developed a rapid and visual TBEV molecular detection method by combining RT-recombinase-aided amplification, the CRISPR/Cas13a system, and lateral flow dipsticks. The diagnostic sensitivity of this method is 50 CFU/ml, with no cross-reactivity with a variety of viruses. The detection can be carried out within 1 h at a temperature between 37 and 42 °C, and the results can be visually determined without the need for complex instruments and professionals. Subsequently, this assay was used to analyze clinical samples from 15 patients suspected of TBEV infection and 10 healthy volunteers, and its sensitivity and specificity reached 100 %, which was consistent with the results of RT-qPCR. These results indicate that this new method can be a promising point-of-care test for the diagnosis of tick-borne encephalitis.
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Affiliation(s)
- Han Zhang
- Department of Dermatology, First Medical Center of PLA General Hospital, Beijing 100853, China; Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Yanan Wang
- Department of Nuclear Medicine, Capital Medical University Electric Power Teaching Hospital (State Grid Beijing Electric Power Hospital), Beijing, 100073, China; Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Changguo Chen
- Department of Clinical Laboratory, Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Weiwei Xing
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Wenrong Xia
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Wenliang Fu
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Aijun Liu
- Department of Neurosurgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Chao Zhang
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Qun Guan
- Department of Disease Control and Prevention, Fifth Medical Center of PLA General Hospital, Beijing 100039, China
| | - Yongqi Zhao
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Gang Sun
- Department of Clinical Laboratory, Inner Mongolia Forestry General Hospital (Second Clinical Medical School of Inner Mongolia, University for the Nationalities), Hulunbeier, 022150, China
| | - Desheng Lu
- Department of Clinical Laboratory, Inner Mongolia Forestry General Hospital (Second Clinical Medical School of Inner Mongolia, University for the Nationalities), Hulunbeier, 022150, China
| | - Zhanzhu Dong
- Department of Clinical Laboratory, Inner Mongolia Forestry General Hospital (Second Clinical Medical School of Inner Mongolia, University for the Nationalities), Hulunbeier, 022150, China
| | - Zizhuo Li
- Department of Dermatology, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Yaguang Zhou
- Department of Dermatology, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Suli Zhang
- Department of Dermatology, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Yandan Du
- Department of Clinical Laboratory, Inner Mongolia Forestry General Hospital (Second Clinical Medical School of Inner Mongolia, University for the Nationalities), Hulunbeier, 022150, China.
| | - Chunfu Zheng
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
| | - Donggang Xu
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China.
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Schwitter J, Branca M, Bicvic A, Abbuehl LS, Suter-Riniker F, Leib SL, Dietmann A. Long-term sequelae after viral meningitis and meningoencephalitis are frequent, even in mildly affected patients, a prospective observational study. Front Neurol 2024; 15:1411860. [PMID: 39087005 PMCID: PMC11288970 DOI: 10.3389/fneur.2024.1411860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction An increasing number of studies demonstrate that viral meningitis and meningoencephalitis, even those with a mild course of meningitis, can result in residual sequelae. Methods We aimed to investigate the long-term outcome in both viral meningitis and meningoencephalitis/encephalitis patients and impact of long-term sequelae on patients' social and professional daily lives in a prospective observational study with a follow-up period of 20 months. Results A total of 50 patients (12% encephalitis, 58% meningoencephalitis and 30% meningitis) and 21 control persons participated in the study. The most common cause was the tick-borne encephalitis (TBE) virus. The most important persistent signs and symptoms after 2 years were subjective cognitive impairment (36%), fatigue and/or excessive daytime sleepiness (31%), disturbed nighttime sleep (31%) and headaches (13%), as well as feeling more rapidly exhausted after cognitive effort (53%). Independent of disease severity in the acute phase, almost one third of patients still reported mildly impaired social and/or professional life due to the long-term sequelae, with scores in the health status assessment still significantly lower compared to healthy controls. Discussion Regardless of the severity of the acute illness and despite constant improvement within 2 years, 67% of patients still had persistent signs and symptoms, but these were only relevant to everyday social or professional life in about 30% of these patients.
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Affiliation(s)
- Janine Schwitter
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Antonela Bicvic
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Skudal H, Lorentzen ÅR, Stenstad T, Quist-Paulsen E, Egeland J, Fevang B, Jaioun K, Hansen BÅ, Solheim AM, Tveten Y, Veje M, Eikeland R, Kersten H. Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022. Eur J Clin Microbiol Infect Dis 2024; 43:1355-1366. [PMID: 38801484 PMCID: PMC11271349 DOI: 10.1007/s10096-024-04855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE). METHODS This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified. RESULTS Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease. CONCLUSION This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease. TRIAL REGISTRATION Prosjekt #2,296,959 - The Norwegian Tick-borne Encephalitis Study - NOTES. Acute phase characteristics and long-term outcomes. - Cristin.
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Affiliation(s)
- Hilde Skudal
- Department of Infectious Diseases, Telemark Hospital Trust, Skien, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway.
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Tore Stenstad
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology Dermatology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Keson Jaioun
- Department of Research, Telemark Hospital Trust, Skien, Norway
| | - Bjørn Åsheim Hansen
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marit Solheim
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngvar Tveten
- Department of Clinical Microbiology, Telemark Hospital Trust, Skien, Norway
| | - Malin Veje
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Randi Eikeland
- Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hege Kersten
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Research, Telemark Hospital Trust, Skien, Norway
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Cao M, Yang W, Yang J, Zhao Y, Hu X, Xu X, Tian J, Chen Y, Jiang H, Ren R, Li C. Minocycline Inhibits Tick-Borne Encephalitis Virus and Protects Infected Cells via Multiple Pathways. Viruses 2024; 16:1055. [PMID: 39066217 PMCID: PMC11281541 DOI: 10.3390/v16071055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Tick-borne Encephalitis (TBE) is a zoonotic disease caused by the Tick-borne Encephalitis virus (TBEV), which affects the central nervous system of both humans and animals. Currently, there is no specific therapy for patients with TBE, with symptomatic treatment being the primary approach. In this study, the effects of minocycline (MIN), which is a kind of tetracycline antibiotic, on TBEV propagation and cellular protection in TBEV-infected cell lines were evaluated. Indirect immunofluorescence, virus titers, and RT-qPCR results showed that 48 h post-treatment with MIN, TBEV replication was significantly inhibited in a dose-dependent manner. In addition, the inhibitory effect of MIN on different TBEV multiplicities of infection (MOIs) in Vero cells was studied. Furthermore, the transcriptomic analysis and RT-qPCR results indicate that after incubation with MIN, the levels of TBEV and CALML4 were decreased, whereas the levels of calcium channel receptors, such as RYR2 and SNAP25, were significantly increased. MIN also regulated MAPK-ERK-related factors, including FGF2, PDGFRA, PLCB2, and p-ERK, and inhibited inflammatory responses. These data indicate that administering MIN to TBEV-infected cells can reduce the TBEV level, regulate calcium signaling pathway-associated proteins, and inhibit the MAPK-ERK signaling pathway and inflammatory responses. This research offers innovative strategies for the advancement of anti-TBEV therapy.
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Affiliation(s)
- Mengtao Cao
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China; (W.Y.); (J.Y.); (Y.Z.); (H.J.)
| | - Wei Yang
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China; (W.Y.); (J.Y.); (Y.Z.); (H.J.)
| | - Jintao Yang
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China; (W.Y.); (J.Y.); (Y.Z.); (H.J.)
| | - Yanli Zhao
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China; (W.Y.); (J.Y.); (Y.Z.); (H.J.)
| | - Xiaoyu Hu
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Xiaoli Xu
- Instrument Analysis & Research Center, South China Agricultural University, Guangzhou 510642, China;
| | - Jing Tian
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- Guangdong Arbovirus Diseases Emergency Technology Research Center, Guangzhou 510507, China
| | - Yue Chen
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- Guangdong Arbovirus Diseases Emergency Technology Research Center, Guangzhou 510507, China
| | - Hongxia Jiang
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China; (W.Y.); (J.Y.); (Y.Z.); (H.J.)
| | - Ruiwen Ren
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- Guangdong Arbovirus Diseases Emergency Technology Research Center, Guangzhou 510507, China
| | - Chunyuan Li
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou 510507, China; (M.C.); (X.H.); (J.T.); (Y.C.)
- Guangdong Arbovirus Diseases Emergency Technology Research Center, Guangzhou 510507, China
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5
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Quarsten H, Andreassen ÅK, Paulsen KM, Diekmann MJ, Eikeland R, Helleren R, Bergström T, Noraas S, Lorentzen ÅR. No detection of tick-borne encephalitis virus RNA in blood, urine or saliva of hospitalised immunocompetent tick-borne encephalitis patients. PLoS One 2024; 19:e0305603. [PMID: 38913668 PMCID: PMC11195967 DOI: 10.1371/journal.pone.0305603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
Tick-borne encephalitis (TBE) is usually diagnosed based on the presence of TBE virus (TBEV)-specific IgM and IgG antibodies in serum. However, antibodies induced by vaccination or cross-reactivity to previous flavivirus infections may result in false positive TBEV serology. Detection of TBEV RNA may be an alternative diagnostic approach to detect viral presence and circumvent the diagnostic difficulties present when using serology. Viral RNA in blood is commonly detectable only in the first viremic phase usually lasting up to two weeks, and not in the second neurologic phase, when the patients contact the health care system and undergo diagnostic work-up. TBEV RNA has previously been detected in urine in a few retrospective TBE cases in the neurologic phase, and furthermore RNA of other flaviviruses has been detected in patient saliva. In this study, blood, saliva and urine were collected from 31 hospitalised immunocompetent patients with pleocytosis and symptoms of aseptic meningitis and/or encephalitis, suspected to have TBE. We wanted to pursue if molecular testing of TBEV RNA in these patient materials may be useful in the diagnostics. Eleven of the 31 study patients were diagnosed with TBE based on ELISA detection of TBEV specific IgG and IgM antibodies. None of the study patients had TBEV RNA detectable in any of the collected patient material.
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MESH Headings
- Humans
- Encephalitis, Tick-Borne/diagnosis
- Encephalitis, Tick-Borne/urine
- Encephalitis, Tick-Borne/blood
- Encephalitis, Tick-Borne/virology
- Encephalitis, Tick-Borne/immunology
- Encephalitis Viruses, Tick-Borne/isolation & purification
- Encephalitis Viruses, Tick-Borne/immunology
- Encephalitis Viruses, Tick-Borne/genetics
- Saliva/virology
- RNA, Viral/urine
- Male
- Female
- Middle Aged
- Adult
- Aged
- Immunoglobulin M/blood
- Immunoglobulin M/urine
- Immunoglobulin G/blood
- Immunoglobulin G/urine
- Antibodies, Viral/blood
- Aged, 80 and over
- Immunocompetence
- Hospitalization
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Affiliation(s)
- Hanne Quarsten
- Department of Medical Microbiology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Åshild K. Andreassen
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Katrine M. Paulsen
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria J. Diekmann
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Randi Eikeland
- The Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sport Science, University of Agder, Grimstad, Norway
| | - Rita Helleren
- Department of Clinical Medicine, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sølvi Noraas
- Department of Medical Microbiology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Åslaug R. Lorentzen
- The Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
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Stupica D, Kejžar N, Collinet-Adler S, Bajrović FF. Which trial do we need? Dexamethasone therapy in adults with tick-borne encephalitis: a double-blind placebo-controlled multicentre randomized trial. Clin Microbiol Infect 2024:S1198-743X(24)00281-7. [PMID: 38851428 DOI: 10.1016/j.cmi.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Daša Stupica
- Department of Infectious Diseases, Clinical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Nataša Kejžar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stefan Collinet-Adler
- Department of Infectious Diseases, Park Nicollet/Health Partners, Methodist Hospital, Saint Louis Park, MN, USA
| | - Fajko F Bajrović
- Department of Neurology, Clinical Centre Ljubljana and Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Srichawla BS, Manan MR, Kipkorir V, Dhali A, Diebel S, Sawant T, Zia S, Carrion-Alvarez D, Suteja RC, Nurani K, Găman MA. Neuroinvasion of emerging and re-emerging arboviruses: A scoping review. SAGE Open Med 2024; 12:20503121241229847. [PMID: 38711470 PMCID: PMC11072077 DOI: 10.1177/20503121241229847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 05/08/2024] Open
Abstract
Background Arboviruses are RNA viruses and some have the potential to cause neuroinvasive disease and are a growing threat to global health. Objectives Our objective is to identify and map all aspects of arbovirus neuroinvasive disease, clarify key concepts, and identify gaps within our knowledge with appropriate future directions related to the improvement of global health. Methods Sources of Evidence: A scoping review of the literature was conducted using PubMed, Scopus, ScienceDirect, and Hinari. Eligibility Criteria: Original data including epidemiology, risk factors, neurological manifestations, neuro-diagnostics, management, and preventive measures related to neuroinvasive arbovirus infections was obtained. Sources of evidence not reporting on original data, non-English, and not in peer-reviewed journals were removed. Charting Methods: An initial pilot sample of 30 abstracts were reviewed by all authors and a Cohen's kappa of κ = 0.81 (near-perfect agreement) was obtained. Records were manually reviewed by two authors using the Rayyan QCRI software. Results A total of 171 records were included. A wide array of neurological manifestations can occur most frequently, including parkinsonism, encephalitis/encephalopathy, meningitis, flaccid myelitis, and Guillain-Barré syndrome. Magnetic resonance imaging of the brain often reveals subcortical lesions, sometimes with diffusion restriction consistent with acute ischemia. Vertical transmission of arbovirus is most often secondary to the Zika virus. Neurological manifestations of congenital Zika syndrome, include microcephaly, failure to thrive, intellectual disability, and seizures. Cerebrospinal fluid analysis often shows lymphocytic pleocytosis, elevated albumin, and protein consistent with blood-brain barrier dysfunction. Conclusions Arbovirus infection with neurological manifestations leads to increased morbidity and mortality. Risk factors for disease include living and traveling in an arbovirus endemic zone, age, pregnancy, and immunosuppressed status. The management of neuroinvasive arbovirus disease is largely supportive and focuses on specific neurological complications. There is a need for therapeutics and currently, management is based on disease prevention and limiting zoonosis.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Arkadeep Dhali
- Department of Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sebastian Diebel
- Department of Family Medicine, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Tirtha Sawant
- Department of Neurology, Spartan Health Sciences University, Spartan Drive St, Saint Lucia
| | - Subtain Zia
- Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Richard C Suteja
- Faculty of Medicine, Udayana University, Kampus Bukit, Jl, Raya Kampus Unud Jimbaran, Kec, Kuta Sel, Kabupaten Badung, Bukit Jimbaran, Bali, Indonesia
| | - Khulud Nurani
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, București, Romania
- Bucharest, Romania and Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, București, Romania
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8
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Brisse M, Ly H. Langat virus, a prototypic tick-borne encephalitis virus, impacts IL-6 signaling by downregulating gp130 expression. J Med Virol 2024; 96:e29572. [PMID: 38533946 DOI: 10.1002/jmv.29572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Morgan Brisse
- Viral Immunity and Pathogenesis Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Hinh Ly
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
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Eikeland R, Henningsson AJ, Lebech AM, Kerlefsen Y, Mavin S, Vrijlandt A, Hovius JW, Lernout T, Lim C, Dobler G, Fingerle V, Gynthersen RM, Lindgren PE, Reiso H. Tick-borne diseases in the North Sea region-A comprehensive overview and recommendations for diagnostics and treatment. Ticks Tick Borne Dis 2024; 15:102306. [PMID: 38183851 DOI: 10.1016/j.ttbdis.2023.102306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
As part of the NorthTick project, co-funded by the European Union through the European Regional Development Fund and the North Sea Region Programme, specialists in the field of tick-borne diseases from seven North Sea countries co-operated with patient organisations and governmental health care institutions to provide this comprehensive overview of diagnostics and treatment recommendations in the region for Lyme borreliosis, Borrelia miyamotoi infection, tick-borne encephalitis, human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis and babesiosis. The main conclusion is that the recommendations in these northern countries are essentially the same, with very few differences. This overview presents the current diagnostics and provides useful clinical guidance.
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Affiliation(s)
- Randi Eikeland
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway; Faculty of Health and Sport science, University of Agder, Grimstad, Norway.
| | - Anna J Henningsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; National Reference Laboratory for Borreliosis and Other Tick-Borne Bacteria, Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Yvonne Kerlefsen
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
| | - Sally Mavin
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Amber Vrijlandt
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Joppe W Hovius
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Tinne Lernout
- Sciensano Epidemiology of infectious diseases, Brussels, Belgium
| | - Chin Lim
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Gerhard Dobler
- Nationales Konsiliarlabor FSME, Institut für Mikrobiologie der Bundeswehr, Munich, Germany
| | - Volker Fingerle
- German National Reference Center for Borreliae, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Rosa M Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Harald Reiso
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
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Olaimat AN, Taybeh AO, Al-Nabulsi A, Al-Holy M, Hatmal MM, Alzyoud J, Aolymat I, Abughoush MH, Shahbaz H, Alzyoud A, Osaili T, Ayyash M, Coombs KM, Holley R. Common and Potential Emerging Foodborne Viruses: A Comprehensive Review. Life (Basel) 2024; 14:190. [PMID: 38398699 PMCID: PMC10890126 DOI: 10.3390/life14020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Human viruses and viruses from animals can cause illnesses in humans after the consumption of contaminated food or water. Contamination may occur during preparation by infected food handlers, during food production because of unsuitably controlled working conditions, or following the consumption of animal-based foods contaminated by a zoonotic virus. This review discussed the recent information available on the general and clinical characteristics of viruses, viral foodborne outbreaks and control strategies to prevent the viral contamination of food products and water. Viruses are responsible for the greatest number of illnesses from outbreaks caused by food, and risk assessment experts regard them as a high food safety priority. This concern is well founded, since a significant increase in viral foodborne outbreaks has occurred over the past 20 years. Norovirus, hepatitis A and E viruses, rotavirus, astrovirus, adenovirus, and sapovirus are the major common viruses associated with water or foodborne illness outbreaks. It is also suspected that many human viruses including Aichi virus, Nipah virus, tick-borne encephalitis virus, H5N1 avian influenza viruses, and coronaviruses (SARS-CoV-1, SARS-CoV-2 and MERS-CoV) also have the potential to be transmitted via food products. It is evident that the adoption of strict hygienic food processing measures from farm to table is required to prevent viruses from contaminating our food.
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Affiliation(s)
- Amin N. Olaimat
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan; (M.A.-H.); (M.H.A.)
| | - Asma’ O. Taybeh
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.O.T.); (A.A.-N.); (T.O.)
| | - Anas Al-Nabulsi
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.O.T.); (A.A.-N.); (T.O.)
| | - Murad Al-Holy
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan; (M.A.-H.); (M.H.A.)
| | - Ma’mon M. Hatmal
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan;
| | - Jihad Alzyoud
- Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan; (J.A.); (I.A.)
| | - Iman Aolymat
- Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan; (J.A.); (I.A.)
| | - Mahmoud H. Abughoush
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan; (M.A.-H.); (M.H.A.)
- Science of Nutrition and Dietetics Program, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 64141, United Arab Emirates
| | - Hafiz Shahbaz
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Anas Alzyoud
- Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan;
| | - Tareq Osaili
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.O.T.); (A.A.-N.); (T.O.)
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mutamed Ayyash
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, P.O. Box 15551, Al Ain 53000, United Arab Emirates;
| | - Kevin M. Coombs
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada;
| | - Richard Holley
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
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11
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Mendoza MA, Hass RM, Vaillant J, Johnson DR, Theel ES, Toledano M, Abu Saleh O. Powassan Virus Encephalitis: A Tertiary Center Experience. Clin Infect Dis 2024; 78:80-89. [PMID: 37540989 PMCID: PMC10810704 DOI: 10.1093/cid/ciad454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Powassan virus (POWV) is an emerging arthropod-borne flavivirus, transmitted by Ixodes spp. ticks, which has been associated with neuroinvasive disease and poor outcomes. METHODS A retrospective study was conducted at Mayo Clinic from 2013 to 2022. We included clinical and epidemiologic data of probable and confirmed neuroinvasive POWV cases. RESULTS Sixteen patients with neuroinvasive POWV were identified; their median age was 63.2 years, and 62.5% were male. Six patients presented with rhombencephalitis, 4 with isolated meningitis, 3 with meningoencephalitis, 2 with meningoencephalomyelitis, and 1 with opsoclonus myoclonus syndrome. A median time of 18 days was observed between symptom onset and diagnosis. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with elevated protein and normal glucose in the majority of patients. Death occurred within 90 days in 3 patients (18.8%), and residual neurologic deficits were seen in 8 survivors (72.7%). CONCLUSIONS To our knowledge, this is the largest case series of patients with neuroinvasive POWV infection. We highlight the importance of a high clinical suspicion among patients who live in or travel to high-risk areas during the spring to fall months. Our data show high morbidity and mortality rates among patients with neuroinvasive disease.
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Affiliation(s)
- Maria Alejandra Mendoza
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Reece M Hass
- Departement of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James Vaillant
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Departement of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michel Toledano
- Departement of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
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12
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Ackermann-Gäumann R, Lang P, Zens KD. Defining the "Correlate(s) of Protection" to tick-borne encephalitis vaccination and infection - key points and outstanding questions. Front Immunol 2024; 15:1352720. [PMID: 38318179 PMCID: PMC10840404 DOI: 10.3389/fimmu.2024.1352720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Tick-borne Encephalitis (TBE) is a severe disease of the Central Nervous System (CNS) caused by the tick-borne encephalitis virus (TBEV). The generation of protective immunity after TBEV infection or TBE vaccination relies on the integrated responses of many distinct cell types at distinct physical locations. While long-lasting memory immune responses, in particular, form the basis for the correlates of protection against many diseases, these correlates of protection have not yet been clearly defined for TBE. This review addresses the immune control of TBEV infection and responses to TBE vaccination. Potential correlates of protection and the durability of protection against disease are discussed, along with outstanding questions in the field and possible areas for future research.
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Affiliation(s)
- Rahel Ackermann-Gäumann
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland
- Swiss National Reference Center for Tick-transmitted Diseases, La Chaux-de-Fonds, Switzerland
| | - Phung Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kyra D. Zens
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
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13
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Abbuehl LS, Branca M, Ungureanu A, Federspiel A, Leib SL, Bassetti CLA, Hakim A, Dietmann A. Magnetic resonance imaging in acute meningoencephalitis of viral and unknown origin: frequent findings and prognostic potential. Front Neurol 2024; 15:1359437. [PMID: 38299018 PMCID: PMC10829495 DOI: 10.3389/fneur.2024.1359437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Background Magnetic resonance imaging (MRI) findings in meningoencephalitis have mainly been described in terms of their diagnostic value rather than their prognostic potential, except for herpes simplex virus (HSV) encephalitis. The aims of our study were to describe frequency and anatomic locations of MRI abnormalities specific to limbic, circadian and motor systems in a cohort of meningoencephalitis patients, as well as to investigate the prognostic value of these MRI findings. Methods A secondary, selective analysis of a retrospective database including all meningitis, meningoencephalitis and encephalitis cases treated between 2016 and 2018 in the University hospital of Bern, Switzerland was performed. Patients with meningitis of any cause, bacterial or autoimmune causes of encephalitis were excluded. Results MRI scans and clinical data from 129 meningoencephalitis cases found that the most frequent causes were tick-borne encephalitis (TBE, 42%), unknown pathogens (40%), VZV (7%), and HSV1 (5%). At discharge, median modified Rankin Score (mRS) was 3 (interquartile range, IQR, 1), 88% of patients had persisting signs and symptoms. After a median of 17 months, median Glasgow Outcome Score (GOS) was 5 (IQR 1), 39% of patients still had residual signs or symptoms. All patients with HSV, 27% with TBE and 31% of those with meningoencephalitis of unknown etiology had fluid-attenuated inversion recovery (FLAIR) and to a lesser extent diffusion-weighted imaging (DWI) lesions in their initial MRI, with highly overlapping anatomical distribution. In one fifth of TBE patients the limbic system was affected. Worse outcome was associated with presence of DWI and/or FLAIR lesions and lower normalized apparent diffusion coefficient (ADC) signal intensities. Conclusion Presence of FLAIR lesions, restricted diffusion as well as the extent of ADC hypointensity in initial MRI are parameters which might be of prognostic value regarding the longterm clinical outcome for patients with meningoencephalitis of viral and of unknown origin. Although not described before, affection of limbic structures by TBE is possible as shown by our results: A substantial proportion of our TBE patients had FLAIR signal abnormalities in these regions.
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Affiliation(s)
- Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Anamaria Ungureanu
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Support Center for Advanced Neuroimaging Translational Imaging Center (sitem-insel), Institute for Diagnostic and Interventional Neuroradiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Claudio L. A. Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Karin H, Ylva B, Sandra S, Aleksandra P, Per B, Klara S. Monkeypox virus-associated meningoencephalitis diagnosed by detection of intrathecal antibody production. BMC Infect Dis 2024; 24:94. [PMID: 38229022 DOI: 10.1186/s12879-024-09000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND In the 2022 mpox-outbreak most patients presented with mild symptoms. Central nervous system (CNS) involvement has previously been described as a rare and severe complication of mpox; however, diagnostic findings in cerebrospinal fluid (CSF) analysis and neuroimaging studies have only been reported in one case previously. CASE PRESENTATION We report a previously healthy 37-year-old man with mpox complicated by encephalitis. He first presented with painful skin lesions and genital ulcers; polymerase chain reaction (PCR) from the lesions was positive for mpox. Twelve days later he was admitted with fever and confusion. Neuroimaging and CSF analysis indicated encephalitis. The CSF was PCR-negative for monkeypox virus but intrathecal antibody production was detected. He spontaneously improved over a few days course and recovered fully. CONCLUSIONS This case of mpox-associated encephalitis shows that CNS involvement in mpox infection may have a relatively mild clinical course, and that detection of intrathecal antibody production can be used to establish the diagnosis if CSF monkeypox virus-PCR is negative.
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Affiliation(s)
- Hansen Karin
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Båtshake Ylva
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Söderholm Sandra
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Pettke Aleksandra
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Björkman Per
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Sondén Klara
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
- Department of Medicine, Karolinska Institutet, Solna, Sweden.
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15
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Kvam KA, Stahl JP, Chow FC, Soldatos A, Tattevin P, Sejvar J, Mailles A. Outcome and Sequelae of Infectious Encephalitis. J Clin Neurol 2024; 20:23-36. [PMID: 38179629 PMCID: PMC10782093 DOI: 10.3988/jcn.2023.0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Abstract
Acute infectious encephalitis is a widely studied clinical syndrome. Although identified almost 100 years ago, its immediate and delayed consequences are still neglected despite their high frequency and possible severity. We reviewed the available data on sequelae and persisting symptoms following infectious encephalitis with the aim of characterizing the clinical picture of these patients at months to years after hospitalization. We searched PubMed for case series involving sequelae after infectious encephalitis. We carried out a narrative review of the literature on encephalitis caused by members of the Herpesviridae family (herpes simplex virus, varicella zoster virus, and human herpesvirus-6), members of the Flaviviridae family (West Nile virus, tick-borne encephalitis virus, and Japanese encephalitis virus), alphaviruses, and Nipah virus. We retrieved 41 studies that yielded original data involving 3,072 adult patients evaluated after infectious encephalitis. At least one of the five domains of cognitive outcome, psychiatric disorders, neurological deficits, global functioning, and quality of life was investigated in the reviewed studies. Various tests were used in the 41 studies and the investigation took place at different times after hospital discharge. The results showed that most patients are discharged with impairments, with frequent deficits in cognitive function such as memory loss or attention disorders. Sequelae tend to improve within several years following flavivirus or Nipah virus infection, but long-term data are scarce for other pathogens. Further research is needed to better understand the extent of sequelae after infectious encephalitis, and to propose a standardized assessment method and assess the rehabilitation efficacy in these patients.
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Affiliation(s)
- Kathryn A Kvam
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, Stanford University, Stanford, CA, USA
| | | | - Felicia C Chow
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra Mailles
- Department of Infectious Diseases, Santé publique France, Saint-Maurice, France.
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16
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Cesaroni CA, Frattini D, Lecis M, Bonvicini F, Bartolomeo D, Rizzi S, Spagnoli C, Napoli M, Pascarella R, De Fanti A, Fusco C. Tick-Borne Encephalitis in a 6-Year-Old Patient: A Case Report. Neurohospitalist 2024; 14:64-68. [PMID: 38235031 PMCID: PMC10790612 DOI: 10.1177/19418744231205626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus belonging to the Flaviviridae family. TBEV transmission typically occurs through infected Ixodes tick bite or by consumption of unpasteurised milk from infected cattle. Case report: We report the clinical, neuroimaging, electroencephalogram (EEG), and laboratory (microbiological tests and spinal tap) data of a 6- year-old boy with Tick-borne encephalitis. Our patient presented with a biphasic course, initially with a myositis-like picture on his first admission to the emergency department, and after a few days with an encephalitic picture, resulting in a second hospitalization. EEG showed focal slow activity, while his brain magnetic resonance imaging (MRI) showed a signal abnormality, which completely resolved on repeat MRI after 3 months. Conclusion: To our knowledge, this is the youngest patient presenting with myositis in the first phase of Tick-borne encephalitis (TBE). In the presence of a biphasic clinical course, with previous myositis, aspecific MRI changes in the thalamic and midbrain regions and an EEG documenting slowed bioelectrical activity should prompt suspicion of TBEV infection.
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Affiliation(s)
| | - Daniele Frattini
- Child Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Lecis
- Pediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Federico Bonvicini
- Pediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Bartolomeo
- Pediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Susanna Rizzi
- Child Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlotta Spagnoli
- Child Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro De Fanti
- Pediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Fusco
- Child Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ackermann-Gäumann R, Brêchet A, Smetana J, Salát J, Lienhard R, Croxatto A, Polcarová P, Chlíbek R, Růžek D. Vaccination against tick-borne encephalitis elicits a detectable NS1 IgG antibody response. J Virol Methods 2023; 322:114831. [PMID: 37838083 DOI: 10.1016/j.jviromet.2023.114831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
Vaccine-induced protection against tick-borne encephalitis virus (TBEV) is mediated by antibodies to the viral particle/envelope protein. The detection of non-structural protein 1 (NS1) specific antibodies has been suggested as a marker indicative of natural infections. However, recent work has shown that TBEV vaccines contain traces of NS1, and immunization of mice induced low amounts of NS1-specific antibodies. In this study, we investigated if vaccination induces TBEV NS1-specific antibodies in humans. Healthy army members (n = 898) were asked to fill in a questionnaire relating to flavivirus vaccination or infection, and blood samples were collected. In addition, samples of 71 suspected acute TBE cases were included. All samples were screened for the presence of TBEV NS1-specific IgG antibodies using an in-house developed ELISA. Antibodies were quantified as percent positivity in reference to a positive control. For qualitative evaluation, cut-off for positivity was defined based on the mean OD of the lower 95% of the vaccinated individuals + 3 SD. We found significantly higher NS1-specific IgG antibody titers (i.e., quantitative evaluation) in individuals having received 2, 3, or 4 or more vaccine doses than in non-vaccinated individuals. Similarly, the percentage of individuals with a positive test result (i.e., qualitative evaluation) was higher in individuals vaccinated against tick-borne encephalitis than in unvaccinated study participants. Although NS1-specific IgG titers remained at a relatively low level when compared to TBE patients, a clear distinction was not always possible. Establishing a clear cut-off point in detection systems is critical for NS1-specific antibodies to serve as a marker for distinguishing the immune response after vaccination and infection.
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Affiliation(s)
- Rahel Ackermann-Gäumann
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland; Swiss National Reference Center for Tick-Transmitted Diseases, Switzerland.
| | - Arthur Brêchet
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland
| | - Jan Smetana
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Jiři Salát
- Laboratory of Emerging Viral Infections, Veterinary Research Institute, Brno, Czech Republic; Laboratory of Arbovirology, Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic; Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Reto Lienhard
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland; Swiss National Reference Center for Tick-Transmitted Diseases, Switzerland
| | - Antony Croxatto
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland; Swiss National Reference Center for Tick-Transmitted Diseases, Switzerland
| | - Petra Polcarová
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Roman Chlíbek
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Daniel Růžek
- Laboratory of Emerging Viral Infections, Veterinary Research Institute, Brno, Czech Republic; Laboratory of Arbovirology, Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic; Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
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Biasizzo H, Kejžar N, Stupica D. Which trial do we need? Mannitol therapy in hospitalized adult patients with tick-borne encephalitis and brain oedema: a double-blind placebo-controlled multicentre randomized trial. Clin Microbiol Infect 2023; 29:1471-1473. [PMID: 37244469 DOI: 10.1016/j.cmi.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Helena Biasizzo
- Department of Infectious Diseases, General Hospital Novo Mesto, Novo Mesto, Slovenia.
| | - Nataša Kejžar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daša Stupica
- Department of Infectious Diseases, Clinical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Hills SL, Poehling KA, Chen WH, Staples JE. Tick-Borne Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-29. [PMID: 37943707 PMCID: PMC10651317 DOI: 10.15585/mmwr.rr7205a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Tick-borne encephalitis (TBE) virus is focally endemic in parts of Europe and Asia. The virus is primarily transmitted to humans by the bites of infected Ixodes species ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. TBE virus can cause acute neurologic disease, which usually results in hospitalization, often permanent neurologic or cognitive sequelae, and sometimes death. TBE virus infection is a risk for certain travelers and for laboratory workers who work with the virus. In August 2021, the Food and Drug Administration approved Ticovac TBE vaccine for use among persons aged ≥1 year. This report summarizes the epidemiology of and risks for infection with TBE virus, provides information on the immunogenicity and safety of TBE vaccine, and summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of TBE vaccine among U.S. travelers and laboratory workers. The risk for TBE for most U.S. travelers to areas where the disease is endemic is very low. The risk for exposure to infected ticks is highest for persons who are in areas where TBE is endemic during the main TBE virus transmission season of April–November and who are planning to engage in recreational activities in woodland habitats or who might be occupationally exposed. All persons who travel to areas where TBE is endemic should be advised to take precautions to avoid tick bites and to avoid the consumption of unpasteurized dairy products because alimentary transmission of TBE virus can occur. TBE vaccine can further reduce infection risk and might be indicated for certain persons who are at higher risk for TBE. The key factors in the risk-benefit assessment for vaccination are likelihood of exposure to ticks based on activities and itinerary (e.g., location, rurality, season, and duration of travel or residence). Other risk-benefit considerations should include 1) the rare occurrence of TBE but its potentially high morbidity and mortality, 2) the higher risk for severe disease among certain persons (e.g., older persons aged ≥60 years), 3) the availability of an effective vaccine, 4) the possibility but low probability of serious adverse events after vaccination, 5) the likelihood of future travel to areas where TBE is endemic, and 6) personal perception and tolerance of risk ACIP recommends TBE vaccine for U.S. persons who are moving or traveling to an area where the disease is endemic and will have extensive exposure to ticks based on their planned outdoor activities and itinerary. Extensive exposure can be considered based on the duration of travel and frequency of exposure and might include shorter-term (e.g., <1 month) travelers with daily or frequent exposure or longer-term travelers with regular (e.g., a few times a month) exposure to environments that might harbor infected ticks. In addition, TBE vaccine may be considered for persons who might engage in outdoor activities in areas where ticks are likely to be found, with a decision to vaccinate made on the basis of an assessment of their planned activities and itinerary, risk factors for a poor medical outcome, and personal perception and tolerance of risk. In the laboratory setting, ACIP recommends TBE vaccine for laboratory workers with a potential for exposure to TBE virus
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Anis H, Basha Shaik A, Karabulut E, Uzun M, Tiwari A, Nazir A, Uwishema O, Alemayehu A. Upsurge of Powassan virus disease in northeastern United States: a public health concern-a short communication. Ann Med Surg (Lond) 2023; 85:5823-5826. [PMID: 37915648 PMCID: PMC10617911 DOI: 10.1097/ms9.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Powassan virus (POWV) is a tick-borne Flavivirus primarily transmitted through ticks in North America which is a significant public health threat in the northeastern United States. POWV infection spans from Ontario to the Mid-Atlantic, Northeast, and Midwest regions in the USA. Climate change, ecological factors, and human-related changes, including shifts in migration and agriculture, contribute to the dissemination of POWV. Symptoms include sore throat, fatigue, headache, and severe neuroinvasive conditions. Specialized attention is required for diagnosing and managing. MRI scans detect central nervous system abnormalities, while neuromonitoring identifies metabolic distress. Severe cases may necessitate ICU hospitalisation with continuous monitoring. Prevention measures, such as awareness, controlling mammals, and protecting pets, reduce POWV infection risk. The recent outbreak of POWV in Maine, USA, highlights the importance of worldwide collaboration for prevention. With the global prevalence of POWV increasing due to climate and socioeconomic changes, implementing preventative measures and promoting awareness are crucial in reducing infection risk.
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Affiliation(s)
- Heeba Anis
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Deccan College of Medical Sciences,Hyderabad, Telangana
| | - Akbar Basha Shaik
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Deccan College of Medical Sciences,Hyderabad, Telangana
| | - Ece Karabulut
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mert Uzun
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Angad Tiwari
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Department of Medicine, King Edward Medical University, Pakistan
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
- Clinton Global Initiative University, NY
| | - Abel Alemayehu
- Oli Health Magazine Organization, Research, and Education, Kigali, Rwanda
- Addis Ababa University, College of Health Science, School of Medicine, Addis Ababa, Ethiopia
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21
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Worku DA. Tick-Borne Encephalitis (TBE): From Tick to Pathology. J Clin Med 2023; 12:6859. [PMID: 37959323 PMCID: PMC10650904 DOI: 10.3390/jcm12216859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a viral arthropod infection, endemic to large parts of Europe and Asia, and is characterised by neurological involvement, which can range from mild to severe, and in 33-60% of cases, it leads to a post-encephalitis syndrome and long-term morbidity. While TBE virus, now identified as Orthoflavivirus encephalitidis, was originally isolated in 1937, the pathogenesis of TBE is not fully appreciated with the mode of transmission (blood, tick, alimentary), viral strain, host immune response, and age, likely helping to shape the disease phenotype that we explore in this review. Importantly, the incidence of TBE is increasing, and due to global warming, its epidemiology is evolving, with new foci of transmission reported across Europe and in the UK. As such, a better understanding of the symptomatology, diagnostics, treatment, and prevention of TBE is required to inform healthcare professionals going forward, which this review addresses in detail. To this end, the need for robust national surveillance data and randomised control trial data regarding the use of various antivirals (e.g., Galidesivir and 7-deaza-2'-CMA), monoclonal antibodies, and glucocorticoids is required to improve the management and outcomes of TBE.
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Affiliation(s)
- Dominic Adam Worku
- Infectious Diseases, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, UK;
- Public Health Wales, 2 Capital Quarter, Cardiff CF10 4BZ, UK
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22
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Baryshnikova V, Turchenko Y, Tuchynskaya K, Belyaletdinova I, Butenko A, Dereventsova A, Ignatiev G, Kholodilov I, Larichev V, Lyapeykova E, Rogova A, Shakaryan A, Shishova A, Gmyl A, Karganova G. Recombinant TBEV Protein E of the Siberian Subtype Is a Candidate Antigen in the ELISA Test System for Differential Diagnosis. Diagnostics (Basel) 2023; 13:3277. [PMID: 37892100 PMCID: PMC10606673 DOI: 10.3390/diagnostics13203277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/01/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The tick-borne encephalitis virus (TBEV) is one of the most common members of the Orthoflavivirus genus, which comprises the causative agents of severe diseases in humans and animals. Due to the expanding areas of orthoflavivirus infection, its differential diagnosis is highly demanded. Commercial test kits based on inactivated TBEV may not provide reliable differentiation between flaviviruses because of serological crossover in this genus. Application of recombinant domains (sE and dIII) of the TBEV Sukhar-strain protein E as antigens in an ELISA test system allowed us to identify a wide range of antibodies specific to different TBEV strains. We tested 53 sera from human patients with confirmed TBE diagnosis (the efficacy of our test system based on sE protein was 98%) and 56 sera from patients with other orthoflavivirus infections in which no positive ones were detected using our ELISA test system, thus being indicative of its 100% specificity. We also tested mouse and rabbit sera containing antibodies specific to 17 TBEV strains belonging to different subtypes; this assay exhibited high efficacy and differentiation ability in detecting antibodies against TBEV from other orthoflaviviruses such as Omsk hemorrhagic fever, Powassan, yellow fever, dengue, West Nile, Zika, and Japanese encephalitis viruses.
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Affiliation(s)
- Victoria Baryshnikova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Yuriy Turchenko
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Ksenia Tuchynskaya
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Ilmira Belyaletdinova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Alexander Butenko
- D.I. Ivanovsky Institute of Virology Division of N.F. Gamaleya National Research Center of Epidemiology and Microbiology of the Ministry of Health of the Russian Federation, Moscow 123098, Russia
| | - Alena Dereventsova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Georgy Ignatiev
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Ivan Kholodilov
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Victor Larichev
- D.I. Ivanovsky Institute of Virology Division of N.F. Gamaleya National Research Center of Epidemiology and Microbiology of the Ministry of Health of the Russian Federation, Moscow 123098, Russia
| | - Ekaterina Lyapeykova
- Infectious Clinical Hospital No. 1 of the Moscow City Health Department, Moscow 125310, Russia;
| | - Anastasiya Rogova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Armen Shakaryan
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
- Department of Infectious Diseases in Children, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Anna Shishova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
- Institute of Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Anatoly Gmyl
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
| | - Galina Karganova
- FSASI “Chumakov FSC R&D IBP RAS” (Institute of Poliomyelitis), Moscow 108819, Russia (Y.T.); (I.B.); (A.S.); (A.S.)
- Institute of Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow 119991, Russia
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23
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Kwasnik M, Rola J, Rozek W. Tick-Borne Encephalitis-Review of the Current Status. J Clin Med 2023; 12:6603. [PMID: 37892741 PMCID: PMC10607749 DOI: 10.3390/jcm12206603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
The tick-borne encephalitis virus (TBEV) is the arboviral etiological agent of tick-borne encephalitis (TBE), considered to be one of the most important tick-borne viral diseases in Europe and Asia. In recent years, an increase in the incidence of TBE as well as an increasing geographical range of the disease have been noted. Despite the COVID-19 pandemic and the imposition of restrictions that it necessitated, the incidence of TBE is rising in more than half of the European countries analyzed in recent studies. The virus is transmitted between ticks, animals, and humans. It seems that ticks and small mammals play a role in maintaining TBEV in nature. The disease can also affect dogs, horses, cattle, and small ruminants. Humans are incidental hosts, infected through the bite of an infected tick or by the alimentary route, through the consumption of unpasteurized milk or milk products from TBEV-infected animals. TBEV infections in humans may be asymptomatic, but the symptoms can range from mild flu-like to severe neurological. In Europe, cases of TBE are reported every year. While there is currently no effective treatment for TBE, immunization and protection against tick bites are critical in preventing this disease.
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Affiliation(s)
- Malgorzata Kwasnik
- Department of Virology, National Veterinary Research Institute, Al. Partyzantow 57, 24-100 Pulawy, Poland; (J.R.); (W.R.)
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Marvik Å, Ravn LM, Randby H, Stamnes Köpp UM, Revhaug C. Tick-borne encephalitis in children. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0222. [PMID: 37830974 DOI: 10.4045/tidsskr.23.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
The incidence of tick-borne encephalitis in Norway is increasing. The risk of infection shows considerable geographical variations, with clusters of cases in certain municipalities in the counties of Agder, and Vestfold and Telemark. There is also a major variation in clinical presentation. Only a small number of cases of tick-borne encephalitis in children have been reported in Norway, and the condition may be underdiagnosed. We present a clinical review, including two case studies, that focuses on the clinical presentation and diagnosis of tick-borne encephalitis in children.
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Affiliation(s)
| | | | - Hans Randby
- Barne- og ungdomsavdelingen, Sykehuset i Vestfold
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25
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Tang J, Fu M, Xu C, Xue B, Zhou A, Chen S, Zhao H, Zhou Y, Chen J, Yang Q, Chen X. Development of a novel virus-like particle-based vaccine for preventing tick-borne encephalitis virus infection. Virol Sin 2023; 38:767-777. [PMID: 37328107 PMCID: PMC10590693 DOI: 10.1016/j.virs.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
Tick-borne encephalitis virus (TBEV) is an important tick-borne pathogen that poses as a serious public health concern. The coverage and immunogenicity of the currently available vaccines against TBEV are relatively low; therefore, it is crucial to develop novel and effective vaccines against TBEV. The present study describes a novel strategy for the assembly of virus-like particles (VLPs) by co-expressing the structural (core/prM/E) and non-structural (NS2B/NS3Pro) proteins of TBEV. The efficacy of the VLPs was subsequently evaluated in C57BL/6 mice, and the resultant IgG serum could neutralize both Far-Eastern and European subtypes of TBEV. These findings indicated that the VLP-based vaccine elicited the production of cross-subtype reactive antibodies. The VLPs provided protection to mice lacking the type I interferon receptor (IFNAR-/-) against lethal TBEV challenge, with undetectable viral load in brain and intestinal tissues. Furthermore, the group that received the VLP vaccine did not exhibit significant pathological changes and the inflammatory factors were significantly suppressed compared to the control group. Immunization with the VLP vaccine induced the production of multiple-cytokine-producing antiviral CD4+ T cells in vivo, including TNF-α+, IL-2+, and IFN-γ+ T cells. Altogether, the findings suggest that noninfectious VLPs can serve as a potentially safe and effective vaccine candidate against diverse subtypes of TBEV.
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Affiliation(s)
- Jielin Tang
- Guangzhou National Laboratory, Guangzhou, 510005, China; State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Muqing Fu
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - Chonghui Xu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Bao Xue
- Guangzhou National Laboratory, Guangzhou, 510005, China; State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Anqi Zhou
- GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Sijie Chen
- GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - He Zhao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Yuan Zhou
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Jizheng Chen
- Guangzhou National Laboratory, Guangzhou, 510005, China; State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China; State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qi Yang
- Guangzhou National Laboratory, Guangzhou, 510005, China; State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China.
| | - Xinwen Chen
- Guangzhou National Laboratory, Guangzhou, 510005, China; State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China; State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, 511436, China.
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26
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Groth M, Skrzydlewska E, Czupryna P, Biernacki M, Moniuszko-Malinowska A. Lipid mediators of cerebrospinal fluid in response to TBE and bacterial co-infections. Free Radic Biol Med 2023; 207:272-278. [PMID: 37499889 DOI: 10.1016/j.freeradbiomed.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Tick-borne diseases are caused by monoinfection or co-infection with different pathogens, including viruses, bacteria and protozoa. Tick-borne diseases are usually accompanied by oxidative stress which promotes the modifications of the host's lipid metabolism. The aim of the study was to compare total antioxidant status and the level of lipid mediators in the cerebrospinal fluid in response to tick-borne encephalitis (TBE) and bacterial co-infections that cause diseases such as that is Lyme borreliosis (LB) and human granulocytic anaplasmosis (HGA). In our study cerebrospinal fluid samples were obtained from 15 patients with TBE and 6 patients with TBE co-infection with LB and/or HGA at admission and after treatment. Control group consisted of 14 patients in whom meningitis was excluded. Total antioxidant status, levels of lipid peroxidation products, endocannabinoids and eicosanoids (determined by liquid and gas chromatography-mass spectrometry) were compared between the groups. It was found that in TBE patients, total antioxidant status was decreased and accompanied by increased levels of lipid peroxidation products (4-HNE, MDA, isoprostanes and neuroprostanes), major endocannabinoids (AEA and 2AG), and eicosanoids (both anti-inflammatory and pro-inflammatory), which generally declined after treatment. On the other hand, in co-infections, significant changes in the levels of some lipid mediators were observed even after the treatment. TBE alone or along with bacterial co-infections promote redox balance disturbances in the cerebrospinal fluid leading to oxidative stress and increased metabolism of phospholipids in the brain tissue reflected in the level of lipid peroxidation products and lipid mediators. Changes in the level of lipid mediators in patients with co-infections after treatment suggest further intensification of metabolic disturbances rather than their resolution.
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Affiliation(s)
- Monika Groth
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Poland
| | | | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Poland
| | - Michał Biernacki
- Department of Analytical Chemistry, Medical University of Białystok, Poland
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Miazga W, Wnuk K, Tatara T, Świtalski J, Matera A, Religioni U, Gujski M. The long-term efficacy of tick-borne encephalitis vaccines available in Europe - a systematic review. BMC Infect Dis 2023; 23:621. [PMID: 37735357 PMCID: PMC10515056 DOI: 10.1186/s12879-023-08562-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Despite the availability of vaccination, TBE (tick-borne encephalitis) remains a global public health problem. Therefore, the aim of our study was to assess the long-term efficacy of vaccinations against tick-borne encephalitis using vaccines available on the European market. METHODS The analysis was conducted on the results of a systematic review conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed in three databases, namely Medline (via PubMed), EMBASE (via Ovid), and the Cochrane Library database. The authors followed the PRISMA method and the selection of the articles was performed with two independent researchers. RESULTS From a total of 199 citations, 9 studies were included in this review. According to the primary studies identified in the search, the efficacy of available anti-TBE vaccines ranges from 90.1% to 98.9%; however, in individuals above the age of 60, the protection wanes as early as one year after vaccination. Administration of a booster dose 3 years after completion of the basic vaccination schedule significantly extended the period of protection against TBE. CONCLUSIONS Anti-TBE vaccines available in Europe have a high level of efficacy. However, the level of protection against TBE is decreasing after vaccination. Therefore, in addition to the conventional schedule, booster vaccines should be administered every 5 years in individuals before the age of 60 and more frequently, e.g. every 3 years, in individuals aged 60 and beyond.
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Affiliation(s)
- Wojciech Miazga
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland
| | - Katarzyna Wnuk
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland
| | - Tomasz Tatara
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland.
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02091, Warsaw, Poland.
| | - Jakub Świtalski
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01445, Warsaw, Poland
| | - Adrian Matera
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland.
| | - Mariusz Gujski
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02091, Warsaw, Poland
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Chiffi G, Grandgirard D, Leib SL, Chrdle A, Růžek D. Tick-borne encephalitis: A comprehensive review of the epidemiology, virology, and clinical picture. Rev Med Virol 2023; 33:e2470. [PMID: 37392370 DOI: 10.1002/rmv.2470] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023]
Abstract
Tick-borne encephalitis virus (TBEV) is a flavivirus commonly found in at least 27 European and Asian countries. It is an emerging public health problem, with steadily increasing case numbers over recent decades. Tick-borne encephalitis virus affects between 10,000 and 15,000 patients annually. Infection occurs through the bite of an infected tick and, much less commonly, through infected milk consumption or aerosols. The TBEV genome comprises a positive-sense single-stranded RNA molecule of ∼11 kilobases. The open reading frame is > 10,000 bases long, flanked by untranslated regions (UTR), and encodes a polyprotein that is co- and post-transcriptionally processed into three structural and seven non-structural proteins. Tick-borne encephalitis virus infection results in encephalitis, often with a characteristic biphasic disease course. After a short incubation time, the viraemic phase is characterised by non-specific influenza-like symptoms. After an asymptomatic period of 2-7 days, more than half of patients show progression to a neurological phase, usually characterised by central and, rarely, peripheral nervous system symptoms. Mortality is low-around 1% of confirmed cases, depending on the viral subtype. After acute tick-borne encephalitis (TBE), a minority of patients experience long-term neurological deficits. Additionally, 40%-50% of patients develop a post-encephalitic syndrome, which significantly impairs daily activities and quality of life. Although TBEV has been described for several decades, no specific treatment exists. Much remains unknown regarding the objective assessment of long-lasting sequelae. Additional research is needed to better understand, prevent, and treat TBE. In this review, we aim to provide a comprehensive overview of the epidemiology, virology, and clinical picture of TBE.
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Affiliation(s)
- Gabriele Chiffi
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Denis Grandgirard
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Stephen L Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Aleš Chrdle
- Department of Infectious Diseases, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
- Royal Liverpool University Hospital, Liverpool, UK
| | - Daniel Růžek
- Veterinary Research Institute, Emerging Viral Diseases, Brno, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
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29
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Abbuehl LS, Hofmann E, Hakim A, Dietmann A. Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review. Front Neurol 2023; 14:1130090. [PMID: 37435162 PMCID: PMC10331601 DOI: 10.3389/fneur.2023.1130090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. This review is intended to provide an overview of the existing scientific literature on this topic from the perspective of a clinician who is confronted with serious decisions about continuation or withdrawal of therapeutic interventions. We performed a literature review searching two databases and included 55 studies in the review. These studies documented or investigated specifically outcome and predictive parameters of outcome of HSV and/or VZV encephalitis. Two reviewers independently screened and reviewed full-text articles meeting the inclusion criteria. Key data were extracted and presented as a narrative summary. Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. Although numerous studies are available, the main limiting factors are the inconsistent patient selection and case definitions as well as the non-standardised outcome measures, which hampers the comparability of the studies. Therefore, larger and standardised observational studies applying validated case definitions and outcome measures including quality of life assessment are required to provide solid evidence to answer the research question.
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Affiliation(s)
- Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eveline Hofmann
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Pustijanac E, Buršić M, Talapko J, Škrlec I, Meštrović T, Lišnjić D. Tick-Borne Encephalitis Virus: A Comprehensive Review of Transmission, Pathogenesis, Epidemiology, Clinical Manifestations, Diagnosis, and Prevention. Microorganisms 2023; 11:1634. [PMID: 37512806 PMCID: PMC10383662 DOI: 10.3390/microorganisms11071634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Tick-borne encephalitis virus (TBEV), a member of the Flaviviridae family, can cause serious infection of the central nervous system in humans, resulting in potential neurological complications and fatal outcomes. TBEV is primarily transmitted to humans through infected tick bites, and the viral agent circulates between ticks and animals, such as deer and small mammals. The occurrence of the infection aligns with the seasonal activity of ticks. As no specific antiviral therapy exists for TBEV infection, treatment approaches primarily focus on symptomatic relief and support. Active immunization is highly effective, especially for individuals in endemic areas. The burden of TBEV infections is increasing, posing a growing health concern. Reported incidence rates rose from 0.4 to 0.9 cases per 100,000 people between 2015 and 2020. The Baltic and Central European countries have the highest incidence, but TBE is endemic across a wide geographic area. Various factors, including social and environmental aspects, improved medical awareness, and advanced diagnostics, have contributed to the observed increase. Diagnosing TBEV infection can be challenging due to the non-specific nature of the initial symptoms and potential co-infections. Accurate diagnosis is crucial for appropriate management, prevention of complications, and effective control measures. In this comprehensive review, we summarize the molecular structure of TBEV, its transmission and circulation in natural environments, the pathogenesis of TBEV infection, the epidemiology and global distribution of the virus, associated risk factors, clinical manifestations, and diagnostic approaches. By improving understanding of these aspects, we aim to enhance knowledge and promote strategies for timely and accurate diagnosis, appropriate management, and the implementation of effective control measures against TBEV infections.
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Affiliation(s)
- Emina Pustijanac
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, 52100 Pula, Croatia
| | - Moira Buršić
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, 52100 Pula, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia
- Institute for Health Metrics and Evaluation and the Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
| | - Dubravka Lišnjić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
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Kjær LJ, Johansson M, Lindgren PE, Asghar N, Wilhelmsson P, Fredlund H, Christensson M, Wallenhammar A, Bødker R, Rasmussen G, Kjellander P. Potential drivers of human tick-borne encephalitis in the Örebro region of Sweden, 2010-2021. Sci Rep 2023; 13:7685. [PMID: 37169798 PMCID: PMC10175290 DOI: 10.1038/s41598-023-34675-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023] Open
Abstract
Incidence of tick-borne encephalitis (TBE) has increased during the last years in Scandinavia, but the underlying mechanism is not understood. TBE human case data reported between 2010 and 2021 were aggregated into postal codes within Örebro County, south-central Sweden, along with tick abundance and environmental data to analyse spatial patterns and identify drivers of TBE. We identified a substantial and continuing increase of TBE incidence in Örebro County during the study period. Spatial cluster analyses showed significant hotspots (higher number of cases than expected) in the southern and northern parts of Örebro County, whereas a cold spot (lower number of cases than expected) was found in the central part comprising Örebro municipality. Generalised linear models showed that the risk of acquiring TBE increased by 12.5% and 72.3% for every percent increase in relative humidity and proportion of wetland forest, respectively, whereas the risk decreased by 52.8% for every degree Celsius increase in annual temperature range. However, models had relatively low goodness of fit (R2 < 0.27). Results suggest that TBE in Örebro County is spatially clustered, however variables used in this study, i.e., climatic variables, forest cover, water, tick abundance, sheep as indicator species, alone do not explain this pattern.
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Affiliation(s)
- Lene Jung Kjær
- Section for Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Magnus Johansson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Naveed Asghar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Hans Fredlund
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Örebro County Council, Örebro, Sweden
| | - Madeleine Christensson
- Grimsö Wildlife Research Station, Department of Ecology, Swedish University of Agricultural Sciences (SLU), Riddarhyttan, Sweden
| | - Amélie Wallenhammar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - René Bødker
- Section for Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Gunløg Rasmussen
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Örebro County Council, Örebro, Sweden
| | - Petter Kjellander
- Grimsö Wildlife Research Station, Department of Ecology, Swedish University of Agricultural Sciences (SLU), Riddarhyttan, Sweden
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Beran J, Lattanzi M, Costantini M, Pammolli A, Galgani I. Sustained antibody persistence for at least 15 years after a booster vaccination against tick-borne encephalitis following different primary vaccination schedules: Third 5-year follow-up. Vaccine 2023; 41:3518-3524. [PMID: 37142462 DOI: 10.1016/j.vaccine.2023.04.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Vaccination is the best mode of protection against tick-borne encephalitis (TBE) and its sequelae. The duration of protection and the optimal interval of repeat booster doses are still debated. The current study evaluated the persistence of the antibody response 11-15 years after a first booster vaccination following different primary vaccination schedules with a TBE vaccine (Encepur Adults, manufactured by Bavarian Nordic, previously by GSK). METHODS This phase IV, open-label, mono-centric extension study enrolled adults who had received (at ≥ 12 years of age) primary vaccination with one of three randomly assigned TBE vaccine schedules (rapid [group R], conventional [group C], or accelerated conventional schedule [group A]) followed by a booster dose 3 years later. The antibody response was measured annually from 11 to 15 years post-booster using a TBE virus neutralization test (NT). An NT titer of ≥ 10 was considered as a clinically meaningful threshold and surrogate for protection. RESULTS In total, 194 participants were enrolled and included in the per-protocol set; 188 completed the study. The percentage of participants with an NT titer ≥ 10 was 100% in group R and 99.0% in group A at all visits and ranged from 100% (year 11) to 95.8% (year 15) in group C. NT geometric mean titers were similar in the three study groups (181-267 in group R, 142-227 in group C, 141-209 in group A). NT geometric mean titers also remained high among participants ≥ 50 years old (98-206) and ≥ 60 years old (91-191) across study groups and time points. CONCLUSIONS This study showed neutralizing antibody persistence for at least 15 years after a first booster dose of the Encepur Adults TBE vaccine in all age groups evaluated, regardless of which primary vaccination schedule was given to adolescents or adults. Trialregistry: ClinicalTrials.gov: NCT03294135.
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Affiliation(s)
- Jiří Beran
- Vaccination and Travel Medicine Center, Tylovo nábřeží 418/6, 500 02 Hradec Králové, Czech Republic; Department for Tropical, Travel Medicine and Immunization, Institute for Postgraduate Medical Education, Ruská 2412/85, 100 00 Prague 10, Czech Republic.
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Paradowska-Stankiewicz I, Pancer K, Poznańska A, Hordowicz M, Skibicka M, Słowiński M, Motak G, Falkiewicz B. Tick-borne encephalitis epidemiology and surveillance in Poland, and comparison with selected European countries before and during the COVID-19 pandemic, 2008 to 2020. Euro Surveill 2023; 28:2200452. [PMID: 37140452 PMCID: PMC10161683 DOI: 10.2807/1560-7917.es.2023.28.18.2200452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/24/2023] [Indexed: 05/05/2023] Open
Abstract
BackgroundTick-borne encephalitis (TBE) is the most common viral central nervous system (CNS) infection in Poland. Previous research suggests that its incidence was underestimated in the pre-pandemic period. The COVID-19 pandemic caused a considerable burden on surveillance systems, which could further impact reporting.AimWe aimed to assess the completeness of reporting of TBE in the years 2008 to 2020 and explore the potential impact of the COVID-19 pandemic on reporting to the epidemiological surveillance system, compared with hospitalisations for TBEV and other viral neuro-infections.MethodsWe compared the Polish epidemiology of TBE and other viral infections of the CNS from national surveillance reports with data on hospitalisations from 2008 to 2020 and data from selected European countries.ResultsBetween 2008 and 2020, 3,016 TBE cases were reported to surveillance compared with 3,620 hospitalisations. There was an increasing trend in hospitalisations, while surveillance data demonstrated the opposite, with the largest discrepancy observed in the first pandemic year (354 hospitalisations vs 159 cases reported to surveillance). Serological testing for TBE was used more in the known endemic region of north-eastern Poland and less in non-endemic areas. Other European countries reported higher TBE case numbers and an increase during the COVID-19 pandemic, whereas Poland observed an opposite trend.ConclusionThe sensitivity of TBE surveillance in Poland requires improvement. There are considerable regional differences. Regions that test for TBE intensively report most cases. Policymakers should be made aware of the value of quality epidemiological data for planning prophylactic measures in risk areas.
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Affiliation(s)
- Iwona Paradowska-Stankiewicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Katarzyna Pancer
- Laboratory BSL3 and Virology Department; National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym's Independent Public Regional Psychiatric Health Care Centre, Radom, Poland
| | - Maria Skibicka
- Pfizer Polska Sp. z o.o., Vaccines Poland, Warsaw, Poland
| | | | - Gerard Motak
- IQVIA Commercial Consulting sp. z o.o., Warsaw, Poland
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Wójcik-Fatla A, Krzowska-Firych J, Czajka K, Nozdryn-Płotnicka J, Sroka J. The Consumption of Raw Goat Milk Resulted in TBE in Patients in Poland, 2022 "Case Report". Pathogens 2023; 12:pathogens12050653. [PMID: 37242323 DOI: 10.3390/pathogens12050653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The alimentary route is the second most important route of tick-borne encephalitis infection. In Poland, the last TBE case due to the consumption of unpasteurized milk or dairy products of infected animals was recorded in 2017 as the fourth documented outbreak of TBEV infection in the country. In this study, two patients infected with TBEV through consumption of unpasteurized goat's milk from one source are described from a cluster of eight cases. In August and September 2022, a 63- and 67-year-old woman were hospitalized at the Infectious Diseases Clinic of the Institute of Rural Health (Lublin, Poland). The patients denied been recently bitten by a tick, and neither had been vaccinated against TBEV. The disease had a biphasic course. In the first case, the patient suffered from a fever, spine pain, and muscle weakness and paresis of the lower left limb. The second patient suffered from fever, vertigo, headaches, abdominal pain, and diarrhoea. The results of IgM and IgG antibodies were positive in both cases. After three weeks hospitalization, the patients were discharged in good condition. In one case, slight hearing impairment was observed. Vaccination and avoiding the consumption of unpasteurized milk remain the most effective ways to prevent tick-borne encephalitis.
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Affiliation(s)
- Angelina Wójcik-Fatla
- Department of Health Biohazards and Parasitology, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland
| | - Joanna Krzowska-Firych
- Infectious Diseases Clinic, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland
| | - Krzysztof Czajka
- Infectious Diseases Clinic, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland
| | | | - Jacek Sroka
- Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Aleja Partyzantów 57, 24-100 Puławy, Poland
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Saegerman C, Humblet MF, Leandri M, Gonzalez G, Heyman P, Sprong H, L’Hostis M, Moutailler S, Bonnet SI, Haddad N, Boulanger N, Leib SL, Hoch T, Thiry E, Bournez L, Kerlik J, Velay A, Jore S, Jourdain E, Gilot-Fromont E, Brugger K, Geller J, Studahl M, Knap N, Avšič-Županc T, Růžek D, Zomer TP, Bødker R, Berger TFH, Martin-Latil S, De Regge N, Raffetin A, Lacour SA, Klein M, Lernout T, Quillery E, Hubálek Z, Ruiz-Fons F, Estrada-Peña A, Fravalo P, Kooh P, Etore F, Gossner CM, Purse B. First Expert Elicitation of Knowledge on Possible Drivers of Observed Increasing Human Cases of Tick-Borne Encephalitis in Europe. Viruses 2023; 15:v15030791. [PMID: 36992499 PMCID: PMC10054665 DOI: 10.3390/v15030791] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a viral disease endemic in Eurasia. The virus is mainly transmitted to humans via ticks and occasionally via the consumption of unpasteurized milk products. The European Centre for Disease Prevention and Control reported an increase in TBE incidence over the past years in Europe as well as the emergence of the disease in new areas. To better understand this phenomenon, we investigated the drivers of TBE emergence and increase in incidence in humans through an expert knowledge elicitation. We listed 59 possible drivers grouped in eight domains and elicited forty European experts to: (i) allocate a score per driver, (ii) weight this score within each domain, and (iii) weight the different domains and attribute an uncertainty level per domain. An overall weighted score per driver was calculated, and drivers with comparable scores were grouped into three terminal nodes using a regression tree analysis. The drivers with the highest scores were: (i) changes in human behavior/activities; (ii) changes in eating habits or consumer demand; (iii) changes in the landscape; (iv) influence of humidity on the survival and transmission of the pathogen; (v) difficulty to control reservoir(s) and/or vector(s); (vi) influence of temperature on virus survival and transmission; (vii) number of wildlife compartments/groups acting as reservoirs or amplifying hosts; (viii) increase of autochthonous wild mammals; and (ix) number of tick species vectors and their distribution. Our results support researchers in prioritizing studies targeting the most relevant drivers of emergence and increasing TBE incidence.
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Affiliation(s)
- Claude Saegerman
- Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, 4000 Liege, Belgium
- Correspondence:
| | - Marie-France Humblet
- Department for Occupational Protection and Hygiene, Unit Biosafety, Biosecurity and Environmental Licences, University of Liege, 4000 Liege, Belgium
| | - Marc Leandri
- UMI SOURCE, Université Paris-Saclay—UVSQ, 78000 Versailles, France
| | - Gaëlle Gonzalez
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | | | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Monique L’Hostis
- Ecole Nationale Vétérinaire Agroalimentaire et de l’Alimentation Nantes-Atlantique, Oniris, 44307 Nantes, France
| | - Sara Moutailler
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Sarah I. Bonnet
- UMR 2000 Institut Pasteur-CNRS-Université Paris-Cité, Ecology and Emergence of Arthropod-borne Pathogens, 75015 Paris, France
- Animal Health Department, INRAE, 37380 Nouzilly, France
| | - Nadia Haddad
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Nathalie Boulanger
- UR7290: VBP: Borrelia Group, France and French Reference Centre on Lyme Borreliosis, CHRU, Unversity of Strasbourg, 67000 Strasbourg, France
| | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | | | - Etienne Thiry
- Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, 4000 Liege, Belgium
| | - Laure Bournez
- ANSES, Nancy Laboratory for Rabies and Wildlife, 54220 Malzéville, France
| | - Jana Kerlik
- Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, 497556 Banská Bystrica, Slovakia
| | - Aurélie Velay
- Unité Mixte de Recherché Immunorhumathologie Moléculaire (UMR IRM_S) 1109, Université de Strasbourg, INSERM, 67000 Strasbourg, France
| | - Solveig Jore
- Zoonotic, Water and Foodborne Infections, The Norwegian Institute for Public Health (NIPH), 0213 Oslo, Norway
| | - Elsa Jourdain
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, Route de Theix, 63122 Saint-Genès-Champanelle, France
| | | | - Katharina Brugger
- Competence Center Climate and Health, Austrian National Institute of Public Health, 1010 Vienna, Austria
| | - Julia Geller
- Department of Virology and Immunology, National Institute for Health Development, 11619 Tallinn, Estonia
| | - Marie Studahl
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, 41685 Gothenburg, Sweden
| | - Nataša Knap
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - Daniel Růžek
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, 37005 Ceske Budejovice, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, 62500 Brno, Czech Republic
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, 62100 Brno, Czech Republic
| | - Tizza P. Zomer
- Lyme Center Apeldoorn, Gelre Hospital, 7300 DS Apeldoorn, The Netherlands
| | - René Bødker
- Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
| | - Thomas F. H. Berger
- Agroscope, Risk Evaluation and Risk Mitigation, Schwarzenburgstrasse, 3003 Bern-Liebefeld, Switzerland
| | - Sandra Martin-Latil
- Laboratory for Food Safety, ANSES, University of Paris-EST, 94700 Maisons-Alfort, France
| | - Nick De Regge
- Operational Direction Infectious Diseases in Animals, Unit of Exotic and Vector-borne Diseases, Sciensano, 1180 Brussels, Belgium
| | - Alice Raffetin
- Reference Centre for Tick-Borne Diseases, Paris and Northern Region, Department of Infectious Diseases, General Hospital of Villeneuve-Saint-Georges, 94100 Villeneuve-Saint-Georges, France
| | - Sandrine A. Lacour
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Matthias Klein
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377 München, Germany
| | - Tinne Lernout
- Scientific Directorate of Epidemiology and Public Health, Sciensano, 1180 Brussels, Belgium
| | - Elsa Quillery
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Zdeněk Hubálek
- Institute of Vertebrate Biology, Czech Academy of Sciences, Květná 8, 60365 Brno, Czech Republic
| | - Francisco Ruiz-Fons
- Health & Biotechnology (SaBio) Group, Instituto de Investigación en Recursos Cinegéticos (IREC), CSIC-UCLM-JCCM, 13071 Ciudad Real, Spain
| | - Agustín Estrada-Peña
- Deptartment of Animal Health, Faculty of Veterinary Medicine, 50013 Zaragoza, Spain
| | - Philippe Fravalo
- Pôle Agroalimentaire, Conservatoire National des Arts et Métiers (Cnam), 75003 Paris, France
| | - Pauline Kooh
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Florence Etore
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Céline M. Gossner
- European Centre for Disease Prevention and Control (ECDC), 17183 Solna, Sweden
| | - Bethan Purse
- UK Centre for Ecology & Hydrology, Benson Lane, Crowmarsh Gifford, Oxfordshire OX10 8BB, UK
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Schley K, Friedrich J, Pilz A, Huang L, Balkaran BL, Maculaitis MC, Malerczyk C. Evaluation of under-testing and under-diagnosis of tick-borne encephalitis in Germany. BMC Infect Dis 2023; 23:139. [PMID: 36882704 PMCID: PMC9990549 DOI: 10.1186/s12879-023-08101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Tick-borne encephalitis (TBE), a viral infectious disease affecting the central nervous system, potentially resulting in prolonged neurological symptoms and other long-term sequelae. Case identification can be challenging as TBE can be associated with non-specific symptoms, and even in cases consistent with typical TBE symptoms, the rate of laboratory testing to confirm cases is unknown. This study assessed real-world TBE laboratory testing rates across Germany. METHODS In this retrospective cross-sectional study, physicians provided data on TBE decision-making, laboratory testing (serological), and diagnostics behavior via in-depth qualitative interviews (N = 12) or a web-based quantitative survey of their patient medical records (N = 166). Hospital-based physicians who specialized in infectious disease, intensive care unit, emergency room, neurology, or pediatrics with experience managing and ordering testing for patients with meningitis, encephalitis, or non-specific central nervous system symptoms in the past 12 months were included. Data were summarized via descriptive statistics. TBE testing and positivity rates were assessed for the aggregate sample of 1400 patient charts and reported by presenting symptoms, region, and tick bite exposure. RESULTS TBE testing rates ranged from 54.0% (non-specific neurological symptoms only) to 65.6% (encephalitis symptoms only); the percentage of TBE positive results ranged from 5.3% (non-specific neurological symptoms only) to 36.9% (meningitis symptoms only). TBE testing rates were higher among those with a tick bite history and/or who presented with headache, high fever, or flu-like symptoms. CONCLUSIONS The findings of this study suggest that patients with typical TBE symptoms are likely under-tested, thus likely leading to under-diagnosis in Germany. To ensure appropriate case identification, TBE testing should be consistently integrated into routine practice for all patients who present with relevant symptoms or exposure to common risk factors.
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Affiliation(s)
| | | | - Andreas Pilz
- Pfizer Corporation, Austria Gesellschaft M.B.H., Floridsdorfer Hauptstraße 1, 1210, Vienna, Austria
| | - Liping Huang
- Pfizer Inc., 235 East 42Nd Street, New York, NY, USA
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37
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Velay A, Janssen-Langenstein R, Kremer S, Laugel E, Lutz M, Pierson AL, Wendling MJ, Schneider F, Fafi-Kremer S. Tick-Borne Encephalitis in Pregnant Woman and Long-Term Sequelae. Emerg Infect Dis 2023; 29:669-671. [PMID: 36823716 PMCID: PMC9973690 DOI: 10.3201/eid2903.221328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We report a case of severe tick-borne encephalitis in a pregnant woman, leading to a prolonged stay in the intensive care unit. She showed minor clinical improvement >6 months after her presumed infection. The patient was not vaccinated, although an effective vaccine is available and not contraindicated during pregnancy.
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Parfut A, Laugel E, Baer S, Gonzalez G, Hansmann Y, Wendling MJ, Fafi-Kremer S, Velay A. Tick-borne encephalitis in pediatrics: An often overlooked diagnosis. Infect Dis Now 2023; 53:104645. [PMID: 36642097 DOI: 10.1016/j.idnow.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Tick-borne encephalitis (TBE) is a vector-borne disease caused by a flavivirus, the tick-borne encephalitis virus (TBEV), and transmitted by the bite of infected Ixodes ricinus ticks. The European subtype (TBEV-Eu) is endemic in 27 European countries. During the last decade, increased TBE incidence was observed in many countries, including some of those believed to be of low endemicity/devoid of TBEV circulation. However, data dealing with TBE in children are far less profuse than with adults. Historically, children are known to have mild TBEV infection with favorable outcomes. That said, recent case reports and observational studies on pediatric cohorts have challenged this point of view. Like adults, children may present severe forms and fail to completely recover following TBE infection, at times leading to long-term cognitive impairment. In this review, we comprehensively describe the incidence, exposure factors, and transmission routes of TBEV in children, as well as the clinical and biological manifestations of TBE and imaging findings in this population. We also harness new data on long-term outcomes and sequelae in pediatric cohorts. Finally, we provide an overview of vaccination recommendations for children in European countries.
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Affiliation(s)
- Assilina Parfut
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France
| | - Elodie Laugel
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Sarah Baer
- CHU de Strasbourg, Service de Pédiatrie Spécialisée et Générale, Unité de Neurologie Pédiatrique, Strasbourg, France
| | - Gaëlle Gonzalez
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Yves Hansmann
- CHU de Strasbourg, Service des maladies infectieuses et tropicales, Strasbourg, France
| | - Marie-Josée Wendling
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France
| | - Samira Fafi-Kremer
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Aurélie Velay
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
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Rescue and in vitro characterization of a divergent TBEV-Eu strain from the Netherlands. Sci Rep 2023; 13:2872. [PMID: 36807371 PMCID: PMC9938877 DOI: 10.1038/s41598-023-29075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Tick-borne encephalitis virus (TBEV) may cause tick-borne encephalitis (TBE), a potential life-threatening infection of the central nervous system in humans. Phylogenetically, TBEVs can be subdivided into three main subtypes, which differ in endemic region and pathogenic potential. In 2016, TBEV was first detected in the Netherlands. One of two detected strains, referred to as Salland, belonged to the TBEV-Eu subtype, yet diverged ≥ 2% on amino acid level from other members of this subtype. Here, we report the successful rescue of this strain using infectious subgenomic amplicons and its subsequent in vitro characterization by comparison to two well-characterized TBEV-Eu strains; Neudoerfl and Hypr. In the human alveolar epithelial cell line A549, growth kinetics of Salland were comparable to the high pathogenicity TBEV-Eu strain Hypr, and both strains grew considerably faster than the mildly pathogenic strain Neudoerfl. In the human neuroblastoma cell line SK-N-SH, Salland replicated faster and to higher infectious titers than both reference strains. All three TBEV strains infected primary human monocyte-derived dendritic cells to a similar extent and interacted with the type I interferon system in a similar manner. The current study serves as the first in vitro characterization of the novel, divergent TBEV-Eu strain Salland.
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Omazic A, Wallenhammar A, Lahti E, Asghar N, Hanberger A, Hjertqvist M, Johansson M, Albihn A. Dairy milk from cow and goat as a sentinel for tick-borne encephalitis virus surveillance. Comp Immunol Microbiol Infect Dis 2023; 95:101958. [PMID: 36893698 DOI: 10.1016/j.cimid.2023.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
Tick-borne encephalitis (TBE) is one of the most severe human tick-borne diseases in Europe. It is caused by the tick-borne encephalitis virus (TBEV), which is transmitted to humans mainly via bites of Ixodes ricinus or I. persulcatus ticks. The geographical distribution and abundance of I. ricinus is expanding in Sweden as has the number of reported human TBE cases. In addition to tick bites, alimentary TBEV infection has also been reported after consumption of unpasteurized dairy products. So far, no alimentary TBEV infection has been reported in Sweden, but knowledge about its prevalence in Swedish ruminants is scarce. In the present study, a total of 122 bulk tank milk samples and 304 individual milk samples (including 8 colostrum samples) were collected from dairy farms (n = 102) in Sweden. All samples were analysed for the presence of TBEV antibodies by ELISA test and immunoblotting. Participating farmers received a questionnaire about milk production, pasteurization, tick prophylaxis used on animals, tick-borne diseases, and TBE vaccination status. We detected specific anti-TBEV antibodies, i.e., either positive (>126 Vienna Units per ml, VIEU/ml) or borderline (63-126 VIEU/ml) in bulk tank milk from 20 of the 102 farms. Individual milk samples (including colostrum samples) from these 20 farms were therefore collected for further analysis. Our results revealed important information for detection of emerging TBE risk areas. Factors such as consumption of unpasteurized milk, limited use of tick prophylaxis on animals and a moderate coverage of human TBE vaccination, may be risk factors for alimentary TBEV infection in Sweden.
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Affiliation(s)
- Anna Omazic
- Department of Chemistry, Environment and Feed Hygiene, National Veterinary Institute, SE-751 89 Uppsala, Sweden.
| | - Amélie Wallenhammar
- School of Medical Sciences, Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden.
| | - Elina Lahti
- Department of Epidemiology and Disease Control, National Veterinary Institute, SE-751 89 Uppsala, Sweden.
| | - Naveed Asghar
- School of Medical Sciences, Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden.
| | - Alexander Hanberger
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Box 7028, SE-750 07 Uppsala, Sweden.
| | - Marika Hjertqvist
- Department of Communicable Disease Control and Health Protection, Public Health, Agency of Sweden, SE-171 82 Stockholm, Sweden.
| | - Magnus Johansson
- School of Medical Sciences, Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden.
| | - Ann Albihn
- Department of Epidemiology and Disease Control, National Veterinary Institute, SE-751 89 Uppsala, Sweden; Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Box 7028, SE-750 07 Uppsala, Sweden.
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Santonja I, Stiasny K, Essl A, Heinz FX, Kundi M, Holzmann H. Tick-Borne Encephalitis in Vaccinated Patients: A Retrospective Case-Control Study and Analysis of Vaccination Field Effectiveness in Austria From 2000 to 2018. J Infect Dis 2023; 227:512-521. [PMID: 35235953 DOI: 10.1093/infdis/jiac075] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are discrepant observations on the severity of tick-borne encephalitis (TBE) in vaccinated persons. We, therefore, analyzed the occurrence of severe and mild disease in hospitalized vaccinated and nonvaccinated patients with TBE and determined the field effectiveness (FE) of vaccination against these forms of disease. METHODS The study covered all patients hospitalized with TBE in Austria from 2000 to 2018. Clinical diagnoses in vaccinated and age- and sex-matched nonvaccinated patients were compared in a nested case-control study. FE was calculated based on vaccination coverage and incidences in the nonvaccinated and vaccinated population. RESULTS Of 1545 patients hospitalized with TBE, 206 were vaccinated. In those, a higher proportion of severe TBE was observed, especially in children. FE was high in all age groups and against all forms of disease. The higher proportion of severe TBE can be explained by a lower FE against severe than against mild disease, a difference especially pronounced in children (FE, 82.7% for severe vs 94.7% for mild disease). CONCLUSIONS The FE of TBE vaccination is excellent. The observed higher proportion of severe disease in vaccinated persons with TBE does not reflect a higher risk associated with vaccination but is rather due to a somewhat lower FE against severe TBE. Because this effect was more pronounced in children, we recommend adapting the immunization schedule.
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Affiliation(s)
- Isabel Santonja
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Astrid Essl
- Astrid Essl Consulting-Gesundheitsforschung, Wiener Neustadt, Austria
| | - Franz X Heinz
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria
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Eyer L, Seley-Radtke K, Ruzek D. New directions in the experimental therapy of tick-borne encephalitis. Antiviral Res 2023; 210:105504. [PMID: 36574904 DOI: 10.1016/j.antiviral.2022.105504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Tick-borne encephalitis (TBE) is a potentially fatal disease common in much of Europe and Asia. There is no specific therapy for the treatment of TBE patients. However, several efforts are being made to develop small molecules that specifically interfere with the life cycle of TBE virus. In particular, recently various nucleoside analogues that can inhibit the viral replicase, such as the RNA-dependent RNA polymerase or viral methyltransferases, have been explored. In addition, human or chimeric (i.e., structural chimeras that combine mouse variable domains with human constant domains) monoclonal antibodies with promising potential for post-exposure prophylaxis or early therapy have been developed. This review summarizes the latest directions and experimental approaches that may be used to combat TBE in humans.
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Affiliation(s)
- Ludek Eyer
- Laboratory of Emerging Viral Diseases, Veterinary Research Institute, Brno, Czech Republic; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic; Institute of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Katherine Seley-Radtke
- Department of Chemistry and Biochemistry, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Daniel Ruzek
- Laboratory of Emerging Viral Diseases, Veterinary Research Institute, Brno, Czech Republic; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic; Institute of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic.
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Fortova A, Hönig V, Salat J, Palus M, Pychova M, Krbkova L, Barkhash AV, Kriha MF, Chrdle A, Lipoldova M, Ruzek D. Serum matrix metalloproteinase-9 (MMP-9) as a biomarker in paediatric and adult tick-borne encephalitis patients. Virus Res 2023; 324:199020. [PMID: 36528170 DOI: 10.1016/j.virusres.2022.199020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Matrix metalloproteinases (MMPs) play an important role in central nervous system infections. We analysed the levels of 8 different MMPs in the cerebrospinal fluid (CSF) of 89 adult patients infected with tick-borne encephalitis (TBE) virus and compared them with the levels in a control group. MMP-9 was the only MMP that showed significantly increased CSF levels in TBE patients. Serum MMP-9 levels were subsequently measured in 101 adult TBE patients at various time points during the neurological phase of TBE and at follow-up. In addition, serum MMP-9 was analysed in 37 paediatric TBE patients. Compared with control levels, both paediatric and adult TBE patients had significantly elevated serum MMP-9 levels. In most adult patients, serum MMP-9 levels peaked at hospital admission, with higher serum MMP-9 levels observed in patients with encephalitis than in patients with meningitis. Elevated serum MMP-9 levels were observed throughout hospitalisation but decreased to normal levels at follow-up. Serum MMP-9 levels correlated with clinical course, especially in patients heterozygous for the single-nucleotide polymorphism rs17576 (A/G; Gln279Arg) in the MMP9 gene. The results highlight the importance of MMP-9 in the pathogenesis of TBE and suggest that serum MMP-9 may serve as a promising bioindicator of TBE in both paediatric and adult TBE patients.
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Affiliation(s)
- Andrea Fortova
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, CZ-62100 Brno, Czechia
| | - Vaclav Hönig
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, CZ-62100 Brno, Czechia; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-37005 Ceske Budejovice, Czechia
| | - Jiri Salat
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, CZ-62100 Brno, Czechia; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-37005 Ceske Budejovice, Czechia
| | - Martin Palus
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, CZ-62100 Brno, Czechia; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-37005 Ceske Budejovice, Czechia
| | - Martina Pychova
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, CZ-62500 Brno, Czechia
| | - Lenka Krbkova
- Department of Children's Infectious Disease, Faculty of Medicine and University Hospital, Masaryk University, CZ-61300 Brno, Czechia
| | - Andrey V Barkhash
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences, 10 Lavrentyeva Ave., Novosibirsk 630090, Russia
| | - Michal F Kriha
- Department of Infectious Diseases, Hospital Ceske Budejovice, CZ-37001 Ceske Budejovice, Czechia; Faculty of Science, University of South Bohemia, CZ-37005 Ceske Budejovice, Czechia
| | - Ales Chrdle
- Department of Infectious Diseases, Hospital Ceske Budejovice, CZ-37001 Ceske Budejovice, Czechia; Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK
| | - Marie Lipoldova
- Institute of Molecular Genetics of the Czech Academy of Sciences, CZ-14220 Prague, Czechia
| | - Daniel Ruzek
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, CZ-62100 Brno, Czechia; Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-37005 Ceske Budejovice, Czechia; Department of Experimental Biology, Faculty of Science, Masaryk University, CZ-62500 Brno, Czechia.
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Picard L, Mailles A, Fillâtre P, Tattevin P, Stahl JP. Encephalitis in travellers: A prospective multicentre study. J Travel Med 2022; 30:6869133. [PMID: 36461934 DOI: 10.1093/jtm/taac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/12/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND As the epidemiology of encephalitis varies from one country to another, international travel may be an important clue for the diagnostic workout of this puzzling disease. METHODS We performed an ancillary study using the ENCEIF prospective cohort conducted in 62 clinical sites in France from 2016 to 2019. All cases of encephalitis in adults that fulfilled a case definition derived from the International Encephalitis Consortium were included. Travellers were defined as patients who spent at least one night in a foreign country within the last six months. RESULTS Of the 494 encephalitis patients enrolled, 69 (14%) were travellers. As compared to non-travellers, they were younger (median age, 48 years [interquartile range, 36-69] vs. 66 [49-76], P < 0.001), less likely to be immunocompromised: 2/69 (3%) vs 56/425 (13%), P = 0.02, and reported more arthralgia: 7/69 (10%) vs. 11/425 (3%), P = 0.007. The risk of poor outcome at hospital discharge (Glasgow outcome scale ≤ 3), was similar for travellers and for non-travellers after adjustment (aOR 0.80 [0.36-1.80], P = 0.594). Arboviruses were the main causes of encephalitis in travellers: 15/69 (22%) vs. 20/425 (5%) in non-travellers, P < 0.001, and Herpes simplex virus (HSV) was the second (9/69, 13%). Of note, in 19% (13/69) of cases, the risk of encephalitis in travellers may have been decreased with a vaccine. CONCLUSION The two primary causes of encephalitis in travellers are arboviruses, and HSV. Empirical treatment of encephalitis in travellers must include aciclovir. Pre-travel advice and vaccination may decrease the risk of encephalitis in travellers.
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Affiliation(s)
- Léa Picard
- Université Rennes 1, Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalo-Universitaire, Rennes, France
| | - Alexandra Mailles
- Santé Publique France, Direction des Maladies Infectieuses, Saint-Maurice, France.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infectious diseases of the Brain (ESGIB), Basel, Switzerland
| | - Pierre Fillâtre
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infectious diseases of the Brain (ESGIB), Basel, Switzerland.,Service de Réanimation Polyvalente, Centre Hospitalier, Saint-Brieuc, France
| | - Pierre Tattevin
- Université Rennes 1, Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalo-Universitaire, Rennes, France.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infectious diseases of the Brain (ESGIB), Basel, Switzerland
| | - Jean-Paul Stahl
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infectious diseases of the Brain (ESGIB), Basel, Switzerland.,Université Grenoble Alpes, Maladies Infectieuses, France
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Li R, Niu Z, Liu Y, Bai X, Wang D, Chen C. Crystal structure and cap binding analysis of the methyltransferase of langat virus. Antiviral Res 2022; 208:105459. [PMID: 36347437 DOI: 10.1016/j.antiviral.2022.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
Tick-borne encephalitis virus (TBEV) is a major dangerous human pathogen, as TBEV infection can cause serious illness that can lead to irreversible neurological sequelae and even death. Langat virus (LGTV), a member of the tick-borne encephalitis virus (TBEV) serogroup, belongs to the family Flaviviridae, genus Flavivirus. Its nonstructural protein 5 (NS5) protein contains a methyltransferase (MTase) domain that can methylate RNA cap structures, which is critical for viral replication. We determined the structure of LGTV NS5 methyltransferase bound to S-adenosyl-L-homocysteine (SAH) at a 1.70 Å resolution. Sequence analysis and structural comparison of homologous MTases suggests that folds and structures are closely conserved throughout Flavivirus species and play important roles. This study provides the key structural information on LGTV MTase and the foundation for research on antiviral drugs targeting LGTV MTase.
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Affiliation(s)
- Ruixue Li
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
| | - Ziping Niu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Yujie Liu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Xue Bai
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Deping Wang
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, the Department of Physiology, Shanxi Medical University, Taiyuan, 030001, China.
| | - Chen Chen
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
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Bogovič P, Kastrin A, Lotrič-Furlan S, Ogrinc K, Avšič Županc T, Korva M, Knap N, Resman Rus K, Strle K, Strle F. Comparison of laboratory and immune characteristics of the initial and second phase of tick-borne encephalitis. Emerg Microbes Infect 2022; 11:1647-1656. [PMID: 35657098 PMCID: PMC9225760 DOI: 10.1080/22221751.2022.2086070] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tick-borne encephalitis (TBE) usually has a biphasic course which begins with unspecific febrile illness, followed by central nervous system involvement. Because TBE is not yet suspected during the initial phase, knowledge of early TBE pathogenesis is incomplete. Herein we evaluated laboratory and immune findings in the initial and second (meningoencephalitic) phase of TBE in 88 well-defined adult patients. Comparison of nine laboratory blood parameters in both phases of TBE revealed that laboratory abnormalities, consisting of low leukocyte and platelet counts and increased liver enzymes levels, were predominately associated with the initial phase of TBE and resolved thereafter. Assessment of 29 immune mediators in serum during the initial phase, and in serum and cerebrospinal fluid (CSF) during the second phase of TBE revealed highly distinct clustering patterns among the three groups. In the initial phase of TBE, the primary finding in serum was a rather heterogeneous immune response involving innate (CXCL11), B cell (CXCL13, BAFF), and T cell mediators (IL-27 and IL-4). During the second phase of TBE, growth factors associated with angiogenesis (GRO-α and VEGF-A) were the predominant characteristic in serum, whereas innate and Th1 mediators were the defining feature of immune responses in CSF. These findings imply that distinct immune processes play a role in the pathophysiology of different phases of TBE and in different compartments.
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Affiliation(s)
- Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Kastrin
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stanka Lotrič-Furlan
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Ogrinc
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Knap
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Resman Rus
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Strle
- Laboratory of Microbial Pathogenesis and Immunology, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Chiffi G, Grandgirard D, Stöckli S, Valente LG, Adamantidis A, Leib SL. Tick-borne encephalitis affects sleep–wake behavior and locomotion in infant rats. Cell Biosci 2022; 12:121. [PMID: 35918749 PMCID: PMC9344439 DOI: 10.1186/s13578-022-00859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 08/30/2023] Open
Abstract
Background/Aims Tick-borne encephalitis (TBE) is a disease affecting the central nervous system. Over the last decade, the incidence of TBE has steadily increased in Europe and Asia despite the availably of effective vaccines. Up to 50% of patients after TBE suffer from post-encephalitic syndrome that may develop into long-lasting morbidity. Altered sleep–wake functions have been reported by patients after TBE. The mechanisms causing these disorders in TBE are largely unknown to date. As a first step toward a better understanding of the pathology of TBEV-inducing sleep dysfunctions, we assessed parameters of sleep structure in an established infant rat model of TBE. Methods 13-day old Wistar rats were infected with 1 × 106 FFU Langat virus (LGTV). On day 4, 9, and 21 post infection, Rotarod (balance and motor coordination) and open field tests (general locomotor activity) were performed and brains from representative animals were collected in each subgroup. On day 28 the animals were implanted with a telemetric EEG/EMG system. Sleep recording was continuously performed for 24 consecutive hours starting at day 38 post infection and visually scored for Wake, NREM, and REM in 4 s epochs. Results As a novelty of this study, infected animals showed a significant larger percentage of time spend awake during the dark phase and less NREM and REM compared to the control animals (p < 0.01 for all comparisons). Furthermore, it was seen, that during the dark phase the wake bout length in infected animals was prolonged (p = 0.043) and the fragmentation index decreased (p = 0.0085) in comparison to the control animals. LGTV-infected animals additionally showed a reduced rotarod performance ability at day 4 (p = 0.0011) and day 9 (p = 0.0055) and day 21 (p = 0.0037). A lower locomotor activity was also seen at day 4 (p = 0.0196) and day 9 (p = 0.0473). Conclusion Our data show that experimental TBE in infant rats affects sleep–wake behavior, leads to decreased spontaneous locomotor activity, and impaired moto-coordinative function. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-022-00859-7.
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Ghiani M, Hagemann C, Friedrich J, Maywald U, Wilke T, von Eiff C, Malerczyk C. Can risk area designation help increase vaccination coverage for Tick-Borne Encephalitis? Evidence from German claims data. Vaccine 2022; 40:7335-7342. [PMID: 36347722 DOI: 10.1016/j.vaccine.2022.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Although vaccine preventable, the incidence of tick-borne encephalitis (TBE) increased in Germany from 2001 to 2021 by on average 2% each year, with a peak of more than 700 TBE infections documented in 2020. TBE-risk areas, as designated by district based on incidence of human cases, expanded north- and northeastward, present in 11 of the 16 Federal States as of 2022. Using claims data from a German statutory health insurance in the Federal States of Saxony and Thuringia (AOK PLUS), we aimed to assess whether official assignment of a district to a risk area had an impact on vaccination rates in Germany. METHODS The data covered the period from 01/01/2010 to 31/12/2018 and included information on vaccine administrations from outpatient physicians. Yearly incident vaccination rates were reported overall and by district. To investigate the association between a new designation of an incident TBE-risk area and vaccination rates, a difference-in-difference analysis was conducted. RESULTS Overall, the incident vaccination rates increased from 6.2 to 9.5 per 1,000 person-years between 2012 and 2018, with a peak of 12.2 in 2015. While districts that had been risk-areas for the whole study period had always a higher vaccination rate compared to districts that were never categorized as risk areas, the increase between 2012 and 2018 was comparable in the two groups (3.0 and 3.2 per 1,000 person-years, respectively). In contrast, districts that were newly designated risk districts during the study period experienced a significantly larger increase in vaccination rates, going from 5.8 to 14.7 per 1,000 person-years between 2012 and 2018, with a peak of 19.6 in 2015. CONCLUSION The results suggest that the new designation of a district as risk area has a significant positive impact on vaccination rates, which is strongest immediately after designation of risk area.
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Affiliation(s)
- M Ghiani
- IPAM e.V, Alter Holzhafen 19, 23966 Wismar, Germany.
| | - C Hagemann
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - J Friedrich
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | | | - T Wilke
- Ingress-Health HWM GmbH, Wismar, Germany
| | - C von Eiff
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - C Malerczyk
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
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Tick-Borne Encephalitis Virus RNA Found in Frozen Goat's Milk in a Family Outbreak. Int J Mol Sci 2022; 23:ijms231911632. [PMID: 36232930 PMCID: PMC9570086 DOI: 10.3390/ijms231911632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Tick-borne encephalitis (TBE) is one of the commonest arthropod-borne viral diseases in Middle-East Europe and North Asia. The main reservoir of the virus is comprised of small rodents and domestic mammals with the common tick (Ixodes) being the usual vector. The clinical spectrum of TBE ranges from mild meningitis to severe meningoencephalomyelitis. This disease can lead to severe sequelae and has a mortality up to 2% in Europe. Even though the majority of cases are transmitted through bites of infected ticks, infections through ingestion of contaminated milk and dairy products from farms in endemic areas have been reported. We report a family outbreak of a febrile disease, initially suggestive of human-to-human infection, during the early summertime in Austria. Tick-borne encephalitis was diagnosed following consumption of unpasteurised goat’s milk and the virus was subsequently detected in frozen milk samples. Although this is a rare manifestation of TBE, this case series shows that TBE should be included in the differential diagnosis of an outbreak of febrile disease, and a careful clinical history with reference to unpasteurized dairy products is crucial in order to prevent further disease spread. The best preventive measure is active immunisation of people living in, or travelling to, endemic areas.
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Varma A, Szlaszynska M, Ben-Haim A, Ilia N, Tarricone S, Lewandowska-Bejm J, Visentin F, Gadler A. Bearing the Burden of Tick-Borne Encephalitis in Europe, 2012-2020: Rising Cases, Future Predictions and Climate Change. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Tick-borne encephalitis (TBE) is a central nervous system disease that is posing a growing public health challenge in Europe. Its disease burden, despite carrying a significant global impact, is still relatively unexplored. This study aims to outline a regression model of how the increasing cases will influence the burden of TBE in the upcoming years, using YLDs (years lived with disability) and DALYs (Disability-adjusted life years), and address climate change as a determinant.
Methods: Information regarding the number of cases, YLDs and DALYs of TBE was collected from European countries using available surveillance data from 2012 to 2020. Number of TBE cases and burden projections were created until 2025, using a linear regression model. The total reported cases of TBE cases in this timeframe, age-group and gender distribution were inserted and modeled in ECDC BCoDE Toolkit, a software application that calculates the burden of communicable diseases, YLDs and DALYs of each year. A non-systematic bibliographic search was conducted exploring the impact of climate change on TBE.
Results: Our findings showed a linear growth in number of TBE cases (74.3% increase), DALYs (71.3%), YLDs (71.75%) in European countries from 2012 to 2020. By 2025, these factors are likely to increase by 141% (95% CI: [108%,175%]), 134% (95% CI: [91%,177%]) and 134% (95% CI: [98%,172%]) compared to 2012, respectively (p<0.0001).
Conclusions: The likelihood of morbidity and mortality increase of TBE, as well as climate-related changes in tick activity, highlight that prompt action is necessary by introducing preventive measures in European populations.
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