Early diagnosis of tick-borne encephalitis (TBE) by demonstration of specific IgM antibodies

Tick-borne encephalitis complicated by monoplegia and sensorineural deafness

Tick-borne encephalitis (TBE) is rarely seen in Britain. We report a case of TBE in a 44-year-old Swedish woman presenting to an accident and emergency department in London. The clinical features of the case, while in many ways typical, were nonspecific and led to difficulty in early diagnosis. The course of the illness was complicated by monoplegia and evidence of bulbar involvement with sensorineural deafness. The last is a very rare manifestation of TBE. With increasing foreign travel, TBE is likely to present more commonly in the U.K. and should be considered in any case of febrile illness with neurological complications following travel abroad. Serological tests to aid early diagnosis should be more readily available.

Tick-borne viral encephalitis in Finland. The clinical features of Kumlinge disease during 1959-1987

During 1959-1987, 126 patients in Aland Islands and main Finland had serologically verified infections with the virus of tick-borne encephalitis (Kumlinge disease). The most useful test for specific virological diagnosis was haemagglutination inhibition-IgM (HI-IgM). Most cases were from Aland Islands and nearby south-western main Finland. Two of the infections were imported. There were three laboratory infections and two transfusion infections. The disease occurred mainly from July to September. Detailed hospital records of 108 of the patients could be obtained. Ninety-five per cent of the patients had headaches, 82% had lymphocytosis of the cerebrospinal fluid, and 81% had high fever. Forty-four per cent had a confirmed biphasic course of disease. Seventeen per cent were severely ill. There were no deaths. The sequels were psychic irritability and fatigue for up to 1 year. There were eight cases of paresis, two of which became permanent.

Multiple mononeuritis and radiculitis with erythema, pain, elevated CSF protein and pleocytosis (Bannwarth's syndrome)

Four patients with Bannwarth's syndrome were examined. One to three weeks weeks after the appearance of a large erythematous skin lesion they developed pain of variable localisation. Four days to four weeks later uni- or bilateral facial palsies and other nerve lesions developed. CSF showed elevated protein and mononuclear pleocytosis. There was a defect of the blood-brain barrier and increased intrathecal production of IgG. Facial nerve latencies were increased 4 to 7 times in three cases and normal in one case examined 15 months after onset. Conduction velocity along other nerves was normal apart from slight slowing in one diabetic patient. Recovery was incomplete in three patients 8 to 15 months after onset of disease and complete in one patient after 15 months.