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Aregay A, Slunečko J, Korva M, Bogovic P, Resman Rus K, Knap N, Beicht J, Kubinski M, Saletti G, Avšič-Županc T, Steffen I, Strle F, Osterhaus ADME, Rimmelzwaan GF. Tick-borne encephalitis vaccine breakthrough infections induce aberrant T cell and antibody responses to non-structural proteins. NPJ Vaccines 2024; 9:141. [PMID: 39112523 PMCID: PMC11306791 DOI: 10.1038/s41541-024-00936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Tick-borne encephalitis virus (TBEV) vaccine breakthrough (VBT) infections are not uncommon in endemic areas. The clinical and immunological outcomes have been poorly investigated. We assessed the magnitude and specificity of virus-specific antibody and T cell responses after TBE in previously vaccinated subjects and compared the results with those of unvaccinated TBE patients and study subjects that received vaccination without VBT infection. Symptomatic TBEV infection of unvaccinated study subjects induced virus-specific antibody responses to the E protein and non-structural protein 1 (NS1) as well as T cell responses to structural and other non-structural (NS) proteins. After VBT infections, significantly impaired NS1-specific antibody responses were observed, while the virus-specific T cell responses to the NS proteins were relatively strong. VBT infection caused predominantly moderate to severe disease during hospitalization. The level of TBEV EDIII- and NS1-specific antibodies in unvaccinated convalescent patients inversely correlated with TBE severity and neurological symptoms early after infection.
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Affiliation(s)
- Amare Aregay
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Jan Slunečko
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Korva
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Bogovic
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Resman Rus
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Knap
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Beicht
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Mareike Kubinski
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Giulietta Saletti
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Tatjana Avšič-Županc
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Imke Steffen
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
- Institute of Biochemistry, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Albert D M E Osterhaus
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Guus F Rimmelzwaan
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
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2
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Christoph R, Giovanni A, Arne S, Sebastian V, Gerhard D, Angelika M, Marc S, Sonja H, Marie S, Lydia J, Michael F, Gerhardt H, Frank D, Martin A, Sonnleitner S, Walder G, Martin F, Martina P. Immunogenicity of tick-borne-encephalitis-virus-(TBEV)-vaccination and impact of age on humoral and cellular TBEV-specific immune responses in patients with rheumatoid arthritis. Vaccine 2024; 42:745-752. [PMID: 38242736 DOI: 10.1016/j.vaccine.2024.01.022] [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: 08/03/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Inactivated vaccines, such as tick-borne-encephalitis-virus-(TBEV) vaccine, have been discussed as less immunogenic in elderly and in immunocompromised patients. In this controlled cross-sectional cohort study, the antibody and cellular responses after TBEV-vaccination were investigated in 36 rheumatoid arthritis (RA) patients and 112 healthy controls (HC) by evaluating IgG-anti-TBEV concentration, neutralization and relative avidity index (RAI). Cellular reactivity was assessed by IFNgamma-producing spot-forming-units (SFU) by ELISPOT assay and flow cytometry. RA patients showed lower IgG-anti-TBEV compared to HC, which were influenced by age at and time since last TBEV vaccination and disease duration. High-responders regarding cellular immunity and avidity were less frequent in RA compared to HC. RA patients who had received booster vaccinations were more likely to demonstrate higher IgG-anti-TBEV responses compared to those who had not. In conclusion, RA patients showed a negative effect of age on anti-TBEV-IgG and immunological benefits of timely booster vaccination are suggested.
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Affiliation(s)
- Rack Christoph
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Almanzar Giovanni
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schäfer Arne
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Diabetes Zentrum Mergengtheim, Bad Mergentheim, Germany
| | - Völkl Sebastian
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Dobler Gerhard
- Institut für Mikrobiologie der Bundeswehr, 80937 Munich, Germany
| | - Mutterer Angelika
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schmalzing Marc
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany
| | - Hick Sonja
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Steimer Marie
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Jahn Lydia
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Fladerer Michael
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Hartmann Gerhardt
- General Medical Practice Dr. Hartmann, Hauptstraße 34, 97204 Höchberg, Germany
| | - Deininger Frank
- Rheumatology Practice Dr. Deininger, Haugerpfarrgasse 7, 97070 Würzburg, Germany
| | - Arbogast Martin
- Center of Rheumatology and Orthopedics, Hubertusstraße 40, 82487 Oberammergau, Germany
| | - Sissy Sonnleitner
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Gernot Walder
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Feuchtenberger Martin
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Department of Rheumatology, MED|BAYERN OST Medical Center Altötting Burghausen, Rheumatologie Krankenhausstraße 1, 84489 Burghausen, Germany
| | - Prelog Martina
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany.
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3
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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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4
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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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5
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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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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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7
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Tang WD, Tang HL, Peng HR, Ren RW, Zhao P, Zhao LJ. Inhibition of tick-borne encephalitis virus in cell cultures by ribavirin. Front Microbiol 2023; 14:1182798. [PMID: 37378295 PMCID: PMC10291047 DOI: 10.3389/fmicb.2023.1182798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Tick-borne encephalitis virus (TBEV) belonging to arboviruses is a major member of zoonotic pathogens. TBEV infection causes severe human encephalitis without specific antiviral drugs. Due to its use of antiviral drug against a wide range of viruses, we investigated antiviral effect of ribavirin against TBEV in susceptible human cell lines A549 and SH-SY5Y. Ribavirin displayed minor cytotoxicity on multiple cell lines. Ribavirin obviously impaired TBEV replication and protected the infected cells from cytopathic effect. Importantly, ribavirin markedly inhibited TBEV propagation, as evidenced by impairment of TBEV production and viral RNA replication. Treatment with ribavirin (co-treatment and post-treatment) led to a dose-dependent reduction in TBEV titers as well as the viral RNA levels. Antiviral protein myxovirus resistance A mRNA expression was significantly up-regulated and signal transducer and activator of transcription 3 was activated in TBEV-infected A549 cells upon the ribavirin treatment. Induction of inflammatory cytokine tumor necrosis factor alpha by TBEV was decreased in A549 cells with the treatment of ribavirin, whereas interleukin 1 beta release appeared to be unaffected. These results suggest that ribavirin might represent a promising safe and effective antiviral drug against TBEV.
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Affiliation(s)
- Wan-Da Tang
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Hai-Lin Tang
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Hao-Ran Peng
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Rui-Wen Ren
- Center for Disease Control and Prevention of Southern Theater Command, Guangzhou, China
| | - Ping Zhao
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Lan-Juan Zhao
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
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8
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Abstract
PURPOSE OF REVIEW Tick-borne encephalitis continues to be one of the most significant causes of viral encephalitis in Europe and Asia. This review will focus on recent developments in the epidemiology, pathogenesis and therapeutic approaches related to infection with tick-borne encephalitis virus. RECENT FINDINGS There is a growing consensus that tick-borne encephalitis viruses are increasing in geographical range, with countries previously free of disease reporting detection of both human cases and presence of virus within indigenous tick populations. The drivers for this are multifactorial but underpinned by human-mediated climate change. Recent developments in pathogenesis have focussed on the intracellular response to infection, particularly in different cell types within the central nervous system (CNS) that are revealing the array of cellular networks triggered by infection. This in turn highlights the need for small molecule therapeutics, such as nucleoside analogues, that can enter the CNS, and the intracellular environment, to inhibit virus replication following neuroinvasion. SUMMARY Based on continued epidemiological surveillance, tick-borne encephalitis viruses will increasingly affect human populations in Europe and Asia. Much of the research highlighted in this review demonstrates incremental advances in our understanding of these viruses. However, more is required if effective prevention and treatment of this devastating encephalitic viruses are to be realized.
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Affiliation(s)
- Nicholas Johnson
- Vector-Borne Diseases, Virology Department, Animal and Plant Health Agency, Woodham Lane, Addlestone, Surrey, UK
| | - Camille V Migné
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR 1161 Virologie, Laboratoire de Santé Animale, Maison-Alfort, France
| | - Gaëlle Gonzalez
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR 1161 Virologie, Laboratoire de Santé Animale, Maison-Alfort, France
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9
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Stone ET, Pinto AK. T Cells in Tick-Borne Flavivirus Encephalitis: A Review of Current Paradigms in Protection and Disease Pathology. Viruses 2023; 15:958. [PMID: 37112938 PMCID: PMC10146733 DOI: 10.3390/v15040958] [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: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
The family Flaviviridae is comprised of a diverse group of arthropod-borne viruses that are the etiological agents of globally relevant diseases in humans. Among these, infection with several of these flaviviruses-including West Nile virus (WNV), Zika virus (ZIKV), Japanese encephalitis virus (JEV), tick-borne encephalitis virus (TBEV), and Powassan virus (POWV)-can result in neuroinvasive disease presenting as meningitis or encephalitis. Factors contributing to the development and resolution of tick-borne flavivirus (TBEV, POWV) infection and neuropathology remain unclear, though many recently undertaken studies have described the virus-host interactions underlying encephalitic disease. With access to neural tissues despite the selectively permeable blood-brain barrier, T cells have emerged as one notable contributor to neuroinflammation. The goal of this review is to summarize the recent advances in tick-borne flavivirus immunology-particularly with respect to T cells-as it pertains to the development of encephalitis. We found that although T cell responses are rarely evaluated in a clinical setting, they are integral in conjunction with antibody responses to restricting the entry of TBFV into the CNS. The extent and means by which they can drive immune pathology, however, merits further study. Understanding the role of the T cell compartment in tick-borne flavivirus encephalitis is instrumental for improving vaccine safety and efficacy, and has implications for treatments and interventions for human disease.
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Affiliation(s)
| | - Amelia K. Pinto
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA
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10
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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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11
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Wang Q, Yan S, Zhang J, Du R, Xue L, Li J, Yu C. The differentially expressed proteins related to clinical viral encephalitis revealed by proteomics. IBRAIN 2022; 8:148-164. [PMID: 37786892 PMCID: PMC10528792 DOI: 10.1002/ibra.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/05/2023]
Abstract
To screen out the prospective biomarkers of viral encephalitis (VE), analyze the biological process and signaling pathways involved by differentially expressed proteins (DEPs). A total of 11 cerebrospinal fluid (CSF) samples with VE and 5 with non-nervous system infection were used to perform label-free proteomic techniques. Then, the bioinformatic analysis of DEPs was applied by Interproscan software. Moreover, 73 CSF samples in the VE group and 53 in the control group were used to verify the changes of some DEPs by enzyme-linked immunosorbent assay (ELISA). Thirty-nine DEPs were identified, including 18 upregulated DEPs and 21 downregulated DEPs. DEPs were mainly enriched in cell adhesion molecules by Kyoto Encyclopedia of Genes and Genomes analysis pathway analysis. The DEPs related to axon tissue were obviously downregulated and the most significant downregulated proteins were neurexin 3, neurofascin, and neuroligin 2 (NLGN2). Moreover, the protein expression of NLGN2 in the VE group was significantly higher than that in the control group by ELISA. The correlation analysis of NLGN2 in the VE group revealed that there was a weak positive correlation with CSF protein and a weak negative correlation with CSF chloride. The clinical VE may be closely related to NLGN2 and the cell adhesion molecule pathway.
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Affiliation(s)
- Qian Wang
- Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | | | | | - Ruo‐Lan Du
- Institute of Neurological Disease and Department of Anesthesiology, Translational Neuroscience Center, West China HospitalSichuan UniversityChengduChina
| | - Lu‐Lu Xue
- Kunming Medical UniversityKunmingYunnanChina
| | - Juan Li
- Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Chang‐Yin Yu
- Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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12
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Stone ET, Hassert M, Geerling E, Wagner C, Brien JD, Ebel GD, Hirsch AJ, German C, Smith JL, Pinto AK. Balanced T and B cell responses are required for immune protection against Powassan virus in virus-like particle vaccination. Cell Rep 2022; 38:110388. [PMID: 35172138 PMCID: PMC8919300 DOI: 10.1016/j.celrep.2022.110388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/07/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Powassan virus (POWV) is a tick-borne pathogen for which humans are an incidental host. POWV infection can be fatal or result in long-term neurological sequelae; however, there are no approved vaccinations for POWV. Integral to efficacious vaccine development is the identification of correlates of protection, which we accomplished in this study by utilizing a murine model of POWV infection. Using POWV lethal and sub-lethal challenge models, we show that (1) robust B and T cell responses are necessary for immune protection, (2) POWV lethality can be attributed to both viral- and host-mediated drivers of disease, and (3) knowledge of the immune correlates of protection against POWV can be applied in a virus-like particle (VLP)-based vaccination approach that provides protection from lethal POWV challenge. Identification of these immune protection factors is significant as it will aid in the rational design of POWV vaccines.
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Affiliation(s)
- E Taylor Stone
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA
| | - Mariah Hassert
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA
| | - Elizabeth Geerling
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA
| | - Colleen Wagner
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA
| | - James D Brien
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA
| | - Gregory D Ebel
- Center for Vector-borne Infectious Diseases, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Alec J Hirsch
- The Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR 97006, USA; Division of Pathobiology & Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Cody German
- The Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR 97006, USA; Division of Pathobiology & Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Jessica L Smith
- The Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR 97006, USA; Division of Pathobiology & Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Amelia K Pinto
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO 63104, USA.
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The manifestation of myositis in tick-borne encephalitis as a prophet of severe disease course: a rare case report. Clin Rheumatol 2022; 41:1241-1245. [PMID: 35024987 DOI: 10.1007/s10067-022-06058-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis (TBE) is one of the most serious neurological tick-transmitted diseases. The initial phase usually occurs with non-specific symptoms such as fever, headache, and muscular pain. The clinical spectrum of the second phase of the disease typically ranges from mild meningitis to severe meningoencephalitis. Our case demonstrates a rare clinical case of acute myositis as manifestation of TBE virus infection. A 33-year-old female was admitted to the Rheumatology centre with a fever followed by proximal muscle pain and weakness. Despite the tick bite history and marginally positive anti-TBE virus IgM titre, the patient did not present any neurological symptoms. Laboratory test results showed elevated creatine kinase (CK) and myoglobin. Other infections, idiopathic inflammatory myopathies, were excluded. TBE virus infection was confirmed by rapid seroconversion of specific IgG class antibodies in serum. The second phase of the disease was followed by neurological symptoms and a repeated increase of CK and myoglobin. We suggest that in the case of acute myositis of unknown cause and the history of thick bite, TBE virus infection should be considered and creatine kinase might be considered as a laboratory marker of disease activity that correlates with the severity of the disease.
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14
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Immunity to TBEV Related Flaviviruses with Reduced Pathogenicity Protects Mice from Disease but Not from TBEV Entry into the CNS. Vaccines (Basel) 2021; 9:vaccines9030196. [PMID: 33652698 PMCID: PMC7996866 DOI: 10.3390/vaccines9030196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
Tick-borne encephalitis virus (TBEV) is a leading cause of vector-borne viral encephalitis with expanding endemic regions across Europe. In this study we tested in mice the efficacy of preinfection with a closely related low-virulent flavivirus, Langat virus (LGTV strain TP21), or a naturally avirulent TBEV strain (TBEV-280) in providing protection against lethal infection with the highly virulent TBEV strain (referred to as TBEV-Hypr). We show that prior infection with TP21 or TBEV-280 is efficient in protecting mice from lethal TBEV-Hypr challenge. Histopathological analysis of brains from nonimmunized mice revealed neuronal TBEV infection and necrosis. Neuroinflammation, gliosis, and neuronal necrosis was however also observed in some of the TP21 and TBEV-280 preinfected mice although at reduced frequency as compared to the nonimmunized TBEV-Hypr infected mice. qPCR detected the presence of viral RNA in the CNS of both TP21 and TBEV-280 immunized mice after TBEV-Hypr challenge, but significantly reduced compared to mock-immunized mice. Our results indicate that although TBEV-Hypr infection is effectively controlled in the periphery upon immunization with low-virulent LGTV or naturally avirulent TBEV 280, it may still enter the CNS of these animals. These findings contribute to our understanding of causes for vaccine failure in individuals vaccinated with TBE vaccines.
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15
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Martínez IZ, Pérez-Martínez C, Salinas LM, Juste RA, García Marín JF, Balseiro A. Phenotypic Characterization of Encephalitis and Immune Response in the Brains of Lambs Experimentally Infected with Spanish Goat Encephalitis Virus. Animals (Basel) 2020; 10:ani10081373. [PMID: 32784781 PMCID: PMC7459603 DOI: 10.3390/ani10081373] [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: 07/10/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
Simple Summary This article studies the local immune response in the central nervous system (CNS) in lambs experimentally infected with Spanish goat encephalitis virus. CNS sections were immunostained to detect microglia, astrocytes, T lymphocytes, and B lymphocytes. In glial foci and perivascular cuffing areas, microglia were the most abundant cell type (45.4% of immunostained cells), followed by T lymphocytes (18.6%) and B lymphocytes (4.4%). Reactive astrogliosis occurred to a greater extent in the lumbosacral spinal cord. Thalamus, hypothalamus, corpus callosum, and medulla oblongata cord contained the largest areas occupied by glial foci. Lesions were more severe in lambs than in goats. Abstract Spanish goat encephalitis virus (SGEV), a novel subtype of tick-borne flavivirus closely related to louping ill virus, causes a neurological disease in experimentally infected goats and lambs. Here, the distribution of microglia, T and B lymphocytes, and astrocytes was determined in the encephalon and spinal cord of eight Assaf lambs subcutaneously infected with SGEV. Cells were identified based on immunohistochemical staining against Iba1 (microglia), CD3 (T lymphocytes), CD20 (B lymphocytes), and glial fibrillary acidic protein (astrocytes). In glial foci and perivascular cuffing areas, microglia were the most abundant cell type (45.4% of immunostained cells), followed by T lymphocytes (18.6%) and B lymphocytes (4.4%). Thalamus, hypothalamus, corpus callosum, and medulla oblongata contained the largest areas occupied by glial foci. Reactive astrogliosis occurred to a greater extent in the lumbosacral spinal cord than in other regions of the central nervous system. Lesions were more frequent on the side of the animal experimentally infected with the virus. Lesions were more severe in lambs than in goats, suggesting that lambs may be more susceptible to SGEV, which may be due to species differences or to interindividual differences in the immune response, rather than to differences in the relative proportions of immune cells. Larger studies that monitor natural or experimental infections may help clarify local immune responses to this flavivirus subtype in the central nervous system.
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Affiliation(s)
- Ileana Z. Martínez
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24006 León, Spain; (I.Z.M.); (C.P.-M.); (L.M.S.); (J.F.G.M.)
- Universidad Popular Autónoma del Estado de Puebla, UPAEP Universidad, Puebla 72410, Mexico
| | - Claudia Pérez-Martínez
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24006 León, Spain; (I.Z.M.); (C.P.-M.); (L.M.S.); (J.F.G.M.)
| | - Luis M. Salinas
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24006 León, Spain; (I.Z.M.); (C.P.-M.); (L.M.S.); (J.F.G.M.)
- Universidad Internacional Antonio de Valdivieso, UNIAV, 47000 Rivas, Nicaragua
| | - Ramón A. Juste
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario, 48160 Derio, Bizkaia, Spain;
| | - Juan F. García Marín
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24006 León, Spain; (I.Z.M.); (C.P.-M.); (L.M.S.); (J.F.G.M.)
- Departamento de Sanidad Animal, Instituto de Ganadería de Montaña, CSIC-Universidad de León, Finca Marzanas, Grulleros, 24346 León, Spain
| | - Ana Balseiro
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, 24006 León, Spain; (I.Z.M.); (C.P.-M.); (L.M.S.); (J.F.G.M.)
- Departamento de Sanidad Animal, Instituto de Ganadería de Montaña, CSIC-Universidad de León, Finca Marzanas, Grulleros, 24346 León, Spain
- Correspondence:
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16
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Murugesan BG, Jafroodifar A, Anilkumar AC, Leontieva L. Differential Diagnosis of Landau-Kleffner Syndrome Versus Post Encephalitis Syndrome in a 13-year-old Boy With Autism Spectrum Disorder. Cureus 2020; 12:e9385. [PMID: 32850252 PMCID: PMC7445094 DOI: 10.7759/cureus.9385] [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] [Indexed: 11/14/2022] Open
Abstract
Landau-Kleffner syndrome (LKS) is a rare childhood neurological condition that causes developmental regression, loss of language skills and abnormal electroencephalogram (EEG) patterns. Its etiology is unknown. This report describes a case of a 13-year-old boy who at 3.5 years of age was bitten by a tick. Two months thereafter, he began losing previously acquired developmental and language skills, and developed seizures. The seizures subsided with valproic acid treatment, but the developmental delays persisted. Family history and disease progression reports obtained from the patient’s father revealed that the patient displayed repetitive behaviors prior to the age of three. Clinical observation also showed the patient having numerous repetitive vocalizations and movements along with difficulty with switching sets. His developmental age at the time of presentation was determined to be 3 to 4 years of age. During the course of diagnostic testing, we were able to rule out tick-borne encephalitis (TBE) and rule in LKS in a premorbidly autistic child. This case describes the similarities between the three conditions and the diagnostic investigations used to arrive at a final diagnosis.
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17
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Divé I, Veje M, Dobler G, Bergström T, Buxmann H, Paul B, Louwen F, Berger A, Jahnke K, Strzelczyk A, Studahl M, Hentz E, Nürnberger L. Tick-borne encephalitis virus (TBEV) infection in pregnancy: Absence of virus transmission to the fetuses despite severe maternal disease - A case study. Ticks Tick Borne Dis 2020; 11:101491. [PMID: 32723645 DOI: 10.1016/j.ttbdis.2020.101491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/07/2020] [Indexed: 12/29/2022]
Abstract
Tick-borne encephalitis (TBE) is an emerging infectious disease in large parts of Europe and Asia. Whereas other members of the Flaviviridae family can harm fetal development, there are only very few reports on TBE virus (TBEV) infections during pregnancy. Thus, the implications for fetal health remain largely unknown. In this study, we present detailed pre- and postnatal health assessment of three children in the context of severe maternal TBEV infection during pregnancy. Following acute TBEV infection of the mothers, intrauterine growth and development of all children were assessed by repetitive prenatal ultrasound. Postnatal examinations included clinical and virological analyses over a follow-up period of 18 months. Prenatally, no signs of intrauterine growth restrictions were observed. All neonates were delivered at term. Umbilical cord blood of the newborns tested negative for TBEV RNA. Virus-specific IgG antibodies were positive at birth but negative at 9 and 11 months of age. Importantly, IgM antibodies remained negative throughout the period of observation. Taken together, these clinical and virological data strongly suggest that fetal TBEV infection did not occur, despite severe manifestations in the mothers.
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Affiliation(s)
- Iris Divé
- Department of Neurology, University Hospital, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
| | - Malin Veje
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Guldhedsgatan 10 A-B, 41346 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Guldhedsgatan 10 A-B, 41346 Gothenburg, Sweden.
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, German Center of Infection Research (DZIF), Neuherbergstraße 11, 80937 Munich, Germany.
| | - Tomas Bergström
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Guldhedsgatan 10 A-B, 41346 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Guldhedsgatan 10 A-B, 41346 Gothenburg, Sweden.
| | - Horst Buxmann
- Department of Pediatric and Adolescent Medicine, Division for Neonatology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Bettina Paul
- Department of Obstetrics and Prenatal Medicine, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Frank Louwen
- Department of Obstetrics and Prenatal Medicine, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Annemarie Berger
- Institute of Clinical Virology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Kolja Jahnke
- Department of Neurology, University Hospital, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
| | - Adam Strzelczyk
- Department of Neurology, University Hospital, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Guldhedsgatan 10 A-B, 41346 Gothenburg, Sweden.
| | - Elisabet Hentz
- Division of Neonatology, Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Rondvägen 10, 41650 Gothenburg, Sweden.
| | - Lucas Nürnberger
- Department of Neurology, University Hospital, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
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18
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The Cerebrospinal Fluid Interleukin-6/Interleukin-10 Ratio Differentiates Pediatric Tick-borne Infections. Pediatr Infect Dis J 2020; 39:239-243. [PMID: 32032308 DOI: 10.1097/inf.0000000000002552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Borrelia burgdorferi and tick-borne encephalitis (TBE) virus are 2 types of tick-borne pathogens that can cause central nervous system infection. Routine diagnostics have so far included analysis of cerebrospinal fluid (CSF) cell numbers, CSF serology for Borrelia burgdorferi and serum serology for TBE virus. However, early diagnosis may be difficult based on antibody detection which takes time to analyze, and with the possibility of false negative results, thus delaying treatment. Cytokine analyses are becoming increasingly available in clinical routine care and may offer important information. METHODS Fifteen cytokines and chemokines were measured in the CSF from the diagnostic lumbar puncture of 37 children with TBE, 34 children with neuroborreliosis and 19 children without evidence of central nervous system infection, using Luminex technology. RESULTS Significantly higher levels of proinflammatory interleukin-6 were detected in the samples from TBE-infected children, when compared with neuroborreliosis or controls. In comparison, children with neuroborreliosis had significantly higher levels of interleukin-7, interleukin-8, interleukin-10, and interleukin-13 when compared with TBE infected or controls. Furthermore, the ratio between interleukin-6 and interleukin-10 was significantly different between the 2 types of tick-borne infections. CONCLUSIONS The interleukin-6/interleukin-10 ratio can be used as a rapid diagnostic cue upon suspected tick-borne infection, enabling fast and correct treatment. Also, in serology-negative results, such information may strengthen a clinical suspicion.
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19
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Toczylowski K, Grygorczuk S, Osada J, Wojtkowska M, Bojkiewicz E, Wozinska-Klepadlo M, Potocka P, Sulik A. Evaluation of cerebrospinal fluid CXCL13 concentrations and lymphocyte subsets in tick-borne encephalitis. Int J Infect Dis 2020; 93:40-47. [PMID: 31978584 DOI: 10.1016/j.ijid.2020.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/31/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Recent studies suggest that the clinical presentation of tick-borne encephalitis (TBE) is determined by the host immune responses to the tick-borne encephalitis virus (TBEV). The aim of the study was to characterize immune responses in TBE to give a better insight into the immunopathogenesis of this disease. METHODS Anti-TBEV antibody levels, cerebrospinal fluid (CSF) and blood lymphoid populations, and concentrations of CXCL13 (a potent B-cell and T-cell chemoattractant), were analyzed in 35 patients with TBE (20 adults and 15 children). RESULTS When compared with the blood, the CSF lymphoid population was significantly enriched in CD4+ T-cells and relatively depleted in natural killer (NK) cells and B lymphocytes. In comparison with TBE meningitis, patients suffering from TBE meningoencephalitis (n = 11, 31%) had a 3.5-fold higher median CSF CXCL13 concentration, 1.8-fold higher CSF/serum ratio of anti-TBEV IgG antibodies, and 1.8-fold higher median CSF cell count. CSF CXCL13 levels did not change significantly in children with TBE meningitis receiving supportive treatment, but decreased in children with TBE meningoencephalitis who received intravenous steroids. CONCLUSIONS CD4+ cells are abundant in the CSF of patients with TBE. CXCL13 may be involved in the neuropathology of TBE by attracting different subsets of lymphocytes to the CSF.
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Affiliation(s)
- Kacper Toczylowski
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Sambor Grygorczuk
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Żurawia 14, 15-540 Bialystok, Poland.
| | - Joanna Osada
- Department of Hematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A, 15-269 Bialystok, Poland.
| | - Malgorzata Wojtkowska
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Ewa Bojkiewicz
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Marta Wozinska-Klepadlo
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Paulina Potocka
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
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20
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Paulsen KM, Granquist EG, Okstad W, Vikse R, Stiasny K, Andreassen ÅK, Stuen S. Experimental infection of lambs with tick-borne encephalitis virus and co-infection with Anaplasma phagocytophilum. PLoS One 2019; 14:e0226836. [PMID: 31856227 PMCID: PMC6922421 DOI: 10.1371/journal.pone.0226836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/05/2019] [Indexed: 12/16/2022] Open
Abstract
Tick-borne encephalitis virus (TBEV) is a zoonotic pathogen which may cause tick-borne encephalitis (TBE) in humans and animals. More than 10,000 cases of TBE are reported annually in Europe and Asia. However, the knowledge on TBE in animals is limited. Co-infection with Anaplasma phagocytophilum and louping ill virus (LIV), a close relative to TBEV, in sheep has been found to cause more severe disease than single LIV or A. phagocytophilum infection. The aim of this study was to investigate TBEV infection and co-infection of TBEV and A. phagocytophilum in lambs. A total of 30 lambs, aged five to six months, were used. The experiment was divided into two. In part one, pre- and post-infection of TBEV and A. phagocytophilum was investigated (group 1 to 4), while in part two, co-infection of TBEV and A. phagocytophilum was investigated (group 5 and 6). Blood samples were drawn, and rectal temperature was measured daily. Lambs inoculated with TBEV displayed no clinical symptoms, but had a short or non-detectable viremia by reverse transcription real-time PCR. All lambs inoculated with TBEV developed neutralizing TBEV antibodies. Our study is in accordance with previous studies, and indicates that TBEV rarely causes symptomatic disease in ruminants. All lambs inoculated with A. phagocytophilum developed fever and clinical symptoms of tick-borne fever, and A. phagocytophilum was present in the blood samples of all infected lambs, shown by qPCR. Significantly higher mean TBEV titer was detected in the group co-infected with TBEV and A. phagocytophilum, compared to the groups pre- or post-infected with A. phagocytophilum. These results indicate that co-infection with TBEV and A. phagocytophilum in sheep stimulates an increased TBEV antibody response.
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Affiliation(s)
- Katrine M. Paulsen
- Department of Virology, Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
- * E-mail: ,
| | - Erik G. Granquist
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | - Wenche Okstad
- Section of Small Ruminant Research and Herd Health, Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway
| | - Rose Vikse
- Department of Virology, Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Åshild K. Andreassen
- Department of Virology, Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Snorre Stuen
- Section of Small Ruminant Research and Herd Health, Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Sandnes, Norway
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21
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Martínez IZ, Pérez-Martínez C, Salinas LM, García-Marín JF, Juste RA, Balseiro A. Phenotypic characterization of encephalitis in the brains of goats experimentally infected with Spanish Goat Encephalitis Virus. Vet Immunol Immunopathol 2019; 220:109978. [PMID: 31821945 DOI: 10.1016/j.vetimm.2019.109978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
Spanish goat encephalitis virus (SGEV) is a novel tick-borne flavivirus subtype, closely related to the flavivirus louping ill virus (LIV). SGEV caused a severe, acute and mortal neurological disease outbreak in northern Spain in a goat herd. In order to characterize the cell population in lesions and to determine the distribution of the inflammatory cells, central nervous system (CNS) samples of nine female Alpine goats challenged subcutaneously with SGEV over the right thorax behind the elbow were evaluated using immunohistochemistry (microglia-Iba1, T lymphocytes-CD3, B lymphocytes-CD20 and astrocytes-GFAP). The number of microglia (37.8 %) and T lymphocytes (21.5 %) was greater than the number of B lymphocytes (16.8 %). Goats were classified into clusters based on the severity of histological lesions in CNS (A-mild to moderate lesions and B-severe lesions). Microglia was significantly more abundant than T and B lymphocytes in cluster B (severe lesions). The total area occupied by glial foci revealed that medulla oblongata and spinal cord were the most affected tissues. Astrogliosis (GFAP+) was present in the majority of the CNS sections being near to the pial surface. The lesion predominance on the right side of the medulla oblongata, which could be associated to the site of challenge suggestive of neurotropic route was also statistically confirmed. Results suggest that the cellular immune response would be the most important response to the SGEV infection.
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Affiliation(s)
- Ileana Z Martínez
- Universidad de León, Campus de Vegazana, León, Spain; Universidad Popular Autónoma del Estado de Puebla, UPAEP Universidad, Puebla, Mexico.
| | | | - Luis M Salinas
- Universidad de León, Campus de Vegazana, León, Spain; Universidad Internacional Antonio de Valdivieso, UNIAV, Rivas, Nicaragua
| | | | - Ramón A Juste
- Centro de Biotecnología, Servicio Regional de Investigación y Desarrollo Agroalimentario, SERIDA, Gijón, Asturias, Spain
| | - Ana Balseiro
- Universidad de León, Campus de Vegazana, León, Spain; Centro de Biotecnología, Servicio Regional de Investigación y Desarrollo Agroalimentario, SERIDA, Gijón, Asturias, Spain
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22
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Velay A, Paz M, Cesbron M, Gantner P, Solis M, Soulier E, Argemi X, Martinot M, Hansmann Y, Fafi-Kremer S. Tick-borne encephalitis virus: molecular determinants of neuropathogenesis of an emerging pathogen. Crit Rev Microbiol 2019; 45:472-493. [PMID: 31267816 DOI: 10.1080/1040841x.2019.1629872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis virus (TBEV) is a zoonotic agent causing severe encephalitis. The transmission cycle involves the virus, the Ixodes tick vector, and a vertebrate reservoir, such as small mammals (rodents, or shrews). Humans are accidentally involved in this transmission cycle. Tick-borne encephalitis (TBE) has been a growing public health problem in Europe and Asia over the past 30 years. The mechanisms involved in the development of TBE are very complex and likely multifactorial, involving both host and viral factors. The purpose of this review is to provide an overview of the current literature on TBE neuropathogenesis in the human host and to demonstrate the emergence of common themes in the molecular pathogenesis of TBE in humans. We discuss and review data on experimental study models and on both viral (molecular genetics of TBEV) and host (immune response, and genetic background) factors involved in TBE neuropathogenesis in the context of human infection.
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Affiliation(s)
- Aurélie Velay
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France.,INSERM, IRM UMR_S 1109 , Strasbourg , France
| | - Magali Paz
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France
| | - Marlène Cesbron
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France
| | - Pierre Gantner
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France.,INSERM, IRM UMR_S 1109 , Strasbourg , France
| | - Morgane Solis
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France.,INSERM, IRM UMR_S 1109 , Strasbourg , France
| | | | - Xavier Argemi
- Service des maladies infectieuses et tropicales, Hôpitaux Universitaires de Strasbourg , Strasbourg , France
| | - Martin Martinot
- Service de Médecine Interne et de Rhumatologie, Hôpitaux Civils de Colmar , Colmar , France
| | - Yves Hansmann
- Service des maladies infectieuses et tropicales, Hôpitaux Universitaires de Strasbourg , Strasbourg , France
| | - Samira Fafi-Kremer
- Virology Laboratory, University Hospital of Strasbourg , Strasbourg , France.,INSERM, IRM UMR_S 1109 , Strasbourg , France
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Inflammatory Immune Responses in the Pathogenesis of Tick-Borne Encephalitis. J Clin Med 2019; 8:jcm8050731. [PMID: 31121969 PMCID: PMC6571551 DOI: 10.3390/jcm8050731] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 01/26/2023] Open
Abstract
Clinical manifestations of tick-borne encephalitis (TBE) are thought to result from the host immune responses to infection, but knowledge of such responses is incomplete. We performed a detailed clinical evaluation and characterization of innate and adaptive inflammatory immune responses in matched serum and cerebrospinal fluid (CSF) samples from 81 adult patients with TBE. Immune responses were then correlated with laboratory and clinical findings. The inflammatory immune responses were generally site-specific. Cytokines and chemokines associated with innate and Th1 adaptive immune responses were significantly higher in CSF, while mediators associated with Th17 and B-cell responses were generally higher in serum. Furthermore, mediators associated with innate and Th1 adaptive immune responses were positively associated with disease severity, whereas Th17 and B cell immune responses were not. During the meningoencephalitic phase of TBE, innate and Th1 adaptive inflammatory mediators were highly concentrated in CSF, the site of the disease. The consequence of this robust immune response was more severe acute illness. In contrast, inflammatory mediators associated with B cell and particularly Th17 responses were concentrated in serum. These findings provide new insights into the immunopathogenesis of TBE and implicate innate and Th1 adaptive responses in severity and clinical presentation of acute illness.
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