Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study.

Maša Velušček,Rok Blagus,Eva Ružić-Sabljić,Fajko F Bajrović,Daša Stupica,Tatjana Avšič-Županc,Tjaša Cerar Kišek

doi:10.3390/jcm8101740

Maša Velušček, Rok Blagus + Show 5 more

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https://doi.org/10.3390/jcm8101740

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Abstract

In this retrospective cohort study of patients with tick-borne encephalitis (TBE), the clinical outcome in relation to co-infection with B. burgdorferi sensu lato (s.l.) and, specifically, the effect of antibiotic treatment on clinical outcome in patients with TBE who were seropositive for borreliae but who did not fulfil clinical or microbiologic criteria for proven co-infection, were assessed at a single university medical center in Slovenia, a country where TBE and Lyme borreliosis are endemic with high incidence. Among 684 patients enrolled during a seven-year period from 2007 through 2013, 382 (55.8%) had TBE alone, 62 (9.1%) had proven co-infection with borreliae and 240 (35.1%) had possible co-infection. The severity of acute illness was similar in all the groups. The odds for incomplete recovery decreased during a 12-month follow-up but were higher in women, older patients, and in those with more severe acute illness. Incomplete recovery was not associated with either proven (odds ratio (OR) 1.21, 95% confidence interval (CI) 0.49–2.95; p = 0.670) or possible co-infection (OR 0.95, 95% CI 0.55–1.65; p = 0.853). Among patients with possible co-infection, older patients were more likely to be prescribed antibiotics, but the odds for incomplete recovery were similar in those who received antibiotics and those who did not (OR 0.82, 95% CI 0.36–1.87; p = 0.630), suggesting that routine antibiotic treatment in patients with TBE and possible co-infection may not be warranted.

Highlights

Tick-borne encephalitis (TBE) and Lyme borreliosis (LB), caused by TBE virus and Borrelia burgdorferi sensu lato (s.l.), respectively, are both transmitted by certain species of the tick Ixodes and are the most prevalent tick-borne diseases in Europe [1,2]
Patients ≥18 years old admitted to the University Medical Center Ljubljana, Slovenia, between January 2007 and December 2013 were eligible for the study if they had TBE defined according to European criteria: a febrile illness with symptoms and/or signs of meningitis, meningoencephalitis, or meningoencephalomyelitis, cerebrospinal fluid (CSF) pleocytosis (>5 × 106 cells/L), and demonstration of specific TBE virus IgM and IgG antibodies in serum or intrathecal synthesis of specific antibodies in patients previously vaccinated against TBE [17]
The rate of borrelial seropositive results differed according to the serologic test used: serum samples tested using the chemiluminescence immunoassay more often gave a positive result than sera tested in the immunofluorescence assay (174/291, 59.8% and 108/393, 27.5%, respectively)

Summary

Introduction

Tick-borne encephalitis (TBE) and Lyme borreliosis (LB), caused by TBE virus and Borrelia burgdorferi sensu lato (s.l.), respectively, are both transmitted by certain species of the tick Ixodes and are the most prevalent tick-borne diseases in Europe [1,2] In countries such as Poland, Russia, and Slovenia [3], with areas where these diseases are endemic, patients with TBE are reported to have borrelial co-infection with frequencies ranging from 13.5% to 16.7% for proven co-infection, 1.9% to 18.8% for borrelial central nervous system (CNS) co-infection, and 7.4% to 46.9% for possible co-infection [4,5,6,7,8,9,10,11,12] (Table 1).

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