Abstract
The biphasic course of tick-borne encephalitis (TBE) is well described, but information on the monophasic course is limited. We assessed and compared the clinical presentation, laboratory findings, and immune responses in 705 adult TBE patients: 283 with monophasic and 422 with biphasic course. Patients with the monophasic course were significantly (p ≤ 0.002) older (57 vs. 50 years), more often vaccinated against TBE (7.4% vs. 0.9%), more often had comorbidities (52% vs. 37%), and were more often treated in the intensive care unit (12.4% vs. 5.2%). Multivariate logistic regression found strong association between the monophasic TBE course and previous TBE vaccination (OR = 18.45), presence of underlying illness (OR = 1.85), duration of neurologic involvement before cerebrospinal fluid (CSF) examination (OR = 1.39), and patients’ age (OR = 1.02). Furthermore, patients with monophasic TBE had higher CSF levels of immune mediators associated with innate and adaptive (Th1 and B-cell) immune responses, and they had more pronounced disruption of the blood–brain barrier. However, the long-term outcome 2–7 years after TBE was comparable. In summary, the monophasic course is a frequent and distinct presentation of TBE that is associated with more difficult disease course and higher levels of inflammatory mediators in CSF than the biphasic course; however, the long-term outcome is similar.
Highlights
The present study is based on 717 patients aged ≥18 years, who were hospitalized for tick-borne encephalitis (TBE) at the Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia in the period 2007–2012, assessed for long-term outcome in 2014, and enrolled in the study on the course and outcome of this disease
Comparison of the two groups revealed that patients with monophasic course were statistically significantly older (57 vs. 50 years), more often had underlying diseases (52% vs. 37%), were more often vaccinated against TBE
Little is known about immune mediators in TBE; the information is predominantly limited to description of the levels of the cytokines/chemokines in the meningoencephalitic phase of TBE and the attempts to assess the levels in relation to severity of illness and to favorable or unfavorable outcome [10,11,15,16,17,18,19,20]
Summary
Tick-borne encephalitis (TBE) is an infection of the central nervous system. It is endemic in many parts of Asia and Europe. During the past few decades, the endemic regions have been expanding, and in almost all of the regions, the incidence has increased [1,2,3,4]. The disease is caused by at least three subtypes of tick-borne encephalitis virus (TBEV); European, Siberian, and Far-Eastern. The three subtypes are genetically and antigenically closely related, the clinical presentation of the disease caused by individual subtypes somewhat varies. Transmission of the infection to humans is predominantly
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
