Signs of tick-borne encephalitis in humans and possible treatment of the disease

Hello! A couple of years ago I went camping with my little daughter. She asked me about this for a long time.

I had to agree and allocate time for this event. However, its results were somewhat overshadowed by the fact that the daughter was bitten by a tick.

A few days later her temperature rose. I was scared, thought it was an encephalitis tick. But it turned out to be a common cold. Want to know about the signs of tick-borne encephalitis in humans? In order not to get confused in the symptoms, as it was in my case. In the article below I will tell you everything in detail.

Symptoms of tick-borne encephalitis in humans. Diagnosis and treatment

Surely, you have already heard about infections that spread ticks, and one of them is tick-borne encephalitis. But worry ahead of time is not worth it.

First you need to pull out the tick. Then it must be submitted for analysis (where you can pass the tick for analysis, we already wrote earlier) in order to exclude the possibility of infection with borreliosis. And tick-borne encephalitis?

Unfortunately, this virus does not show a tick analysis. In such cases, it is recommended to closely monitor any changes in health and decide whether you need an infectious disease specialist for referral for a blood test.

How does infection happen?

Tick-borne encephalitis is a viral infection that is transmitted with insect saliva and has three varieties, depending on the habitat of the peddler: Central European, Far Eastern and Siberian tick-borne encephalitis.

The disease, if left untreated on time, affects the central and peripheral nervous systems and can lead to paralysis and death.

Therefore, you can even catch encephalitis not from the tick itself, but, for example, from unboiled cow milk, which the tick once bitten. An infection can enter the body through an open wound, mucous membranes of the mouth and eyes, if, for example, crush the tick by hand.

The most difficult option: when tick-borne encephalitis infection is accompanied by other infectious diseases (measles, herpes, hepatitis, chickenpox), then the effect of the virus on brain tissue is much more destructive.

Tick-borne encephalitis symptoms

Tick-borne encephalitis virus does not enter the blood and lymph immediately; first, it multiplies at the site of the tick bite. Unfortunately, visually these changes are difficult to determine and they do not last long - 1-2 days. The first symptoms of tick-borne encephalitis infection appear only when the virus spreads throughout the body.

The first symptoms may appear two weeks after the bite, or even 20 days later and at first resemble a cold.A person infected with tick-borne encephalitis feels weakness, aches and chills, the temperature can rise to 38-40 degrees. But there are cases when in the first stages of encephalitis there are no symptoms at all.

After contact with the infection, some people develop antibodies and the body fights encephalitis on its own. Such is the specificity of their body defenses. The whole process goes completely without symptoms. The lucky ones may even develop immunity to the virus. True, these cases are not numerous.

There is another not the worst option. The nature of man is such that the body itself is trying to protect itself from infections. The central nervous system, the brain, is best armed. Before reaching the goal, the virus must overcome the blood-brain barrier to the brain. If a person has strong immunity, the risk of complications is much less.

The severity of the disease and the timing of recovery also depend on the form of the disease with tick-borne encephalitis. Five of them are distinguished: febrile, meningeal, meningoencephalitic, poliomyelitic, polyradiculoneuritis.

A third of people easily tolerate the febrile form of encephalitis, some do not even realize that they caught the virus. And yet, hoping for immunity is not entirely reasonable, and with the first symptoms of tick-borne encephalitis in a febrile form, you need to see a doctor.

The febrile period, on average, lasts from three to five days, but can also end in a few hours. Fever attacks are able to attack twice. At the same time, different types of headaches can disturb, muscles weaken, feel sick and sleepy.

Symptoms of tick-borne encephalitis in meningeal form. This is the most common manifestation of tick-borne encephalitis. Initially, the symptoms are no different from the previous milder form of the disease.

The whole organism at this time lends itself to general infectious intoxication, but even in this form complications are extremely rare, and treatment is successful.

Symptoms of the meningoencephalitic form of tick-borne encephalitis. It is not difficult to notice that the severity of the occurrence of forms of tick-borne encephalitis is increasing. But there is good news. The more severe the form of the disease, the less common are cases of the disease in this form.

Only about 15% of those infected with the virus survive meningoencephalitis. The case is really complicated, because the patient may experience hallucinations and delusions, epileptic seizures (up to obtaining status epilepticus).

Symptoms of tick-borne encephalitis in polio form. This form of tick-borne encephalitis begins, like all the previous ones: with a general malaise within 1-2 days, but then the disease rapidly progresses, affecting the functioning of the brain.

Already in the first weeks (and sometimes days), signs of damage to the muscles of the neck and shoulders are noticeable. Head hangs, posture changes.

Over the course of 7-12 days, the ability to move worsens, and by the end of the second week, the affected muscles may even fail. Partial numbness and loss of sensation in the arms and legs may intensify and develop into paralysis.

Symptoms of tick-borne encephalitis in a polyradiculoneuric form. This is the most complex and extremely rare form of tick-borne encephalitis, which begins with the usual "goose bumps" and tingling. After this, the body gradually covers paralysis, starting with the muscles of the legs.

When the muscles of the upper body cease to work, paralysis of the pharynx, larynx and tongue occurs, disrupting the person’s breathing.

Diagnosis and treatment

The risk of contracting tick-borne encephalitis is relatively small. Only five percent of ticks carry tick-borne encephalitis.

Even after a tick bite, fever, temperature, and muscle aches do not always indicate this virus. It can be just a coincidence and a common cold, as well as other dangerous diseases, such as tick-borne borreliosis (Lyme disease) or meningitis.

The tests help to find out how far viral encephalitis has got and what parts of the body it has taken, from checking the PCR (polymerase chain reaction) of blood, cerebrospinal fluid and lymph for the presence of the virus, to checking for antibodies, which also indicate the virus.

In the early stages, tick-borne encephalitis is treated with immunoglobulin therapy: infected people are given a tick-borne encephalitis vaccine, and in case of exacerbation, bed rest is recommended, a course of vitamins and a diet are prescribed.

If the severity of tick-borne encephalitis is moderate or severe, gamma globulin is introduced into the body, which reduces the symptoms of tick-borne encephalitis. And various drugs to maintain the water-electrolyte balance in the patient’s body contribute to recovery.

Causes and symptoms of TBE

Tick-borne encephalitis (TBE) is an acute viral disease of the nervous system. The causative agent of the disease is a specific virus, which often enters the human body with a tick bite. Possible infection by eating raw milk from sick animals.

People living in areas with a high prevalence of the disease are subject to preventive vaccination. Vaccination reliably protects against the disease. From this article you will learn how tick-borne encephalitis proceeds, how it manifests itself and how to prevent the disease.

Tick-borne encephalitis is sometimes called differently - spring-summer, taiga, Siberian, Russian. Synonyms have arisen due to the characteristics of the disease. Spring-summer, because the peak incidence occurs in the warm season, when ticks are most active.

Taiga, because the natural focus of the disease is mainly located in the taiga. Siberian - because of the distribution zone, and Russian - because of the identification mainly in Russia and the description of a large number of virus strains by Russian scientists.

The causes of the disease

The disease is caused by a virus belonging to the arbovirus group. The prefix "arbo" means the transmission by arthropods. Tick-borne encephalitis virus reservoir is ixodid ticks that live in the forests and forest-steppes of Eurasia. The virus among ticks is transmitted from generation to generation.

The virus enters a person with a bite of an ixodid tick. Moreover, the suction of the tick, even for a short period of time, is dangerous for the development of encephalitis, since the saliva of the tick containing the pathogen immediately enters the wound.

Of course, there is a direct correlation between the amount of the pathogen that has entered the human blood and the severity of the disease. The duration of the incubation period (the time from the pathogen entering the body until the first symptoms appear) also depends on the amount of virus.

The second method of infection is the consumption of raw milk or food products made from thermally unprocessed milk (such as cheese). More often the disease is caused by the use of milk of goats, less often - cows.

Another rare method of infection is the following: a tick is crushed by a person before suction, but from contaminated hands the virus enters the mucous membrane of the oral cavity if personal hygiene is not observed.

After entering the body, the virus multiplies at the site of penetration: in the skin, in the mucous membrane of the gastrointestinal tract. Then the virus enters the bloodstream and spreads throughout the body. A favorite place for the localization of the virus is the nervous system.

Several types of virus have been identified that have a certain territorial affinity. In the European part of Russia, a virus lives that causes less severe forms of the disease. The closer to the Far East, the worse the prognosis for recovery, and deaths are more common.

Symptoms

The incubation period lasts from 2 to 35 days. When infected due to the use of infected milk, it is 4-7 days. You should know that a patient with tick-borne encephalitis is not dangerous to others, since it is not contagious.

Along with this, there may be abdominal pain, sore throat, nausea and vomiting, redness of the mucous membranes of the eyes and throat. In the future, the disease can proceed in different ways. In this regard, several clinical forms of tick-borne encephalitis are distinguished.

Clinical forms of the disease

Currently, 7 forms are described:

The febrile form is characterized by the absence of signs of damage to the nervous system. The disease proceeds like a common cold. That is, an increase in temperature lasts 5-7 days, accompanied by general intoxication and general infection signs.

Then comes an independent recovery. No changes in cerebrospinal fluid (as with other forms of tick-borne encephalitis) are detected. If a tick bite has not been fixed, then usually there is no suspicion of tick-borne encephalitis.

Against the background of an increase in temperature, meningeal signs appear: tension in the muscles of the neck, symptoms of Kernig and Brudzinsky. Perhaps a violation of consciousness by type of stunning, lethargy. Sometimes there can be motor excitement, hallucinations and delusions. The fever lasts up to two weeks.

When conducting spinal puncture in the cerebrospinal fluid, an increase in the content of lymphocytes, a slight increase in protein are found. Changes in the cerebrospinal fluid last longer than clinical symptoms, that is, health may improve, and the tests will still be poor.

This form usually ends with a full recovery in 2-3 weeks. Often leaves behind a long-term asthenic syndrome, characterized by increased fatigue and fatigue, sleep disturbance, emotional disorders, poor physical exercise tolerance.

Perhaps a violation of the contraction of the facial muscles of the face associated with damage to the nucleus of the facial nerve in the brain. In this case, the eye does not close on one half of the face, food flows out of the mouth, the face looks skewed. Among other cranial nerves, glossopharyngeal, vagus, additional, sublingual are more often affected.

This is manifested by impaired speech, nasal voices, choking when eating (food enters the respiratory tract), impaired tongue movements, weakness of the trapezius muscles. Perhaps a violation of the rhythm of breathing and heartbeat due to damage to the vagus nerve or centers of respiration and cardiac activity in the brain.

Often with this form, epileptic seizures and impaired consciousness of varying severity, up to coma, occur. An increase in the content of lymphocytes and protein is detected in the cerebrospinal fluid.

This is a severe form of tick-borne encephalitis, in which the development of cerebral edema with dislocation of the stem and the violation of vital functions is possible, as a result of which the patient may die. After this form of tick-borne encephalitis, paresis, persistent speech disorders, and swallowing, which cause disability, often remain.

The polyencephalitic form is characterized by the appearance of symptoms of damage to the cranial nerves on the 3-5th day of an increase in body temperature. The bulbar group is most often affected: glossopharyngeal, vagus, hyoid nerves.

This is manifested by a violation of swallowing, speech, immobility of the tongue. The facial and trigeminal nerves are less likely to suffer, which causes symptoms such as sharp pains in the face and its deformation.

At the same time, it is impossible to wrinkle your forehead, to close your eyes, your mouth is twisted in one direction, food spills from the mouth. Perhaps lacrimation due to constant irritation of the mucous membrane of the eye (because it does not close completely even during sleep).

The polio form has this name in view of its similarity to polio. It is observed in approximately 30% of patients.

Initially, general weakness and lethargy, increased fatigue appear, against which minor muscle twitches (fasciculations and fibrillation) occur. These twitches indicate damage to motor motor neurons of the anterior horns of the spinal cord.

And then paralysis develops in the upper extremities, sometimes asymmetric. It can be combined with a violation of sensitivity in the affected limbs. For several days, muscle weakness captures the muscles of the neck, chest and arms.

Usually, the severity of paralysis increases for about a week, and after 2-3 weeks an atrophic process develops in the affected muscles (the muscles are depleted, “lose weight”). Muscle recovery is almost impossible, muscle weakness remains with the patient for the rest of his life, making it difficult to move and self-care.

The polyencephalomyelitis form is characterized by the symptoms characteristic of the two previous ones, that is, the simultaneous damage to the cranial nerves and neurons of the spinal cord.

The polyradiculoneuritis form is manifested by symptoms of damage to peripheral nerves and roots. The patient develops severe pain along the nerve trunks, impaired sensitivity, paresthesia (crawling, tingling, burning, and others).

A separate form of tick-borne encephalitis is described, characterized by a peculiar two-wave course of fever.

With this form, in the first wave of fever, only general infection symptoms appear, reminiscent of a catarrhal disease. After 3-7 days, the temperature normalizes, the condition improves.

Then comes the “bright” period, which lasts 1-2 weeks. There are no symptoms. And then comes the second wave of fever, along with which there is a lesion of the nervous system according to one of the above options.

There are also cases of a chronic course of infection. For some reason, the virus is not completely eliminated from the body. And after a few months or even years, "makes itself felt." More often this is manifested by epileptic seizures and progressive muscle atrophy, which leads to disability.

The transferred disease leaves behind a stable immunity.

Diagnostics

To make a correct diagnosis, the fact of a tick bite in areas endemic for the disease is important. Since there are no specific clinical signs of the disease, an important role in the diagnosis is played by serological methods by which antibodies against tick-borne encephalitis virus are detected in the blood and cerebrospinal fluid.

If a virus is detected in tick tissues, prophylactic treatment is carried out - the introduction of a specific anti-tick-borne immunoglobulin or the administration of Iodantipirin according to the scheme.

Treatment and prevention

Treatment is carried out using various means:

Tick-borne encephalitis prophylaxis can be nonspecific and specific.

Specific prevention is emergency and planned:

• emergency is the use of anti-mite immunoglobulin after a tick bite. It is carried out only in the first three days after a bite, later it is no longer effective;
• Iodantipirin can be taken within 9 days after a bite according to the scheme: 0.3 g 3 r / day for the first 2 days, 0.2 g 3 times a day for the next 2 days and 0.1 g 3 times a day for the last 5 days ;
• routine prevention consists of vaccination. The course consists of 3 injections: the first two with an interval of a month, the last one year after the second. Such an introduction provides immunity for 3 years. To maintain protection, revaccination is necessary once every 3 years.

Tick-borne encephalitis is a viral infection that occurs initially under the guise of a common cold. It can pass unnoticed by the patient, and can cause severe damage to the nervous system.

It is impossible to get sick with tick-borne encephalitis again, since the infection leaves a persistent lifelong immunity. In areas endemic for this disease, specific prophylaxis and vaccination are possible, which reliably protects against tick-borne encephalitis.

Tick-borne encephalitis: symptoms and first signs, treatment methods, incubation period and tests

The warmest days of late spring and the last days of summer are drawn to enjoy the beauty of nature and the gentle rays of the sun. I want to go to the forest, admire the trees awakened from a dream or feel the fallen autumn gold underfoot.

At such moments, one does not think at all about the danger and protection that needs to be taken from a tick bite and the occurrence of tick-borne encephalitis.

This disease is an acute viral infection that affects the entire nervous system, and its complications can cause serious health problems.

Tick-borne encephalitis is a fairly common seasonal disease on the territory of Russia, transmitted by ticks of the ixodic group. This large group has about 680 species, but two species of ticks pose a real epidemiological danger.

One of them, the European forest tick, is distributed in the territories of European countries. Encephalitis can be infected not only through the bite of the insect itself, but also through the use of unboiled milk from animals infected with the infection.

Symptoms and signs of tick-borne encephalitis

The development of the disease from a direct pathogen lasts from one to three weeks. With infections from animals, everything happens much faster - within 4-6 days. It all starts with mild fever, general malaise, pain in the muscles and joints appears, after which the temperature rises sharply and the second phase of the fever begins.

Febrile. The easiest form with a favorable course, a fairly high chance of recovery. The patient fever for several days with mild neurological symptoms.

Meningeal. One of the most common forms. The fever lasts 6-12 days. Stiff neck muscles, lethargy, lethargy. Throughout the period, there are pronounced meningeal symptoms. The disease always ends favorably.

Meningoencephalitic. In this case, the disease takes a severe form. There are two types of foci of manifestations: diffuse and focal meningoencephalitis. The diffuse focus is characterized by inflammation of the membranes and brain matter.

Focal manifestation is characterized by damage to many cranial nerves. Later, epileptic seizures with a complete loss of consciousness may appear. The form of the disease is extremely severe, death can be in 25% of cases.

Polio. The onset of this form of the disease is manifested by severe fatigue, general weakness. There is numbness in the body, after which flaccid paralysis of the muscles of the neck and arms, proximal upper limbs. The “hanging head" syndrome appears.

The increase in motor disorders occurs within a week, after which there is an atrophy of the affected muscles.The poliomyelitis form of the course of the disease is quite common, in almost 30% of cases. The course is unfavorable, disability is possible.

The disease is characterized by damage to the peripheral nerves and roots. The prognosis is quite favorable, unlike previous forms of the disease.

The course and forecast

The acute form of the disease lasts for two weeks. Then focal symptoms gradually disappear. In mild cases of the disease, complete recovery occurs.

For several months after the onset, asthenic syndrome may remain.

In more severe diseases, recovery without consequences does not occur.

In addition to deaths, various consequences remain in the form of neurological disorders, memory loss, headaches, and paralysis. The recovery of the body can last for years, sometimes without success.

Diagnostics

Encephalitis can be diagnosed based on epidemic data. With seasonal danger of visiting a forest and a tick bite, the presence of foci of diseases in this region and the appearance of clinical symptoms, a suspicion of tick-borne encephalitis immediately arises.

But according to some clinical signs, the diagnosis of encephalitis cannot be established. A special study of the cerebrospinal fluid and blood serum of the patient is carried out, for the presence of detection of viral antigens.

Treatment

When treating patients with a severe form of the disease, they monitor the general condition of the whole organism. They carry out the prevention of pressure sores, provide procedures for urination and defecation. Having established the diagnosis, the patient is injected with serum of donor gamma - globulin.

In the treatment of tick-borne encephalitis, along with drug treatment, folk remedies are used.

Pour alcohol tinctures of plants into dark glass dishes:

• 4 parts tincture of nettle leaves.
• 3 parts of tincture prepared from growths on oak leaves.
• 3 parts of tincture of lemon balm leaves.
• For 2 parts of tinctures of flowers of hawthorn, grass of a shepherd's purse, chicory, St. John's wort, centaury, walnut leaves, hop cones, burdock roots and ripe rose hips.
• 1.5 parts of tincture of elecampane root.

The resulting balm is taken 3 times a day for 15 minutes after eating and the same one hour after eating.

Well-proven treatment with vegetable juices. It can be carrot, cucumber, beetroot juices mixed in various proportions, with the addition of celery juice, spinach or parsley roots.

Prevention

To protect against insects, repellents are used, which process clothes, open areas of the body. Going into the forest with seasonal activity of ticks, it is necessary to pick up clothes with the ability to close the whole body.

After returning home, all clothing is examined for ticks, and those found immediately burned or poured with boiling water. Anyone who is involved in working with endemic areas or staying in them temporarily is given a tick-borne encephalitis vaccine.

Tick-borne encephalitis

Tick-borne encephalitis is a natural focal transmissible (tick-borne) viral infection characterized by a predominant lesion of the central nervous system.The disease is characterized by polymorphism of clinical manifestations and the severity of the course (from mild erased forms to severe progressive).

Tick-borne encephalitis is currently registered in Siberia, the Far East, the Urals, Belarus, and also in the central regions of the country.

Etiology

Tick-borne encephalitis virus (TBE) belongs to the genus Flavivirus (group B), which is part of the togavirus family of the ecological group of arboviruses. There are three varieties of the pathogen - the Far Eastern subspecies, the Central European subspecies and the causative agent of two-wave meningoencephalitis.

Tick-borne encephalitis virus virions have a spherical shape with a diameter of 40-50 nm. The internal component is nucleocapsid. It is surrounded by an external lipoprotein membrane, in which spikes consisting of a glycoprotein with hemagglutinating properties are immersed.

Boiling inactivates it after 2 minutes, and in hot milk at 60 ° C the virus dies after 20 minutes. Formalin, phenol, alcohol and other disinfectants, ultraviolet radiation also have an inactivating effect.

Epidemiology

Tick-borne encephalitis belongs to the group of natural focal human diseases. The main reservoir and carrier of the virus in nature are ixodid ticks - Ixodes persulcatus, Ixodes ricinus with transovarian transmission.

An additional reservoir of the virus are rodents (hare, hedgehog, chipmunk, field mouse), birds (thrush, goldfinch, taptails, finch), predators (wolf). The disease is characterized by a strict spring-summer seasonality of the disease.

The dynamics of the incidence is closely related to the species composition of ticks and their greatest activity. More often, people aged 20-40 are sick. The main route of human infection is through transmission through tick bites.

It is also possible to transmit the infection by alimentary route when eating raw milk of goats and cows, as well as by crushing the tick at the time of its removal from the human body and, finally, by airborne droplets in case of violation of the working conditions in the laboratories. With alimentary infection, the presence of family-group cases of the disease is noteworthy.

Pathogenesis

The infectious process develops as a result of the introduction of a neurotropic virus and its interaction with the human body. These relationships are determined by the introduction, properties and dose of the pathogen, as well as the resistance and reactivity of the macroorganism.

Tick-borne encephalitis virus enters the human body in vivo through the skin when a tick is sucked in or through raw milk of domestic animals.

After sucking a tick, the virus spreads hematogenously and quickly penetrates the brain, being fixed here by cells. In parallel with the accumulation of the virus, inflammatory changes in the vessels and membranes of the brain develop.

In some cases, one way or another prevails, which is reflected in the clinical features of tick-borne encephalitis. The occurrence of meningeal and meningoencephalic syndromes corresponds to the hematogenous, and polio and radiculoneuric syndromes correspond to the lymphogenic pathway of the virus.

Invasion of the nervous system is also possible in the neural way through the centripetal spread of the virus through the olfactory tract.

The rarity of lesions of the lower extremities with tick-borne encephalitis does not correspond to the frequency of tick suction in the skin areas innervated by the lumbar and sacral segments of the spinal cord, which indicates a known tropism of the virus to the cells of the cervical segments and their analogues in the bulbar regions of the medulla oblongata.

Long-term carrier virus is possible, which may be different in its manifestations and consequences: latent infection (the virus is integrated with the cell or exists in a defective form), persistent infection (the virus reproduces, but does not cause clinical manifestations), chronic infection (the virus reproduces and causes clinical manifestations with recurrent, progressive or regressing course), slow infection (the virus reproduces after a long incubation period, causes clinical manifestations with steady progression leading to death).

Symptoms and course

The following clinical forms of the disease are distinguished: 1) febrile; 2) meningeal; 3) meningoencephalitic; 4) polio; 5) polyradiculoneuritis.

Regardless of the clinical form, patients have common infectious manifestations of the disease, characterized by fever and other signs of general infectious intoxication syndrome. The incubation period of tick-borne encephalitis lasts an average of 7-14 days with fluctuations from one day to 30 days.

In a number of patients, the onset of the disease is preceded by a prodromal period, lasting 1-2 days and manifested by weakness, malaise, weakness; mild pains in the muscles of the neck and shoulder girdle, pains in the lumbar region in the form of aches and numbness, and headache are sometimes noted.

The febrile form is characterized by a favorable course without visible lesions of the nervous system and a quick recovery. This form makes up about 1/3 of the total number of tick-borne encephalitis diseases. The febrile period lasts from several hours to several days (an average of 3-5 days).

Two-wave fever is sometimes noted. The onset is usually acute, without a prodromal period. A sudden rise in temperature to 38-39 ° C is accompanied by weakness, headache, nausea. In rare cases, with this form of the disease, phenomena of meningism can be observed.

More often, symptoms characterizing local damage to the brain and spinal cord are absent. In cerebrospinal fluid changes are not detected.

Meningeal form of tick-borne encephalitis is the most common. The initial manifestations of the disease with the meningeal form are almost no different from the febrile one. However, signs of general infectious intoxication are much more pronounced.

Stiff neck muscles, Kernig and Brudzinsky symptoms are determined. Meningeal syndrome is expressed, cerebrospinal fluid is transparent, sometimes slightly opalescent, its pressure is increased (200-350 mm of water. Art.). In a laboratory study of cerebrospinal fluid revealed moderate lymphocytic pleocytosis (100-600 cells in 1 μl, rarely more).

The duration of the fever is 7-14 days.Sometimes a two-wave course of this form of tick-borne encephalitis is observed. The outcome is always favorable.

The meningoencephalitic form is observed less frequently than the meningeal one - on average 15% in the country (up to 20-40% in the Far East). It has a more severe course. Often there are delusions, hallucinations, psychomotor agitation with a loss of orientation in place and in time.

Epileptic seizures may develop. Distinguish between diffuse and focal meningoencephalitis.

With diffuse meningoencephalitis, cerebral disturbances are expressed (deep disturbances of consciousness, epipressures up to an epileptic status) and scattered foci of organic brain damage in the form of pseudobulbar disorders (respiratory failure in the form of brady or tachycardia, such as Chain-Stokes, Kussmaul, etc.), cardio -vascular system, unevenness of deep reflexes, asymmetric pathological reflexes, central paresis of facial muscles and muscles of the tongue.

In rare cases (as a result of disturbance of vegetative centers), gastric bleeding syndrome with bloody vomiting may develop. Focal lesions of cranial nerves of III, IV, V, VI pairs are characteristic, somewhat more often VII, IX, X, XI and XII pairs.

Later, Kozhevnikovskaya epilepsy may develop when general epileptic seizures with loss of consciousness appear against the background of constant hyperkinesis.

Polio form. It is observed in almost 1/3 of patients. It is characterized by a prodromal period (1-2 days), during which general weakness and increased fatigue are noted.

Suddenly, weakness in a limb or the appearance of a feeling of numbness in it can develop (later on, expressed motor disorders often develop in these limbs).

Subsequently, against the background of febrile fever (1st – 4th day of the first febrile wave or 1st – 3rd day of the second febrile wave) and cerebral symptoms, flaccid paresis of the cervico-brachial (cervico-thoracic) localization develops, which can increase over several days , and sometimes up to 2 weeks.

The symptoms described by A. G. Panov are observed: “hanging down on the chest of the head”, “proud posture”, “bent stooped posture”, techniques of “torso throwing of hands and tilting of the head”.

Poliomyelitis disorders can be combined with conductive, usually pyramidal: flaccid paresis of the hands and spastic paresis of the legs, combinations of amyotrophy and hyperflexia within the same paretic limb.

In the early days of the disease in patients with this form of tick-borne encephalitis, pain is often pronounced. The most characteristic localization of pain is in the area of ​​the muscles of the neck, especially along the back surface, in the region of the shoulders and arms. The increase in motor disorders lasts up to 7-12 days. At the end of the 2-3rd week of the disease, atrophy of the affected muscles develops.

Residual effects of CE

Polyradiculoneuritis form. It is characterized by damage to peripheral nerves and roots. Patients develop pain along the nerve trunks, paresthesia (feeling of “crawling crawl”, tingling sensation). Symptoms of Lasseg and Wasserman are determined.

Sensory disorders appear in the distal extremities of the polyneural type. Like other neuroinfections, tick-borne encephalitis can occur as Landry's ascending spinal paralysis.

Complications and lesions of the nervous system. With all the above clinical forms of tick-borne encephalitis, epileptiform, hyperkinetic syndromes and some other signs of damage to the nervous system can be observed.

It depends on the epidemic outbreak (western, eastern), on the method of infection (transmissible, alimentary), on the state of the person at the time of infection and on the methods of therapy.

Hyperkinetic syndrome is recorded relatively often (in 1/4 of patients), and mainly in people under 16 years of age. The syndrome is characterized by the appearance of spontaneous rhythmic contractions (myoclonus) in individual muscle groups of paretic limbs already in the acute period of the disease.

In these cases, the infectious process does not end, but goes into the phase of chronic (progressive) infection. Chronic infection with tick-borne encephalitis can occur in a latent form and manifest itself after several months and years under the influence of provoking factors (physical and mental injuries, early spa and physiotherapeutic treatment, abortion, etc.).

The following types of progressive course are possible: primary and secondary progressive, and subacute course.

Diagnosis and differential diagnosis

Clinical and epidemiological diagnosis is valid.

The patient’s stay in endemic areas, a history of visiting the forest, the fact of sucking a tick, seasonality (tick activity in the spring-summer period for the Central European and eastern foci and in the spring-summer and summer-fall season for the Baltic region, Ukraine, Belarus are taken into account ) and the onset of the disease, the use of raw goat milk.

On examination, hyperemia of the skin of the face, pharynx, vascular injection of the sclera and conjunctiva are noted. Sometimes small inflammatory erythema is noted on the skin at the site of tick suction. Subsequently, sheath and encephalic symptoms develop.

The detection of moderate neutrophilic leukocytosis in the peripheral blood and the acceleration of ESR are of diagnostic value. Laboratory confirmation of the diagnosis is an increase in antibody titer detected by RSK, RTGA, RPGA, RDNA and the neutralization reaction.

Diagnostic is an increase in antibody titer by 4 times. In the absence of an increase in antibody titer, patients are examined three times: in the first days of the disease, after 3-4 weeks and after 2-3 months from the onset of the disease.

It should be borne in mind that in patients treated with immunoglobulin in the first 5-7 days of the disease, temporary suppression of active immunogenesis is noted, therefore, additional serological examination is necessary after 2-3 months. The third examination significantly increases the number of serological confirmations of the diagnosis of tick-borne encephalitis.

A promising method is the isolation of the virus in tissue culture. The virus and its antigens are detected in the first 7 days of illness. Recently, an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of tick-borne encephalitis has been tested and has proven itself well.

Using ELISA, antibodies to tick-borne encephalitis virus are detected earlier and in higher dilutions of serums than in rtga and cSC, and also they often determine the change in the intensity of specific immunity necessary to confirm the clinical diagnosis.

Treatment

Treatment of patients with tick-borne encephalitis is carried out according to general principles, regardless of previously conducted prophylactic vaccinations or the use of specific gamma globulin for prophylactic purposes. In the acute period of the disease, even with mild forms, patients should be prescribed bed rest until the symptoms of intoxication disappear.

Taking into account the imbalance of vitamin balance observed in a number of patients, it is necessary to prescribe B and C vitamins. Ascorbic acid, which stimulates the adrenal gland function and also improves the antitoxic and pigment functions of the liver, should be administered in an amount of 300 to 1000 mg / day.

Etiotropic therapy consists in the appointment of a homologous gamma globulin titrated against tick-borne encephalitis virus. The drug has a clear therapeutic effect, especially with moderate to severe illness. Gamma globulin is recommended to be administered 6 ml intramuscularly daily for 3 days.

The therapeutic effect occurs 12-24 hours after the introduction of gamma globulin - the body temperature drops to normal, the general condition of the patients improves, headaches and meningeal phenomena decrease, and sometimes completely disappear.

On the first day of treatment, serum immunoglobulin is recommended to be administered 2 times at intervals of 10-12 hours, 3 ml each for mild course, 6 ml each for moderate and 12 ml for severe. In the next 2 days, the drug is prescribed 3 ml once intramuscularly. Homologous polyglobulin is administered intravenously in 60-100 ml.

It is believed that antibodies neutralize the virus (1 ml of serum binds from 600 to 60,000 lethal doses of the virus), protect the cell from the virus by binding to its surface membrane receptors, neutralize the virus inside the cell, penetrating into it by binding to cytoplasmic receptors.

For specific antiviral treatment of tick-borne encephalitis, ribonuclease (RNAse) is also used - an enzyme preparation prepared from the tissue of the pancreas of cattle. RNAse inhibits the reproduction of the virus in the cells of the nervous system, penetrating the blood-brain barrier.

The first injection is performed after desensitization according to Infrequently. The daily dose of the enzyme introduced into the body is 180 mg. Treatment is continued for 4-5 days, which usually corresponds to the moment of normalization of body temperature.

A modern method of treating viral neuroinfections is the use of interferon preparations (reaferon, leukinferon, etc.), which can be administered intramuscularly, intravenously, endolumbally and endolymphatically.

It should be borne in mind that large doses of interferon (IFN) 1-3-6o106 ME - have an immunosuppressive property, and the resistance of cells to virus penetration is not directly proportional to IFN titers.

Therefore, it is advisable to use relatively small doses of the drug, or to use interferon inducers (double-stranded RNA of phage 2, amixin, gum, and others) that provide low titers of IFN and have an immunomodulating property.

Double-stranded phage RNA (larifan) is administered intramuscularly in 1 ml intervals of 72 hours from 3 to 5 times.Amixin in a dose of 0.15-0.3 g is administered orally with an interval of 48 hours from 5 to 10 times.

Pathogenetic therapy for febrile and meningeal forms of tick-borne encephalitis, as a rule, consists in carrying out measures aimed at reducing intoxication. For this purpose, oral and parenteral administration of the liquid is carried out taking into account the water-electrolyte balance and the acid-base state.

With meningoencephalitic, poliomyelitic and polyradiculoneuric forms of the disease, the additional appointment of glucocorticoids is mandatory. If the patient does not have bulbar disorders and impaired consciousness, then prednisone is used in tablets at a rate of 1.5-2 mg / kg per day.

With bulbar disorders and disorders of consciousness, prednisone is administered parenterally with an increase in the above dose by 4 times.

In case of bulbar disorders (with swallowing and breathing disorders), from the moment the first signs of respiratory failure appear, conditions must be provided for transferring the patient to mechanical ventilation. At the same time, lumbar puncture is contraindicated and can be performed only after the removal of bulbar devices.

To combat hypoxia, it is advisable to systematically administer moistened oxygen through nasal catheters (for 20-30 minutes every hour), conduct hyperbaric oxygenation (10 sessions under pressure p 02-0.25 MPa), use neuroplegics and antihypoxants: intravenous administration of sodium oxybutyrate 50 mg / kg body weight per day or seduxen at 20-30 mg / day.

Central paralysis is treated with antispasmodics (midocal, melliktin, baclofen, lyoresal, etc.), drugs that improve microcirculation in blood vessels and brain trophism in the lesion sites and cells that take on the function of dead structures (sermion, trental, cavinton, stugeron, nicotinic acid on glucose intravenously) in usual dosages.

The muscle relaxant effect is seduxen, scutamyl C, sibazon.

Convulsive syndrome requires a long (4-6 months) administration of antiepileptic drugs: with Jackson's epilepsy - phenobarbital, hexamidine, benzonal or convulex; with generalized seizures - a combination of phenobarbital, definin, suxilep; with Kozhevnikovsky epilepsy - seduxen, iprazide or phenobarbital.

Hyperkinetic syndrome is treated with nootropil or piracetam, in the acute period or with myoclonic seizures, sodium oxybutyrate and lithium are used intravenously. In case of cast hyperkinesis similar to Gilles de la Tourette’s syndrome, a combination of melleril, elenium and seduxen is recommended in usual dosages.

In the poliomyelitis form, live enterovirus vaccines can be used (in particular, a multivalent 1 ml polio vaccine per tongue three times with an interval of 1-2 weeks). As a result, the induction of interferon is enhanced, phagocytosis and the functional activity of incompetent cells are stimulated.

Forecast. With meningeal and febrile form favorable. With meningoencephalitis, polio and polyradiculoneuritis, it is significantly worse. Lethal outcomes up to 25-30%.

In convalescents for a long time (up to 1-2 years, and sometimes for life), pronounced organic changes in the central nervous system (convulsive syndromes, muscle atrophies, signs of dementia, etc.) remain.

Prevention and measures in the outbreak. Destruction and prevention of tick bites.During the first day after tick suction - emergency prevention: donor immunoglobulin (titer 1:80 and above) intramuscularly at a dose of 1.5 ml for children under 12 years old, 2 ml - from 12 to 16 years old, 3 ml - for people aged 16 years and older.

Tick-borne encephalitis symptoms

In the disease, the initial period and the period of neurological disorders are distinguished.
Common symptoms of the initial period:

• increase in body temperature to 39-40 ° C;
• chills;
• headache;
• back pain;
• pain in the eyeballs, intolerance to bright light (photophobia);
• weakness;
• lethargy;
• possible nausea and vomiting,
• redness of the skin of the face, neck, chest;
• frequent breathing, rare pulse, low blood pressure;
• the tongue is covered with plaque;
• the stomach is swollen;
• possibly enlarged liver and spleen.

When the virus enters the membrane of the brain, and then into the substance of the brain, symptoms of disturbances in its activity (neurological) appear:

1. sensation of goosebumps, touch on the skin;
2. skin sensitivity disorders;
3. disturbances in muscle movements (at first mimic, then the ability to arbitrarily make movements of the arms and legs);
4. convulsive seizures are possible.