Tick-borne encephalitis signs. Symptoms of tick-borne encephalitis in febrile form. Features of the use of immunoglobulin

Spring, summer, early autumn are the time for picnics, hikes and a wide variety of leisure activities in nature. It is at this time that a large number of visits to medical institutions due to tick bites are recorded.

These arachnids are not as harmless as other insects, such as ants, bees or wasps. In another article we talked about Let's talk about a more dangerous type of tick.

A tick can become a carrier of such a terrible disease as tick-borne encephalitis.

It is very important to know by what symptoms you can independently diagnose a bite, what to do and where to go. We will talk about all this in detail in the article.

What kind of disease is encephalitis?

The word "encephalitis" first appeared in Greek. It is translated as “inflammation of the brain,” from which the definition of the disease itself follows: encephalitis is an inflammatory process, as a result of which the brain is damaged.

The cause of inflammation can be various factors: the influence of pathogenic bacteria, toxins, infections, especially viruses. It is viral encephalitis of the brain that is the most common.

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Ways of infection with encephalitis

Infection with encephalitis can occur in various ways:

transmissible - due to the bite of various insects (fleas, lice) and ticks;
nutritional - through products consumed by people, in particular, when consuming animal products affected by viral encephalitis, for example, goat or cow's milk;
aspiration - through the lungs, by inhalation;
contact - through the skin: despite the fact that an infected person cannot be the direct source of the disease, the virus can be transmitted through contact with the blood of the victim;
transplacental (a pregnant woman exposed to a tick bite will transmit the virus to her child).

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What does a tick bite look like?

The most convenient places for ticks are places with delicate skin, for example:

groin area;
abdominal and lower back area;
chest and armpits;
ears, neck and scalp.

In these places, arthropods have the opportunity to hide for a while and drink blood, while remaining unnoticed. a small red painless spot with a dark dot in the middle.

How dangerous is a tick bite?

Itching and irritation are not the worst consequences of a bite. Some diseases, including tick-borne encephalitis, can manifest themselves after some time.

Sometimes a person forgets about the bite or does not notice it at all, and during this period the disease enters a progressive phase. A tick bite can cause diseases that are quite difficult to treat and can lead to serious consequences.

This list of diseases includes:

tick-borne encephalitis;
Lyme disease or borreliosis. We discussed in another article.
tick-borne acarodermatitis and dermatobiasis.

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Symptoms of a tick bite

There are several symptoms that can indicate the penetration of tick venom into the body:

lethargic state;
headache;
increased drowsiness;
increased body temperature;
chills;
joint pain;
painful reaction to light;
nausea, possible vomiting;
decrease in pressure;
skin rashes accompanied by itching.

Of course, the main sign of poison penetration into the body is the detection of a tick on the body. In this case, it is necessary to remove the tick as soon as possible and find out whether it is infected in order to immediately begin the necessary therapy and eliminate serious complications.

Forms of encephalitis

Scientists have identified 5 forms of encephalitis caused by a tick bite:

Feverish form– the least severe form of encephalitis, lasting 3-5 days. It is characterized by:
- signs of intoxication;
- heat;
- malaise;
- dizziness.
Meningeal form- one of the most common. Rigidity of the neck muscles, headache, weakness, vomiting are symptoms characteristic of this form of the disease, the duration of which can be 7-14 days.
Meningoencephalitic form- but the most complex, but rarely encountered. The infected person shows signs of impaired consciousness (delusions, hallucinations).
Poliomyelitis form– approximately 30% of infected people experience the disease in this form. Impaired motor functions, malaise, numbness of the upper and lower extremities are accompanying symptoms. Muscle atrophy is noticed within 2-3 weeks.
Polyradiculoneuritic form– peripheral nerves and roots are affected. A person suffers from pain along the nerve trunks, paresthesia, Lassegue and Wassermann symptoms, sensitivity disorders in the extremities. Landry's spinal paralysis, flaccid paralysis extending to the muscles of the cervical region and torso are symptoms that characterize this form of encephalitis.

Symptoms of tick-borne encephalitis

Tick-borne encephalitis can be identified by the following symptoms:

the victim notices weakness in the arms, legs, muscles;
the state of fever can last up to 10 days;
there is an increase in body temperature to 38 - 40 degrees, the appearance of chills is possible;
The patient’s well-being and sleep deteriorate, attacks of nausea and vomiting occur, and headaches occur;
hyperemia affects the mouth, pharynx and skin in the face, neck and chest;
possible development of conjunctivitis;
possible numbness of the limbs and paralysis caused by muscle pain;
Erythema may appear.

Diagnosis of tick-borne encephalitis

During the diagnosis, the doctor records the patient’s description of the symptoms: complaints of a sharp headache, fever, convulsions and other symptoms with which the patient came in. In addition, a general examination of the patient is necessary.

The fact of a person’s presence in forest and park-type areas several days before the deterioration of their health is also taken into account. Some examinations are necessary to make an accurate diagnosis. For this purpose, computed tomography of the brain, cerebrospinal fluid and blood sampling are used.

Treatment of encephalitis

Treatment takes place in a hospital setting, under the supervision of a doctor.

The treatment process includes:

the victim complains to a medical institution, makes a preliminary diagnosis and subsequent hospitalization;
administration of anti-tick immunoglobulin;
pathogenetic treatment consists of:
- detoxification therapy;
- dehydration;
- post-syndromic therapy.

It is not recommended to treat the consequences of a tick bite on your own! The lack of adequate therapy can only worsen the situation.

Drug treatment

When tick-borne encephalitis is detected in a patient, the first step is anti-encephalitis immunoglobulin therapy. The patient is administered a drug that contains ready-made antibodies against the tick-borne encephalitis virus.

In addition, specialists are appointed:

antibiotics;
antiviral drugs;
vitamins B and C;
immunostimulating agents.

Folk remedies

In addition to drug treatments, there are also traditional medicine.

But it is important to note that such drugs are absolutely unsuitable as the main method of treating tick-borne encephalitis. They can only be an addition to drug treatment or treatment of the consequences of the disease.

To facilitate the recovery period, you can use the following traditional medicine:

Grind 30 grams of black poplar buds, pour in a glass of boiling water and leave for an hour. Take 2-3 tablespoons before meals for 3-5 days;
A piece of cotton wool soaked in an alcohol solution of propolis is placed in the ear. This will help with hearing loss;
Grind 3-4 lemons and the same number of heads of garlic, add 0.5 liters of vegetable oil and 200 grams of honey. Let it brew in the refrigerator for 10 days. Take the finished product before meals, 1 tablespoon 3-4 times a day for a month, then take a break for 2 weeks and resume the course;
You need 60-90 grams of lemon balm and brew 1 liter of boiling water in a thermos like tea and let it brew for 30 minutes. Drinking it instead of tea will help get rid of muscle spasms and dizziness.

Consequences of tick-borne encephalitis

A mild form of encephalitis is completely cured in about 3 months. More severe forms can be treated over several years. At the same time, the severe course of the disease in approximately 70% of cases ends in the death of the victim.

Complications may also occur, which will have to be overcome during the rehabilitation period.

Complications in adults

Subsequently, encephalitis can lead to disability. Danger from the endocrine system associated with damage to the hypothalamic region may await the patient during the most acute period of the disease.

Women may experience menstrual irregularities. Often the disease causes damage to internal organs.

After suffering from encephalitis, one should not assume that all the bad things are behind us; complications of the disease can manifest themselves over a long period of time in the form of:

dysfunction of the auditory and visual canals;
difficulty breathing;
mental retardation;
memory impairment;
mental disorders;
acute headaches;
development of epilepsy.

Complications in children

Delayed diagnosis of encephalitis ticks in a child or incorrectly selected treatment can lead to death. Flaccid paralysis of the upper limbs is the most common complication of encephalitis in children. Also, manifestations of psychiatric diseases often occur in the form of complications.

Prevention of tick-borne encephalitis

The following types of prevention of tick-borne encephalitis are distinguished:

Specific prevention involves vaccination against tick-borne encephalitis.
Passive prevention is the administration of specific anti-tick immunoglobulin to people affected by tick bites. It is effective for the first 3 days immediately after the bite.
Prevention with iodantipyrine.
Nonspecific prevention - compliance with the rules of behavior in potentially dangerous places, the use of specialized chemical protective equipment.

Vaccination against tick-borne encephalitis

Vaccination against tick-borne encephalitis is a preventive measure. The population of areas with stable endemic disease is subject to mandatory vaccination. Vaccination can be obtained in specialized medical institutions.

Information about vaccination sites against tick-borne encephalitis can be obtained free of charge:

in the clinic;
in the infectious diseases department of the hospital;
sanitary and epidemiological stations.

People who, for certain reasons, are in the group of potential victims are recommended to be vaccinated without fail, so as not to endanger their health.

These potential victims include:

people working in forest belts and fields;
fishermen, hunters, mushroom pickers;
adults and children traveling outside the city on vacation;
tourists hiking through forests, mountains and rocks.

Today there is a huge selection of drugs for vaccination, both domestic and imported.

It should be noted that this vaccination has contraindications:

pregnancy and postpartum period;
alcohol abuse on the eve of vaccination;
allergic reaction to chicken protein;
inflammatory processes in orgasm;
age (it is not recommended to vaccinate children under 1 year of age).

Vaccination scheme

The effectiveness of the vaccination procedure does not depend on the use of the selected drugs, because they are all similar and, according to experts, interchangeable, but on compliance with vaccination regimens.

The first vaccination is given, and after 1-3 months - the second. The third time it is necessary to get vaccinated after 9-12 months. But in emergency situations, a different scheme is followed: the second vaccination is carried out 2 weeks after the first, and the third – after 9-12 months.

Vaccine price

Prices for vaccination against tick-borne encephalitis vary from 400 to 5000 rubles , depending on the region, the chosen medical institution and the vaccine itself (foreign drugs, as a rule, are more expensive than their domestic counterparts).

Conclusion

Today tick-borne encephalitis cannot be called an incurable disease. If it is detected on time, the risk of dangerous consequences is minimal.

Timely detection of a tick on the skin is key, so it is necessary to independently inspect the body after being in a forest area.

A person who has been vaccinated against tick-borne encephalitis must also follow some rules, because even the vaccine does not provide a 100% guarantee.

In places where the presence of ticks is inevitable (forests, parks, fields, summer cottages), it is necessary:

Wear clothing that is as closed as possible, mostly in light colors, so that the tick can be easily detected.
Treat clothing with special preparations (repellents) that repel ticks.
Regularly inspect the surface of the body and outer clothing, and also carefully examine your children, because they are most susceptible to tick bites.
Ticks hide along the hairline, in the area of the ears, neck, abdomen, groin and armpits.

Tick-borne encephalitis is a natural focal infectious disease caused by tick-borne encephalitis viruses, transmitted transmissibly (through insects) and through nutrition (by eating the milk of sick animals), and clinically manifested by an infectious-toxic syndrome with predominant damage to the central and peripheral nervous system.

Tick-borne encephalitis is widespread with the presence of natural foci. There are the most endemic areas for tick-borne encephalitis (a high percentage of ticks infected with this virus). Based on the results of 2012, these include - Kirov region, Perm region, Nizhny Novgorod region, Udmurtia, Bashkortostan, MariEl, Tatarstan, Samara region, Sverdlovsk region, Tyumen region, Chelyabinsk region, Novgorod region, Pskov region, Leningrad region, almost the entire Siberian Federal district, Far Eastern Federal District, part of the districts of the Yaroslavl and Tver regions. The disease is rare in the Central Federal District and does not occur at all in the Southern Federal District.

The symptoms of the disease are varied, which makes it difficult to recognize, but they are all associated with damage to the nervous system. Certain concerns are caused by the formation of chronic forms of the disease with the development of disability.

The causative agent of tick-borne encephalitis– An RNA virus belonging to the Vlaviviridae family. There are 3 types of the virus: 1) Far Eastern - the most virulent (can cause severe forms of the disease), 2) Siberian - less virulent, 3) Western - the causative agent of 2-wave encephalitis - causes mild forms of the disease.

Features of the pathogen:
a) tropism (favorite lesion) to nervous tissue, mainly affecting the motor structures of the brain; b) the possibility of persistence (long-term presence) in the human body, which causes virus carriage (the virus is inside cells and is not recognized by the immune system).

Properties of the virus: the ability to remain viable at low temperatures, but high temperatures (for example, boiling for 2 minutes) have a detrimental effect on it.

Causes of tick-borne encephalitis

The reservoir and carrier of the infection are ixodid ticks, of which there are more than 15 species, but two species are of epidemiological importance - Ixodes perculcatus (taiga) and Ixodes Ricinus (European). The ixodid tick senses a warm-blooded animal and a person within 5-6 meters. The tick attaches itself to the skin and injects the tick-borne encephalitis virus into the blood. Why doesn't a person feel the bite? This is due to the presence of analgesic, vasodilating and hemolysing substances in ticks. The result is pain relief, good blood flow to the bite site and reduced blood clotting. The tick “gets full” when it expands 120 times. In areas of tick-borne encephalitis, after a tick bite, immunity can develop and there will be no disease - this is called pro-epidemic control - that is, some local residents are already protected from this disease. There are two seasons for tick activity and the risk of human infection: spring (May-June) and late summer (August-September).

Ways of transmission of infection:

Transmissible (with a tick bite), and you need to remember that the tick crawls on clothes in search of an open place, and on the body in search of a bite site, therefore, after visiting forest areas, a bite can occur only after an hour;
- nutritional (consumption of milk from sick animals - goats, cows, in whose blood there is a virus);
- infection may occur when ticks are crushed, which is strictly not recommended;
- transplacental (in the case of a bite from a pregnant woman, transmission of the virus from mother to fetus).

A patient with tick-borne encephalitis is NOT contagious to others.
Susceptibility to infection is high, all age groups are affected, but men are more often affected (up to 75%). Often there is an occupational component of the disease, the risk groups for which are foresters, loggers, and geologists.

Symptoms of tick-borne encephalitis

The virus penetrates human skin through a tick bite. Highlight: 1st phase– latent – the virus accumulates in the human body (there are no symptoms, this is an incubation period that lasts on average 7-12 days, but can vary from 1 to 30 days); next comes 2 phase– the virus enters the blood – viremia – and enters the central nervous system (the patient has an infectious-toxic syndrome); 3 phase– neural (the patient has all the symptoms of damage to the nervous system); 4 phase– formation of immunity (the patient recovers). Sometimes the virus does not leave the human body, but is integrated into the genome of brain cells and a progradient course is formed (recovery does not occur, the disease either subsides or is reactivated).

There are acute and chronic forms of tick-borne encephalitis. The acute form of the disease is characterized by 2 syndromes:

1. Infectious toxic syndrome (ITS)– patients complain of high temperature up to 38-40° for 4-6 days, severe headache, which increases as the temperature rises, dizziness, vomiting for 1-2 days, sleep disturbance in the form of insomnia, muscle pain in the neck , shoulder girdle, upper extremities, less often in the lumbar region, lower extremities, weakness and fatigue, feeling of numbness in the upper extremities, muscle twitching, increased sensitivity of the skin (hyperesthesia).
Features in children: there may be loss of consciousness, the appearance of delirium, agitation, and convulsive syndrome.
This syndrome occurs in all forms of tick-borne encephalitis.

2. Craniocervical syndrome– most patients have redness of the face, neck, upper extremities and conjunctivitis.
Further symptoms depend on the form of the disease.

Febrile form of tick-borne encephalitis(prevails, registered in 50-60% of patients). Only ITS and mild redness of the skin. The current is favorable.

Meningeal form. Occurs in a third of patients. Two syndromes are added on the 3-4th day of illness: meningeal syndrome (severe persistent headache, vomiting) and meningeal signs (Kernig's sign, Brudzinski, stiff neck) - only a doctor checks. Meningeal signs persist throughout the febrile period, then they can persist against a background of normal temperature for another 6-8 weeks. During spinal puncture: an increase in the number of cells to several hundred in 1 μl, lymphocytes predominate, the liquid is transparent and flows out under pressure.

Meningoencephalitic form of tick-borne encephalitis. It is diagnosed in 10-20% of patients. It is difficult because focal or diffuse brain damage is formed. Patients, in addition to the 2 syndromes described above, describe complaints characteristic of a general cerebral syndrome: disturbance of consciousness from states of stupor to stupor (prolonged sleep), possible development of coma of varying degrees, convulsive syndrome, there may be spastic hemiparesis (sharp and pronounced weakness in the upper and lower limbs on one side or the other). Death can occur on days 2-4 of illness in 20-30% of patients. In 20% of patients, a progradient course with epileptic seizures and memory loss develops.

Poliomyelitis-like form. It is characterized by the appearance of flaccid paresis and paralysis of mainly the upper extremities and cervicobrachial muscles. On days 1-4 from the onset of fever, the symptom of a “hanging head” and the symptom of a “falling hand” appear; tendon reflexes from the hands are not evoked. Muscle atrophy forms (at 2-3 weeks of illness). There may be muscle twitching and a feeling of numbness in the limbs. In 50% of patients, the condition improves and recovers, and in 50% a progradient course and disability are observed.

Polyradiculoneuritic form. Peripheral nerves are affected: patients complain of pain along the nerve trunks, paresthesia (a feeling of pins and needles in the limbs), symptoms of nerve tension - Lassegue, Wassermann, descending Landry's palsy (determined by the doctor). In 70% of cases, residual effects, paresis, and paralysis persist.

Two-wave form of the disease. Patients have a first wave of fever for a week without brain damage, then a period of normal temperature for 7-14 days, and then a second wave and a full picture of brain damage.

Chronic form of tick-borne encephalitis can be: primary progradient (symptoms of the disease intensify and do not go away in the acute period of the disease, despite the treatment) or secondary progradient (symptoms of the disease resume again after a period of complete or partial restoration of impaired functions).
Immunity after an infection is developed type-specific, long-lasting: antibodies to the virus last a lifetime. Recurrent diseases practically do not occur.

Complications of tick-borne encephalitis

A complication may be the development of epilepsy after the meningeal form, cerebral edema with a fatal outcome after the meningoencephalitic form, damage to the cranial nerves with the development of strabismus, nasal voice, difficulty swallowing, speech, paralysis of the muscles of the neck, trunk and limbs after the polio-like form, immobility and atrophy muscles after the polyradiculoneuritic form of encephalitis and other serious consequences.

Diagnosis of tick-borne encephalitis

A doctor can assume tick-borne encephalitis after analyzing complaints, a thorough examination and collecting an epidemiological history (visiting a forest or field area, especially during the period of tick activity, a tick bite).

What to do if you are bitten by a tick? Under no circumstances should you scratch the bite site or crush the tick itself, or try to immediately pull it out with tweezers or anything else. It is advisable to contact a surgeon for removal, but if this is not possible, then tie the thread into a knot as close to the tick’s proboscis as possible, then carefully swing it and lift it a little until it is removed. Remove carefully, as the head may remain inside, which is very difficult to remove later.

Treat the bite site with iodine. Do not throw away the tick itself, place it in a glass container with damp cotton wool, and place it in the refrigerator. As soon as possible, take the tick for laboratory testing to a virology laboratory. It is advisable to deliver the tick alive for research. The result of the analysis is extremely important for you, since on its basis subsequent measures will be taken in relation to you as a person who was bitten.
Laboratories can be located at infectious diseases hospitals, diagnostic and treatment centers, hygiene centers, and emergency rooms.

The final diagnosis is made after laboratory tests:
1) Detection of E antiene of tick-borne encephalitis virus using an ELISA reaction in ticks (the result is usually ready within 24 hours), the cerebrospinal fluid of a patient, or when examining the milk of a sick animal; or PCR diagnosis of ticks.
2) PCR diagnostics of the RNA virus of tick-borne encephalitis in the patient’s blood - carried out no earlier than 10 days after the tick bite;
3) ELISA diagnostics for detecting IgM antibodies in the blood no earlier than 2 weeks after the bite;
4) ELISA diagnostics for detecting IgG antibodies in the blood no earlier than 3 weeks after the bite.

Treatment of patients with tick-borne encephalitis

1) Organizational and routine measures: hospitalization in an infectious diseases hospital for all patients, bed rest for the entire period of fever and 7 days of normal temperature.
2) Etiotropic treatment (directed at the virus) includes the administration of specific anti-tick immunoglobulin. Immunoglobulin is administered during the febrile period, and when a second wave occurs, it is reintroduced in the same dose. You can prescribe iodantipyrine, interferon preparations (roferon, intron A, reaferon and others), interferon inducers (cycloferon, amixin, neovir).
3) Pathogenetic treatment includes detoxification therapy, dehydration, syndromic therapy (antipyretic, anti-inflammatory, drugs that improve microcirculation, cerebral circulation, and others).

You cannot try to treat tick-borne encephalitis at home. You can wait for complications, the disease becomes chronic, and you become disabled.

Patients are discharged on days 14-21 of normal temperature. Dispensary observation is provided by an infectious disease specialist and a neurologist for 1 year after a febrile form with examination once every 6 months. After other forms of the disease - 3 years with quarterly examination.

Prevention of tick-borne encephalitis

1) Specific prevention includes vaccination against tick-borne encephalitis. There are several vaccines: cultural inactivated (Russia), Encevir (Russia), Encepur for adults and children (Germany), FSME-immune-inject (Austria). This is a planned prevention; you need to get vaccinated in the fall (September-October). The course consists of 3 doses, the first two with an interval of 1 month, the third – a year after the second. Immunity lasts for 3 years, then you need to do 1 revaccination for the next 3 years.

2) Passive prevention - administration of specific anti-tick immunoglobulin to persons attacked by ticks. It is carried out and is effective in the first 3 days after the bite.

3) Prevention with iodantipyrine. Several schemes are known: after a bite for 9 days (medical course); - before visiting places with possible tick attacks.

4) Nonspecific prevention - use of repellents, acaricides, wearing special protective clothing (or at least tuck pants into socks plus a long sleeve with a tight elastic band at the end), self-examination during and after visiting forests, drinking boiled milk.

Infectious disease doctor N.I. Bykova

Tick-borne encephalitis is an acute viral disease that mainly affects nerve cells in the human body. These may be brain structures, peripheral innervation, or radicular nerve endings in the spinal cord.

The main source of infection is the ixodid taiga tick. To reproduce these insects, animal or human blood is required. Spring-summer seasonality is associated with the biology of tick vectors. The virus, entering the stomach of a tick with the blood of infected animals, penetrates all organs of the tick and is then transferred to other animals, and is also transmitted to the offspring of the tick (transovarial transmission of the virus).

The penetration of the virus into the milk of farm animals (goats) has been proven, so nutritional routes of infection of people through goats and cows are possible. Alimentary “goat” endemic foci of encephalitis have been identified in various regions of the former Soviet Union.

Where is tick-borne encephalitis common?

Currently, the disease of tick-borne encephalitis is registered almost throughout the entire territory of Russia (about 50 territories of the constituent entities of the Russian Federation are registered), where its main carriers are ticks. The most disadvantaged regions in terms of morbidity are: the Ural, West Siberian, East Siberian and Far Eastern regions, and those adjacent to the Moscow region are Tver and Yaroslavl.

Incubation period

The time from the moment of infection to the appearance of the first symptoms of tick-borne encephalitis is approximately 10-14 days. The incubation period may lengthen in people who received vaccinations against tick-borne encephalitis in childhood.

There are also several stages of the disease:

Lightning fast. With it, the initial symptoms appear already on the first day. In the absence of adequate treatment, the sick person quickly falls into a coma and dies from paralysis of the central nervous system.
Protracted. In this case, the duration of the incubation period can be about a month, sometimes even a little longer.

The first signs of the disease (what you should pay attention to): usually a week after relaxing in nature, a person suddenly develops a headache, nausea, vomiting that does not bring relief, an increase in body temperature to 39-40°, and severe weakness. Then brain symptoms appear: paralysis of the limbs, strabismus, pain along the nerve endings, convulsions, loss of consciousness.

Classification

The clinical classification of tick-borne encephalitis is based on determining the form, severity and nature of the disease. Forms of tick-borne encephalitis:

inapparent (subclinical):
febrile;
meningeal;
meningoencephalitic;
polio;
polyradiculoneuritic.

According to the nature of the course, acute, two-wave and chronic (progressive) courses are distinguished.

Symptoms of tick-borne encephalitis

After a tick bite, the virus multiplies in tissues and penetrates the lymph nodes and blood. When the virus multiplies and enters the bloodstream, flu-like symptoms form. The virus penetrates the blood-brain barrier and infects brain tissue, causing neurological symptoms.

But the brightness of clinical manifestations, the speed of their growth and specificity always depend on the subtype of the disease and the location of the virus.

European - it is characterized by 2 phases. The first symptoms are similar to the flu and last about a week. The second phase is characterized by damage to the nervous system of varying degrees: from mild meningitis to severe encephalitis.
Far Eastern– usually begins with a feverish state and is acute. Other symptoms can increase just as quickly, leading to paralysis and coma. Death can occur within 6-7 days.

Despite the wide variety of symptoms and manifestations of the disease, there are 4 main clinical forms of tick-borne encephalitis:

Feverish. The tick-borne encephalitis virus does not affect the central nervous system; only symptoms of fever appear, namely high temperature, weakness and body aches, loss of appetite, headache and nausea. Fever can last up to 10 days. The cerebrospinal fluid does not change, there are no symptoms of damage to the nervous system. The prognosis is most favorable.
Meningeal. After a period of fever, a temporary decrease in temperature occurs, at which time the virus penetrates the nervous system, and again the temperature rises sharply, and signs of neurological disorders appear. Headaches with vomiting, severe photophobia and stiffness of the neck muscles, symptoms of irritation of the meninges appear, and there are changes in the cerebrospinal fluid.
Meningoencephalitic. It is characterized by damage to brain cells, which are characterized by impaired consciousness, mental disorders, convulsions, weakness in the limbs, and paralysis.
Poliomyelitis. The onset of this form of the disease is manifested by severe fatigue and general weakness. Numbness occurs in the body, followed by flaccid paralysis of the muscles of the neck and arms, proximal parts of the upper extremities. “Dangling head” syndrome appears. The increase in motor disorders occurs within a week, after which atrophy of the affected muscles occurs. The polio form of the disease occurs quite often, in almost 30% of cases. The course is unfavorable, disability is possible.

It is worth noting that different people have different susceptibility to tick-borne encephalitis. When living for a long time in a natural outbreak, a person may be exposed to repeated tick bites and small doses of the virus. After this, antibodies are produced in the blood, the accumulation of which contributes to the development of immunity to the virus. If such people become infected, the disease will be mild.

Diagnosis of tick-borne encephalitis

In the case of tick-borne encephalitis, diagnosis is carried out using tomographic studies of the brain, serological and virological studies. Based on all indicators, an accurate diagnosis is established.

Brain damage is determined primarily based on complaints during a neurological examination by a doctor. The presence of inflammation and the nature of brain damage are established, and the causes of encephalitis are determined.

How to treat tick-borne encephalitis

In the case of tick-borne encephalitis, there is no specific treatment. If symptoms indicating damage to the central nervous system (meningitis, encephalitis) occur, the patient should be immediately hospitalized to provide supportive care. Corticosteroids are often used as symptomatic treatment. In severe cases, there is a need for tracheal intubation followed by artificial ventilation.

Etiotropic therapy consists of prescribing homologous gamma globulin titrated against the tick-borne encephalitis virus. Thanks to this drug, a clear therapeutic effect can be observed, especially if we are talking about severe or moderate disease. Gamma globulin is administered 6 ml intramuscularly, every day for three days. The therapeutic effect is observed 13-24 hours after administration of the drug - the patient’s body temperature returns to normal, general condition improves, meningeal symptoms and headaches decrease, and may even disappear completely. In recent years, serum immunoglobulin and homologous polyglobulin, which are obtained from the blood plasma of donors living in natural foci of tick-borne encephalitis, have been used to treat tick-borne encephalitis.

Only 2-3 weeks after intensive treatment, subject to normalization of body functions and stabilization of the patient’s condition, should the patient be discharged from the hospital. Hard work and mental stress are contraindicated. Regular walks are recommended, and it is advisable to use tick repellents. Visiting a doctor is mandatory for two years.

Tick-borne encephalitis and its prevention

As a specific prevention of tick-borne encephalitis, vaccination is used, which is the most reliable preventive measure. All persons living in endemic areas or traveling to them are subject to mandatory vaccination. The population in endemic areas accounts for approximately half of the total population of Russia.

In Russia, vaccination is carried out with foreign (FSME, Encepur) or domestic vaccines according to the main and emergency schemes. The basic regimen (0, 1-3, 9-12 months) is carried out with subsequent revaccination every 3-5 years. To build immunity by the beginning of the epidemic season, the first dose is administered in the fall, the second in the winter. An emergency regimen (two injections with an interval of 14 days) is used for unvaccinated persons arriving in endemic areas in the spring and summer. Emergency vaccinated individuals are immunized for only one season (immunity develops in 2-3 weeks); after 9-12 months they are given the 3rd injection.

As an emergency prophylaxis against tick bites, unvaccinated people are injected intramuscularly with immunoglobulin from 1.5 to 3 ml. depending on age. After 10 days, the drug is re-administered in an amount of 6 ml.

Forecast

With tick-borne encephalitis, the prognosis for death depends on the degree of damage to the nervous system. In the febrile form, as a rule, all patients recover completely. In the meningeal form, the prognosis is also favorable, but in some cases persistent complications from the central nervous system may be observed in the form of chronic headaches and the development of migraines.

The focal form of tick-borne encephalitis has the most unfavorable prognosis. The mortality rate can reach 30 people per 100 cases. Complications of this form are the occurrence of persistent paralysis, convulsive syndrome, and decreased mental abilities.

Where can I get vaccinated against tick-borne encephalitis 2016?

In 2016, in Moscow, in all administrative districts, from March to September, vaccination points operate annually at the bases of clinics, medical units, and health centers of educational institutions: (in the Western Administrative District - in children's clinic No. 119; in clinics for adults: No. 209, No. 162 and Moscow State University Polyclinic No. 202), as well as the Central Vaccination Point based on Polyclinic No. 13 (Trubnaya St., 19, building 1 telephone: 621-94-65).

Where to conduct laboratory testing of ticks?

Research of ticks for infection with pathogens of natural focal infections is carried out at the Federal Budgetary Institution of Health "Federal Center for Hygiene and Epidemiology", Federal State Budgetary Institution "Center for Hygiene and Epidemiology in Moscow", at the Federal State Budgetary Institution Central Research Institute of Epidemiology of Rospotrebnadzor.
When contacting the laboratory, it is necessary to provide information about the date and territory in which the tick suction occurred (region, region, locality).

Unfortunately, tick-borne encephalitis is a fairly common disease. This disease poses a threat to human health and even life. That is why proper therapy and prevention are so important in this case.

Today, many people are interested in additional information about this disease. What is it? What is the mechanism of transmission of infection? What are the first signs of encephalitis? Are there effective treatments and remedies? The answers to these questions will be useful for everyone.

What is the disease?

Tick-borne encephalitis is a fairly common disease, especially in some regions. This disease is of viral origin. But its carriers are blood-sucking arthropods, namely ixodid ticks.

Penetrating into the human body, the virus affects the central and peripheral nervous system. The disease is accompanied by fever and various neurological disorders. The disease is fraught with various damage to the nervous system; often, in the absence of timely treatment, it ends in death.

Description of the pathogen and vector of infection

Western encephalitis virus, as a rule, causes mild forms of the disease, which are characterized by a two-wave course;
the Far Eastern virus is considered the most virulent and in most cases causes severe forms of the disease;
In addition, the Siberian virus is isolated, which is less virulent, but nevertheless dangerous to humans.

It is worth noting that these viruses mainly infect the tissues of the nervous system, and most often “settle” in its motor structures. In addition, viral particles can remain inside the cells of the human body for quite a long time without causing an appropriate immune response.

As already mentioned, viral particles are transmitted by certain types of ixodid ticks. In particular, two representatives of this group are of great epidemiological importance: the taiga and European ticks.

The greatest activity of ticks is observed in spring (from May to June) and summer (from August to September). To date, it has been possible to identify some areas of tick-borne encephalitis where the percentage of ticks infected with the virus is extremely high. In particular, the following areas are considered potentially dangerous: Kirov, Pskov, Novgorod, Tyumen, Chelyabinsk, Nizhny Novgorod, Samara and Leningrad regions, as well as Udmurtia, Perm Territory, Siberian Federal District, Bashkortostan, Tatarstan and some other parts of the country.

Interestingly, most residents of these regions have natural immunity to this disease. But visiting guests or tourists are more susceptible to the virus.

Main routes of infection

As already mentioned, tick-borne encephalitis is a viral disease. And in most cases, transmission of infection occurs during the bite of a certain type of tick. In some cases, you can even pick up the pathogen by squashing a blood-sucking pest, which is strictly not recommended. However, there are other ways of infecting the body that you also need to be aware of.

To begin with, it is worth noting that an infected person is not a source of disease for others (except for contact with blood), since the encephalitis virus is not transmitted through the air. But nutritional transmission of infection is quite possible. This is observed when humans consume waste products of infected animals, in particular, milk from cows or goats. By the way, this virus can withstand exposure to cold, but at high temperatures it quickly dies - which is why milk must be boiled before consumption.

Naturally, a transplacental route of transmission of infection cannot be excluded. If a pregnant woman is bitten by a tick vector, there is a high probability of infection of the fetus.

Tick-borne encephalitis: incubation period and first signs

As already mentioned, upon entering the human body, viral particles are localized in the tissues of the central and peripheral nervous system. So what symptoms are accompanied by tick-borne encephalitis?

The incubation period usually lasts from seven to twelve days. On the other hand, in some patients the first symptoms appear the very next day after the bite, while others feel fine for another month after infection. In modern medicine, the course of the disease is usually divided into four main stages:

The first phase is the latent period, during which there are no signs of the disease.
In the second phase, the virus enters the blood and, along with its current, moves into the nerve tissue. It is at this time that the first signs of intoxication appear.
The third phase is characterized by damage to the nervous system and the appearance of neurological disorders.
At the fourth stage, immunity to the disease is formed and gradual recovery occurs.

As a rule, the first signs of tick-borne encephalitis look the same regardless of the form of the disease. First, a fever appears - the body temperature rises sharply to 38-40 degrees. Signs of encephalitis also include headaches, which intensify as the disease progresses. In the first few days, attacks of pain are accompanied by severe nausea and vomiting. In addition, weakness, increased fatigue, and various sleep disorders appear (mostly insomnia).

Patients also complain of severe muscle pain that affects the muscles of the neck, shoulders, and upper extremities. In some cases, muscle spasms may occur. In children, the disease is often accompanied by confusion, delirium, and sometimes loss of consciousness.

Characteristic symptoms may also include redness of the skin of the face and neck, as well as developing conjunctivitis. These are the first signs of the disease. Subsequently, the clinical picture depends on the form of inflammation.

Tick-borne encephalitis: symptoms and main forms of the disease

Most patients experience a febrile form of encephalitis, which is accompanied by the symptoms described above. However, there are other types of encephalitis:

In the meningeal form, in addition to fever, the patient also experiences some of the main symptoms of meningitis. In particular, it is a constant headache, which is accompanied by frequent vomiting. In addition, stiffness of the neck muscles develops. When performing a lumbar puncture, you may notice that cerebrospinal fluid flows out under pressure. After therapy, weakness and headaches may bother the patient for another 6-8 weeks.
In approximately 10-20% of cases, patients are diagnosed with the meningoencephalic form of the disease, which, as a rule, is severe. In this case, large foci of inflammation form in the brain, which is accompanied by the manifestation of pronounced neurological disorders. In particular, the patient may notice some disturbances in consciousness, sometimes even to the point of stupor. Muscle cramps may occur. Severe weakness of the upper and lower extremities and the inability to move them are also signs of tick-borne encephalitis. In especially severe cases, the patient falls into a coma. For 20-30% of patients, this form of the disease is fatal.
The polio-like form of the disease is characterized by the development of flaccid paralysis, with the muscles of the neck, shoulders and upper extremities predominantly affected. Tendon reflexes disappear. At about 2-4 days, the “falling arm” or “dangling head” syndromes appear. Muscle tissue atrophy gradually develops. In approximately 50% of cases, this disease leads to the development of disability.
There is also polyradiculoneuritic tick-borne encephalitis. Symptoms of the disease are paresis and paralysis, which often persist even after full therapy. In this form of the disease, the virus mainly affects the peripheral nerves.
In modern medicine, so-called two-wave encephalitis is quite common. What is special about his clinical picture? After the latent period, the patient experiences the first wave of fever. Quite often it is confused with a common cold, since there are no characteristic symptoms other than high fever and weakness. The fever then goes away, sometimes even for several weeks. This is followed by a second wave, in which the main signs of brain damage appear.

As you can see, the signs of this disease can be completely different. Some forms of encephalitis are quite difficult to diagnose. That is why it is extremely important to consult a doctor in time, preferably before the appearance of disorders of the nervous system. The earlier therapy is started, the less likely it is to develop certain complications.

What should I do if bitten by a tick?

Modern diagnostic methods

Only a doctor can diagnose a patient with tick-borne encephalitis. Diagnosis, as usual, begins with a general examination. Doctors are also obliged to collect complete information about the patient’s health status, get acquainted with his complaints, ask about his place of stay over the last few days, etc.

After this, an analysis for tick-borne encephalitis is carried out. Modern medicine offers several ways to detect a virus in the human body. Naturally, if the patient brought a tick with him, then the pest is tested first, in particular, this is PCR diagnostics and the detection of specific antigens.

In other cases, the cerebrospinal fluid of a sick person is taken for analysis. The samples are then tested for the presence of specific E antigens using an ELISA reaction. In some cases, additional tests are carried out on the patient’s blood for the presence of specific immunoglobulins M and G. But these tests give an accurate result only 2-3 weeks after the insect bite, which, of course, is not always a suitable option.

And remember that only an experienced doctor knows what tick-borne encephalitis looks like, diagnosis, treatment and prevention of this disease. Never neglect the help of a specialist.

What complications are possible?

Today, many people are interested in questions about what complications may arise after tick-borne encephalitis. According to statistical data, with the febrile and meningeal form of the disease, the prognosis for patients is quite favorable - treatment is easy without any consequences.

But other forms of the disease can be extremely dangerous. Some patients develop epilepsy. The meningoencephalitic type of the disease can lead to severe swelling of the brain, which often ends in coma and death of the patient. Sometimes tick-borne encephalitis affects the cranial nerves, which leads to irreversible consequences such as speech impairment, strabismus, paralysis of the muscles of the neck, limbs or torso, as well as a nasal voice and problems with swallowing.

In some cases, after an illness, the patient develops muscle atrophy, which leads to disability. In fact, complications after encephalitis can be different. This is why well-executed therapy is so important.

Treatment of tick-borne encephalitis

Only a doctor knows what tick-borne encephalitis is, the symptoms, treatment and complications of this disease. Therefore, at the first suspicion of the presence of such an ailment, immediately go to a specialist. Under no circumstances should you try to treat yourself. Various folk methods will not only bring no benefit, they can also aggravate the condition.

So what kind of therapy does tick-borne encephalitis require? Treatment is carried out in a hospital setting. All patients must be hospitalized in the infectious diseases department of the hospital. Bed rest, rest and proper nutrition are mandatory in this case.

As for drug treatment, in this case the patient is immediately administered a specific immunoglobulin. In addition, antiviral therapy is carried out. In particular, patients are administered drugs that contain interferon (for example, Intron A, Roferon). In addition, it is necessary to take interferon inducers. In particular, the drugs “Neovir”, “Cycloferon” and “Amiksin” are considered quite effective.

What other means can be used to overcome tick-borne encephalitis? Treatment includes taking other medications. In particular, patients undergo detoxification therapy. Patients are also prescribed anti-inflammatory and antipyretic drugs. The treatment regimen may also include drugs that improve the trophism of nerve tissue and normalize blood microcirculation.

As a rule, the course of treatment lasts from 3 to 5 weeks. But even after discharge, the patient remains registered with an infectious disease specialist, as well as with a neurologist. Depending on the form and severity of the disease, the patient is required to undergo repeated examinations every 3-6 months over the next 1-3 years.

Chronic encephalitis and its features

Even after full-fledged therapy, the patient must remain registered with a doctor for some time. The fact is that sometimes the disease develops into chronic tick-borne encephalitis. This form of the disease is not very common. However, the possibility of its development should not be excluded.

The chronic form can be primary progradient - in this case, the symptoms of the disease intensify and do not disappear at the acute stage, even with appropriate treatment. But secondary forms are more common, in which an exacerbation occurs after therapy and the onset of full recovery (sometimes even six months after the illness).

In any case, chronic encephalitis is dangerous, as it can lead to a host of complications, including paresis, paralysis, epilepsy and other disorders.

Basic methods of prevention

Of course, today many people are interested in questions about what prevention of tick-borne encephalitis looks like. Are there really effective remedies to combat this disease?

In fact, the full development of the disease can be avoided. What does drug prevention of tick-borne encephalitis look like? In fact, there are several really effective schemes:

First of all, this is a vaccine (vaccination) against tick-borne encephalitis. This drug contains a small amount of a weakened or dead pathogen that cannot harm a person. After entering the body, such a product activates the immune system and promotes the production of its own antibodies. As a rule, vaccination against tick-borne encephalitis is recommended for people living in potentially dangerous areas inhabited by virus carriers. Most often, planned prevention begins in the fall and includes three doses of the vaccine. Immunity lasts approximately three years. After this time, you must undergo the vaccination procedure again.
Quite often, people are given a specific immunoglobulin against tick-borne encephalitis. This procedure is considered passive prevention, since the human body receives ready protection against the virus. Immunoglobulin against tick-borne encephalitis is administered in the first three days after a tick bite.
In addition, modern medicine also offers some antiviral drugs. In particular, Yodantipirin is considered to be a fairly effective medicine. This medicine is used both to prevent infection and after a tick bite.
When a child becomes infected, doctors prescribe the use of the children's drug Anaferon. The dosage regimen is determined by the attending physician.

On the other hand, we should not forget about non-drug methods of prevention. In particular, when visiting forests or parks in areas where dangerous types of ticks live, you need to take care of special protective clothing - you need to try to cover the skin as much as possible with clothing. After each walk, you need to carefully inspect your body for ticks or bite marks. In case of a tick attack, you should immediately go to the hospital.

Since the virus can also be present in animal waste products, you need to carefully monitor the quality of the food you eat. In particular, you can only drink pasteurized or boiled milk. And don’t forget that preventing a disease is sometimes much easier than coping with its consequences.

Tick-borne encephalitis is a specific viral inflammation of the brain with simultaneous damage to the central and peripheral nervous system.

The tick-borne encephalitis virus is transmitted by the bites of special types of ticks and has an unfavorable course and even death.

Causes

Tick-borne encephalitis is caused by a special type of virus. In nature, the virus is carried by ixodid ticks - taiga and European. These species are mainly found in Siberia, the Far East, and the Urals. Encephalitis as a natural focal infection occurs in spring and summer, with a peak in May-June and August-September, when ticks are highly active.

People become infected when tick saliva enters the bloodstream. The female tick can remain on the human body for several days until it is completely saturated with blood, while the bite itself is not painful. Less commonly, tick-borne encephalitis is transmitted through consumption of raw milk from cows and goats infected with the virus.

Kinds

Experts distinguish three types of virus and, accordingly, three subtypes of tick-borne encephalitis:

Far Eastern encephalitis, with severe course and mortality rate up to 30-40%
European, with a mild course and relatively low mortality,
Siberian.

The severity of the disease largely depends on the age of the patient, his immune system, and the ability of the virus to penetrate the brain.

Symptoms of tick-borne encephalitis

After a tick bite, the virus multiplies in tissues and penetrates the lymph nodes and blood. When the virus multiplies and enters the bloodstream, flu-like symptoms form.

The virus penetrates the blood-brain barrier and infects brain tissue, causing neurological symptoms.

The incubation period lasts from 2 days to 3 weeks, the infection develops depending on the infecting dose and the characteristics of the immune system. The prodromal (preceding) period is manifested by chills, fever up to 40 degrees, body aches, and general toxicosis.

Several distinct forms of encephalitis can be distinguished:

febrile form without penetration of the virus into the nervous system: manifestations of a severe viral infection with fever, severe weakness and body aches are characteristic, symptoms are very similar to the flu. They last up to 10 days, there are no changes in the cerebrospinal fluid (brain fluid). At this stage, patients always recover.
meningeal form: after a period of fever, a temporary decrease in temperature occurs, at this time the virus penetrates the nervous system, and the temperature rises sharply again, signs of neurological disorders appear. Headaches with vomiting, severe photophobia and stiffness of the neck muscles, symptoms of irritation of the meninges appear, and there are changes in the cerebrospinal fluid.
encephalitic form: damage to the brain substance with the formation of focal signs. All of the above symptoms are accompanied by mental disorders, disturbances of consciousness, paresis and paralysis, and convulsions. This form is the most severe and has a high mortality rate.
polio form: causes damage to neurons in the motor areas of the spinal cord, similar to polio. This results in flaccid paralysis of the neck and muscles, leading to disability.

Diagnostics

Tick-borne encephalitis can be suspected in the case of trips to nature in endemic areas, with tick bites, in the presence of fever, headache, and neurological symptoms. But the clinic does not make a diagnosis.

To accurately confirm the diagnosis, it is necessary to determine specific antibodies -

immunoglobulin class M for encephalitis (IgM) - the presence indicates an acute infection,
IgG - the presence indicates contact with infection in the past, or the formation of immunity.

If both types of antibodies are present, this is a current infection.

The virus is also determined in the blood by PCR and PCR of the cerebrospinal fluid is performed.

In addition, another infection in the blood is determined in parallel - tick-borne borreliosis.

Treatment of tick-borne encephalitis

A specific cure for tick-borne encephalitis has not yet been developed, so all treatment methods are aimed at relieving the symptoms of encephalitis. For a patient with suspected tick-borne encephalitis, hospitalization in the infectious diseases department is necessary.

Carry out:

symptomatic therapy - administration of detoxification drugs, glucose, diuretics, antiviral drugs,
fight against fever and complications, especially neurological.
strict bed rest, intensive care unit,
As the condition improves, light food, physiotherapeutic treatments and massages are indicated.

Sometimes, according to indications, anti-tick immunoglobulin is administered to fight the virus and stimulate one’s own immunity to the virus.

Forecast

The patient is not contagious to others; the virus is not transmitted from person to another person.

When the brain and spinal cord are damaged, the prognosis is questionable, paralysis and focal symptoms, mental disorders may remain, and sometimes death is possible. After recovery, headaches, paralysis, and a sharp decrease in memory may remain for a long time. Stable lifelong immunity is formed.

Prevention

The basis for the prevention of tick-borne encephalitis is the introduction of a specific vaccine and the prevention of tick bites.

Children from 12-24 months and adults are vaccinated with special vaccines - Encepur, Encevir. In case of tick bites, emergency prevention is carried out - immunoglobulin and iodantipyrine are administered.