Early summer meningoencephalitis (TBE) is an infectious disease caused by TBE viruses. These, in turn, are mostly transmitted by ticks or wood ticks. Since in Germany about 5% of all ticks are infected with this virus, it is advisable to be vaccinated against early summer meningoencephalitis (FSME) and to cover the whole body with suitable clothing when walking through meadows and forests.
What is early summer meningoencephalitis (TBE)?
Early summer meningoencephalitis (TBE) is an inflammatory disease of the brain and spinal cord. The technical term “meningoencephalitis” is composed of the word components “meninx” (Greek: meninges) and “enképhalon” (Greek: brain). This meningitis occurs more frequently in the months of June, July and August. Baden-Württemberg and Bavaria are high-risk areas in Germany. However, the frequency distribution suggests that early summer meningoencephalitis (TBE) is increasingly moving northward as well. According to the Infection Protection Act, cases of TBE within Germany must be reported to the public health department.
Causes
Early summer meningoencephalitis (TBE) is caused by infection with the TBE virus. Infection occurs by means of the bite of a wide range of tick species. However, the main causative agent is the wood tick, one of our most common native ticks. The parasites lurk mainly in the grass and low herbaceous layer and cling to our bodies in case of accidental contact. When the animals bite the skin for the purpose of a blood meal, their saliva enters the human body, allowing the viruses to enter the bloodstream. Not every person who becomes infected with tick-borne meningoencephalitis becomes ill. In fact, the majority of infected individuals who actually become ill experience very few symptoms of the disease. When symptoms do become noticeable, they resemble the flu. In addition to fever, fatigue and pain in the limbs, there is also neck stiffness in the typical case. If the central nervous system is severely damaged by early summer meningoencephalitis, permanent paralysis may result. Mental performance may also be impaired. If the late effects are severe, the result is need for care, sometimes even complete bed confinement.
Symptoms, complaints, and signs
Early summer meningoencephalitis (TBE) basically progresses in two phases. However, only a small proportion of those infected develop any symptoms at all. In the first phase, the first symptoms appear after a few days to several weeks after the bite of an infected tick. Flu-like symptoms occur with fever, loss of appetite, headache and pain in the limbs. These first symptoms often recede after a short time. However, fever may reappear after some time. After this first phase, the disease is either over or the second, more serious phase of TBE follows. In the second phase of the disease, the TBE virus attacks the central nervous system. Here, inflammation of the meninges (meningitis), the brain (encephalitis) and the spinal cord (myelitis) can occur. Consequences of these inflammations are headaches, nausea, vomiting and fever. Especially typical for meningitis is a stiff neck and increasing photophobia. If the brain is affected by the inflammation, speech disorders, paralysis, epileptic seizures and changes of character may occur. A possible respiratory paralysis is feared. If the spinal cord is also affected, the disease spreads further. Due to its function as a central connection between the brain and the rest of the body, paralysis can now also occur in the arms and legs, for example.
Course
In addition to the general flu-like symptoms, however, more severe symptoms can occur in the course of early summer meningoencephalitis (TBE). Approximately 10 percent of those affected will contract the second phase of TBE. This can lead to complications in the form of meningitis and inflammation of the spinal cord. Paralysis related to the nervous system, epileptic seizures and other mental disorders (dizziness) may also occur. However, these complications mostly occur in children who have contracted early summer meningoencephalitis (TBE).Older people who fall ill with TBE, however, not infrequently tend to die from these diseases, because the symptoms and discomfort, the usually already old and weak body, too much stress.
Complications
Complications are rather rare to fear with early summer meningoencephalitis. However, if an illness manifests itself, there is a possibility that a second stage will occur after the first phase, which resembles the flu. In such cases, approximately ten percent of all patients must expect a complicated course of the disease. Often, the negative sequelae occur in the context of meningoencephalomyelitis. This is an inflammation of the brain, the meninges and the spinal cord. If TBE results in a severe course of the disease, there is sometimes a risk of permanent damage. In the worst case, even death of the patient is possible. Approximately one percent of all affected persons die from the severe effects of early summer meningoencephalitis. The risk of death increases with the number of nerve structures affected by the disease. In addition, there is a risk that certain functions of the body will fail for the rest of the person’s life. One of the biggest problems of TBE is that many patients suffer from secondary symptoms for months or even years after a severe course of the disease. Typical symptoms include headaches, paralysis and epileptic seizures. In some cases, the symptoms take a chronic course. Complications of early summer meningoencephalitis almost always occur only in adult patients. Children, on the other hand, are rarely affected. However, because of the higher proportion of tick bites, the risk is considered higher in children.
When should you see a doctor?
A visit to the doctor is necessary when a tick in the skin cannot be safely removed under its own power. If the tick is in a difficult-to-reach area or if the person feels overwhelmed during removal, it is safer to have a doctor professionally remove the tick. If the tick could not be completely removed with independent treatment, a doctor should be consulted immediately. The remains of the animal’s body can introduce viruses into the organism at the site of the tick bite, leading to early summer meningoencephalitis. Therefore, professional removal of the remaining animal carcass is necessary as soon as possible. If health irregularities develop after a tick bite, a doctor should also be consulted. In case of a general malaise, increased body temperature, dizziness or vomiting, a doctor is needed. If there is inflammation of the wound, redness of the skin and noticeable swelling, these should be medically clarified and treated. If there is a diffuse feeling of pain in various parts of the body or if the affected person suffers from diarrhea, coughing, and other flu-like symptoms, he or she should consult a doctor. In case of disturbances of consciousness it is advisable to call an emergency doctor. Until the arrival of the latter, the instructions of the emergency services should be followed and calm maintained.
Treatment and therapy
Causal treatment of early summer meningoencephalitis (TBE) is not possible. Only the symptoms can be alleviated, so the patient is prescribed pain and fever-reducing drugs. In addition, strict bed rest is advised. Nevertheless, if TBE is suspected, a doctor should be consulted immediately to rule out complications.
Outlook and prognosis
In 70 to 90 percent of all cases, early summer meningoencephalitis progresses without significant complications and heals without consequences. If the disease reaches the second phase, the prognosis is more cautious: Depending on the affected area of the central nervous system, long-lasting sequelae may occur. In the worst case, the disease can lead to death. Life-threatening courses occur mostly in adults, only very rarely in children. Inflammation of the meninges is most common in the second phase of the disease. This form of TBE requires inpatient monitoring, and complete recovery may take several weeks. In most cases, however, meningitis does not cause permanent damage. If the inflammation spreads from the meninges to the brain tissue, the prognosis worsens significantly. Despite intensive medical treatment, paralysis symptoms occur in some cases, which can be life-threatening.If the patient survives the acute phase of the disease, he often continues to suffer from motor disorders or epileptic seizures for several months. The recovery process usually progresses slowly, but a complete cure is still possible. Deaths occur predominantly in the rare myelitic course of early summer meningoencephalitis: Here, the spinal cord is affected in addition to the brain. In this form, destruction of the nerve cells can lead to respiratory paralysis and thus death.
Prevention
Because of the lack of treatment options when the disease has broken out, preventive measures are particularly important in the fight against early summer meningoencephalitis (TBE). These primarily include avoiding tick infestations. Anyone who goes out into nature, even if it is only the lawn at home, should only do so well dressed. Sturdy shoes and long pants are obligatory, and legwear should be tied at the ankle. Special care should be taken when working in the garden. Incidentally, it should be noted that infections with early summer meningoencephalitis are also rare outside the main season, but are certainly possible. This is because the ticks become active from a temperature of 7° Celsius. After spending time outdoors, the entire skin surface should be searched for ticks and these should be removed immediately. Quick action is important! Because in animal experiments it has been proven that the probability of infection increases significantly with the duration of tick infestation. To remove the parasites, pharmacies and drugstores have special tick tongs ready. The animals should be either pulled straight out or twisted out with the instrument. Pressure on the entire body of the tick must be avoided if possible. The best protection against infection with early summer meningoencephalitis is active immunization, also known as vaccination. In this process, the physician injects TBE viruses that have been rendered harmless, whereupon the human organism forms its own antibodies. Three vaccination sessions over the course of a year are necessary to achieve complete protection against TBE. Lifelong booster immunization is required, as with other vaccinations. This should first be done 3 years after the main vaccination in the case of early summer meningoencephalitis.
Follow-up
In general, there are no direct and specific options for follow-up care available to the affected person in the case of early summer meningoencephalitis. The patient is primarily dependent on medical care and treatment to prevent further complications. In general, all contact with ticks should be avoided. Outdoors, those affected must protect themselves from early summer meningoencephalitis by wearing clothing or using sprays. Clothing that covers the entire body should be worn, especially in forests or meadows. Treatment for early summer meningoencephalitis usually involves medicines that reduce fever and relieve pain. No special treatment is necessary in this case. Care must be taken to take these drugs regularly and, above all, correctly in order to combat the symptoms quickly. The affected person must also rest and take care of his body. In the case of early summer meningoencephalitis, strict bed rest applies, and all stressful and strenuous activities are to be discouraged. This is the only way the body can fully recover and fight early summer meningoencephalitis. The life expectancy of the affected person is usually not reduced by this disease. However, in case of severe symptoms, a hospital should be visited.
What you can do yourself
In accordance with the fact that there is no causative therapy for early summer meningoencephalitis by medication, the self-help measures that infected persons can initiate are limited. Those affected can take care of a few things that help the body fight the infection. For example, bed rest is very important and should be followed. Physical and excessive mental exertion should be avoided. Food should not be avoided, but a good eating, small portioned and balanced diet should be forced. The fever – as long as it does not rise too high – should not be suppressed at all, because it fights the pathogen of TBE. A warm development promotes warmth and sufficient fluid intake promotes sweating.In addition, regular checks should be made on the affected person, as this allows possible complications to be detected at an early stage and hospitalization to take place in good time. After surviving a severe infection, affected persons should participate in the therapies in their daily lives, depending on the degree of existing damage caused by TBE. This includes creating an appropriate environment (in the case of motor impairments) and should include memory games, speech exercises, etc.
