- TBE: description
- TBE: symptoms
- TBE: causes and risk factors
- FSME: examinations and diagnosis
- TBE: treatment
- TBE: disease course and prognosis
The TBE (Tick-borne encephalitis) is a form of brain and / or spinal cord inflammation and is triggered by the TBE virus. The pathogen is transmitted by ticks to humans, the disease occurs mainly in the summer months. A risk of infection exists only in areas where ticks are infected with the TBE virus. In Germany, these are especially forest and meadow areas in southern Germany. Read all important information about FSME here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. Z24A84
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
What is FSME?
Early-summer meningoencephalitis (TBE) is a form of brain / meningitis. It is also called tick encephalitis because it is transmitted mainly by ticks, but sometimes also by mosquitoes and sandflies. Ticks in Germany are almost always transmitted by FSME.
The TBE virus is one of the flaviviruses as well as the viruses of dengue fever, Japanese encephalitis and yellow fever. In contrast to these tropical diseases, TBE is native to Germany. This means that the disease does not have to be imported from abroad, but can be transmitted by ticks in German forests. The viral transmission to humans takes place with the saliva of blood-sucking ticks. The ticks themselves become infected with wild animals in the forest, which themselves often carry the virus, but without developing TBE. These animals are an important source of food for ticks, so they become infected with blood meals. They then remain life-time virus carriers and pass on the pathogen to their victims as well as humans. Infection from person to person is not possible.
Not every tick bite makes you sick
The saliva of a tick contains not only the virus but also narcotic substances, so that many people do not notice the tick bite and in retrospect can not remember if the doctor asks for it. However, not every tick bite (colloquial: tick bite) leads to an infection, and not every infection leads to the disease. Accurate data on the number of infected ticks and the frequency with which an infection actually leads to the disease vary slightly. In risk areas, two to five percent of ticks carry the TBE virus. Even if the virus is transmitted to humans, only up to one-third of those affected develop early-meningoencephalitis. However, one should keep in mind that one in a hundred sick patients dies from the disease. In the case of the TBE virus type occurring in Russia and Asia, as many as 20 percent of the patients die.
The time between infection (tick bite) and onset of the disease is called the incubation period. Since the virus must first spread in the body after the tick bite to reach the brain, the TBE incubation period is about one to two weeks. The disease is therefore not directly detectable after a tick bite. If you have been bitten by a tick in a TBE risk area, you should pay particular attention in the coming weeks to complaints such as fever or headache.
In 2013, approximately 400 people in Germany contracted an early-summer meningoencephalitis. This is almost 200 more cases than in 2012. However, in the past there were already very different case numbers. Mainly, people become involved in recreational activities during the months of June to August.
Not to be confused with Lyme disease
The TBE must not be confused with another tick-borne disease, Lyme disease. It is a disease caused by bacteria, which manifests itself with the first symptoms days to weeks after the bite. The complaints can last for several years. With timely diagnosis, however, the Lyme disease is easily curable.
Where you can get infected with TBE, read the article TBE Areas.
Read all about the typical signs of TBE in the article TBE - Symptoms.
TBE: causes and risk factors
TBE is mainly transmitted to humans through tick bites. Ticks are parasites that feed on the blood of a host organism. They live in tall grass, scrub and deciduous forests. For Germany, the Robert Koch Institute informs annually about the TBE risk areas.
Ticks live mainly in forest and meadow areas. However, the tick-borne encephalitis affects not only forest workers, foresters and farmers. A large part of those affected become infected with recreational activities with the pathogens.
In rare cases, contaminated raw milk or raw milk products (such as goat or sheep cheese) may infect with FSME. This transmission path presents a risk of infection especially in Eastern Europe, in Germany it is regarded as a rarity.
What is the TBE risk?
The risk of developing tick-borne encephalitis depends on several factors. Anyone who travels outdoors in a TBE risk area is at risk. However, the risk is less than you think. On average, one out of every 50 ticks in a TBE risk area carries the pathogen. The risk of contracting the virus is about 25 percent.
From these statistical data, the overall risk of TBE infection can be derived: an early-summer meningoencephalitis occurs in one out of 150 tick bites in a risk area.
Risk of consequential damage
In addition to the actual TBE sequelae of meningitis are another problem. These may be, for example, impaired concentration or headache, more rarely, paralysis or sensory disturbances. Statistically, one of 500 tick bites shows such consequential damage.
FSME: examinations and diagnosis
First, the doctor will conduct a detailed conversation with the patient (anamnese). He asked, for example, about stays in a TBE risk area and possible tick bites in the previous weeks. Often the tick bite has already been forgotten or was not even noticed. If the patient can not remember a tick bite, the TBE will not rule out a long time.
In the anamnesis interview, the doctor also asks the patient for his exact complaints. Striking is the disease typical of FSME with two fever episodes (biphasic course).
There is a suspicion of a TBE blood tests and a analysis cerebrospinal fluid (Cerebrospinal fluid) provide further crucial information. Increased blood levels of inflammation as well as the detection of specific antibodies to TBE viruses in blood or cerebrospinal fluid provide certainty. Only at the beginning of the disease can the virus be detected directly in the body. If meningitis has already developed as a result of the infection, it is usually too late for that. It can then only the immune response of the body to the virus (antibody) are measured.
In some cases, it is necessary to detect the spread of inflammation in the brain. An important tool here is the magnetic Resonance Imaging (MRI). With their help, details can be detailed in the skull. However, it can not be determined from the MRI images how bad the disease is or whether it leaves lasting damage.
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Vaccinate or not? The fact check
In Germany, it is a perennial favorite - the discussion about the benefits and risks of vaccinations. Few health topics are fought with such passion as those seconds spiked to arm the immune system against the onslaught of potentially life-threatening viruses. But what is really up to the arguments of the vaccination opponents - and what speaks for the immuno-boosters from the laboratory? We have collected the most important points.
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Better immune system?
Unvaccinated children have a better trained immune system, say vaccine opponents. They forget that the vaccines give the immune cells in the body the same alarm signals as pathogenic viruses. They are not infectious. In addition, because the vaccine serums are highly specialized, the immune system of vaccinated children also comes into daily contact with thousands of other pathogens, against which it has to defend its own strength.
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It used to be without it!
Infections with so-called teething troubles do not always go well: lung infections or inflammation of the brain and meninges are a common complication of measles, and young males can become infertile, and by the way, unvaccinated adults are one Special danger for children: So-called Impflücken are often responsible for the fact that epidemics can suddenly spread again.
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In fact, vaccinations also mean stress for the very young infant organism. But some infections - such as measles, whooping cough or Haemophilus influenzae - mean for them a particularly high risk. Early protection may be life-saving. Incidentally, there is no evidence that infants are less tolerable than older children.
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Vaccinations make you sick
Many vaccines consist of attenuated (eg the measles vaccine) or killed viruses. In this way, the immune system is stimulated - the defense reaction often manifests itself in more or less pronounced disease symptoms. The fact that vaccines actually make ill, however, is extremely rare in modern preparations.
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That vaccinations promote the development of allergies seems to be supported even by some studies.But proof of a factual connection is difficult, because many parents of vaccinators by a more critical attitude, such as nutrition issues, at the same time keep other potentially allergenic factors away from their children. On the other hand, in the former GDR, where vaccination was required, very few children suffered from allergies.
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In fact, some vaccines contain formaldehyde, aluminum, mercury or other potentially toxic substances in order to preserve or enhance their effects. However, in extremely low concentrations and below defined toxic limits. Nevertheless, the industry has responded to the discussion and has now developed mercury-free vaccines.
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Antibiotics instead of vaccination?
Many diseases are easier to treat with modern medicines than they were 30 or 40 years ago. However, antibiotics are not effective against viruses - in measles and their counterparts, they can only fight those bacteria that, as so-called opportunists, exploit the weakness of the immune system and cause complications. And in some bacteria, such as the cause of tetanus meningitis or whooping cough, antibiotics hardly.
TBE treatment is not easy. Unfortunately, there is no specific therapy that combats the TBE virus in the body. All therapeutic approaches can only support the body in its fight against the pathogen.
An important goal of the therapy is to alleviate discomfort and prevent long-term damage. Common medications for pain and fever are ibuprofen and paracetamol. Since the fever helps the body to fight the disease, a complete reduction in fever is not recommended.
About every twentieth TBE patient has life-threatening symptoms and needs to be monitored more closely. Respiratory paralysis and severe disorders of consciousness should always be treated in an intensive care unit.
Important treatment options, especially for consequential damages of the infection, are physiotherapy, occupational therapy and speech therapy.
The administration of immunoglobulins after a tick bite in a risk area to prevent a possible TBE disease is now no longer recommended. Also, no corresponding preparations are sold anymore. The reason: it could never conclusively be proven that this so-called post-exposure prophylaxis lowers the risk of disease sufficiently.
The only sure protection against an early-summer meningoencephalitis is offered by the TBE vaccine.
The only effective protection against FSME is vaccination. Other protective measures aim to prevent tick bites from the outset: Wear tight-fitting, light-colored clothing when staying in the woods and tall grass. If you are not looking for mushrooms, you should avoid the dense undergrowth. The effect of tick repellents (repellents) is limited and lasts only a few hours.
If you are outdoors, look for ticks and clothing. In children, the bloodsuckers are mainly between the hair and the neck. As ticks seek warmth, other preferred sites are the armpits, groins and hollows of the knees. Bear in mind: The TBE agents are located in the salivary glands of the tick and are immediately transferred to the wound during the sting. The immediate removal of the tick therefore does not protect against TBE, but at least mostly from Lyme disease.
Everything important for the vaccination against the tick-borne encephalitis you read in the article TBE vaccination.
TBE: disease course and prognosis
In 70 percent of the patients the TBE shows a uniform course of disease: After a tick bite it usually takes about ten days until the first symptoms appear. Particularly striking is the characteristic two-phase (biphasic) course of the disease: First, flu-like symptoms with fever, headache, vomiting and dizziness appear. Then the fever goes down for about a week (up to 20 days). Then it comes (in about ten percent of cases) to an inflammation of the brain and meninges (meningoencephalitis).
In most cases, TBE infection is uncomplicated and completely heals. But it can also lead to long-term damage, especially in the most severe form of the disease, the simultaneous inflammation of the meninges, brain and spinal cord (meningoencephalomyelitis). For many months and years after the illness, many suffer from lack of concentration, paralysis, epileptic seizures or headaches. Some of these complaints can persist permanently.
Severe disease courses are almost exclusively observed in adults, but rarely in children. However, children are more prone to tick bites and are therefore at greater risk.
Risk of death in FSME
The general risk of dying of an early-summer meningoencephalitis is about one percent. This value is obtained if one does not look at gradients, age groups and risk factors separately. Depending on the risk factors, the mortality can be many times higher.
The risk of death increases with the number of affected nerve structures: The most severe form of FSME (meningoencephalomyelitis) ends in ten percent of cases fatal.
Experts believe that people are immune to the virus after a TBE overcame, and for life. This means you can only get sick of TBE once. On the other hand, a vaccine against TBE provides temporary protection TBEVaccination must be refreshed regularly.