Tick-borne Encephalitis in Childhood: Rare or Missed?

Magnus E. A. Hansson, MD; Claes Örvell, MD, PhD; Mona-Lisa Engman, MD, PhD; Katarina Wide, MD, PhD; Lars Lindquist, MD, PhD; Karl-Johan Lidefelt, MD, PhD; Mikael Sundin, MD, PhD

Disclosures

Pediatr Infect Dis J. 2011;30(4):355-357. 

In This Article

Results

Of 3635 anti-TBE serologies, 699 (19.2%) were obtained from patients <16 years (Table 1, and Table 2). Sampling occurred from spring to late autumn with a peak in August. In total, 296 (8.1%) anti-TBE serologies suggested TBE. Interpretation of serology in relation to clinical picture by responsible clinician resulted in 287 (7.9%) diagnoses. Of 3635 serologies, 692 (19.1%) displayed negative anti-TBE IgM but positive IgG. Data from 444 available questionnaires showed that 116 (26.3%) patients had no previous flavivirus infection and were nonimmunized against flaviviruses, suggesting subclinical infection (Table 1, and Table 2; and Table, Supplemental Digital Content 1, http://links.lww.com/INF/A634).

Epidemiologic and Clinical Findings in Childhood TBE

Most children either resided in or visited TBE endemic areas and tick-bites were recalled by 75%. Nonspecific findings and symptoms (eg, elevated body temperature, headache, and malaise/fatigue) were more common in children, whereas those suggesting encephalitic origin (eg, cognitive dysfunction, impaired general appearance, and motor abnormalities) occurred more frequently in adults. Meningeal signs (eg, sensory disturbances and neck stiffness) were found in comparable frequencies in children and adults. Biphasic course was less frequent in preschool children than in schoolchildren and adults (Table, Supplemental Digital Content 1, http://links.lww.com/INF/A634). Sensory disturbances, neck stiffness, vertigo/balance problems, and biphasic course were significantly more frequent in children with TBE than in non-TBE cases with completed questionnaires (Table, Supplemental Digital Content 2, http://links.lww.com/INF/A635). Duration of hospitalization was shorter in children than in adults. No deaths occurred in children (Table, Supplemental Digital Content 1, http://links.lww.com/INF/A634).

Laboratory Findings in Childhood TBE

Patients with TBE in different age groups displayed slightly elevated mean values in blood inflammatory indices without statistical difference—except for white blood cell count, which was significantly higher in children than in adults. Erythrocyte sedimentation rate and white blood cells were significantly elevated in children with TBE compared with non-TBE cases (Table, Supplemental Digital Content 2, http://links.lww.com/INF/A635). CSF analyses showed pleocytosis with mononuclear preponderance and a normal mean CSF glucose concentration in most patients, without statistically significant deviations between the age groups. Mean CSF albumin concentration was significantly higher in adults than in children. CSF glucose concentrations were significantly elevated in children with TBE compared with non-TBE cases (Table, Supplemental Digital Content 3, http://links.lww.com/INF/A636).

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