Search

Tick-borne encephalitis (TBE) is endemic in South-Scandinavia, Central Europe and Eastern Europe. In 2016 the first patient was reported with TBE virus infection contracted in the Netherlands, in a forested area between Driebergen and Maarn (near Utrecht). At the time, field research did not identify any TBE-positive ticks at the supposed infection site. In the last two years, two patients have been diagnosed with TBE in the Diakonessenhuis Hospital in Utrecht; one patient was bitten by a tick in the Netherlands. This time round, tests on ticks from a different area near Utrecht (the forests around Zeist) did identify TBE-positive ticks. TBE infection is often asymptomatic. However, in a small proportion of patients, disease can develop and there is currently no curative therapy available. An effective vaccine is available. At the moment no vaccination recommendation is issued in the Netherlands. TBE should be considered in patients presenting with fever after a recent tick bite. When neurological symptoms appear, referral to a neurologist is necessary.

Background: 'Tick-borne' encephalitis virus (TBEV) is a flavivirus that is transmitted by ticks. TBEV is endemic in East Asia, Russia and a number of other European countries. In the Netherlands it is seen only in travellers who have been to these regions. The clinical picture is variable: from a mild form of meningitis to lethal meningoencephalomyelitis. There are no therapeutic options available, only symptomatic treatments., Case Description: A 48-year-old woman with a history of systemic lupus erythematosus (SLE) for which she used immunosuppressives, developed meningoradiculoencephalitis following a holiday in Germany. She was initially treated for cerebral SLE vasculitis, but it later became apparent that it was a tick-borne encephalitis. The patient died of abscessing pneumonia following protracted mechanical ventilation., Conclusion: Tick-borne encephalitis may have serious consequences. Important is to think of this infection in patients who travelled to endemic areas. Vaccination should be recommended to travellers visiting endemic regions, especially if they are immunocompromised.