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Chapter 6: TBE in children

Worth noting is that many adults with TBE To conclude, the clinical picture of TBE in
have shown less pronounced blood childhood bears similarity to the disease in
3,5
inflammatory indices. As in adults, children adults. However, some pediatric patients,
with TBE have experienced thrombocytopenia more likely the younger ones, may not present
17
and elevated transaminases. as ‘expected’. Fever, headache, and vomiting
are common. Children tend to more com-
Laboratory evaluation for children with monly present with symptoms and findings of
suspected TBE should include lumbar meningitis, with increased blood inflammatory
puncture, as cerebrospinal fluid pleocytosis indices. Anti-TBE serology and cerebrospinal
with a mononuclear preponderance has been fluid analysis are essential in establishing the
described. 1–3,5,16,17,20 Additionally, some diagnosis. EEG and MRI can strengthen the
children have presented with elevated diagnostics.
cerebrospinal fluid protein/albumin levels.
However, this has been more common in Short-term consequences
3,5
adults than in children, suggesting a more
restricted encephalitic presentation in As in adults, most tick bites from TBEV-
childhood TBE. This can also be concluded carrying ticks have not resulted in clinical
from the lower frequencies of meningo- disease. Nevertheless, childhood TBE has been
encephalitis and meningoencephalomyelitis associated with severe disease in those with
observed in children than in adults, as noted clinical infection, as described above—that
above. was concluded by Fritsch et al., who
demonstrated that children required a median
Electroencephalographic (EEG) examinations of 18 days of care in pediatric hospital
in the acute phase of childhood TBE can help wards. Others have reported median hospital
1
establish the diagnosis as well. The EEG stays ranging 5–13 days. 2,3,6,16,17 A large
abnormalities seen included mild to moderate, proportion of children still have symptoms but
generalized, slowing background activity, but do not require medical attention at
also sharp waves in contrast, though seldom discharge, 19,23 which contrasts with children
generalized spike wave activity. 2,20 Magnetic who have other CNS infections. Nonetheless,
23
resonance imaging (MRI) has been used Engman et al have reported significantly more
infrequently in children with TBE, but the most days of acute illness in childhood TBE
frequent reported finding is alterations in the compared to children with neuroborreliosis or
thalami. 2,20–22 MRI changes also have been other infections with CNS symptoms. Addi-
noted in cerebellar structures, putamen, and tionally, they found a prolonged period of
caudate nucleus, as well as the cortex. Of convalescence and more days of sick leave in
note, for some children the MRI was unable to the TBE cases.
24
detect any pathology. 20,22 In a recent review of
the spectra of MRI findings in childhood TBE, TBE in childhood naturally affects both boys
von Stülpnagel et al reported poor outcomes, and girls, but the disease has been seen more
i.e., long-term neurologic disabilities and often in boys (approximately twice as many
22
death, in children with MRI changes. cases). Boys also tended to have a more
severe disease. 2,3,7,25,26 That pediatric TBE has
However, these data were retrospective and been associated with severe disease courses
there might be a selection bias towards more can be further supported by reported rates of
severe cases that underwent MRI. None- admission into intensive care units, ranging
theless, it can be concluded that pronounced from 5% to 22% of TBE cases. 1,17,25 Compared
CNS damage in TBE seems ominous. with adults, childhood deaths in TBE have
been reported only infrequently. 5,27

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