Page 139 - TBE_Book_V2_2019

Chapter 7

TBE in special situations

Gerhard Dobler and Igor Stoma

Key Points

• TBE often takes a severe clinical course in immuno-supressed patients.
• In transplant patients TBE usually takes a fatal course.

• TBE vaccination in immuno-suppressed patients can be non-effective
• TBE in pregnancy has been rarely reported; from recent cases there is no evidence of
transplacental infection of the offspring.

• The alimentary route of infection of TBE is still common in some European countries resulting
in a high clinical manifestation index.

• TBEV can be infectious in milk and milk products for up to 14 days under optimal
environmental conditions.
• TBE is an important travel-related disease. Increasing numbers of non-endemic countries
report imported cases.
• Imported TBE cases in non-endemic areas pose challenges regarding the diagnosis of TBE.

TBE in immuno-suppressed patients

Changes in modern treatment regimens in cases of patients treated with anti-CD20
hematology, oncology and autoimmune monoclonal antibody rituximab have been
diseases significantly improved both quality of reported. The disease course in both cases
life as well as survival rates for numerous was extremely fulminant with severe
diseases. Modern approaches including neurological symptoms and damage, and in
hematopoietic stem cell transplantation both cases delayed antibody formation was
1
(HSCT), solid organ transplantation, mono- observed. Two additional cases of rituximab-
clonal antibodies and target therapy are treated patients developing severe TBE were
becoming more accessible, and thus the published by Steininger et al., indicating that
number of people living with immune- TBE is a previously unrecognized severe
2
suppression continues to grow. It is well infectious complication of rituximab therapy.
documented that there is a higher risk for this In a recent case (Dobler, personal observa-
population for (severe) infections and this tion), a 22-year-old male patient suffering
includes infections with the TBEV. from non-Hodgkin lymphoma treated with
rituximab developed clinically severe TBE one
Currently, there are only few published cases year after the end of a successful therapy.
of TBE in immunocompromised hosts, how- According to the treating physician the clinical
ever, these show common patterns. Two fatal course was life-threatening with fever and

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