Palyga-Bysiecka et al.
Clinical course and neurological sequels after tick-borne encephalitis in children – case report
Ann. Agric. Environm. Med. 2021. doi: 10.26444/aaem/133206
TBE mostly affects adults, however about 15% of TBE cases are reported in individuals younger than 19 years of age in European endemic areas. While the clinical symptoms of TBE are usually milder in children compared to adults, the illness may yet have more severe courses, and long-term outcomes from TBE in childhood can result in cognitive problems.
A Polish team studied from 2006 to 2020 clinical features of TBE in eight children (14 to 17 years of age) to determine the neurological sequelae and risk of cognitive consequences in long-term TBE infections. Among the eight patients two had mild, three had moderate and three had severe form of TBE. In four patients, two phases of illness were observed with fever, headache and vomiting during the second stage in all eight patients. Five patients suffered from meningitis and three patients had meningoencephalitis.
Severe sequelae persisted in three children (patients #1, #5, #8), while in two other patients (#2, #4), it was classified as moderate. In the current study, neurocognitive deviations, including lasting tremor of the upper extremities, speech impairment, wakefulness, atypical hyperkinetic movements, and irritability were found in four hospitalized children (#2, #3, #5, #8). Behavioral disorders were observed in two children (#1, #5). They had problems with initiating activities and working memories. Patient #2 was still experiencing trembling of the upper extremities while lifting three years after acute TBE, and patients #4 and #5 had memory problems during the follow up period.
Cognitive impairment after TBE in children is more common than formerly thought. A substantial morbidity of TBE observed in children highlights the importance of vaccination also of this age group.