Camprubi et al.
First imported case of tick-borne encephalitis in Spain – was it alimentary
Travel Med. Infect. Dis. 2020, in press, doi.org/10.1016/j.tmaid.2020.101701
The most southwesterly European countries with endemic TBE regions are Italy and France. In Spain, no autochthonic TBE case and no imported TBE case have been reported so far.
Here, the first imported case is being described: an 18-year old Spanish man has worked as a volunteer in a workcamp of a farm in Estonia for three weeks in 2019, where he had different farm activities. He developed acute meningitis and various diagnostic tests were carried out for bacterial, viral, and fungal infections, but all were negative.
The patient reported that during the first week of his stay in the farm, three mates got ill, diagnosed with TBE. Using a commercial ELISA, TBE specific IgM in the CSF and IgM and IgG in the patient’s serum were detected as well as an 8-fold increase of TBE IgG antibodies in paired serum samples.
The authors concluded that the consumption of unpasteurized contaminated milk and/or milk products which the patient had taken during his stay at the farm may have been the route of infection.
This report highlights the importance of monitoring infections like TBE as well in non-endemic countries, especially in travelers returning home, and illustrates the usefulness of vaccination for individuals living in non-endemic regions traveling to TBE endemic countries.