{"version":"1.0","provider_name":"TBE Book","provider_url":"https:\/\/tbenews.com\/tbe","author_name":"IT","author_url":"https:\/\/tbenews.com\/tbe\/author\/brianong\/","title":"Chapter 8: TBE in children - TBE Book","type":"rich","width":600,"height":338,"html":"<blockquote class=\"wp-embedded-content\" data-secret=\"D93jMuafau\"><a href=\"https:\/\/tbenews.com\/tbe\/chapter-8-tbe-in-children\/\">Chapter 8: TBE in children<\/a><\/blockquote><iframe sandbox=\"allow-scripts\" security=\"restricted\" src=\"https:\/\/tbenews.com\/tbe\/chapter-8-tbe-in-children\/embed\/#?secret=D93jMuafau\" width=\"600\" height=\"338\" title=\"&#8220;Chapter 8: TBE in children&#8221; &#8212; TBE Book\" data-secret=\"D93jMuafau\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\" class=\"wp-embedded-content\"><\/iframe><script>\n\/*! This file is auto-generated *\/\n!function(d,l){\"use strict\";l.querySelector&&d.addEventListener&&\"undefined\"!=typeof URL&&(d.wp=d.wp||{},d.wp.receiveEmbedMessage||(d.wp.receiveEmbedMessage=function(e){var t=e.data;if((t||t.secret||t.message||t.value)&&!\/[^a-zA-Z0-9]\/.test(t.secret)){for(var s,r,n,a=l.querySelectorAll('iframe[data-secret=\"'+t.secret+'\"]'),o=l.querySelectorAll('blockquote[data-secret=\"'+t.secret+'\"]'),c=new RegExp(\"^https?:$\",\"i\"),i=0;i<o.length;i++)o[i].style.display=\"none\";for(i=0;i<a.length;i++)s=a[i],e.source===s.contentWindow&&(s.removeAttribute(\"style\"),\"height\"===t.message?(1e3<(r=parseInt(t.value,10))?r=1e3:~~r<200&&(r=200),s.height=r):\"link\"===t.message&&(r=new URL(s.getAttribute(\"src\")),n=new URL(t.value),c.test(n.protocol))&&n.host===r.host&&l.activeElement===s&&(d.top.location.href=t.value))}},d.addEventListener(\"message\",d.wp.receiveEmbedMessage,!1),l.addEventListener(\"DOMContentLoaded\",function(){for(var e,t,s=l.querySelectorAll(\"iframe.wp-embedded-content\"),r=0;r<s.length;r++)(t=(e=s[r]).getAttribute(\"data-secret\"))||(t=Math.random().toString(36).substring(2,12),e.src+=\"#?secret=\"+t,e.setAttribute(\"data-secret\",t)),e.contentWindow.postMessage({message:\"ready\",secret:t},\"*\")},!1)))}(window,document);\n\/\/# sourceURL=https:\/\/tbenews.com\/tbe\/wp-includes\/js\/wp-embed.min.js\n<\/script>\n","thumbnail_url":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2024\/06\/Chapter-8-TBE-IN-CHILD-scaled.jpg","thumbnail_width":2560,"thumbnail_height":1935,"description":"Chapter 8:TBE in children Malin Veje, Zane Freimane, Dace Zavadska Key points Clinical course and findings Compared to TBE in adults, data on TBE in children is relatively sparse. It used to be generally accepted that TBE in childhood was rare and followed a milder course compared to adults. However, during the past two decades, this notion has been challenged. Various European countries such as Sweden and Latvia have reported severe cases and neurological sequelae after TBE also in children. In general, the clinical picture of children with TBE is similar to the one described in adults. In both children and adults, TBE manifests as a neurological illness, most commonly meningitis. However, children and adolescents as a group tend to have milder neurological symptoms, and the disease less frequently has severe and lethal consequences. Children have a better long-term prognosis, compared to adults.1-3 The largest multicenter study performed in Europe, showed that meningitis is more common among children compared to adults.4 A large retrospective study from Poland, comparing 68 pediatric to 601 adult TBE cases, concluded that the disease was milder in children.5 In this cohort, 97% of the cases in children were classified as meningitis. A nationwide prospective study in Latvia identified 40 TBEV-infected children 1\u201315 years of age and 90% of children had symptoms of CNS inflammation and all were hospitalized. In this cohort, 83% of the cases in children were classified as meningitis and 17% as meningoencephalitis, 33% of them with a moderate clinical course.6 Another recent large cohort study from Germany, including 66 pediatric and 515 adult cases, confirmed that children as a group have milder disease manifestations compared with adults.7 However, the same study noted that 56% of the children had a moderate or severe disease. Children with TBE initially present with non-specific symptoms such as headache, fever, malaise\/fatigue and because of that, cases may be overlooked. This idea was substantiated by a prospective Swedish study on children seeking medical care for neurological complaints8 and confirmed by a Swiss case series.9 Initial clinical diagnosis of TBE in children can be challenging due to a lack of specific symptoms. TBE can disguise as other common infectious diseases. TBEV infection should therefore be considered in all children with or without tick bite history presenting with non-specific symptoms during tick activity season in endemic countries. Although rare, cases in newborns and children a few months old have been published.10-13 A case from Slovakia described TBEV transmitted via breastfeeding to an eight-month old infant.14 As concluded in the recent review article by Parfut et al, the incidence of TBE in children seems to peak at around nine years of age and increases continually with age.1,15-19 TBE in childhood naturally affects both boys and girls, but approximately twice as many cases are seen in boys. Boys also tend to have a more severe disease.1-3,20,21 Tick-bites have been recalled in 48-76% of childhood TBE cases.2,8,16,17,19,22,23 A biphasic course is reported in around 70 (20-100) % of cases.1,2,5,7,8,16,18,19,24,25 Cases presenting with only fever are rarely studied, but do exist.19,26 In the majority of reports on pediatric TBE, fever is present in virtually all cases at diagnosis.1,2,16,19 However, both retrospective data from a fairly large cohort22 and prospective data from a study with broad inclusion criteria,8 show that fever &gt;38.5\u00b0 C is not always observed in pediatric TBE. &nbsp;In addition to fever, headache and vomiting have been reported as central features of childhood TBE at rates of approximately 90\u2013100% and 50\u201390%, respectively. Self-reported fatigue\/malaise, behavioral changes, photophobia, muscle pain, etc. are commonly reported, but occur at varying frequencies.1-3,7,8,16,17,19,22 Meningeal signs (nausea, vomiting, and nuchal rigidity) are prevalent findings, noted in &gt;80% of infected children,1,2,7,16,19,23 but young children have a less-pronounced clinical presentation.8 The clinical picture of pediatric TBE usually manifests as meningitis in 63\u201379% of cases, meningoencephalitis in 21\u201338%, and meningoencephalomyelitis in 0\u20134%. A study from Latvia reported that a mild disease course was seen more often in children than adults:&nbsp; 67% in 1-15 years of age and 60.5% in adults. However, none of the children had severe disease compared to 9% of the adults.6 A recent Lithuanian study showed that milder disease manifestations were more common in children aged 1-8 years than in those 9-17 years old.1,4,16,17,23 Clinical findings in childhood TBE include tremor, ataxia, impaired general appearance, somnolence, lymphadenopathy, apatheia, hyperesthesia, speech disorders, sensation disorders, and confusion\/cognitive dysfunction.1,2,5,8,16,17,19,22,24 Though uncommon, some children present with seizures, hemiparesis, paresis of the limbs, or cranial nerve pareses.1,5,7,22,27 The largest clinical studies on TBE in children report median hospital stays ranging between 5-18 days, similar numbers or slightly shorter than what is described in the adult population.1-3,7,16,19,22,28,29 TBE without signs of CNS inflammation are not mandatorily reported and included in official surveillance, therefore the non-CNS TBE form is not well recognized and investigated. In the literature this TBE clinical picture has been described as \u201cfever form\u201d, \u201cnon-CNS cases of TBE\u201d or \u201cFebrile illness\u201d and is characterized by the presence of fever and constitutional symptoms, and the absence of clinical signs of CNS involvement at the time of illness.&nbsp; According to the published data, up to 50% of symptomatic TBEV infections manifest without CNS involvement.30,31 However, a recent population-based study reported less frequent non-CNS TBE cases among children than in adults, 8.7% and 18.7%, respectively.6 This may indicate higher TBE awareness in children, especially towards excluding neurological involvement of the disease. Diagnosis For TBE diagnosis, detection of TBEV-specific IgM and IgG is required to prove TBEV infection, see ECDC criteria.32 Lumbar puncture should be performed to confirm CNS inflammation and shows an elevated leukocyte count with predominantly mononuclear cells.1-3,16,19,22,24 Increased CSF protein\/ albumin levels seem to be more common in adults than in children with TBE.2,5,22 CRP and leukocyte counts are often elevated, but in analogy with the adult population, no laboratory tests can discriminate TBE from other viral infections.1-3,5,16,19,22 Electroencephalogram (EEG) results can help confirm the diagnosis, but are not specific for TBE. The EEG abnormalities seen include mild to moderate, generalized, slowing background"}