Berger, Christoph

Iff, Tobias

Meier, Roland

Olah, Eva

Schneider, Jacques

Tibussek, Daniel

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SHORT REPORTTobias Iﬀ Æ Roland Meier Æ Eva OlahJacques F. L. Schneider Æ Daniel TibussekChristoph BergerTick-borne meningo-encephalitis in a 6-week-old infantReceived: 5 April 2005 / Accepted: 23 June 2005 / Published online: 20 August 2005 Springer-Verlag 2005Tick-borne encephalitis (TBE) in infants is extremelyrare [3, 4, 5]. We report a 6-week-old girl with tick-bornemeningo-encephalitis demonstrating that TBE virus(TBEV) has to be considered as a causative agent ofmeningo-encephalitis in infants in endemic areas.A 6-week-old girl born at term presented after a2-day history of fever with vomiting, irritability and abulging fontanelle. CSF examination showed a pleocy-tosis (172 lymphocytes, 81 monocytes/ll), elevated pro-tein (0.83 g/l), and glucose of 2.4 mmol/l (38% of serumglucose), and serum C-reactive protein concentrationwas elevated (46 mg/l). Empiric antibiotic treatment wasstarted. Because of a partial, secondary generalised sei-zure, EEG and MRI were initiated, which demonstratedintermittent slowing in the right parieto-temporal regionand T2-weighted cortico-subcortical hyperintensity withcontrast enhancement in both fronal lobes and lepto-meningeal enhancement, respectively, consistent withdiagnosis of meningo-encephalitis (Fig. 1). During thefollowing 3 days, the girl developed repetitive seizuresand, accordingly in the EEG, interictal series of sharpwaves in the right parieto-temporal region. Treated withphenobarbitone (5 mg/kg/day), she became seizure-freeand recovered within 9 days. The history of a tickbite onthe infant’s head 10 days before admission in an endemicarea for TBEV in Switzerland prompted us to examinespeciﬁc TBEV antibodies. The detection of IgG and IgMagainst TBEV in serum, and IgM in CSF established theaetiological diagnosis of TBE. Bacterial cultures as wellas PCR for herpes simplex virus DNA in CSF and ser-um antibodies against Borrelia burgdorferi were nega-tive. At the last follow-up at the age of 11 months, thegirl’s neurological examination, development and EEGwere normal.This 6-week-old infant presenting with meningitisand seizures had meningo-encephalitis with corre-sponding ﬁndings in CSF, EEG and MRI. The historyof a tick bite in an endemic area prompted us to checkTBEV serology. The detection of TBEV antibodies inserum and CSF established the diagnosis of TBE, aftertransmission of antibodies from the seronegative motherhad been ruled out. In the western parts of Europeincluding Switzerland, TBE is caused by the westernsubtype of the TBEV, belonging to the ﬂaviviridae andtransmitted predominantly by infected ticks (Ixodesricinus) in endemic regions [2]. To our knowledge this isthe youngest patient with TBE [2, 3, 5]. Although TBEin a 3.5-month-old girl has been reported, the incidenceof TBE is lowest in children <3 years of age [3, 4, 5]. Inchildren, TBE manifests most commonly as meningitisand runs milder than in adults without or only withtransient meningo-encephalitis [2, 4, 5]. The outcome ofchildhood TBE is generally favourable with completerecovery and no mortality [2, 4, 5]. Nevertheless, pre-ventive measures are crucial because of recently reportedrare neurological sequelae in children [1], a reportedincrease in incidence in Switzerland [6] and the lack ofeﬀective therapy [2]. Active vaccination in Switzerland isrecommended in endemic areas for children >6 years ofage with considerable risk of tick-exposure. However,even an extended vaccination policy including youngerchildren (>6 months for selected cases as in Austria)could not have prevented TBE in this patient [4]. Thus,as this young infant with TBE illustrates, exposureprophylaxis, i.e. simple measures for avoiding tickbitesand immediate removal of ticks from the body, arethe only and most important preventive strategies forinfants and young children without the option of activevaccination [2, 6].T. Iﬀ (&) Æ R. Meier Æ D. TibussekDivision of Neurology, University Children’s Hospital,Steinwiesstrasse 75, 8032 Zu¨rich, SwitzerlandE-mail: tobias.iﬀ@kispi.unizh.chTel.: +41-1-2667111Fax: +41-1-2667163E. Olah Æ C. BergerDivision of Infectious Diseases, University Children’s Hospital,Zu¨rich, SwitzerlandJ. F. L. SchneiderDepartment of Radiology, University Children’s Hospital,Zu¨rich, SwitzerlandEur J Pediatr (2005) 164: 787–788DOI 10.1007/s00431-005-1753-5References1. Cizman M, Rakar R, Zakotnik B, Pokorn M, Arnez M (1999)Severe forms of tick-borne encephalitis in children. Wien KlinWochenschr 111: 484–4872. Dumpis U, Crook D, Oksi J (1999) Tick-borne encephalitis. ClinInfect Dis 28: 882–8903. Grubbauer HM, Dornbusch HJ, Spork D, Zobel G, Trop M,Zenz W (1992) Tick-borne encephalitis in a 3-month-old child.Eur J Pediatr 151: 743–7444. Kunze U, Asokliene L, Bektimirov T, Busse A, Chmelik V,Heinz FX, Hingst V, Kadar F, Kaiser R, Kimmig P, Kraigher A,Krech T, Linquist L, Lucenko I, Rosenfeldt V, Ruscio M,Sandell B, Salzer H, Strle F, Suss J, Zilmer K, Mutz I (2004)Tick-borne encephalitis in childhood—consensus 2004. WienMed Wochenschr 154: 242–2455. Lesnicar G, Poljak M, Seme K, Lesnicar J (2003) Pediatric tick-borne encephalitis in 371 cases from an endemic region inSlovenia, 1959 to 2000. Pediatr Infect Dis J 22: 612–6176. Schwanda M, Oertli S, Frauchiger B, Krause M (2000) Tick-borne meningoencephalitis in Thurgau Canton: a clinical andepidemiological analysis. Schweiz Med Wochenschr 130: 1447–1455Fig. 1 Coronal post-contrastT1-weighted image showscortical enhancement in bothfrontal lobes (white arrows) anddiscrete leptomeningealenhancement (arrowhead)788

Tick-borne meningo-encephalitis in a 6-week-old infant

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Tick-borne meningo-encephalitis in a 6-week-old infant

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