4.6 Review

Tick-Borne Encephalitis Virus: A Comprehensive Review of Transmission, Pathogenesis, Epidemiology, Clinical Manifestations, Diagnosis, and Prevention

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Summary: Flaviviruses are globally distributed viruses that cause significant morbidity and mortality. They can reach the central nervous system by disrupting or bypassing the blood-brain barrier, as well as through axonal transport from peripheral nerves. Once in the CNS, flaviviruses cause various neurological symptoms through different mechanisms. This review summarizes the current knowledge on the mechanisms of neuroinvasion and neuropathogenesis of flaviviruses and discusses the potential contributions and timing of each pathway.

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Evaluation of under-testing and under-diagnosis of tick-borne encephalitis in Germany

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Summary: This study evaluated the real-world laboratory testing rates for tick-borne encephalitis (TBE) in Germany, and found that patients with typical TBE symptoms are likely under-tested, leading to under-diagnosis.

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Immune Functions of Astrocytes in Viral Neuroinfections

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INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2023)

Article Environmental Sciences

Comparison of Extraction Methods for the Detection of Tick-Borne Encephalitis Virus RNA in Goat Raw Milk and Cream Cheese

Irene Mueller et al.

Summary: This study compares different virus extraction methods for the detection of TBEV-RNA in goat raw milk and goat raw milk cream cheese. The results show that direct RNA extraction from the aqueous interphase after sample centrifugation is the most effective method for raw milk, while treatment of the samples with TRI Reagent and chloroform prior to RNA extraction is the best method for cream cheese.

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Review Virology

T Cells in Tick-Borne Flavivirus Encephalitis: A Review of Current Paradigms in Protection and Disease Pathology

E. Taylor Stone et al.

Summary: The Flaviviridae family consists of diverse arthropod-borne viruses that cause globally relevant diseases in humans. Infection with certain flaviviruses, like West Nile virus, Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, and Powassan virus, can lead to neuroinvasive diseases such as meningitis or encephalitis. T cells have been identified as a contributor to neuroinflammation, but their role in tick-borne flavivirus encephalitis requires further study. Understanding the involvement of T cells in tick-borne flavivirus encephalitis is crucial for improving vaccine safety and efficacy, as well as developing treatments for human disease.

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Review Infectious Diseases

Tick-borne encephalitis in pediatrics: An often overlooked diagnosis

Assilina Parfut et al.

Summary: Tick-borne encephalitis (TBE) is caused by the tick-borne encephalitis virus (TBEV) transmitted by infected Ixodes ricinus ticks. TBEV-Eu is endemic in 27 European countries, and there has been an increase in TBE incidence, even in countries with low endemicity. Children with TBE may experience severe forms and long-term cognitive impairment. This review comprehensively describes TBEV incidence, transmission routes, clinical manifestations, imaging findings, and long-term outcomes in children, as well as vaccination recommendations in European countries.

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Efficacy and safety of intravenous immunoglobulins for the treatment of viral encephalitis: a systematic literature review

Judith N. Wagner et al.

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Alimentary Infections by Tick-Borne Encephalitis Virus

Martina Lickova et al.

Summary: Tick-borne encephalitis virus can be transmitted to humans through ticks and the alimentary route, which involves consuming raw milk products from infected ruminants. The alimentary route of TBEV infection is recognized as a contributing factor to the increase in TBE incidence in Europe.

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Article Environmental Sciences

Food-Borne Transmission of Tick-Borne Encephalitis Virus-Spread, Consequences, and Prophylaxis

Alicja M. M. Buczek et al.

Summary: Tick-borne encephalitis (TBE) is a common viral neurological disease in Eurasia, transmitted through tick bites and consumption of infected milk and dairy products. TBE outbreaks from milk consumption occur in central, eastern, and north-eastern Europe. Consumers of unpasteurised milk are especially vulnerable. Pasteurisation and vaccination are effective prevention measures.

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Review Biology

Ticks and their epidemiological role in Slovakia: from the past till present

Michal Stanko et al.

Summary: In Slovakia, 22 tick species have been identified, with some species posing public health risks. These ticks carry and transmit various pathogens, including tick-borne encephalitis virus, Borrelia bacteria, and Babesia parasites. Incidence rates of tick-borne encephalitis and Lyme borreliosis have been increasing in Slovakia, while human cases of rickettsiosis and anaplasmosis remain sporadic.

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Method for tick-borne encephalitis virus detection in raw milk products

Catherine Hennechart-Collette et al.

Summary: A molecular method based on the international standard was developed to detect TBEV in raw milk products. The recovery rates of TBEV varied under different inoculation levels and conditions. The sensitivity and reliability of the method were confirmed, making it suitable for routine diagnosis and assessment of potential health risks.

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Potential Mechanisms of Transmission of Tick-Borne Viruses at the Virus-Tick Interface

Mahvish Maqbool et al.

Summary: Ticks are important vectors for transmitting pathogens to humans, animals, and wildlife. Tick-borne viruses are highly pathogenic and pose a significant threat to public health, especially in resource-poor communities. Understanding tick saliva, host interactions, and control strategies is crucial in preventing tick-borne viral diseases.

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Integrative RNA profiling of TBEV-infected neurons and astrocytes reveals potential pathogenic effectors

Martin Selinger et al.

Summary: This study provides a comprehensive analysis of alterations in host gene expression during TBEV infection in different cell lines, revealing significant changes in inflammatory and immune response pathways, nervous system development, and mitosis regulation. These changes are likely responsible for the differences in virulence manifestation between TBEV strains.

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Human Co-Infections between Borrelia burgdorferi s.l. and Other Ixodes-Borne Microorganisms: A Systematic Review

Pierre H. Boyer et al.

Summary: Co-infections in tick-borne diseases are common, involving both ticks carrying multiple pathogenic microorganisms and humans being simultaneously infected with multiple tick-borne microorganisms. A systematic review found possible co-infections between Lyme borreliosis and other tick-borne microorganisms. Most cases of co-infections were characterized by patients having one tick-borne disease and antibodies against another tick-borne microorganism. Co-disease was particularly frequent in patients with high fever and erythema migrans or neurological symptoms linked to tick-borne encephalitis virus or neuroborreliosis.

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Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe

Michael Kunze et al.

Summary: There has been an increase in reported cases of tick-borne encephalitis (TBE) in Europe since 2015, reaching a peak in some countries in 2020. However, TBE surveillance is currently limited due to varying diagnostic guidelines, access to testing, and awareness of TBE, resulting in underestimated prevalence and inadequate vaccination recommendations. This review summarizes the findings of a workshop that aimed to improve TBE surveillance and vaccine uptake in Europe. Strategies to address these issues include aligning diagnostic criteria and testing, expanding vaccine recommendations, and increasing public education about the risks of TBEV infection.

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Epidemiological Trends of Trans-Boundary Tick-Borne Encephalitis in Europe, 2000-2019

Mulugeta A. Wondim et al.

Summary: Tick-borne encephalitis is a neuroinfection widely distributed in the Euro-Asia region, primarily transmitted by infected ticks. The total number of confirmed cases reported in Europe from 2000 to 2019 was 51,519, with a decrease in cases in 2014 and 2015 but an increasing trend since 2015.

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Identification of Host Factors Differentially Induced by Clinically Diverse Strains of Tick-Borne Encephalitis Virus

Niluka Goonawardane et al.

Summary: Tick-borne encephalitis virus (TBEV), spread by ticks, causes neurological disease. There is currently no specific treatment for TBE. The study generated a self-replicating TBEV replicon to compare highly pathogenic and low pathogenic TBEV strains. The study showed that the replicon of the highly pathogenic strain replicated more in mammalian cells, while the difference was related to the NS5 region. The study also found different host cell responses driven by NS5 that may contribute to the different clinical characteristics of TBEV strains.

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Predicting habitat suitability for Ixodesricinus and Ixodespersulcatus ticks in Finland

Ruut Uusitalo et al.

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A Journey to the Central Nervous System: Routes of Flaviviral Neuroinvasion in Human Disease

Eleanor M. Marshall et al.

Summary: This review focuses on the mechanisms of arboviral neuroinvasion, specifically on the haematogenous and transneural routes employed by flaviviruses. The gaps in knowledge regarding lesser-studied interfaces and novel routes are identified. The complex balance of pro-inflammatory and antiviral immune responses, particularly in the context of the hypothesized Trojan horse mechanism, is also discussed.

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The epidemiology of infectious diseases in Europe in 2020 versus 2017-2019 and the rise of tick-borne encephalitis (1995-2020)

Victoria A. Jenkins et al.

Summary: Health control measures implemented in Europe in 2020 to combat COVID-19 had varying effects on infectious diseases. While the cases of many diseases decreased, the incidence of tick-borne encephalitis actually increased. This could be attributed to increased outdoor activities and higher tick counts in endemic regions. The World Health Organization recommends vaccination for all age groups, including children, in highly endemic areas.

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Serological cross-reactivity among common flaviviruses

Kai Rol Chan et al.

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FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY (2022)

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Quantification of Antiviral Cytokines in Serum, Cerebrospinal Fluid and Urine of Patients with Tick-Borne Encephalitis in Croatia

Snjezana Zidovec-Lepej et al.

Summary: Tick-borne encephalitis virus (TBEV) is a significant arbovirus affecting the human CNS in Europe. Limited data on cytokine response in TBEV infection. TBE patients have higher levels of IL-6 and IFN-gamma in CSF compared to controls. Different clinical samples of TBE patients show a diverse network of early innate immune response cytokines.

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Systematic Review and Meta-analysis of Foodborne Tick-Borne Encephalitis, Europe, 1980-2021

Meital Elbaz et al.

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Breast Milk as Route of Tick-Borne Encephalitis Virus Transmission from Mother to Infant

Jana Kerlik et al.

Summary: This is a case of probable transmission of Tick-borne encephalitis virus (TBEV) from an unvaccinated mother to an infant through breast-feeding. It highlights the importance of being cautious when exposed to infected animals or consuming raw food products, especially for individuals who are not vaccinated.

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Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement

Petra Bogovic et al.

Summary: Information on febrile illness caused by tick-borne encephalitis virus (TBEV) without central nervous system involvement is limited. This study characterized 98 patients who had TBEV RNA in their blood but no central nervous system involvement at the time of evaluation. The most common symptoms were malaise or fatigue, fever, headache, and myalgias. Laboratory findings showed leukopenia, thrombocytopenia, and abnormal liver test results.

EMERGING INFECTIOUS DISEASES (2022)

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Dominika Hromnikova et al.

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Selected Biomarkers of Tick-Borne Encephalitis: A Review

Monika Gudowska-Sawczuk et al.

Summary: Tick-borne encephalitis (TBE) is an acute disease caused by the tick-borne encephalitis virus, with no curative treatment available. The flu-like symptoms in the initial phase of the disease make diagnosis difficult, while the neurological phase affects structures in the central nervous system. Biomarkers such as free light chains and metalloproteinases have shown potential in evaluating TBE.

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Changing the Recipe: Pathogen Directed Changes in Tick Saliva Components

Michael Pham et al.

Summary: Ticks are obligatory hematophagous parasites that transmit a wide range of pathogens, including those causing Lyme disease and tick-borne encephalitis. They secrete pharmacologically active molecules in their saliva to counteract host defense mechanisms and create a conducive environment for pathogen transmission. These bioactive molecules in tick saliva may be manipulated by tick-transmitted pathogens to enhance their survival and evasion of host defenses.

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH (2021)

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Low Virus-Specific IgG Antibodies in Adverse Clinical Course and Outcome of Tick-Borne Encephalitis

Petra Bogovic et al.

Summary: Serum IgG antibody levels against TBEV at the onset of neurologic involvement are crucial for determining the clinical course and long-term outcome of Tick-borne encephalitis (TBE), with low levels associated with more severe clinical manifestations.

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New advances in immune components mediating viral control in the CNS

Ilena Vincenti et al.

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Ronak K. Kapadia et al.

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Sequential MAVS and MyD88/TRIF signaling triggers anti-viral responses of tick-borne encephalitis virus-infected murine astrocytes

Luca Ghita et al.

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Alexander Ullrich et al.

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Igor Dumic et al.

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