Cough

Tick-borne encephalitis: what to do. What are the symptoms of an encephalitis tick bite in humans?

– an infectious disease based on damage to the brain and spinal cord by a flavivirus, transmitted to humans through the bites of ixodid ticks. Depending on the form of the disease, its manifestations are fever, headache, convulsions, vomiting, impaired coordination of movements, pain along the nerves, flaccid paresis and paralysis. The diagnosis is confirmed using PCR of blood and cerebrospinal fluid. Treatment in the early stages of the disease consists of prescribing immunoglobulin against tick-borne encephalitis and antiviral drugs. In the later stages, only prevention of life-threatening conditions and symptomatic treatment are possible.

ICD-10

A84 Tick-borne viral encephalitis

General information

Treatment includes specific (directed at the pathogen), pathogenetic (blocking the mechanisms of disease development) and symptomatic therapy. The patient is prescribed strict bed rest. The specific treatment regimen depends on the time that has passed since the first symptoms appeared. At the very beginning of the disease (first week), the administration of anti-mite immunoglobulin to patients showed high effectiveness. It is administered over 3 days. Also, with early diagnosis, the use of antiviral drugs gives good results: ribonuclease, ribavirin, interferon, potato shoot extract.

All these drugs are ineffective in the later stages of the disease, when the virus has already infected the central nervous system. In this case, treatment is not aimed at combating the causative agent of the disease, but at pathological mechanisms that threaten the patient’s life. To do this, use oxygen supply through a mask, mechanical ventilation in case of breathing problems, diuretics to reduce intracranial pressure, drugs that increase the brain’s resistance to oxygen starvation, and antipsychotics.

Forecast and prevention of tick-borne encephalitis

The prognosis for tick-borne encephalitis depends on the degree of damage to the nervous system. In the febrile form, as a rule, all patients recover completely. In the meningeal form, the prognosis is also favorable, however, in some cases, persistent complications from the central nervous system may be observed in the form of chronic headaches and the development of migraines. The focal form of tick-borne encephalitis has the most unfavorable prognosis. The mortality rate can reach 30 people per 100 cases. Complications of this form are the occurrence of persistent paralysis, convulsive syndrome, and decreased mental abilities.

Prevention of tick-borne encephalitis is divided into 2 areas: organizational measures and vaccination. Organizational measures consist of training residents of endemic regions (places where the disease is spread) to observe the rules for visiting forest areas and outdoor recreation areas during the period of tick activity: wearing clothes that cover most of the body (with long sleeves and trousers, a Panama hat or a cap on the head); thorough examination of clothing and body to identify live ticks; immediately seek medical help if an attached insect is detected; a warning about the inadmissibility of removing an attached tick from the skin on your own; applying repellent to clothes before a walk; mandatory boiling of milk, purchasing dairy products only from official producers.

Vaccination includes: passive immunization - administration of immunoglobulin to patients who have not previously been vaccinated against tick-borne encephalitis (in case of a tick bite) and active immunization - vaccination of residents of the area where the disease is spread 1 month before the season of tick activity.

Tick-borne encephalitis (spring-summer type encephalitis, taiga encephalitis) is a viral infection that affects the central and peripheral nervous system. Severe complications of acute infection can result in paralysis and death.

The main carriers of the encephalitis virus in nature are ixodid ticks, whose habitat is located throughout the forest and forest-steppe temperate climatic zone of the Eurasian continent. Despite the significant number of species of ixodid ticks, only two species are of real epidemiological significance: Ixodes Persulcatus ( taiga tick) in the Asian and in a number of areas of the European part, Ixodes Ricinus ( European wood mite) - in the European part.

Tick-borne encephalitis is characterized by a strict spring-summer seasonality of the onset of the disease, associated with the seasonal activity of vectors. In the range of I. Persulcatus, the disease occurs in spring and the first half of summer (May-June), when the biological activity of this species of ticks is highest. For ticks of the species I. Ricinus, there is an increase in biological activity twice per season, and in the range of this tick there are 2 peaks of seasonal incidence of tick-borne encephalitis: in spring (May-June) and at the end of summer (August-September).

Infection human infection with the tick-borne encephalitis virus occurs during the blood-sucking of virus-forming ticks. The female tick's blood-sucking continues for many days, and when fully saturated, it increases in weight 80-120 times. Blood sucking by males usually lasts several hours and may go unnoticed. Transmission of the tick-borne encephalitis virus can occur in the first minutes of tick attachment to a person. It is also possible to become infected through the digestive and gastrointestinal tracts by ingesting raw milk from goats and cows infected with tick-borne encephalitis.

Signs of tick-borne encephalitis. The incubation period of tick-borne encephalitis lasts on average 7-14 days with fluctuations from one day to 30 days. Transient weakness in the limbs, neck muscles, numbness of the skin of the face and neck are noted. The disease often begins acutely, with chills and an increase in body temperature to 38-40°C. Fever lasts from 2 to 10 days. General malaise, severe headache, nausea and vomiting, weakness, fatigue, and sleep disturbances appear. In the acute period, hyperemia (overflow of blood vessels of the circulatory system of any organ or area of the body) of the skin of the face, neck and chest, mucous membrane of the oropharynx, injection of the sclera and conjunctiva is noted.

I am worried about pain throughout the body and limbs. Muscle pain is characteristic, especially significant in muscle groups, in which paresis (partial loss of muscle strength) and paralysis usually occur in the future. From the moment the disease begins, clouding of consciousness and stupor may occur, the intensification of which can reach the level of coma. Often, erythema of varying sizes (redness of the skin caused by dilation of the capillaries) appears at the site of tick suction.

If symptoms of tick-borne encephalitis are detected, the patient should be urgently admitted to an infectious diseases hospital for intensive treatment.

Treatment patients with tick-borne encephalitis is carried out according to general principles, regardless of previous preventive vaccinations or the use of specific gamma globulin (a drug containing antibacterial and antiviral antibodies) for preventive purposes.

In the acute period of the disease, even in mild forms, patients should be prescribed bed rest until the symptoms of intoxication disappear. Almost complete restriction of movement, gentle transportation, and minimizing pain stimulation improve the prognosis of the disease. An equally important role in treatment is the rational nutrition of patients. The diet is prescribed taking into account functional disorders of the stomach, intestines, and liver.

Taking into account the vitamin balance observed in a number of patients with tick-borne encephalitis, it is necessary to prescribe vitamins B and C. Ascorbic acid, which stimulates the function of the adrenal glands, and also improves the antitoxic and pigmentary functions of the liver, should be administered in an amount of 300 to 1000 mg per day.

Prevention of tick-borne encephalitis

The most effective protection against tick-borne encephalitis is vaccination. Clinically healthy people are allowed to get vaccinated after examination by a therapist. Vaccination can only be done in institutions licensed for this type of activity.

Modern vaccines contain inactivated (killed) tick-borne encephalitis virus. After the vaccine is administered, the immune system recognizes viral antigens and learns to fight the virus. Trained cells of the immune system begin to produce antibodies (immunoglobulins), which block the development of the virus that has entered the body. To maintain the protective concentration of immunoglobulin for a long time, it is necessary to administer several doses of the vaccine.

The effectiveness of vaccination can be assessed by the concentration of protective antibodies in the blood (IgG to tick-borne encephalitis virus).

Vaccines against tick-borne encephalitis registered in Russia:
- Tick-borne encephalitis vaccine, culture-based, purified, concentrated, inactivated, dry - for children over 4 years of age and adults.
- EnceVir - for children over 3 years of age and adults.
- FSME-IMMUN Inject - from 16 years old.
- FSME-IMMUN Junior - for children from 1 year to 16 years. (Children should be vaccinated during the first year of life if they are at risk of contracting tick-borne encephalitis.)
- Encepur adult - from 12 years old.
- Encepur for children - for children from 1 year to 11 years.

The above vaccines differ in virus strains, antigen dose, degree of purification, and additional components. The principle of action of these vaccines is the same. Imported vaccines are capable of developing immunity to Russian strains of tick-borne encephalitis virus.

Vaccination is carried out after the end of the tick season. In most regions of Russia, vaccination can begin in November. However, in case of urgent need (for example, if you are going to travel to a natural focus of tick-borne encephalitis), the vaccination can be done in the summer. In this case, the protective level of antibodies appears after 21-28 days (depending on the vaccine and vaccination schedule).

Immunity appears two weeks after the second dose, regardless of the type of vaccine and the chosen regimen. The third dose is administered to consolidate the result. Emergency regimens are not intended for protection after a tick bite, but for the fastest possible development of immunity if the timing of standard vaccination has been missed.

Local adverse reactions include: redness, thickening, soreness, swelling at the injection site, urticaria (an allergic rash resembling that of a nettle burn), and enlargement of the lymph nodes close to the injection site. Usual local reactions are observed in 5% of vaccinated people. The duration of these reactions can reach 5 days.

Common post-vaccination reactions include a rash covering large areas of the body, increased body temperature, anxiety, sleep and appetite disturbances, headache, dizziness, short-term loss of consciousness, cyanosis, cold extremities. The frequency of temperature reactions to Russian vaccines does not exceed 7%.

If a tick is attached, it should be removed immediately. It should be borne in mind that the likelihood of contracting tick-borne encephalitis depends on the amount of virus that penetrates during the “bite” of the tick, that is, on the time during which the tick was in the attached state. If you do not have the opportunity to seek help from a medical facility, then you will have to remove the tick yourself.

When removing a tick yourself, you must follow the following recommendations:

A strong thread is tied into a knot as close as possible to the tick’s proboscis, and the tick is removed by pulling it up. Sudden movements are not allowed.

If, when removing the tick, its head, which looks like a black dot, comes off, the suction site is wiped with cotton wool or a bandage moistened with alcohol, and then the head is removed with a sterile needle (previously calcined in a fire). Just like an ordinary splinter is removed.

Removing a tick must be done with caution, without squeezing it, since this may squeeze the contents of the tick along with pathogens into the wound. It is important not to tear the tick when removing it - the remaining part in the skin can cause inflammation and suppuration. It is worth considering that when the head of the tick is torn off, the infection process can continue, since a significant concentration of TBE virus is present in the salivary glands and ducts.

There is no basis for some recommendations that for better removal it is recommended to apply ointment dressings to the attached tick or use oil solutions.

After removing the tick, the skin at the site of its attachment is treated with tincture of iodine or alcohol. A bandage is usually not required.

After removing the tick, save it for testing for infection - usually such a test can be done in an infectious diseases hospital. After removing the tick, place it in a small glass bottle with a tight lid and place a cotton swab lightly moistened with water. Cap the bottle and store it in the refrigerator. For microscopic diagnosis, the tick must be delivered to the laboratory alive.

The material was prepared based on information from open sources

One of the most terrible diseases that cannot be treated is tick-borne encephalitis. It is aggravated by the fact that you can become infected with it simply by walking in nature, because the main carriers are ticks.

What is it

Tick-borne encephalitis, otherwise called spring-summer or taiga encephalitis, is a viral infection whose area of action is the central and peripheral nervous system. The invasion is acute with severe complications in the form of paralysis or death.

The neurotropic tick-borne encephalitis virus, which has a high degree of preservation in low-temperature conditions, is responsible for the appearance of the disease, but when the temperature changes to +70 degrees, it immediately disintegrates.

The virus can be transmitted by ixodid ticks, which makes it possible to classify tick-borne viral encephalitis as an arboviral infection (borne by arthropods).

Pathogenesis

If bitten, the virus enters the blood within the first minutes of contact. In addition, you can become infected by consuming uncooked milk from infected pets. This is called alimentary invasion.

But the tick-borne encephalitis virus always spreads through the bloodstream and in the perineural spaces. On the second or third day, it is already possible to conduct a blood test for tick-borne encephalitis and diagnose infection of brain tissue; the peak level of virus concentration occurs on the 4th day. The duration of the incubation period for tick-borne encephalitis ranges from a week to three, in the case of nutritional infection - less than one week.

The duration of incubation is directly dependent on the virulence of the virus and the protective forces of the human body. The disease develops differently, depending on the characteristics of the invasion in a particular geographic area. Therefore, it can be noted that the Far East, Siberia, and the Urals are characterized by a more severe course of infection.

A study of the state of brain tissue and membranes during infection with tick-borne encephalitis demonstrates the presence of edema, hyperemia, infiltrates in the form of mono and polynuclear cells, mesodermal and glial reactions. The most destructive effects are observed in the area of the anterior horns of the cervical spinal cord, medulla oblongata, and tissues of the cerebral cortex.

Small areas of tissue breakdown and pinpoint hemorrhages may also form. In the chronic form, the membranes change, adhesions and arachnoid cysts form.

Symptoms of tick-borne encephalitis

If you study the signs of tick-borne encephalitis, you can note that they differ depending on the type of virus that causes the disease, of which there are three (the names demonstrate the endemicity of a particular region):

West.
Siberian.
Far Eastern.

European tick-borne encephalitis is not as severe as eastern tick-borne encephalitis. For comparison, the number of deaths in the first case reaches 1-3%, and in the second - 20-40% of all infected people.

According to many researchers, the disease can become more or less severe depending on the ability of the virus to cross the blood-brain barrier and cause damage to brain tissue.

The most common and noticeable signs of an encephalitis tick bite:

transient weakness of the limbs;
weakness of the muscle tissue of the cervical region;
feeling of numbness of the facial and cervical skin.

The disease can proceed completely differently in each individual case, usually characterized by an acute onset (chills and temperature up to 40 degrees). This febrile state lasts about 7-10 days. Accompanied by general malaise, severe headache, vomiting, nausea and increased fatigue. There may be a disruption of biorhythms, a pathological increase in blood supply to various areas of the face, cervical and thoracic region, mucous membranes (especially the oropharynx).

Painful sensations are observed in the muscle tissues of some parts of the body (most likely, later these areas will be in a state of paresis and paralysis). A feeling of numbness may be a preliminary symptom.

Once the disease has arisen, moments of confusion and a state of stupor may be observed (in the most severe cases, the infected person falls into a coma). But much more often, the febrile period is short-lived, and all the symptoms of encephalitis after a tick bite appear in an erased form.

The classification of tick-borne encephalitis includes the following types of disease:

Feverish.
Meningeal.
Meningoencephalitic.
Poliomyelitis.
Polyradiculoneuritis.
Dual wave.

They can be classified according to the leading syndrome, as well as the stability of neurological symptoms. Thus, the clinical picture varies depending on the type of encephalitis.

Feverish form

The febrile form of tick-borne encephalitis is characterized by a favorable outcome. The disease lasts relatively short time. The fever ends within a maximum of 5 days. The most typical manifestations include headache, weakness and nausea. In this case, neurological symptoms are mild. An analysis for tick-borne encephalitis, which involves examining the cerebrospinal fluid, shows normal.

Meningeal form

This form is the most common. Characteristic manifestations:

headache (becomes worse if you need to move your head);
dizziness;
nausea;
single and multiple cases of vomiting;
presence of photophobia.

Lethargy and lethargy also occur, the occipital muscles gradually harden, and reflexes characteristic of Kernig’s and Brudzinski’s symptoms appear. Symptoms that appear after an encephalitis tick bite in a person continue until the end of the fever (1-2 weeks). In some cases, it persists even when the temperature normalizes. When examining the cerebrospinal fluid, it is likely to reveal moderate lymphocytic pleocytosis up to 100-200 per 1 mm3, increased protein content.

Meningoencephalitic form

In the meningoencephalitic form, infection poses the greatest danger. The disease may be accompanied by delusional states, psychomotor agitation (in this case the ability to navigate geographically and temporally is lost), and epileptic seizures.

There are two subtypes of meningoencephalitis:

Diffuse. It implies pathologies of the general cerebral type, expressed in disorders of consciousness, epileptic seizures that are demonstrated by the bitten person (the epileptic status may even be assigned), excessively slow or accelerated breathing, uneven deep reflex reactions and asymmetry of pathological reflexes. There is a weakening of the facial muscles and tongue muscles.
Focal. Signs of encephalitis after a tick bite are expressed in capsular hemiparesis, central monoparesis, and epileptic seizures. With pathologies of the autonomic centers, gastric bleeding and bloody vomiting are observed; almost all pairs of cranial nerves (cranial nerves), except I and II, can be affected. The final symptom is the development of skin epilepsy, expressed in loss of consciousness and general epileptic seizures against the background of hyperkinetic disorders (disinhibition, excessively increased motor activity).

Poliomyelitis form

It is registered in almost 30% of patients who have experienced encephalitis tick bites. The manifestation of symptoms begins with a prodromal period lasting 1-2 days. This stage is characterized by increased fatigue and weakness. Later, fibrillar and fascicular muscle twitches are recorded, which appear as a result of destructive phenomena in the region of the medulla oblongata and spinal cord. Numbness may be felt in the extremities (not interconnected), which indicates that movement disorders can be expected to develop.

If left untreated, then febrile fever begins (may not appear until the fourth day in the first febrile wave and until the third day in the second wave), symptoms in the form of excessive relaxation of the cervicothoracic muscles become more and more obvious over the course of 1-2 weeks . There is flaccidity of the arm muscles and muscle tension in the legs, or a combination of these two conditions for one limb.

Motor pathologies progress over 1-1.5 weeks. From the beginning of the second to the end of the third week, the muscles begin to atrophy.

Polyradiculoneuritic form

Signs of an encephalitis tick bite in a person with a polyradiculoneuritic form include damage to the peripheral nervous system, tingling sensations and pain syndromes “attached” to the course of the nerve trunks. Sensitivity in the central parts of the body is impaired. The course of the disease is possible in the form of Landry's ascending spinal palsy (first the paralysis overtakes the lower limbs, and then rises higher, affecting other parts of the body).

Dual waveform

With a two-wave course, an acute onset of the disease is observed. The first signs of tick-borne encephalitis of this form include:

chills;
headache;
nausea;
vomiting;
dizziness;
causeless pain syndromes;
jet lag;
physical exhaustion.

The main distinguishing point: two-wave fever.

The duration of the first wave is less than one week, and it proceeds quite easily. Meningeal symptoms are mild and do not affect the cranial nerve. Next, an almost two-week apyrexic period passes (the febrile state is replaced by normalization of temperature or even loss of strength).

Treating tick-borne encephalitis in people with a two-wave form of the disease is the least difficult.

The beginning of the second feverish wave is accompanied by a sharp and high rise in temperature. There is lethargy, lethargy, as well as symptoms characteristic of the first wave, plus typical symptoms of tick-borne encephalitis in humans, indicating damage to the nervous system. The disease passes quite quickly and is replaced by complete recovery.

Diagnostics

When diagnosing tick-borne encephalitis, the entire medical history is taken into account:

Duration of stay in the source of infection.
The patient's area of professional activity.
The season of the year during which the infestation occurred.
Has an encephalitis tick bite been recorded?

In order to make the diagnosis as accurately as possible, a laboratory diagnosis of tick-borne encephalitis is carried out, which includes: RSC (relevant in the 2nd week from the moment of infection), RN (8-9th week) and X-ray studies.

Treatment

In the case of tick-borne encephalitis, there is no need to talk about eliminating the root cause, so you can fight mainly in a roundabout way. The means of indirect influence include:

anti-tick gamma globulin;
blood serum from those who have had this disease, it contains the necessary antibodies to the tick-borne encephalitis virus igm - tick-borne immunoglobulin (human immunoglobulin against tick-borne encephalitis);
immunoregulator in the form of alpha-interferon protein;
ribavirin.

Using immunoglobulin against tick-borne encephalitis, you can stop the activity of the virus. But it is allowed to use this remedy only in the first two days after infection, or already on the 28th day. Human immunoglobulin against tick-borne encephalitis must be administered intramuscularly (into the buttock or thigh).

For many, the use of these drugs is practically useless, since the main problem is not the presence of antibodies in the blood or other body fluids, but the resistance of each individual cell to the virus.

Among other things, detoxification therapy (getting rid of toxins, poisons) and medications that help regulate water and electrolyte balance may be prescribed. In some cases, dehydration and symptomatic treatment of tick-borne encephalitis are required.

The only answer to the question: what to do if suddenly bitten by an encephalitis tick is to deliver the patient to the nearest infectious diseases hospital as soon as possible.

Ways of infection, who is at risk

According to epidemiology, tick-borne encephalitis can spread in two ways:

Transmissible. Infection occurs through a bite, and the virus is transmitted by a tick. This is how the greatest number of invasions occur, especially if basic safety rules are not followed when being in nature. Infection occurs for sure, even if the tick is immediately removed immediately after the bite, symptoms characteristic of tick-borne encephalitis soon appear.
Nutritional. The virus enters the body through the gastrointestinal tract. This is most likely when consuming unboiled goat, sheep or cow's milk, if the animal is already infected.

Therefore, we can say quite objectively that the best protection against tick-borne encephalitis is vigilance and compliance with basic rules of prevention (appropriate clothing in the forest, heat treatment of milk before consumption).

Possible complications

The consequences of an encephalitis tick bite cannot be called pleasant. You can endlessly list why the encephalitis tick is dangerous and what its attack is fraught with.

First of all, the disease can become the starting point for the development of hyperkinetic and epileptiform syndromes, as well as a number of symptoms associated with a violation of the integrity of the nervous system.

The manifestation of hyperkinetic syndrome is typical for 25% of patients (this mainly applies to those who have not reached the age of 16). Among the main manifestations, rhythmic contractions (myoclonus) of individual muscle groups are noted, starting from the first stage of the development of the disease.

An infection from the acute stage can become chronic. This suggests that it may subside for a while, and then, under the influence of unfavorable health factors, become active again after a few months or years. These are the most likely consequences of tick-borne encephalitis.

Forecast

If you are bitten by an encephalitis tick, the consequences will be unpleasant. All forms of the disease caused by it, in addition to two-wave and meningeal, are considered serious, capable of leading to a significant outcome.

The development of the meningoencephalitic form of the disease often leads to disability or death. For polio, the mortality rate is not so high, but disability is also common. In the case of tick-borne encephalitis, treatment has virtually no effect on the person’s condition after the illness, but increases the survival rate among those sick (applies to severe forms).

For a chronic course, any of the forms is extremely unfavorable, so the relevance of the problem of complete recovery from tick-borne encephalitis today is beyond doubt. But don’t forget about it; perhaps it’s better to take care of this in advance.

Tick-borne encephalitis is a severe infectious naturally-mediated disease that is caused by a virus from the genus Flavivirus and is usually manifested by fever, damage to the central nervous system (central nervous system) and the development of flaccid paralysis and paresis.

An innocent walk in nature can turn into a profound disability for an absolutely healthy person, and even lead to death.

The disease was first described by the head of the neurological department of the naval hospital in Vladivostok A. G. Panov in 1934, and already in 1937 the virus was isolated from the cerebrospinal fluid, blood, brain of the dead and ixodid ticks by a group of scientists headed by Academician L. A. Zilber.

Soviet neurologist, Doctor of Medical Sciences, Professor. Discoverer of tick-borne encephalitis in 1935.

Soviet immunologist and virologist, founder of the Soviet school of medical virology. Researcher and discoverer of the disease tick-borne encephalitis.

Every year, 10 - 12 thousand people are infected, and the real figure is considered much higher than indicated. Basically, all cases are associated with a tick bite in forest or park areas.

Recently it is believed that the most dangerous for infection are the territories of the Russian Federation, Slovenia and the Baltics. Infected ticks are present in many other countries and therefore residents of these regions are also at risk of infection (Austria, Poland, Switzerland, Slovakia, Albania, Sweden, Ukraine, Turkey, Korea and others).

Consequences of tick-borne encephalitis

The consequences of this disease in certain cases include disability from the central nervous system (central nervous system), paralysis, cognitive impairment, and more. The mortality rate for Russian spring-summer tick-borne encephalitis is 25%, for European tick-borne encephalitis - 5%.

The causative agent of tick-borne encephalitis

The causative agent of tick-borne encephalitis is an RNA-containing flavivirus, which belongs to the arboviruses. The virus has a spherical shape, contains a nucleocapsid (a complex of nucleic acid and a protein shell), protected by an outer lipid shell, into which spikes are immersed (provoking the adhesion of red blood cells).

There are 3 known subtypes of the pathogen:

European (western, Najdorf),
Far Eastern (spring-summer encephalitis, Sofin)
and Siberian (Vasilchenko and Zausaev).

These three subtypes differ from each other in biological properties. The Far Eastern strain of the Sofiin virus is one of the first isolates of the tick-borne encephalitis virus. Due to its wide distribution in virus collections, it has become a reference strain.

They carry the virus and its natural reservoirs are infected ixodid ticks (Ixodes persulcatus and Ixodes ricinus), less commonly - gamasid ticks, and even less often - fleas and horseflies.

Ticks often remain firmly attached to the skin for several days.

Additional sources of infection are about 130 species of wild mammals. Most often these are squirrels, moles, hedgehogs, wild boars and even some species of birds.

An interesting fact is that the greatest likelihood of infection with the largest amount of virus can be obtained from the taiga tick (Ixodes persulcatus), because the most favorable conditions for the active reproduction of the virus have been created in its body.

Infection most often occurs through a tick bite, less commonly, it is also possible when swallowing thermally untreated milk that has been contaminated with tick feces (in this case, familial outbreaks of the disease may occur).

There is no direct transmission of the virus from person to person

People are highly susceptible to the virus. Due to the activation of the life cycle of ticks, the disease has a spring-summer seasonality.

Tick-borne encephalitis infection clinic

The virus, penetrating into the blood after a bite, multiplies in protective blood cells - macrophages. Then the stage of viremia begins, when new viruses enter the blood. After this, they follow to the regional lymph nodes, cells of the liver, spleen, blood vessels and multiply there again. Next, the viruses enter the motor neurons of the anterior horns of the cervical part of the spinal cord (as a result of which paresis and paralysis occur), into the cells of the cerebellum and pia mater.

The period from infection to the onset of clinical symptoms averages from 7 to 14 days. The severity of the disease depends on the type of bitten tick, the type of pathogen and the duration of blood sucking (the longer, the higher the likelihood of receiving a large dose of the pathogen). It is also known that the severity of the disease increases with the age of the patient.

In the acute period A ring-shaped erythema may be observed at the site of tick suction. But the main clinical syndromes are general infectious, meningeal and focal.

During the prodromal period General infectious syndrome manifests itself in the form of the following symptoms:

temperature rise,
general weakness, lethargy,
headaches,
nausea,
Sometimes muscle pain occurs in the neck and shoulder girdle,
feeling of numbness.

With a benign course this period is from 3 to 5 days. In some cases, against the background of severe intoxication, meningeal syndrome occurs, and meningeal signs may not be pronounced, and changes can be observed only in the cerebrospinal fluid.

In severe cases When encephalitis or meningoencephalitis develops, patients experience delusions, hallucinations, agitation, and the person is poorly oriented in time and space. The patient is inhibited and may feel fear and apathy.

Patient's appearance characterized by the following features: redness of the face, neck, conjunctiva, injection of scleral vessels, the tongue is covered with a whitish coating, the pharyngeal mucosa is often hyperemic. Abdominal bloating may occur. People often complain of photophobia, lacrimation, and blurred vision.

For diffuse brain symptoms disorders of consciousness, epileptic seizures, respiratory and cardiac problems, signs of cerebral edema, pathological reflexes, as well as paresis of facial muscles and tongue may occur.

With focal brain symptoms hemiparesis, paresis after convulsions, epileptic seizures, and less often subcortical and cerebellar symptoms develop quickly. Characteristic lesions of the cranial nerve nuclei. Occasionally, gastric bleeding with bloody vomiting is possible (as a consequence of a violation of the autonomic nervous system).

In some patients, after the prodromal period, a pronounced pain syndrome occurs in the neck and shoulder girdle with periodic muscle twitching, which indicates damage to the motor neurons of the anterior horns of the spinal cord. Weakness and numbness may suddenly occur in any limb, which will subsequently be accompanied by movement disorders.

Over the course of several days, and sometimes even weeks, against the background of elevated temperature and general cerebral symptoms, the intensity of flaccid paralysis of the cervicobrachial and cervicothoracic localization increases (hunched over, stooping, “proud” posture, drooping of the head on the chest).

Movement disorders can be mixed. For example, flaccid paresis appears on the upper limbs, and spastic paresis appears on the lower limbs. An increase in motor impairment is observed for up to 12 days. By the end of 2-3 weeks, atrophy of the damaged muscles is observed. Also, paralysis can begin in the reverse order - from the lower extremities to the muscles of the trunk and upper extremities.

All these manifestations can occur when infected with any type of tick-borne encephalitis virus, but with the Far Eastern variant, severe and pronounced damage to the central nervous system develops. The disease begins acutely, is very difficult to tolerate, and often ends in death and disability of the patient.

Clinical features of tick-borne encephalitis

Clinical features of Central European tick-borne encephalitis- two-wave fever.

1st stage corresponds to viremia (circulation of the virus in the patient’s blood). It is accompanied by nonspecific symptoms (fever, weakness, loss of appetite, muscle pain, nausea). In most cases, the person recovers. But in about 30% of cases, remission is observed (5-8 days), and then follows
2nd stage, which is characterized by damage to the central nervous system (meningitis, encephalitis).

It should be remembered that with nutritional infection (through milk), an enlargement of the liver and spleen is often observed.

Depending on which symptom complex prevails in a patient with tick-borne encephalitis, the following clinical forms are distinguished:

febrile,
two-wave milk fever,
meningeal,
meningoencephalitis,
polio-like,
polyradiculoneurotic.

After infection and the acute stage, the infectious process can become chronic in several forms (hyperkinetic, which is characterized by Kozhevnikov’s epilepsy; amyotrophic, when the activity of the pathological process is localized in the cervical-brachial girdle).

The virus can remain in active form in the central nervous system and, under favorable conditions, manifest itself after several months or years.

With tick-borne encephalitis, the development of complications is quite often observed. Most often they occur when infected with the Russian spring-summer subtype of the virus.

The most common complications include:

cerebral edema with the development of cerebral coma,
hemorrhages in the brain matter,
gastric hemorrhages,
Jacksonian or Kozhevnikov epilepsy,
respiratory and cardiac disorders as a result of damage to the medulla oblongata,
infectious-toxic myocarditis,
paralysis
and, as a consequence, disability of the patient.

Nonspecific complications include the addition of bacterial flora against the background of decreased immunity and the development of severe pneumonia with respiratory failure.

Laboratory diagnostics are used to confirm the diagnosis.

Clinical blood test: decreased leukocytes and increased lymphocytes and monocytes.
Clinical urine analysis: the appearance of protein and casts in the urine (with moderate severity of the disease and especially with severe disease).
Cerebrospinal fluid - slight increase in lymphocytes and increased protein levels.
Virological methods: isolation of the virus from the blood, cerebrospinal fluid (on the 5-7th day of illness), in cell cultures with further identification using the method of fluorescent antibodies.
Serological methods: enzyme immunoassay, complement fixation reaction, passive hemagglutination reaction, neutralization reaction in paired sera taken at intervals of 2-3 weeks.
Polymerase chain reaction: determination of viral RNA in the blood.

Treatment of patients with tick-borne encephalitis is carried out in the infectious diseases department or in intensive care. Bed rest and a protein diet with a high potassium content are recommended.

Antiviral treatment consists of administering homologous immunoglobulin against the tick-borne encephalitis virus. The faster it is administered, the faster the clinical effect will occur. Its mechanism of action is due to the fact that the antibodies that are part of the drug neutralize the effect of the virus (1 ml binds from 600 to 60,000 lethal doses of the virus), and also protect the cell from further penetration of the virus by binding to membrane receptors.

Also for specific treatment, ribonuclease is used, which penetrates the membranes of the brain and inhibits the reproduction of the virus in the cells of the nervous system. In some cases, the administration of interferons in small doses is recommended.

Pathogenetic treatment is associated with detoxification (administration of saline solutions). If there is a risk of cerebral edema, glucocorticosteroids are administered. If breathing problems are noted, the patient is transferred to artificial ventilation. To combat hypoxia, hyperbaric oxygenation and sodium hydroxybutyrate are administered. For psychomotor agitation, lytic mixtures and sedatives (Seduxen, Relanium) are used. To treat paralysis, muscle relaxants are administered, as well as drugs that improve blood supply and trophism of brain tissue. To eliminate seizures, patients take anticonvulsant and antiepileptic drugs.

The criterion for discharging a patient who has suffered tick-borne encephalitis is complete normalization of the clinical condition and the possibility of outpatient treatment.

How not to get infected? Prevention of tick-borne encephalitis

Prevention of tick-borne encephalitis is divided into general and specific. General prevention consists of individual protection against ticks. To do this, use special clothing, masks, and repellents (tick repellents). It is especially important to examine people after walking in forests and park areas, and to remove the tick from the human body as quickly as possible, since the time of blood sucking affects the amount of the pathogen in the blood and the severity of the disease. Also, in endemic regions, the consumption of unboiled milk should be avoided.

The most effective and reliable method is specific prevention. For this purpose, vaccination is used, which is indicated for tick-borne encephalitis in risk groups.

But according to the recommendations of the World Health Organization (WHO), in areas where the disease is very endemic (that is, where the average incidence from vaccination is ± 5 cases per 100,000 people per year), implying that there is a high individual risk of infection, Vaccination is necessary for all ages and groups, including children.

Where the incidence and prevalence of a disease is moderate or low (that is, the annual average over a five-year period is less than 5 cases per 100,000 population) or is limited to specific geographic locations, certain outdoor activities, immunization should be targeted at individuals, most cases in cohorts that are at high risk of infection.

People who travel from non-endemic to endemic areas should also be vaccinated if visits to endemic areas will involve extensive outdoor activities.

There are several types of vaccines for specific prevention.

Western European vaccines

In Western Europe, two vaccines are available for both adult and pediatric formulations ( - Germany; - Austria). Despite the fact that these vaccines are based on the European (Western) subtype of the virus, the immune system produces antibodies against all subtypes of the tick-borne encephalitis virus. These vaccines contain a suspension of purified virus that is inactivated with formaldehyde. All of these vaccines provide safe and reliable protection.

According to WHO guidelines, outside countries or areas at risk, tick-borne encephalitis vaccines may not be licensed and must be obtained upon special request.

Russian vaccines

Inactivated tick-borne encephalitis vaccines (cultural purified dry concentrated, “Encevir”), produced in the Russian Federation, are based on the Far Eastern subtype of the virus and are multiplied in primary chicken embryo cells.

Side effects of vaccines

As for side effects, Western European vaccines are rarely characterized by adverse reactions, sometimes short-term redness and pain at the injection site appear in no more than 45% of cases and fever with a temperature above 38°C in less than 5-6%. However, none of these reactions are life-threatening or serious.

It is reported that Russian vaccines are moderately reactogenic and do not cause serious adverse reactions. Vaccines that were relatively common in causing fever and allergic reactions, particularly in children, were withdrawn from production.

What to do if bitten by a tick?

Passive prophylaxis for persons who have been bitten by ticks infected with encephalitis consists of immediate administration of human immunoglobulin against tick-borne encephalitis. The most effective administration of this drug is in the first 96 hours of the disease, with the necessary repetitions according to a three-fold scheme.

Procedure for dealing with a tick bite

Vaccination is the most effective medical intervention ever invented by man.

Contents of the article

Tick-borne encephalitis(synonyms of the disease: tick-borne encephalomyelitis, spring-summer encephalitis, taiga, Russian Far Eastern, spring-summer meningoencephalitis) is an acute viral natural focal disease that is transmitted through a tick bite, sometimes through nutritional means, characterized by fever and severe damage to the central nervous system, in in typical cases, multiple flaccid paresis and paralysis of mainly the muscles of the shoulder girdle, a variety of clinical forms, sometimes chronic.

Historical data of tick-borne encephalitis

In the 30s of the XX century. In the regions of the Far East, outbreaks of severe neuroinfection occurred, which was initially considered a toxic flu. In 1934, A.G. Panov first established the nosological independence of the disease. Due to the tense epidemiological situation, complex scientific expeditions were organized (1937) under the leadership of L. A. Zilber, E. N. Pavlovsky, A. A. Smorodintsev, N. I. Rogozin, A. N. Shapoval, which made it possible to identify the causative agent of the disease, establish the basic patterns of its spread, study the pathogenesis, morphology and clinical picture of the disease, and the biology of the vector. The research results made it possible to extremely quickly develop and introduce the world's first inactivated viral vaccine (N.V. Kagan). During expeditions and laboratory tests, N. V. Kagan died due to infection with the virus. A. Utkina, V. I. Pomerantsev, M. P. Chumakov, V. D. Solovyov suffered from a severe form of encephalitis. The research results formed the basis of E. N. Pavlovsky’s doctrine of natural focal infections.

Etiology of tick-borne encephalitis

The causative agent of tick-borne encephalitis belongs to the genus Flavivirus, family Togaviridae. Virions contain single-stranded RNA. Virus strains isolated in various endemic zones, differing in biological properties. The virus multiplies in many cell cultures of mammals, birds and arthropods, and is capable of causing agglutination of geese red blood cells used for identification in RGGgA. The virus is not resistant to environmental factors, sensitive to the action of ether, detergents, disinfectants and UV radiation, is quickly inactivated by boiling (2 minutes), at a temperature of 60-70 ° C it dies in 10-15 minutes, at 37 ° C it remains 2 days.

Epidemiology of tick-borne encephalitis

The reservoir and vector of infection are ixodid ticks. The source of infection can be about 130 species of mammals and 170 birds. In some animals that hibernate, the virus persists for a long time. Domestic animals, most often goats, sheep, cows, become infected while grazing in wild habitats, and can also be a source of infection. Transmission factors in these cases may be milk and dairy products (usually from goats and sheep) that have not been subjected to heat treatment.
In Asia, the infection is mainly transmitted by ticks Ixodes persulcatus, in Europe - Ixodes ricinus. In addition, other types of ticks, as well as some gamasids, act as carriers. Infections from animal carriers and virus replication can occur at all stages of tick development. Transovarial transmission of the virus is possible.
Encephalitis is seasonal, with the peak incidence occurring in May - June.
The distribution area of tick-borne encephalitis covers the entire Eurasian continent.
There are three types of foci of infection:
1) natural,
2) transitional with a changed biocenosis as a result of human economic activity,
3) secondary, anthropurgic, where, in addition to wild animals and birds, domestic animals are the reservoir of infection.
In Ukraine (Polesie, the foothills of the Carpathians, the Carpathians proper and the mountainous regions of Crimea) there are structures of the second and lesser degree of the third type.

Pathogenesis and pathomerphology of tick-borne encephalitis

The entry point for infection during a tick bite is the skin, and for alimentary infection, it is the mucous membrane of the stomach and intestines. Much less often the portal of entry is the conjunctiva, the mucous membrane of the upper respiratory tract. With the flow of blood, the virus enters the nervous tissue. The meninges are a barrier to the virus, so the disease often occurs as meningitis. When the blood-brain barrier is broken, encephalomyelitis develops. The pronounced tropism of the virus for motor neurons of the medulla oblongata and spinal cord determines the nature of the clinical manifestations of the disease. In severe cases, inflammatory and degenerative changes in the nervous tissue: they can spread, covering large areas.
The spread of the pathogen perineurally is also of certain importance. This is evidenced by the frequent occurrence of paresis-paralysis in areas anatomically associated with the site of the tick bite. In case of infection through the nutritional route, the virus probably multiplies in the cells of the intestinal mucosa. The most common and intense changes are observed in the nuclei of the medulla oblongata and the cervicobrachial part of the spinal cord, in the neurons of Amon's horn, and less often in other parts of the nervous system. The dura and soft meninges, the substance of the brain are edematous, full-blooded with pinpoint hemorrhages. Multiple small foci of melting (necrosis) of the gray matter of the brain, diffuse inflammation of the paravertebral sympathetic nodes, and peripheral nerves are detected. Dystrophic changes, hemorrhages in the myocardium, kidneys, liver, and spleen are observed.
After an illness, strong immunity remains.

Tick-borne encephalitis clinic

The incubation period lasts 2-21, usually 7-14 days, but can last up to 70 days. In a third of patients, the disease begins with prodromal phenomena - general weakness, irritability, minor headache. After 2-3 days, most patients suddenly experience a sudden increase in body temperature to 38-40 ° C, and an intense headache appears, accompanied by vomiting, myalgia, and peresthesia. High body temperature lasts 6-8 days. Sometimes it is possible to increase it again (two-wave fever). Characteristic manifestations include significant localized hyperemia of the skin of the face, neck and mucous membranes, injection of scleral vessels. From the circulatory system, bradycardia, muffled heart sounds, and decreased blood pressure are observed. Breathing is shallow and frequent. Against the background of catarrhal changes in the upper respiratory tract, the development of early pneumonia is possible. The prognosis is unfavorable, because respiratory failure is aggravated by disturbances in the central regulation of the rhythm of breathing and blood circulation.
Already from the second or third day of the disease, meningeal symptoms are detected - stiffness of the neck muscles, Kernig's, Brudzinski's symptoms and others, which, although not always clear enough, can be observed for several days after the body temperature has normalized. In some patients, simultaneously with the development of meningeal syndrome, signs of focal lesions of the nervous system appear, often in the form of flaccid paresis and paralysis of the muscles of the neck (drooping head) and shoulder girdle characteristic of this disease. Spastic hemiparesis and monoparesis of the lower extremities, dysfunction of cranial nerves and bulbar disorders, paresis of the muscles of the face, soft palate, tongue, strabismus, diplopia, ptosis, aphonia, dysarthria, and dysphagia occur less frequently. An unfavorable sign is a violation of the breathing rhythm. The early development of local hyperkinesis and epileptiform seizures, sometimes turning into an epileptic state, indicates a significant prevalence of the process and is also prognostically unfavorable.
In the cerebrospinal fluid, changes characteristic of serous inflammation are more often detected - slight lymphocytic pleocytosis and an increase (or normal) protein content.
The depth and extent of damage to the nervous system are decisive in the clinical course and prognosis. The predominance of general cerebral symptoms is one group of cases of the disease, the other is forms of the disease in which local brain pathology predominates. Although these differences are not always clear enough and in this regard there is a wide variety of clinical manifestations (syndromes) of the disease, the accumulated data have made it possible to identify its main clinical forms.
The febrile form is marked by a benign course, an increase in body temperature for no more than 3-6 days. Headache and nausea are moderate, neurological symptoms are minimal and disappear quickly.
Two-wave tick-borne encephalitis, or two-wave milk fever, is identified by most authors as a separate benign form, which develops during alimentary infection, most often when consuming raw goat milk. This form of the disease begins acutely with chills and increased body temperature of the patient, characterized by headache, nausea, vomiting, and muscle pain.
The first temperature wave lasts 2-7 days, followed by a period of apyrexia lasting 5-12 days. The second febrile period also begins acutely. This is a qualitatively new phase of the disease, its course is more severe and clinically resembles serous meningitis with minor manifestations of diffuse and focal brain damage.
The meningeal form is characterized by fever for 7-10 days, severe headache, vomiting, and clear meningeal symptoms. Changes in the cerebrospinal fluid are characteristic of serous meningitis and may appear within 2-4 weeks. The course is benign, the disease ends with complete recovery, sometimes signs of asthenia persist for a long time.

Meningoencephalitic form

The meningoencephalitic form is the most severe and has an unfavorable prognosis; mortality can reach 25%. From the 2-4th day of illness, against the background of hyperthermia and lethargy, a syndrome of diffuse inflammation-cerebral edema develops with severe meningeal syndrome, delirium, psychomotor agitation, hallucinations and convulsions, reminiscent of an epileptic state. Often, the stupor of the first days turns into pathological drowsiness, from which the patient cannot be brought out. General cerebral symptoms may be accompanied by disorders caused by damage to the brain stem, especially paresis of the oculomotor, glossopharyngeal and vagus nerves, with disturbances in the rhythm of breathing, swallowing, nasal voice, and strabismus. If focal lesions of the substance of one of the cerebral hemispheres predominate, the main symptom is spastic hemiparesis, and if the conductive parts of the brain stem are damaged, an alternating syndrome develops - hemiparesis on the opposite side with paresis of the cranial nerve nuclei on the side of the lesion. In the cerebrospinal fluid there is lymphocytic pleocytosis with a slight increase in protein and glucose content.

Poliomyelitis-like form

The polio-like form is the most typical, caused by damage to the gray matter of the spinal cord and, to a lesser extent, pathology of the brain stem. Fever, lethargy, and meningeal syndrome are quite moderate, but against this background, peripheral flaccid paresis and paralysis of the muscles of the neck and shoulder girdle develop early, that is, the localization of the pathological process predominates in the cervicobrachial region of the spinal cord. Less typical for this form are paresis of the lower extremities and ascending paresis with delight in the pathological process of the brain stem. After 2-3 weeks from the onset of the disease, significant atrophy of the affected muscles begins, which leads to persistent residual changes.

Polyradiculoneuritic form

The polyradiculoneuritic form in the initial stage clinically differs little from the poliomyelitis-like form. The main difference is significant pain along the nerve trunks, accompanied by paresthesia (crawling sensation, tingling), sensitivity disorders in the distal extremities (like socks, gloves).
The possibility of developing chronic tick-borne encephalitis is debatable. In some cases, it is not possible to establish an acute period in the anamnesis, and the disease takes on a progressive course with asthenia, hyperkinetic or epileptiform syndrome, and signs of cerebral hypertension. In the fundus there is hyperemia, signs of congestion, optic neuritis, and a narrowing of the visual fields. It is not always possible to distinguish chronicity from residual manifestations, in which flaccid paralysis, most often of the muscles of the shoulder girdle, neck and less often of the limbs, can be accompanied by dyskinesias reminiscent of tremors' paralysis (Parkinson's disease), frequent residual paresis of facial and oculomotor muscles, and decreased intelligence.

Complications of tick-borne encephalitis

Severe forms of tick-borne encephalitis in the acute period are often accompanied by the addition of a secondary bacterial infection, most often pneumonia.

Forecast of tick-borne encephalitis

With the exception of two-wave encephalitis and the meningeal form, the prognosis is serious. If the meningoencephalitic form, in addition to high mortality, can lead to severe disability, then the poliomyelitis-like form is marked by significantly less mortality, but often also results in disability. All forms of progressive chronic course of tick-borne encephalitis are prognostically unfavorable.

Diagnosis of tick-borne encephalitis

The main symptoms of the clinical diagnosis of tick-borne encephalitis are the acute onset of the disease, fever, increasing headaches and muscle pain, flushing of the skin of the face, neck, injection of scleral vessels, paresthesia, in typical cases a combination of symptoms of meningitis and encephalomyelitis, flaccid paresis, (paralysis) of the neck muscles (hanging head), shoulder girdle, back, sometimes the presence of a primary affect at the site of the tick bite. The epidemiological history is taken into account - stay in an endemic area, tick bites, consumption of raw goat milk.
Specific diagnostics based on the isolation of the virus from patients or from the brains of the dead. Newborn mice are infected with blood, cerebrospinal fluid, or intracerebral homogenate, followed by identification of the isolated virus in the RN or HRT. For serological diagnosis, RSC, RTGA in the dynamics of the disease (paired serum method), as well as RN in white mice and cell cultures are used.

Differential diagnosis of tick-borne encephalitis

The febrile form of tick-borne encephalitis and the initial period of other clinical forms of the disease should be differentiated from influenza, which is characterized by catarrhal manifestations, tracheobronchitis, and a predominant incidence in the cold season. The meningeal form is similar to viral serous meningitis caused by enteroviruses, mumps viruses, herpes, etc. Seasonality, epidemiological history data, symptoms characteristic of each of these infections, as well as the results of virological and serological studies are taken into account.
Tuberculous meningitis, which can also damage the cranial nerves, is characterized by the gradual development of the disease and pronounced cerebral hypertension with characteristic changes in the cerebrospinal fluid (protein-cell dissociation, etc.).
The meningoencephalitic form is differentiated from all primary and secondary meningoencephalitis and brain pathology with acute encephalitis syndrome. Differentiation is based on an assessment of the clinical characteristics of focal brain lesions, epidemiological history data (endemic areas, vectors, seasonality) and the results of virological and serological studies.
Differentiation from mosquito encephalitis, which occurs with muscle hypertension, spastic paralysis, and significant mental disorders, is necessary. Residual manifestations of tick-borne encephalitis are flaccid paralysis, mosquito encephalitis - physical and mental asthenia, decreased intelligence, psychosis. In addition, differences in the seasonality of diseases should be taken into account.
Economo's epidemic lethargic encephalitis is sporadic, gradual in development, lacking severe intoxication and convulsive syndrome. It is characterized by oculoletargic and vestibular syndrome, stiffness, and the subsequent development of parkinsonism.
There are clear differences between secondary encephalitis caused by influenza, rubella, measles, chickenpox, herpes and enteroviruses and tick-borne encephalitis. In the case of secondary encephalitis with the above infectious diseases, one can detect (including from the anamnesis) their inherent symptoms; the manifestations of encephalitis are predominantly cerebral; there are no signs of severe focal lesions of the nervous system, characteristic of tick-borne encephalitis.
The poliomyelitis-like form should be differentiated from poliomyelitis, in which the lower extremities are more often affected, flaccid paralysis is preceded by catarrhal manifestations and (or) short-term diarrhea, and predominantly affects young children.
Certain difficulties arise when differentiating the meningoencephalitic form of the disease from non-infectious brain pathology (combined parenchymal-subarachnoid hemorrhage).
A detailed history and objective data allow us to establish the correct diagnosis. Brain tumors can sometimes also mimic encephalitis. Changes in the cerebrospinal fluid and the results of instrumental studies (angio- and echoencephalography, computed tomography) are of decisive importance.

Treatment of tick-borne encephalitis

A specific drug against tick-borne encephalitis is heterogeneous equine immunoglobulin, which is administered with Bezredka for 3 days: on the 1st day twice (mild form - 1 ml, moderate - 6 ml, severe - 12 ml), on 2-3 - 1st day - 3 ml once. In case of repeated fever, the administration of immunoglobulin is repeated according to the same scheme. In recent years, serum polyglobulin obtained from donors in the area has been used. Ribonuclease and interferon (reoferon) are prescribed. In addition, for meningoencephalomyelitis syndrome, pathogenetic treatment is carried out using glycocorticosteroids, dehydrating, sedative and symptomatic agents.
If there is a threat of boulevard disorders, paresis of the respiratory muscles, resuscitation measures are needed, including controlled breathing.
Strict bed rest is required for 2-3 weeks. Further treatment is aimed at restoring the function of the affected muscles and reducing possible disability.

Prevention of tick-borne encephalitis

Non-specific prevention measures include disinsection and deratization, destruction of ixodid ticks on domestic animals, consumption of only boiled milk in foci of infection, improvement of recreational suburban areas. Means of personal prevention include the use of special overalls when working in wild biotopes, repellents, -and after mutual inspection, removal of ticks.
For the purpose of specific prevention, vaccination of the population and professional groups at high risk with an inactivated tissue antiencephalitis vaccine is carried out. If ticks are found to have been sucked in, 6 ml of specific immunoglobulin is administered for emergency prevention.