BOJ
TICK-BORNE ENCEPHALITIS
Fulfilled: Аltayev A.А.
PLAN:
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Introduction
Taxonomy
Resistance
Epidemiology
Pathogenesis
Types
Clinical manifestations
Treatment
Prevention
TICK-BORNE ENCEPHALITIS IS A NATURALLY
TRANSMITTED DISEASE CAUSED BY FLAVIVIRUSES,
TRANSMITTED BY A TRANSMISSION MECHANISM,
FEVER AND DAMAGE TO THE CENTRAL NERVOUS
SYSTEM ARE CHARACTERISTIC OF THE CLINIC.
THIS INFECTION IS CHARACTERIZED BY THE
SPRING AND SUMMER SEASON. THE VIRUS WAS
ISOLATED IN 1937 (L. A. ZILBER, M. P. CHUMAKOV,
ETC.) FROM PEOPLE WITH TICK-BORNE
ENCEPHALITIS. TAXONOMY. FAMILY ˸ FAMILY
FLAVIVIRIDAE ˸ FLAVIVIRUSES.
TICK-BORNE ENCEPHALITIS ENDEMIC AREAS
IN KAZAKHSTAN
Almaty region (Talgar, Enbekshi-Kazakh,
Kaskelensky, Raimbeksky, Alakol, Aksu,
Kerbulak, Sarkand districts, Almaty,
Taldykorgan, Tekeli)
Akmola region
The East Kazakhstan region
Kostanay region
Karaganda region
North-Kazakhstan region
THE VIRUS IS TRANSMITTED TO HUMANS BY THE BITE OF
INFECTED TICKS (80%) OR BY EATING RAW GOAT AND SHEEP MILK.
WHEN YOU DRINK MILK, THE STOMACH ACID BECOMES ALKALINE,
SO IT CANNOT INTERFERE WITH THE VIRUS. THE VIRUS IS NOT
TRANSMITTED BY DRINKING COW'S MILK, BECAUSE DURING THE
LACTATION PERIOD OF COWS, MILK CONTAINS VIRUSNEUTRALIZING ANTIBODIES (IMMUNOGLOBULINS). PATHOGENESIS:
THE DURATION OF THE LATENT PERIOD IS FROM 5 TO 30 DAYS. THE
VIRUS FIRST MULTIPLIES AT THE SITE OF ENTRY (AT THE
ENTRANCE) AND ENTERS THE BLOODSTREAM - VIREMIA
DEVELOPS.
THE VIRUS ENTERS THE ENDOTHELIUM OF BLOOD VESSELS,
INTERNAL ORGANS (LIVER, SPLEEN) AND PHAGOCYTIC CELLS AND
BEGINS TO MULTIPLY ACTIVELY. IN THE CASE OF FOODBORNE
INFECTIONS, THE MUCOUS MEMBRANE OF THE PHARYNX AND
SMALL INTESTINE IS THE GATEWAY FOR ENTRY. AT THE END OF
THE LATENT PERIOD IN THE VASCULAR ENDOTHELIUM, AS A
RESULT OF ACTIVE REPRODUCTION OF THE VIRUS, SECONDARY
VIREMIA OCCURS FOR 5 DAYS. THE VIRUS HEMATOGENOUSLY AND
PREFERABLY PERINEURALLY PENETRATES INTO THE BRAIN AND
SPINAL CORD, DAMAGING MOTOR NEURONS. PARTICULARLY
AFFECTED ARE THE LARGE CELLS THAT ACT AS MOTIVES IN THE
GRAY MATTER OF THE SPINAL CORD, AND THE SKELETAL MOTOR
NERVE NUCLEUS CELLS IN THE BRAINSTEM.
Epidemiological table
Human
Eggs
Tick
infestation
Larva
Infected dairy
products
Small
mammals
Vital
tick cycle
Pets (goats)
Infection
Adult
mite
Nymph
TE TYPES:
febrile
 meningeal
 meningoencephalitis
 meningoencephalomyelitis (poliomyelitis)
 polyradiculoneuritis

Types:
The febrile form of tick-borne encephalitis occurs in about 1/3 of patients without
damage to the nervous system. Usually it begins without a prodrome, and the body
temperature quickly reaches 38-39 ° C. It is obvious that the temperature does not
drop from several hours to several days (sometimes there is a manifestation of
meningism). There are obvious headaches, myalgias, hyperemia of the skin of the
face and neck. The duration of the disease is 3-7 days, the course is safe, the
prognosis is favorable.
Meningeal type is a typical type of tick-borne encephalitis. Meningitis develops at a
high temperature, headache, vomiting, meningeal syndrome. Cerebrospinal fluid is
transparent, sometimes slightly opalescent, with high blood pressure and moderate
lymphocytic pleocytosis (100-600 cells per 1 μl). Protein is often normal or does not
exceed 1-2 g / l. Cerebrospinal fluid changes can last from 2-3 weeks to several
months.
Some patients may have symptoms of transient encephalitis. The forecast is
favorable.
Meningoencephalitis occurs in 15% (up to 40% in the form of crumbs) and is
characterized by a strong course. Fever, meningeal syndrome, encephalitis, resistance to
antipyretic drugs. The patient may often become agitated, slow down and pass out. Brain
damage is diffuse or focal. With diffuse meningoencephalitis, there are impaired
consciousness, tremor, tremor of the fibrillar muscles of the face and tremor of the limbs,
arms, deep reflexes, and decreased muscle tone. With clinical manifestations of
meningoencephalitis, foci of brain damage are determined. If one of the cerebral
hemispheres is damaged, spastic paresis of the right or left limb develops, as well as
paresis of the facial and hypoglossal nerves on this side. In the left hemisphere, there is a
process of speech impairment. If there is a lesion of the white matter in the vascular part of
the brain, then with an alternative syndrome, paresis of the cranial nerve develops on the
inflamed side and paresis of the limbs on the opposite side of the body. Pairs III, IY, Y, YI,
YII, IX, X, XI, XII are damaged between the cranial nerves. Especially for tick-borne
encephalitis, the nature of involvement in the pathological process of IX, X, XII pairs of
nuclei of the cranial nerve, leading to paresis of the soft palate, hoarseness, fuzzy speech,
aphonia, disorders of the pharynx, obstruction of the airways. Paresis in the form of
increased salivation, tachycardia, shortness of breath. Bulbar disorders occur in 1/4 of
patients. Patients may have epilepsy, Jackson-type seizures.
Meningoencephalopoliomyelitis (poliomyelitis) occurs in about 1/3 of patients. It is
characterized by general intoxication and meningeal syndromes, focal or diffuse
encephalitis, paresis of the neck muscles, manifested in the chest, extremities,
symmetric lesions of the muscles of the neck, shoulders, shoulders, and sometimes
lesions of the intercostal muscles. The most frequent symptom in these patients is
"drooping of the head to the chest" (the head does not rise vertically, but hangs
passively), described by A.G. Panov. Obviously, in patients, movement disorders worsen
within 7-12 days, and after 2-3 weeks, the patient develops muscle weakness. Tickborne encephalitis polyradiculoneuritis is rare (2-4% of cases).
Two-wave tick-borne encephalitis is characterized by an alimentary infection (two-wave
milk fever). With this clinical form, the fever lasts 3-5 days, the period of apyrexia
begins, and encephalomyelitis develops after 3-8 days.
The prognosis for meningeal and febrile forms is safe, the risk of death in
meningoencephalitis, poliomyelitis, polyradiculoneuritis reaches 25-30%. According to
the available data, organic changes in the central nervous system persist for up to 1-2
years, and sometimes for the whole life, which manifests itself in the form of dementia,
muscle weakness, dyskinesia, mental retardation, and sometimes epilepsy.
After the illness, strong immunity develops. The process of natural immunization is
formed in the local population in natural foci.
CLINICAL MANIFESTATIONS ACCORDING TO THE
CLINICAL COURSE, TWO MAIN VARIANTS OF THE
DISEASE ARE DISTINGUISHED: THE EASTERN ONE IS
VERY SEVERE, THE WESTERN ONE IS MILD. THE
INCUBATION PERIOD IS 7-14 DAYS. THE DISEASE
BEGINS ACUTELY: CHILLS, SEVERE HEADACHE,
FEVER UP TO 39 ° C, NAUSEA, VOMITING, MUSCLE
PAIN AND RECURRENT CRAMPS. ACCORDING TO
CLINICAL MANIFESTATIONS AND LESIONS OF THE
NERVOUS SYSTEM, TICK-BORNE ENCEPHALITIS IS
DIVIDED INTO 2 TYPES: NON-PARALYTIC AND
PARALYTIC.
Clinical table
Infection
Incubation period for
tick bites
7-14 days
When taking milk
3-4 days
Subclinical
infection
70-98%
Nonspecific febrile
disease
Neurological syndrome
Слабость,
anorexia,
myalgia,
Headache,
Nausea
Vomiting
Febrile type
Aseptic meningitis
Meningoencephalitis
Meningomyeloencephalitis
NON-PARASITIC TYPES: FEBRILE, MENINGEAL AND
INDETERMINATE. THE TYPE OF FEVER IS 30-50%,
THERE ARE NO SIGNS OF MENINGITIS, THE ENDING IS
FAVORABLE, ASTHENIA IS RARE. THE MENINGEAL
TYPE ACCOUNTS FOR 40-60% OF CASES,
CHARACTERIZED BY MENINGEAL SYNDROMES,
CHANGES IN THE CEREBROSPINAL FLUID, INCREASED
PRESSURE OF THE CEREBROSPINAL FLUID.
COLORLESS TRANSPARENT LIQUID. FEVER IS A TWOWAVE FORM, POST-INFECTIOUS ASTHENIC SYNDROME
OCCURS IN 40% OF PATIENTS. IN THE FORM OF VAGUE
HEADACHES, THE CEREBROSPINAL FLUID DOES NOT
CHANGE, PASSES WITH A SLIGHT INCREASE IN BODY
TEMPERATURE.
PARALYTIC TYPES: IN THE FORM OF ENCEPHALITIS, MENINGEAL
SYMPTOMS, HEMIPARESIS AND HEMIPLEGIA ARE OBSERVED. IN
THE FORM OF POLIOMYELITIS, THE PRESENCE OF PARALYSIS OR
PARESIS IS MANIFESTED. THE PATIENT HAS WEAKENED ARMS
AND SHOULDERS, NECK MUSCLES, THE NECK SAGS, THE
SHOULDERS RESEMBLE A BIRD'S WING. TENDON REFLEXES ARE
REDUCED. WITH THE BULBAR FORM, THERE IS ATROPHY OF THE
TONGUE, IMPAIRED SWALLOWING, IMPAIRED SWALLOWING
REFLEX. ARE DIVIDED INTO TYPES OF POLYRADICULONEURITIS.
PERIPHERAL NERVES AND NERVE ROOTS ARE DAMAGED.
IMMUNITY STRONG HUMORAL IMMUNITY DEVELOPS
AFTER ILLNESS. USED FOR TREATMENT AND
PREVENTION ˸
● DONOR-SPECIFIC HOMOLOGOUS GAMMA GLOBULIN
AGAINST TICK-BORNE ENCEPHALITIS 6.0 ML FOR 3
CONSECUTIVE DAYS OR FOR 2 CONSECUTIVE DAYS
GAMMA GLOBULIN, RIBONUCLEASE 30 MG
INTRAMUSCULARLY FOR 4 DAYS. TREATMENT 3-4 DAYS
AFTER THE ONSET OF THE DISEASE. APPOINT LATER;
● IMMUNE HEMODSORPTION;
● VIFERON, IODANTIPYRINE, RIDOSTIN,
PREVENTION. IN ADDITION TO GENERAL MEDICAL
PRECAUTIONS, SPECIFIC PROPHYLAXIS IS USED ˸ ●
PURIFIED INACTIVATED DRY CULTURE VACCINE
AGAINST ENCEPHALITIS FOR CHILDREN AND ADULTS
(RUSSIA - MOSCOW). ● ENCEVIR IS A PURIFIED,
CONCENTRATED, INACTIVATED LIVE TICK-BORNE
ENCEPHALITIS VACCINE (RUSSIA-TOMSK). ● FSME IMMUNE INJECTABLE - INACTIVATED VACCINE
(AUSTRIA). ● ENCEPUR - INACTIVATED VACCINE FOR
ADULTS AND CHILDREN (GERMANY).
SOURCES:
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LB Borisov Medical microbiology, virology,
immunology 3rd ed., M., 2002.
ND Yashchuk, Yu. Ya. Vengerov Infectious Diseases - M
.: Medicine, 2003.
http://medkarta.com
http://dic.academic.ru/dic.nsf/enc_medicine/31846
http://vse-zabolevaniya.ru/bolezni-infekcionnye