Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The disease most often manifests as meningitis, encephalitis or meningoencephalitis. Myelitis and spinal paralysis also occurs. In about one third of cases sequelae, predominantly cognitive dysfunction, persists for a year or more.The number of reported cases has been increasing in most countries. TBE is posing a concerning health challenge to Europe, as the number of reported human cases of TBE in all endemic regions of Europe have increased by almost 400% within the last three decades.The tick-borne encephalitis virus is known to infect a range of hosts including ruminants, birds, rodents, carnivores, horses, and humans. The disease can also be spread from animals to humans, with ruminants and dogs providing the principal source of infection for humans. Signs and symptoms
The disease is most often biphasic. After an incubation period of approximately one week (range: 4–28 days) from exposure (tick bite) non-speciﬁc symptoms occurs. These symptoms are fever, malaise, headache, nausea, vomiting and myalgias that persist for about 5 days. Then, after approximately one week without symptoms, some of the infected develop neurological symptoms, i.e. meningitis, encephalitis or meningoencephalitis. Myelitis also occurs with or without encephalitis.Sequelae persists for a year or more in approximately one third of people who develop neurological disease. Most common long-term symptoms are headache, concentration difficulties, memory impairment and other symptoms of cognitive dysfunction.Mortality depends on the subtype of the virus.
Screening is recommended for people who have:
Vascular disease elsewhere in the body, including:
Peripheral artery disease (PAD)
Coronary artery disease (CAD)
Atherosclerotic aortic aneurysm (AAA)
Two or more of the following risk factors:
High blood pressure (hypertension)
High cholesterol (hyperlipidemia)
Tobacco smoking
Family history – First-degree relative diagnosed with atherosclerosis before age 60 or who had an ischemic strokeThe American Heart Association also recommends screening if a physician detects a carotid bruit, or murmur, over the carotid artery by listening through a stethoscope during a physical exam. For people with symptoms, the American Heart Association recommends initial screening using ultrasound. Treatment
The goal of treating carotid artery stenosis is to reduce the risk of stroke. The type of treatment depends on the severity of the disease and includes:
Lifestyle modifications including smoking cessation, eating a healthy diet and reducing sodium intake, losing weight, and exercising regularly. Medications to control high blood pressure and high levels of lipids in the blood. Surgical intervention for carotid artery revascularization. Medication
Clinical guidelines (such as those of the American Heart Association (AHA) and National Institute for Clinical Excellence (NICE)) recommend that all patients with carotid stenosis be given medications to control their vascular risk factors, usually blood pressure lowering medications (if they have hypertension), diabetes medication (if they have diabetes), and recommend exercise, weight reduction (if overweight) and smoking cessation (for smokers). In addition, they would benefit from anti-platelet medications (such as aspirin or clopidogrel) and cholesterol lowering medication (such as statins, which were originally prescribed for their cholesterol-lowering effects but were also found to reduce inflammation and stabilize plaque).