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Volume 25, Number 10—October 2019
Dispatch

Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017–2018

Elisabeth Botelho-NeversComments to Author , Amandine Gagneux-Brunon, Aurelie Velay, Mathilde Guerbois-Galla, Gilda Grard, Claire Bretagne, Alexandra Mailles, Paul O. Verhoeven, Bruno Pozzetto, Sylvie Gonzalo, Samira Fafi-Kremer, Isabelle Leparc-Goffart, and Sylvie Pillet
Author affiliations: University Hospital of Saint-Etienne, Saint-Etienne, France (E. Botelho-Nevers, A. Gagneux-Brunon, P.O. Verhoeven, B. Pozzetto, S. Gonzalo, S. Pillet); Strasbourg University, Strasbourg, France (A. Velay, S. Fafi-Kremer); Aix-Marseille University, Marseille, France (M. Guerbois-Galla, G. Grard, I. Leparc-Goffart); Antoine Béclère Hospital, Clamart, France (C. Bretagne); French National Public Health Agency, Saint-Maurice, France (A. Mailles)

Main Article

Table 1

Characteristics of 3 case-patients with tick-borne encephalitis acquired in the Auvergne-Rhône-Alpes region of France, 2017–2018*

Characteristic Case-patient 1 Case-patient 2 Case-patient 3
Medical history
 Myelofibrosis associated with a JAK 2 mutation, treated with hydroxicarbamide
 None
 Zoster Bell palsy in 1990, arterial hypertension, obesity (BMI 34 kg/m2)
Outdoor activity
Date/duration 2017 Jun 2/2 d 2017 Aug 13–19 All year
Location Allègre region (43270, Haute Loire) Montarcher forest (42380, Loire) Saint-Bonnet-le-Courreau (42940, Loire)
Type
 Hiking for 10 km
 Hiking, camping
 Farming
Tick exposure
 3 nonidentified insect bites on legs and left arm (no eschar, slight erythema at localizations of bites) while hiking
 1 tick bite; tick removed 48 h later
 Yes, frequent
Clinical manifestations
Date of symptom onset 2017 Jun 17 2017 Aug 30 2018 Jul 21
Main clinical signs Headache, left cervicobrachial neuralgia, asthenia, delayed persistent fever (>38.5°C) Low-grade fever (38.5°C), headache, cervical pain, nausea, vomiting Dizziness, headache, fever (38.4°C), unable to lift right shoulder
Physical findings No abnormality Neck stiffness Proximal deficit in right arm; 3 days later, light deficit in right leg, inability to walk because of motor deficit and dizziness
Encephalitis
 No
 No
 Yes
Radiologic findings
 Unremarkable cerebral CT scan
 None
 Unremarkable cerebral CT scan and cerebral MRI
Biological parameters
CSF analysis 2017 Jun 23 2017 Sep 2 2018 Jul 21 (first one)
Leukocytes, cells/mm3 5 62 (50% PMNs) 195 (88% lymphocytes)
Erythrocytes, cells/mm3 2 1 51
Proteinorachia, g/L 0.67 0.48 0.77
Glycorachia/glycemia, mmol/L
 2.98/5.8
 3.4/5.6
 3.18/5.68
Etiologic investigations
 Absence of HSV, VZV, or enterovirus by PCR or RT-PCR; presence of TBEV IgM
 Absence of enterovirus by RT-PCR; presence of TBEV IgM
 Absence of HSV, VZV, or enterovirus by PCR or RT-PCR; presence of Borrelia burgdorferi IgG in CSF; Reiber index <2; presence of TBEV IgM
Blood analyses
 Blood serology negative for Mycoplasma pneumonia, Bartonella henselae, Coxiella burnetii, Legionella pneumophila, HIV, hepatitis B and C viruses, B. burgdorferi (both in serum and CSF); positive for cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, and Chlamydia pneumophila, revealed past immunization
 None
 Blood serology for B. burgdorferi IgG >0; blood serology negative for M. pneumonia, B. henselae, C. burnetii, L. pneumophila, HIV, hepatitis B and C viruses
Treatment
2017 Jun 17: paracetamol; 2017 Jun 19: ceftriaxone 1 g/d + levofloxacin 1 g/d; 2017 Jun 23: treatment stopped
 2017 Feb 17: ceftriaxone 100 mg/kg/d; 2017 Sep 4: ceftriaxone stopped, switched to doxycycline 200 mg/d
 2018 Jul 21: acyclovir 3,000 mg/d amoxicillin 12 g/d; 2018 Jul 27: acyclovir stopped, amoxicillin switched to ceftriaxone 2 g/d for 14 d
Outcome
 Headache and asthenia waned progressively, fever disappeared; discharged 2017 Jun 29
 Discharge 2017 Sep 4
 Discharged 2018 Aug 17 to rehabilitation center because of persistent dizziness and motor deficit in right arm and leg
Follow-up
 Consultation 2017 Jul 27; patient felt good, no headache or fever
 Consultation 2017 Sep 18: complete recovery
 Consultation 2018 Sep 19; patient able to walk alone but always with a slight motor deficit of right arm and leg and dizziness
Sequelae No No Yes

*Case-patient 1, 76-year-old man; case-patient 2, 8-year-old boy; case-patient 3, 66-year-old woman. No patients had been vaccinated against arboviruses. BMI, body mass index; CSF, cerebrospinal fluid; CT, computed tomography; HSV, herpes simplex virus; MRI, magnetic resonance imaging; PMN, polymorphonuclear cell; RT-PCR, reverse transcription PCR; TBEV, tick-borne encephalitis virus; VZV, varicella zoster virus.

Main Article

Page created: September 17, 2019
Page updated: September 17, 2019
Page reviewed: September 17, 2019
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