Tick-Borne Encephalitis in Pregnant Woman and Long-Term Sequelae

Abstract

We report a case of severe tick-borne encephalitis in a pregnant woman, leading to a prolonged stay in the intensive care unit. She showed minor clinical improvement >6 months after her presumed infection. The patient was not vaccinated, although an effective vaccine is available and not contraindicated during pregnancy.

Keywords: France; Germany; TBEV; intensive care; long-term sequelae; meningitis/encephalitis; pregnant woman; tick-borne encephalitis; tick-borne encephalitis virus; ticks; viruses; zoonoses.

Figure

Tick-borne encephalitis in pregnant woman and long-term sequelae showing relevant clinical and laboratory findings, including TBEV antibody kinetics in serum samples. TBEV IgM (blue curve) and IgG (red curve) were detected in serum samples by using the Serion ELISA Classic TBE Virus IgG/IgM Kit (https://www.serion-immunologics.com) according to the manufacturer’s instructions. Results are expressed in arbitrary units (AU) per milliliter, with a positive threshold of 15 AU/mL for IgM (blue dot-dash line) and 150 AU/mL for IgG (red dot-dash line). Green arrows indicate clinical findings; black circles indicate timing of MRIs; purple arrows indicate TBE real-time RT-PCR performed for CSF, with the Ct value for a positive result. An in-house RT-PCR for TBEV nucleic acid was performed on CSF samples. Primer and probe sequences targeted the 3′-untranslated region of the viral genome as described by Cassinoti and Swchaiger (2). A positive control, a negative control, and an internal control were included to monitor overall efficiency of the RT-PCR. CSF, cerebrospinal fluid; Ct, cycle threshold; D, day after admission; M, month after admission; MRI, magnetic resonance imaging; RT-PCR, reverse transcription-PCR; TBEV, tick-borne encephalitis virus.