Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022

Abstract

Purpose: To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE).

Methods: This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified.

Results: Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease.

Conclusion: This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease.

Trial registration: Prosjekt #2,296,959 - The Norwegian Tick-borne Encephalitis Study - NOTES. Acute phase characteristics and long-term outcomes. - Cristin.

Keywords: Clinical characteristics; Encephalitis; Meningitis; Myelitis; TBE; Tick-borne encephalitis.

Fig. 1

Patient enrolment. ^a Confirmed TBE or clinically suspected TBE with or without positive TBEV-IgM. ^b Seventy-seven patients were included during hospitalization and 12 shortly after discharge. Data were obtained from the medical records of 31 patients. Moreover, 33 patients were included at the three- (n = 3), 12- (n = 22) and > 18 (n = 8)-month follow-up visits after TBE hospitalization

Fig. 2

Symptoms and findings stratified by TBE disease severity in the CNS phase. Each bar represents the total percentage of symptoms or objective findings. The colors show the percentages for each severity group: mild, moderate and severe. The following symptoms were recorded as “other symptoms”: diarrhoea n = 27 (18%); dizziness, n = 23 (15%); reduced appetite, n = 23 (15%); diplopia, n = 11 (7%); weight loss > 5 kg, n = 16 (11%); and dysesthesia, n = 15 10%