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Aktuelle Neurologie 2017; 44(03): 161-169
DOI: 10.1055/s-0043-101424
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

Frühsommer-Meningoenzephalitis (FSME)[*]

Tick-Borne Encephalitis
Reinhard Kaiser
1   Neurologische Klinik, Klinikum Pforzheim
,
Juan-Jose Archelos-Garcia
2   Klinische Abteilung für allgemeine Neurologie, Universitätsklinik Graz, Österreich
,
Wolfgang Jilg
3   Institut für Med. Mikrobiologie und Hygiene, Universität Regensburg
,
Sebastian Rauer
4   Neurologische Klinik, Universität Freiburg
,
Mathias Sturzenegger
5   Neurologische Universitätsklinik, Inselspital, Bern, Schweiz
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
25. April 2017 (online)

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Zusammenfassung

Die Frühsommer-Meningoenzephalitis (FSME) ist eine durch ein gleichnamiges Virus verursachte akute Entzündung des Nervensystems. Reservoir für die FSME-Viren sind Kleintiernager des Waldes und der Wiesen und selten auch Ziegen, was die räumliche Begrenzung von Endemiegebieten erklärt („Naturherde“). Die FSME-Viren werden hauptsächlich durch Zecken übertragen, gelegentlich aber auch durch Produkte aus nicht pasteurisierter Ziegenmilch. Infektionen können das gesamte Jahr über erfolgen, die meisten Erkrankungen treten jedoch in den Hochsommermonaten auf. Mehr als 90 % der Infektionen erfolgen während der Freizeit. Dennoch ist die FSME eine typische Berufserkrankung von Land- und Forstwirten. Bei ca. 70 % der Patienten manifestiert sich die FSME mit einem zweigipfligen Fieberverlauf.

Nach einer Inkubationszeit von 5 – 28 Tagen entwickeln die Patienten zunächst ein allgemeines Krankheitsgefühl, Kopfschmerzen und Fieber (Prodromalphase). Nach vorübergehender Besserung markiert dann ein erneuter Fieberanstieg wenige Tage später den Beginn der zweiten Krankheitsphase. Diese manifestiert sich in ca. 50 % der Fälle als isolierte Meningitis, in 40 % als Meningoenzephalitis und in 10 % als Meningoenzephalomyelitis. Häufig finden sich quantitative und qualitative Bewusstseinsstörungen und eine Ataxie. Das frühzeitige Auftreten von Schluck- und Sprechstörungen, Lähmungen der Gesichts- und Halsmuskulatur sowie einer Atemlähmung weist auf eine ungünstige Prognose hin. Die FSME verläuft bei Kindern und Jugendlichen häufig unspezifisch mit den Symptomen eines grippalen Infektes und somit gutartiger als bei Erwachsenen. Mit zunehmendem Alter ist nicht nur der Verlauf gravierender, auch steigt die Zahl der Defektheilungen.

Die Diagnose basiert auf der Anamnese mit Aufenthalten in einem Risikogebiet, der neurologischen Symptomatik mit deutlicher Beeinträchtigung des Allgemeinbefindens, dem positiven Nachweis von FSME-spezifischen IgM- und IgG-Antikörpern im Blut und einer Pleozytose im Liquor. Es existiert keine kausale Therapie, die Behandlung erfolgt symptomatisch. Vor der Erkrankung kann man sich durch eine aktive Immunisierung gut schützen. Die Impfung wird allen Personen empfohlen, die sich wiederholt in einem Risikogebiet aufhalten.

Abstract

Tick-borne encephalitis (TBE) is an acute inflammation of the nervous system caused by a virus of the same name. Reservoirs for the TBE viruses are small rodents of the forest and meadows and rarely also goats, which explains the spatial limitation to endemic areas (“natural foci”). TBE virus is transmitted mainly by ticks, but occasionally also by products from non-pasteurized goatʼs milk. Infections can occur throughout the year, but most of the diseases present during the high summer months.

More than 90 % of infections occur during leisure time. However, it is a typical occupational disease for farmers and foresters. In approximately 70 % of the patients, TBE manifests itself with a two-phase fever course. After an incubation period of 5 – 28 days, the patients first develop a general feeling of illness, headaches and fever (prodromal phase). After a temporary improvement, a new episode of fever marks the beginning of the second phase of the disease a few days later. This is manifested in about 50 % of the cases as isolated meningitis, in 40 % as meningoencephalitis and in 10 % as meningoencephalomyelitis. Frequently, there are quantitative and qualitative disturbances of consciousness and ataxia. The early onset of swallowing and speech disturbances, paralysis of the facial and throat muscles as well as the need for assisted ventilation indicates an unfavorable prognosis. In children and adolescents, TBE is often unspecific with the symptoms of a flu infection and thus more benign than in adults. With age, not only the course is more serious, but also the number of residual deficits increases.

The diagnosis is based on history with stays in a risk area, the neurological symptoms with marked impairment of the general condition, the demonstration of TBE-specific IgM and IgG antibodies in the blood and a pleocytosis in the CSF. No specific treatment for TBE is known so far, but TBE can be successfully prevented by active immunization. Vaccination is recommended for all persons who stay repeatedly in a risk area.

Schlüsselwörter

FSME - Frühsommer-Meningoenzephalitis - Meningitis - Encephalitis - Myelitis - Impfung

Key words

TBE - Tick-borne encephalitis - Meningitis - Encephalitis - Myelitis - Vaccin

* Den Leitlinientext zusammen mit der Interessenkonflikterklärung finden Sie auch auf www.dgn.org/leitlinien sowie www.awmf.de Frühsommer-Meningoenzephalitis.


 

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