Tick-borne encephalitis: treatment and prevention
Last reviewed: 23.04.2024
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Medical treatment of tick-borne encephalitis
Etiotropic treatment of tick-borne encephalitis is prescribed to all patients with tick-borne encephalitis, regardless of previous vaccination or use of an antiancephalitic immunoglobulin for prophylactic purposes.
Depending on the form of the disease, immunoglobulin against tick-borne encephalitis is administered intramuscularly in the following doses.
- Patients with a febrile form: daily in a single dose of 0.1 ml / kg, for 3-5 days before the regression of general infectious symptoms (improvement of general condition, disappearance of fever). The course dose for adults is at least 21 ml of the drug.
- Patients with meningeal form: daily in a single dose of 0.1 ml / kg 2 times a day with an interval of 10-12 hours for at least 5 days until the patient's overall condition improves. The average daily dose is 70-130 ml.
- Patients with focal forms: daily in a single dose of 0.1 ml / kg 2-3 times a day at intervals of 8-12 h at least 5-6 days before the temperature decreases and the neurological symptoms stabilize. The average course dose for an adult is not less than 80-150 ml of immunoglobulin.
- In extremely severe disease, a single dose of the drug can be increased to 0.15 ml / kg.
The effectiveness of use in the acute period of interferon alfa-2 preparations and inducers of endogenous interferon has not been studied enough.
Ribonuclease is administered intramuscularly at 30 mg in 4 hours for 5 days.
Nonspecific treatment of tick-borne encephalitis is aimed at combating common intoxication, edema of the brain, intracranial hypertension, bulbar disorders. Recommended dehydrating agents (loop diuretics, mannitol), 5% glucose solution, polyionic solutions; with respiratory disorders - ventilation, oxygen inhalation; to reduce acidosis - 4% solution of sodium bicarbonate. With meningoencephalitic, poliomyelitis and polyradiculoneuritic forms of the disease, glucocorticoids are prescribed. Prednisolone is used in tablets at the rate of 1.5-2 mg / kg per day in equal doses of 4-6 doses for 5-6 days, then gradually reduce the dose by 5 mg every 3 days (course of treatment 10-14 days). With bulbar disorders and disorders of consciousness, prednisolone is administered parenterally. With convulsive syndrome, anticonvulsants are prescribed: phenobarbital, primidone, benzobarbital, valproic acid, diazepam. In severe cases, antibiotic therapy is used to prevent bacterial complications. Apply protease inhibitors: aprotinin. The chronic form of tick-borne encephalitis is difficult to treat, the effectiveness of specific drugs is much lower than in the acute period. Recommend general restorative therapy, glucocorticoids in short courses (up to 2 weeks) from prednisolone at 1.5 mg / kg. Of anticonvulsants with kozhevnikovskoy epilepsy used benzobarbital, phenobarbital, primidon. It is advisable to prescribe vitamins, especially group B, with peripheral paralysis - anticholinesterase drugs (neostigmine methyl sulfate, ambenonium chloride, pyridostigmine bromide).
Additional treatment of tick-borne encephalitis
In an acute period exclude physical activity, balneotherapy, exercise therapy, massive electroprocedures. Sanatorium-and-curative treatment of tick-borne encephalitis is carried out not earlier than 3-6 months after discharge from the hospital in the sanatoriums of the climatic and general strengthening profile.
Mode and diet for tick-borne encephalitis
Strict bed rest is shown, regardless of the general condition and state of health during the entire febrile period and 7 days after the temperature normalization. A special diet is not required (common table). During the feverish period, abundant drinking is recommended: fruit drinks, juices, bicarbonate mineral waters.
Approximate terms of incapacity for work
Patients with febrile and meningeal forms are discharged from the hospital on the 14th-21st day of normal temperature in the absence of meningeal symptoms, patients with focal forms - at a later date, after clinical recovery.
Approximate terms of incapacity for work, taking into account outpatient treatment and rehabilitation, are at a febrile form - 2-3 weeks; meningeal form - 4-5 weeks; meningoencephalitic, polyradiculoneuritic - 1-2 months; poliomyelitic - 1,5-3 months.
Clinical examination
All transferred tick-borne encephalitis, irrespective of the clinical form, are subject to follow-up for 1-3 years. Dispensary patients (with the exception of a febrile form) are co-administered with a neurologist. The basis for removal from dispensary registration is a complete restoration of working capacity, satisfactory state of health, complete sanation of cerebrospinal fluid, absence of focal symptomatology.
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What should the patient know about tick-borne encephalitis?
Patients with tick-borne encephalitis should have an idea of the ways of transmission of the virus, the rules for removing the tick. It is possible to study the tick for the presence of infectious agents. Relatives need to explain the absence of epidemiological danger to others around the patient. The patient is explained by the possibility of progression of the disease and the consequent need for strict adherence to bed rest during the entire febrile period. In the presence of long-term asthenic syndrome, it is necessary to observe the protective regime, adequate nutrition, organization of rest. It is recommended to exclude physical and mental overload. The patient is explained by the necessity of dispensary observation to check the completeness of recovery.
How to prevent tick-borne encephalitis?
Prevention of tick-borne encephalitis is divided into two main groups: nonspecific and specific.
Nonspecific prophylaxis of tick-borne encephalitis
Nonspecific prophylaxis of tick-borne encephalitis is associated with protecting a person from attack by ticks. Public prophylaxis of tick-borne encephalitis is aimed at destroying or reducing the number of ticks. Personal prevention measures include the use of specially selected clothing, the use of various insect repellents, and mutual visits after visiting forests and parks within the city.
Specific prophylaxis of tick-borne encephalitis
Specific prophylaxis of tick-borne encephalitis includes active and passive immunization of the population. Vaccination from tick-borne encephalitis is carried out by tissue culture vaccine (triple grafts) followed by revaccination at 4. 6 and 12 months.
Specific seroprophylaxis is carried out by homologous donor immunoglobulin as pre-exposure (before the expected tick bite, when entering the risk zone), and post-exposure (after tick bite). Immunoglobulin is administered intramuscularly from the calculation of 0.1 ml / kg once a few hours before entering the forest zone or within the first 24 hours after the tick bite. In the next 2-3 days the effectiveness of post-exposure immunoprophylaxis is reduced.
Tick-borne encephalitis is more common in unvaccinated patients, a higher percentage of residual events and lethality. Heavy forms among the ungrafted are 4 times more likely than those vaccinated.