Tick-borne encephalitis differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Tick-borne encephalitis must be differentiated form other tick-borne diseases as well as infections induced by the different subtypes of tick-borne encephalitis virus (TBEV). TBEV also shares a common disease vector with many other tick-borne diseases, therefore a healthcare provider must recognize the potential for multiple co-infections. Found below are tables outlining the clinical manifestations of TBEV subtypes as well as commonly transmitted tick-borne diseases.
Tick-borne encephalitis must be differentiated form other tick-borne diseases as well as infections induced by the different subtypes of tick-borne encephalitis virus (TBEV). TBEV also shares a common [[disease]] [[vector]] with many other [[tick-borne disease]]s, therefore a healthcare provider must recognize the potential for multiple co-infections. Found below are tables outlining the clinical manifestations of TBEV subtypes as well as commonly transmitted tick-borne diseases.


==Differentiating between infections among TBEV subtypes==
==Differentiating between infections among TBEV subtypes==
*Three subtypes of tick-borne encephalitis are commonly responsible for infection. These subtypes and their specific clinical manifestations are outlined in the table below:
*Three subtypes of tick-borne encephalitis are commonly responsible for [[infection]]. These subtypes and their specific clinical manifestations are outlined in the table below:


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| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Siberian'' <ref name= "Enceph Prime"> Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Siberian''<ref name="Enceph Prime">Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
*May persist as a chronic disease.   
*May persist as a [[chronic]] disease.   
*5% of cases present in focal encephalitic forms  
*Less [[Encephalitis overview|focal encephalitic]] forms  
*47% present in meningeal forms
*Majority of cases present in [[meningeal]] forms  
*40% present in febrile forms
*May present itself as [[biphasic]].  
*21% present in a biphasic form.
*Fatality is apporxiamtely 2%, with continuous complications and a potentially chronic condition.  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Far Eastern'' <ref name= "Enceph Prime"> Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Far Eastern''<ref name="Enceph Prime">Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
*31-64% of cases present in focal encephalitic forms.  
*Commonly present in focal encephalitic forms.  
*26% present in meningeal forms
*Less [[meningeal]] forms
*14-16% present in febrile forms
*Rarely in biphasic form
*3-8% present in biphasic forms
*25% of cases recover fully
*Fatality is approximately 35% and chronic disease develops is an estimated 0.5% of patients.
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''European'' <ref name= "Enceph Prime"> Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''European''<ref name="Enceph Prime">Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016. </ref>
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| style="background: #DCDCDC; padding: 5px;" |
*72-87% experience a biphasic illness. The first phase includes an onset of non-specific flu like symptoms. Following phase one is a remission period of approximately 8 days, during which phase most patients will appear asymptomatic. Further neurological manifestations will appear in phase two.
*Commonly a biphasic illness.  
*20-30% of patients will progress in to phase two.  
*Clinical characteristic features of the second stage include meningitis, meningoencephalitis, meningoencephalomyelitis, and meningoencephaloradiculitis.  
*Clinical characteristic features of the second stage include meningitis, meningoencephalitis, meningoencephalomyelitis, and meningoencephaloradiculitis.  
*Fatality occurs in less than 2% of cases.
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==Differentiating between tick-borne encephalitis and other tick-borne diseases==
==Differentiating between tick-borne encephalitis and other tick-borne diseases==
*Disease vectors responsible for the transmission of tick-borne encephalitis are commonly carriers of other tick-borne diseases. Therefore due to this common disease vector, a healthcare provider must recognize all potential co-infections. A healthcare provider must also be able to distinguish between the different tick-borne diseases and TBEV. Found below is a table of tick-borne diseases, including TBEV, and their typical clinical manifestations.  
*Disease vectors responsible for the transmission of tick-borne encephalitis are commonly carriers of other [[tick-borne disease]]s. Therefore due to this common disease vector, a healthcare provider must recognize all potential co-infections. A healthcare provider must also be able to distinguish between the different tick-borne diseases and TBEV. Found below is a table of tick-borne diseases, including TBEV, and their typical clinical manifestations.  


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! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Symptoms}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Symptoms}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Tick-borne meningoencephalitis''' <ref name="TBE CDC”">General Disease Information (TBE). Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Tick-borne meningoencephalitis'''<ref name="TBE CDC”">General Disease Information (TBE). Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.  
| style="background: #DCDCDC; padding: 5px;" | Early Phase: Non-specific symptoms including [[fever]], [[malaise]], [[anorexia]], [[muscle pains]], [[headaches]], [[nausea]], and [[vomiting]]. Second Phase: [[Meningitis]] symptoms, [[headache]], stiff neck, [[encephalitis]], [[drowsiness]], sensory disturbances, and potential [[paralysis]].  
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Bacterial Infection'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Bacterial Infection'''}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Borreliosis (Lyme Disease)'' <ref name="Lyme CDC”">Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Borreliosis (Lyme Disease)''<ref name="Lyme CDC”">Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
| style="background: #DCDCDC; padding: 5px;" |Flu-like illness, [[fatigue]], [[fever]], [[arthritis]], neuroborreliosis, [[cranial nerve palsy]], carditis and erythema migrans.
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Relapsing Fever'' <ref name="TBRF CDC”">Relapsing Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Relapsing Fever''<ref name="TBRF CDC”">Relapsing Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
| style="background: #DCDCDC; padding: 5px;" |Consistently documented high fevers, flu-like illness, [[headaches]], muscular soreness or joint pain, altered mental state, painful urination, [[rash]], and rigors.
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever''
| style="background: #DCDCDC; padding: 5px;" | Fever, alterations in mental state, myalgia, rash, and headaches.
| style="background: #DCDCDC; padding: 5px;" | [[Fever]], alterations in mental state, [[myalgia]], [[rash]], and [[headaches]].
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever'' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever''<ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
| style="background: #DCDCDC; padding: 5px;" | Rash: spotted, red dots. Respiratory symptoms ([[dyspnea]], cough), muscle pain, and headaches.
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis'' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis''<ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).  
| style="background: #DCDCDC; padding: 5px;" | Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Tularemia'' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Tularemia''<ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.  
| style="background: #DCDCDC; padding: 5px;" | [[Ulceroglandular]], [[Glandular]], [[Oculoglandular]], [[Oroglandular]], [[Pneumonic]], [[Typhoidal]].  
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Viral Infection'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Viral Infection'''}}
|-  
|-  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Colorado Tick Fever <ref name="GenTickDis CDC”">General Tick Deisease Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Colorado Tick Fever<ref name="GenTickDis CDC”">General Tick Deisease Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.  
| style="background: #DCDCDC; padding: 5px;" |Common symptoms include [[fever]], [[chills]], [[headache]], body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A [[biphasic]] fever is a hallmark of [[Colorado Tick Fever]] and presents itself in nearly 50% of infected patients.  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Crimean-Congo Hemorrhagic Fever
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Crimean-Congo Hemorrhagic Fever
| style="background: #DCDCDC; padding: 5px;" |Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.  
| style="background: #DCDCDC; padding: 5px;" |Initially infected patients will likely feel a few of the following symptoms; [[headache]], high [[fever]], back and joint pain, stomach pain, [[vomiting]], flushed face, red throat, [[petechiae]] of the palate, and potentially changes in mood as well as sensory perception.  
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Protozoan Infection'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Protozoan Infection'''}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Babesiosis <ref name="Babesiosis CDC”">Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Babesiosis<ref name="Babesiosis CDC”">Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.</ref>
| style="background: #DCDCDC; padding: 5px;" |Non-specific flu like symptoms.
| style="background: #DCDCDC; padding: 5px;" |Non-specific flu like symptoms.
|}
|}
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Infectious Disease]]

Latest revision as of 21:53, 9 March 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

Tick-borne encephalitis must be differentiated form other tick-borne diseases as well as infections induced by the different subtypes of tick-borne encephalitis virus (TBEV). TBEV also shares a common disease vector with many other tick-borne diseases, therefore a healthcare provider must recognize the potential for multiple co-infections. Found below are tables outlining the clinical manifestations of TBEV subtypes as well as commonly transmitted tick-borne diseases.

Differentiating between infections among TBEV subtypes

  • Three subtypes of tick-borne encephalitis are commonly responsible for infection. These subtypes and their specific clinical manifestations are outlined in the table below:
Subtype Clinical manifestations
Siberian[1]
Far Eastern[1]
  • Commonly present in focal encephalitic forms.
  • Less meningeal forms
  • Rarely in biphasic form
European[1]
  • Commonly a biphasic illness.
  • Clinical characteristic features of the second stage include meningitis, meningoencephalitis, meningoencephalomyelitis, and meningoencephaloradiculitis.

Differentiating between tick-borne encephalitis and other tick-borne diseases

  • Disease vectors responsible for the transmission of tick-borne encephalitis are commonly carriers of other tick-borne diseases. Therefore due to this common disease vector, a healthcare provider must recognize all potential co-infections. A healthcare provider must also be able to distinguish between the different tick-borne diseases and TBEV. Found below is a table of tick-borne diseases, including TBEV, and their typical clinical manifestations.
Disease Symptoms
Tick-borne meningoencephalitis[2] Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Bacterial Infection
Borreliosis (Lyme Disease)[3] Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
Relapsing Fever[4] Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
Typhus (Rickettsia)
Rocky Mountain Spotted Fever Fever, alterations in mental state, myalgia, rash, and headaches.
Helvetica Spotted Fever[5] Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis Anaplasmosis[6] Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia[7] Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.
Viral Infection
Colorado Tick Fever[8] Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat, petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis[9] Non-specific flu like symptoms.

References

  1. ↑ 1.0 1.1 1.2 Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016.
  2. ↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
  3. ↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
  4. ↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
  5. ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
  6. ↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
  7. ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
  8. ↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
  9. ↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
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