Sunday, August 19, 2018

PRO/AH/EDR> Tick-borne encephalitis - UK: (England) louping ill susp

TICK-BORNE ENCEPHALITIS - UNITED KINGDOM: (ENGLAND) LOUPING ILL
SUSPECTED
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Date: Thu 16 Aug 2018
Source: iNews [edited]
<https://inews.co.uk/news/health/dog-walker-meningitis-tick-borne-illness-bitten-in-uk/>


A dog walker developed life-threatening meningitis after he was bitten
by a tick which he believes happened in the UK.

[TV], from the Lake District, was rushed to hospital with an extreme
headache and near paralysis of his limbs. Doctors diagnosed him with
tick-borne encephalitis (TBE), a potentially fatal infection spread by
tick bites found in woodland habitats.

Officials say the disease is not found in the UK, but there's risk of
getting it in other parts of Europe -- where it is endemic in 27
countries -- and Asia.

The 33-year-old had travelled to Sardinia before he got ill --
however, doctors were left baffled because TBE typically emerges 1 to
2 weeks after a bite and [the man] only became symptomatic 6 weeks
after his trip, raising the possibility he caught the disease after a
bite in the UK. If so, this would make him the 1st such case in the
UK.

There have been fears TBE could become a problem here after vets
previously warned British pets are catching deadly diseases from
foreign ticks after travelling to Europe on pet passports.

The sous-chef, who lives in Ambleside, said: "In Sardinia we were on
the coast. I was never in an environment where I would come into
contact with ticks. In England, I've been exposed to them almost daily
by taking my dog out. "I can't say with 100 per cent certainty, but
I'd be amazed if the TBE hasn't been contracted here in the UK."

An expert has told iNews that one possible diagnosis for [the patient]
could be louping ill, a tick-borne TBE-like illness that is found in
the UK. The viral infection of the central nervous system (brain and
spinal cord) affects sheep and grouse in the UK and has been found in
humans, although this is very rare. A 2014 research paper reports
there have been 45 people who've had it and Public Health England
confirmed it has seen just 2 laboratory-confirmed human cases in the
UK since 2010.

[The man] visited Sardinia in the 2nd week of May [2018], and became
suddenly ill in the middle of June. "I started experiencing extreme
lethargy and headaches," he said. "The pain felt like my eyes were on
fire, as if they'd been replaced by 2 pieces of red-hot charcoal,
melting my sockets."

He also suffered a stiff neck and extreme light sensitivity. After
being sent away by his GP with paracetamol and ibuprofen, he was taken
to A&E when his symptoms deteriorated. "At this point I couldn't move
my eyes and it felt like my body was paralysing," he explained.

[TV] who originally hails from Hungary, was treated with antibiotics.
Because he'd returned from a holiday to Africa (where TBE is not
reported) in February this year [2018], he was kept in isolation for 6
days, with hospital medics fearing he had a contagious tropical
disease.

Doctors also considered and tested him for HIV. But following a
battery of tests -- including lumbar puncture, CT scan, X-ray and
blood tests -- he was diagnosed with TBE, which often manifests as
meningitis (inflammation of the meninges, the membranes that surround
the brain and spinal cord) or encephalitis (inflammation of the brain
itself), or both.

The initial symptoms of TBE usually occur 1-2 weeks after a tick bite
and include fever, headache, and general flu-like illness followed by
2-10 days of no symptoms, before inflammation of the central nervous
system occurs with fever, headache, and signs of meningitis and/or
brain inflammation. An incubation of up to 28 days has been described,
according to European Centre for Disease Prevention and Control
(ECDC).

TBE is endemic in many parts of Europe, as well as Russia, northern
China, and Japan.

The number of human cases in Europe has increased by almost 400
percent in the last 30 years, according to ECDC. It is predicted that
the areas affected will grow due to global warming.

But so far, "TBE virus has never been present in the UK; the cases of
TBE in the UK are those who travelled in the endemic areas," said
Professor Tom Solomon, chair of neurological science from the
University of Liverpool.

But veterinary surgeon Iain Booth, from vetuk.co.uk, is warning pet
owners in particular to be vigilant. He said: "More and more vets are
reporting increased numbers of parasites in the UK, including ticks
and tick-borne diseases. "One possible reason for the rise is the fact
more dogs have pet passports to travel in Europe, as well as an
increase in dogs being imported to the UK from rescue centres abroad.
"We already know that new pathogens, such as _Babesia canis_, have
manifested in existing UK tick populations.

Meanwhile infestations of brand new ticks - such as _Rhipicephalus
sanguineus_ - have also been reported in the UK. "It was always the
fear that tick-borne encephalitis could enter the UK and infect ticks
here."

He urged people to avoid being bitten by wearing trousers and long
sleeves and get into the habit of checking yourself and pets for
ticks.

[Mr TV] says he he's been bitten by a tick in the Lakes last year
[2017] and his exposure to them here is high. He said: "I've recently
been spending a prolonged period of time on the fells as I've been
attempting to 'bag' all 214 of the Lakeland fells documented by famous
fell walker Alfred Wainwright. "My girlfriend also goes fell running
with the dog and we often find them crawling on the dog. "We have a
lot of ticks here in the Lake district. They're a common sight for me,
so much so that I end up picking them off the dog once a week. The dog
often sleeps in our bed, too. "I'm 95 percent recovered now, I get the
odd shock-like sensation in my head but it's been a scary
experience."

Dr Nick Beeching, senior lecturer in clinical infectious diseases at
Liverpool School of Tropical Medicine, said TBE and louping ill virus
(LIV) are 2 closely related tick-borne viruses. He said: "There are
rare cases of louping ill in the UK, which is the UK variant of TBE.

TBE is common in central Europe and is an underestimated risk for
those going into forest areas. It is transmitted by tick bites and/or
drinking unpasteurised milk. "Cases have been rising in these
countries so much that Switzerland, for example, is considering
introduction of universal immunisation for the whole population,
similar to Austria.

"A few cases are imported to the UK each year by returning visitors
and tourists. It is often a severe illness which can cause long-term
brain damage and people visiting these areas, especially if hiking and
similar activities, should consider being vaccinated against it and
taking measures to reduce risk of tick bites. Louping ill is generally
regarded as a much milder version of TBE."

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Louping ill (LIV) virus seems the most likely etiological agent
involved in this encephalitis case. LIV is present in the UK and can
cause encephalitis in humans. Tick-borne encephalitis virus, although
a frequent cause of encephalitis in humans in Europe, has never been
detected in the UK.

Louping ill virus (LIV) is a tick-borne flavivirus that is part of the
tick-borne encephalitis complex of viruses (TBEV). LIV has economic
importance by causing illness and death in livestock, especially sheep
(_Ovis aries_), and red grouse (_Lagopus lagopus scoticus_) an
economically valuable gamebird. The virus occurs predominantly in
upland areas of the UK and Ireland. This distribution is closely
associated with the presence of its arthropod vector, the hard tick
_Ixodes ricinus_.

Louping ill references
----------------------
1. Jeffries CL, Mansfield KL, Phipps LP, et al. Louping ill virus: an
endemic tick-borne disease of Great Britain. J Gen Virol. 2014; 95(Pt
5): 1005-14. doi: 10.1099/vir.0.062356-0. Epub 2014 Feb 19; available
at
<http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/vir.0.062356-0#tab2>.
2. Gilbert L. Louping ill virus in the UK: a review of the hosts,
transmission and ecological consequences of control. Exp Appl Acarol.
2016; 68(3): 363-74. doi: 10.1007/s10493-015-9952-x. Epub 2015 Jul 24;
abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/26205612>.

The advice to wear light-colored clothing to more easily see ticks,
use repellants, tuck pantlegs into socks, and carefully inspect
oneself and one's dogs for ticks after being outdoors is prudent to
avoid bites of ticks and the pathogens that they can transmit. -
Mod.TY

HealthMap/ProMED-mail map of Lake District, England, UK:
<http://healthmap.org/promed/p/64469>]

[See Also:
2009
---
Louping ill - UK: vaccination
http://promedmail.org/post/20090420.1492
2001
---
Tick-borne disease - UK: increased risk (02)
http://promedmail.org/post/20010703.1272
1999
---
Encephalitis, tick-borne, alert - Russian Far East
http://promedmail.org/post/19990506.0745
1995
---
Louping ill virus, grouse chicks: Arbovirus Info Exchange (5)
http://promedmail.org/post/19951128.1144]
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