Tick-borne encephalitis virus (TBEV)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
First cases described in the literature (2017)
Time to detection: 
17-49 days (from transplantation to encephalitis detection)
Alerting signals, symptoms, evidence of occurrence: 
Three patients (patient 1, liver; patients 2 and 3, kidney) who received solid organ transplants from a single donor developed encephalitis 17-49 days after transplantation and subsequently died (61 - 134 days from transplantation to death). Clinical signs of encephalitis included fever>39 °C, headache, meningeal signs, nystagmus, disarthria, aphasia, paralysis of cranial nerves II and IV and positive Babinski sign.
Demonstration of imputability or root cause: 
Single donor: traumatic head injury following motor accident, only paraffin embedded brain tissue was available for analysis. Solid organ recipients: no history of travel to endemic areas. Cerebrospinal fluid (CSF) was normal in patients 1 and 3 and with moderate increase of cellularity (patient 2). Metagenomics was used as tests for common causes of encephalitis yielded negative results. Although bacterial, viral, fungal and parasitic sequences were found in CSF and brain tissue, TBE virus sequences were the only ones found in samples from the donor and the 3 recipients. TBE specific RT PCR confirmed identification and direct sequencing of amplification products corroborated the presence of the same viral strain. PCR was negative in serum (patients 1 and 3) and tissues (patients 1 and 2).
Imputability grade: 
3 Definite/Certain/Proven
Suggest references: 
Lipowski D, Szablowska M, Perlejewski K, Nakamura S, Bukowska-Ośko I, et al. A Cluster of Fatal Tick-borne Encephalitis Virus Infection in Organ Transplant Setting. J Infect Dis. 2017 Feb 7
Add tick-borne encephalitis virus (TBEV) to the list of viruses (EP)
Expert comments for publication: 
When compared to course of infection in immucompetent individuals, there are some important differences in this first described cluster of organs related transmission of TBE. The same include the prolonged time to presentation, monophasic as opposed to biphasic clinical course, high mortality, the absence of CSF alterations. Outdoors actitivites during the warmer months in endemic areas constitute a potential risk of exposure to TBE.