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ID naloge: 12 Letnik: 1997 Predmet: infekcijske bolezni
Ugotavljanje in analiza morebitnih poznih posledic klopnega meningoencefalitisa
Avtor: Aleš Rozman, Tjaša Šubic
Mentor: prof. dr. Franjo Pikelj
IZHODIŠCA: S klopnim meningoencefalitisom se v Sloveniji srecujemo od druge svetovne vojne naprej. Bolezen glede na število obolelih ni zaskrbljujoca (niha med 5 in 10 primeri na 100000 prebivalcev letno), ce ne bi pušcala posledic na živcevju, kjer je vsako poslabšanje lahko neprijetno in cloveka mocno ovira. V literaturi je malo opisov poznih posledic klopnega meningoencefalitisa, o pozno nastalih posledicah pa se do sedaj, po najinih podatkih, še ni pisalo. Virusu klopnega meningoencefalitisa je po patogenezi in klinicni sliki podoben poliovirus, s katerim sva tudi iskala skupne tocke.
NAMEN: Želela sva preuciti, ce in kaksne posledice pušca klopni meningoencefalitis. Zanimalo naju je tudi, ce se posledice s casom slabšajo in se pojavljajo nove. Dobljene rezultate sva primerjala s spremembami, znacilnimi za postpolio sindrom.
PREISKOVANCI IN METODE DELA: Oblikovala sva tri skupine preiskovancev: prebolevnike izpred desetih let (35 oseb), prebolevnike izpred treh let (168 oseb) ter kontrolno skupino (100 oseb). Podatke sva zbrala z anketo, ki sva jo izdelala v ta namen. Del prebolevnikov sva klinicno pregledala in z dobljenimi podatki skušala ovrednotiti pomen anketne preiskovalne metode.
REZULTATI: V primerjavi skupine prebolevnikov izpred treh let s kontrolno skupino sva ugotovila statisticno pomembno razliko (p<0,005) za simptome: hitrejša utrujenost, pojavljanje dvojnih slik, težave pri izgovorjavi, mravljincenje in nenavadni obcutki na koži, bolecine v sklepih in mišicah, pogostejši glavoboli, težave z zbranostjo, nespecnost in nemiren spanec, depresivnost, razdražljivost, brezvoljnost, pogostejše potenje, obcasno povišana telesna temperatura. V primerjavi skupine prebolevnikov izpred desetih let s kontrolno skupino so statisticno pomembne razlike (p<0,005) pri simptomih: zaletavanje hrane ali sline, pogostejši glavoboli, pogostejše potenje. Meniva, da je velik del teh težav lahko posledica motene homeostaze vegetativnega živcevja. Med skupinama prebolevnikov izpred treh in desetih let prakticno ni statisticno pomembnih razlik.
ZAKLJUCKI: Preboleli klopni meningoencefalitis pušca posledice, med katere z veliko verjetnostjo stejemo tiste, ki so omenjene v rezultatih. Nisva pa mogla prikazati, da se v skupini prebolevnikov klopnega meningoencefalitisa posledice bolezni s casom slabšajo ali da se pojavljajo nove. Domneve o obstoju postpolio sindromu podobnega post-klopno meningoencefaliticnega sindroma nisva mogla podpreti
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[Abstract / English version]
Identification and analysis of possible late sequelae of tick-born meningoencephalitis
Author: Aleš Rozman, Tjaša Šubic
Mentor: prof. dr. Franjo Pikelj
BACKGROUND: Tick-borne meningoencephalitis has been known in Slovenia since World War II. Its incidence is comparatively low, from 5 to 10 cases per 100.000 inhabitants per year. Nevertheless, it is considered a serious health problem since its effects on nervous system may result in permanent disability. The late sequelae of the infection have received little attention in the literature so far, and there have been no reports of further complications appearing after the acute phase of illness. The causative virus closely resembles the poliovirus regarding the pathogenesis and clinical course of the disease. We tried to identify similarities between the two viruses.
AIMS: We wished to determine whether tick-borne meningoencephalitis might be associated with late sequelae. If so, we wanted to know what they are and whether they progress with time, giving rise to additional complications. The results obtained were compared with changes characteristic of the post-poliomyelitis syndrome.
PATIENTS AND METHODS: The study population consisted of 35 patients treated for tick-borne meningoencephalitis 10 years ago, 168 patients treated for the infection 3 years ago and 100 randomly selected subjects who served as controls. Data were gathered with the use of a special questionnaire prepared for study. Some patients were also examined clinically, and the findings were used for assessing the value of the questionnaire-based method.
RESULTS: Comparison of the patients treated 3 years ago with the control group revealed significant differences (p<0.005) for following symptoms and signs: fatigue, double vision. dysarthria, tingling and paraesthesias, joint and muscle pains, frequent headaches, problems with concentration, insomnia and disturbed sleep, depression, irritability, lassitude, increased sweating and intermittent fever. Comparison of the patients treated 10 years ago with the control group showed significant differences (p<0.005) in the occurence of dysphagia, frequent headaches and increased sweating. Most of the problems reported by the patients may be attributed to impaired homeostasis of the vegetative nervous system. No significant differences were found between the two patient groups.
CONCLUSION: In all likelihood the problems experienced by our patients are largely a consequence of tick-borne meningoencephalitis. According to our results, the late sequelae of the disease seem to be stable and additional complications are uncommon. Our study provides no support for the hypothesis that tick-borne meningoencephalitis might give rise to a syndrome resembling the post-poliomyelitis syndrome.
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