Tick-borne encephalitis: a case with fatal outcome

The first lethal case of Tick-borne encephalitis (TBE) to be registered in Italy occurred in 2006 in Friuli Venezia Giulia, an Italian region at the border between Austria and Slovenia. The case involved a 72-year-old woman, who had not received a preventive vaccination against TBE. She lived in the same area where the disease was first reported in 2003. It was the epidemiological data, supported by the clinical picture that first raised suspicion of a TBE infection. The infection was subsequently confirmed by the serological tests on serum and cerebrospinal fluid (CSF). The same investigations also showed some characteristic alterations in certain blood chemical parameters (thrombocytopenia and transaminase increase) as well as onset of anemia, which has been observed in other cases of TBE with fatal outcome. During the first 24 hours of hospitalization, the course of the disease was characterized by rapid and progressive worsening of the clinical situation, which determined the irreversible development of tetraparesis, coma, and severe respiratory insufficiency. Death occurred on day 32 because of respiratory complications. X-rays performed during hospitalization and autopsy showed no lesion of brain, cervical spine, and spinal cord directly related to TBE. The potential severity of TBEV infection confirms the need to raise awareness on the necessity of vaccinal prophylaxis for people living in or frequenting at-risk areas.