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The main sequela of disease is paresis, which occurs in up to 10% of Western and up to 25% of Eastern subtype disease Among those with encephalitis, about 25% recover within 2 months In the remaining 40%, either protracted, cognitive

dysfunction or persistent spinal nerve paralysis with or without other postencephalitic symptoms develops The postencephalitic syndrome, characterized by headache, difficulties concentrating, balance disorders, dysphasia, hearing defects, and chronic fatigue, occurs with both subtypes A progressive motor neuron disease may occur with the Eastern subtype

Colorado tick fever is an acute coltivirus infection transmitted by Dermacentor andersoni bites The disease is limited to the western United States and Canada and is most prevalent during the tick season (March to November) There is a discrete history of tick bite or exposure in 90% of cases The virus infects the marrow erythrocyte precursors, leading to viremia lasting the life span of the infected red cells Blood transfusions can be a vehicle of transmission

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The differential diagnosis includes other causes of aseptic meningitis such as enteroviral infections, herpes simplex encephalitis, and a variety of tick-borne pathogens including tularemia, the rickettsial diseases, babesiosis, Lyme disease, poliomyelitis (no longer reported from Eastern Europe) and other flaviviral infections

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The incubation period is 3 6 days The onset is usually abrupt with fever (to 389 406 C), sometimes with chills Severe myalgia, headache, photophobia, anorexia, nausea and vomiting, and generalized weakness are prominent symptoms Physical findings are limited to an occasional faint rash The acute symptoms resolve within a week The remission is followed in 50% of cases by recurrent fever and a full recrudescence lasting 2 4 days In an occasional case there may be three bouts of fever The differential diagnosis includes influenza, Rocky Mountain spotted fever, numerous other viral infections and, in the right setting, relapsing fevers

Prevention is based on vaccination Although a vaccine has not been approved in the United States, a variety of vaccines are in current use, with the most popular and most effective being a formaldehyde-inactivated whole virus vaccine from Austria Alternative effective vaccines have been developed in Germany and Russia The initial vaccination schedule requires 1 year with boosters every 3 years Other prevention recommendations include avoidance of tick exposure, pasteurization of milk, and passive immunization with immunoglobulin within 4 days of exposure (disease exacerbation from exposure to immunoglobulin is not substantiated)

Leukopenia (2000 3000/mcL) with a shift to the left and atypical lymphocytes occurs, reaching a nadir 5 6 days after the onset of illness Thrombocytopenia may occur Viremia may be demonstrated by inoculation of blood into mice or by fluorescent antibody staining of the patient s red cells (with adsorbed virus) Complementfixing antibodies do not appear until the third week of disease but are the most frequently used tool to document an infection An RT-PCR assay may be used to detect viremia

Sometimes you will know you have a collection of a general type for example, a collection of controls but you do not know (or care) about the specific subtype of each control (one may be a button, another a listbox). The important thing is that you know they all inherit shared abilities (such as the Draw method) and that you can treat them all as controls. If you write a programming instruction that tells each control to draw itself, the Draw( ) method is implemented properly on a per-control basis (buttons draw as buttons, listboxes draw as listboxes). You do not need to know how each subtype accomplishes this; you only need to know that each type is defined to be able to draw. Polymorphism allows you to treat a collection of disparate derived types (buttons, listboxes) as a group. You treat the general group of controls the same way, and each individual control does the right thing according to its specific type. 11 provides details and examples.

Therapy is largely supportive Some clinicians believe corticosteroids or other nonsteroidal anti-inflammatory drugs may be useful, although no controlled clinical trials exist

Bratton RL et al Tick-borne disease Am Fam Physician 2005 Jun 15;71(12):2323 30 [PMID: 15999870] Charrel RN Tick-borne virus diseases of human interest in Europe Clin Microbiol Infect 2004 Dec;10(12):1040 55 [PMID: 15606630] Kunze U et al Tick-borne encephalitis in childhood consensus 2004 Wien Med Wochenschr 2004 May;154(9 10):242 5 [PMID: 15244050] Zent O et al Protection against tick-borne encephalitis with a new vaccine formulation free of protein-derived stabilizers J Travel Med 2005 Mar Apr;12(2):85 93 [PMID: 15996453]

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