Kleszczowe zapalenie mózgu – najważniejsze fakty, które warto znać
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Większość z nas kleszcze przerażają. Kontakt z nimi to nic przyjemnego, w dodatku są niebezpieczne dla nas, naszych bliskich oraz naszych pupili, głównie psów. W dodatku część z nich roznosi boreliozę oraz kleszczowe zapalenie mózgu. I właśnie o tej drugiej chorobie jest poniższy tekst.
Wraz z nowym sezonem na kleszcze wielu z nas zetknęło się już bądź zetknie z tymi groźnymi pajęczakami i roznoszonymi przez nie chorobami. Jedną z potencjalnie najbardziej niebezpiecznych jest kleszczowe zapalenie mózgu (KZM), którego częstość występowania w Polsce jest zdaniem ekspertów niedoszacowana. Dowiedz się, po czym można tę chorobę rozpoznać, jak duże wiąże się z nią ryzyko wystąpienia trwałych powikłań neurologicznych i jak można jej zapobiegać.
Pierwsze objawy kleszczowego zapalenia mózgu pojawiają się zwykle w ciągu dwóch tygodni od ukąszenia przez zakażonego kleszcza. Niestety, można w ogóle nie zwrócić na nie uwagi lub też je zlekceważyć, gdyż często są one łagodne i dość mało specyficzne – wskazujące np. na „zwykłe” przeziębienie czy grypę. Należą do nich m.in.:
- bóle głowy
- gorączka,
- nudności i wymioty,
- bóle mięśni i stawów,
- nieżyt górnych dróg oddechowych.
„W przypadku, gdy wirusy przedostaną się do ośrodkowego układu nerwowego, po krótkim okresie od ustąpienia objawów zakażenia, może się rozwinąć druga faza choroby z objawami zapalenia rdzenia kręgowego i opon mózgowo-rdzeniowych lub zapalenia mózgu i opon mózgowo-rdzeniowych. W większości przypadków kleszczowe zapalenie mózgu przebiega łagodnie, jednak mogą wystąpić powikłania powodujące trwałe następstwa” – ostrzegają specjaliści z Narodowego Instytutu Zdrowia Publicznego-Państwowego Zakładu Higieny (NIZP-PZH).
Jakie objawy mogą wskazywać na rozwój drugiej fazy KZM?
Warto wiedzieć, że pierwsza faza zakażenia trwa zwykle 1-9 dni. Po niej część chorych wraca do zdrowia, jednak u niektórych osób, po krótkim, kilkudniowym okresie remisji, może rozwinąć się druga, groźniejsza faza choroby – związana z przedostaniem się wirusów KZM do układu nerwowego. Może ona trwać wiele tygodni, a nawet miesięcy, manifestując się takimi objawami jak np.:
- nagły skok gorączki (ok. 40 stopni),
- zmiana nastroju,
- nękające bóle i zawroty głowy,
- światłowstręt, oczopląs, widzenie podwójne,
- niedosłuch,
- spadek ciśnienia krwi,
- niedowłady,
- zaburzenia świadomości.
Na tym niestety nie koniec. W efekcie zajęcia ośrodkowego układu nerwowego przez wirusa może dojść u chorych do wielu groźnych powikłań, do których należą m.in.: porażenia nerwów rdzeniowych i czaszkowych, zaburzenia czucia, porażenia kończyn, zaburzenia procesów poznawczych (m.in. uwagi, pamięci, kojarzenia), zaburzenia psychiczne (np. zespoły depresyjne, neurasteniczne, charakteropatie), a także zaburzenia wegetatywne (pobudliwość nerwowa, męczliwość, wybuchowość, zmienność nastrojów, potliwość).
Ciężki przebieg infekcji
Pocieszający jest jednak fakt, że do bardzo ciężkiego przebiegu infekcji i wspomnianych wyżej powikłań dochodzi u relatywnie niedużego odsetka ogółu osób zakażonych wirusem KZM. Maciej Kondrusik z Kliniki Chorób Zakaźnych i Neuroinfekcji Uniwersytetu Medycznego w Białymstoku podaje, że zakażenia objawowe stanowią maksymalnie 30 proc. wszystkich zakażeń wirusem KZM. Podobnie ocenia tę kwestię NIZP-PZH, który w swoim najnowszym raporcie epidemiologicznym dotyczącym KZM informuje ponadto, że w grupie osób z objawowym przebiegiem zakażenia „jedynie” w około 40 proc. przypadków dochodzi do rozwoju objawów drugiej fazy (z zajęciem ośrodkowego układu nerwowego). Nawet jednak i na tym etapie mamy wciąż spore szanse na wyjście z opresji obronną ręką.
„Do trwałych powikłań neurologicznych dochodzi u 35–58 proc. chorych z zajęciem ośrodkowego układu nerwowego, a u około 1/100 chorych zakażenie kończy się zgonem” – czytamy w fachowym opracowaniu na temat KZM dostępnym na stronie „Szczepienia Info”.
Zatem zdecydowana większość zakażeń wirusem KZM ma przebieg bezobjawowy, skąpoobjawowy lub łagodny, podobnie jak w przypadku zakażeń nowym koronawirusem.
„Objawowe zakażenia stwierdza się najczęściej u osób powyżej 20. roku życia. Ciężkość przebiegu choroby wzrasta z wiekiem. Młodzież i dorośli chorują ciężej niż małe dzieci. Im człowiek jest starszy tym częściej występują powikłania i przypadki śmiertelne. Wśród chorych przeważają mężczyźni” – informują eksperci NIZP-PZH.
Nie tylko kleszcze!
Zdecydowana większość zachorowań na Kleszczowe zapalenie mózgu rozwija się wskutek pokąsania przez kleszcze zakażone wirusami KZM (są to wirusy RNA, z rodziny Flaviviridae – czyli flawiwirusy). Warto jednak wiedzieć, że są też inne możliwe drogi zakażenia wirusem KZM: np. wypicie niepasteryzowanego mleka (zwłaszcza koziego) lub transfuzja krwi czy przeszczep narządów od dawcy, który był nim zakażony.
Zapobieganie, diagnozowanie i leczenie KZM
Choć powyższe statystyki dają pewne powody do optymizmu, to jednak w praktyce nikt rozsądny nie powinien lekceważyć ryzyka związanego z potencjalnym zakażeniem KZM. Na szczęście można się przed nim dobrze zabezpieczyć.
„Jedynym skutecznym sposobem zapobiegania kleszczowemu zapaleniu mózgu i jego następstwom są szczepienia ochronne. Można je rozpocząć w dowolnej porze roku, jednak najlepiej zrobić to zimą lub wiosną” – przypomina Ministerstwo Zdrowia, wskazując na konkretne grupy społeczne, którym takie szczepienie jest szczególnie zalecane (m.in. rolnikom, leśnikom, pracownikom służb mundurowych, ale także i uczestnikom letnich obozów czy kolonii, zwłaszcza na terenach znanych z dużej liczby kleszczy).
„Szczepionki przeciw kleszczowemu zapaleniu mózgu cechuje wysoka skuteczność – na 100 szczepionych powyżej 95 osób wytwarza przeciwciała ochronne zabezpieczające przed powikłaniami” – czytamy na stronie „Szczepienia Info”.
Warto jeszcze dodać, że aby uzyskać silną i trwałą odporność szczepienia przeciw KZM realizowane są poprzez podanie kilku dawek szczepionki w odpowiednich odstępach czasowych (dawek podstawowych i przypominających).
Inne środki zapobiegawcze, takie jak stosowanie repelentów (środków odstraszających kleszcze), odpowiedniej odzieży czy też unikanie miejsc, w których najczęściej występują kleszcze (takich jak gęste zarośla w lasach lub na ich obrzeżach, wysokie trawy) również są polecane przez medyków, choć nie gwarantują już tak wysokiego stopnia ochrony jak szczepienia.
W kontekście KZM warto jeszcze wiedzieć, że tak naprawdę nie istnieje leczenie przyczynowe tej choroby.
Leczenie jest wyłącznie objawowe
„Leczenie jest wyłącznie objawowe” – podkreślają eksperci NIZP-PZH.
W praktyce zatem, jeśli ktoś chce się ustrzec groźnych powikłań tej choroby, to nie może za bardzo liczyć na leki. Wysoką skuteczność ochrony zapewnić można sobie jedynie poprzez szczepienie – zgodnie podkreślają lekarze.
Warto jeszcze w kontekście KZM dodać, że w związku z brakiem objawów odróżniających kleszczowe zapalenie mózgu (KZM) od innych neuroinfekcji wirusowych, rozpoznanie tej choroby wymaga potwierdzenia laboratoryjnego.
„Podstawą potwierdzenia laboratoryjnego zachorowania na kleszczowe zapalenie mózgu jest wykrycie swoistych przeciwciał w surowicy i/lub płynie mózgowo-rdzeniowym” – informują eksperci NIZP-PZH, wskazując też konkretnie, jakiego rodzaju testy są aktualnie najczęściej używane do rozpoznawania zakażenia KZM (są to m.in. swoiste testy immunoenzymatyczne – ELISA, testy immunofluorescencji pośredniej oraz testy zahamowania hemaglutynacji).
Występowanie KZM w Polsce i Europie
Na koniec warto przytoczyć jeszcze najnowsze dane epidemiologiczne na temat występowania KZM w naszym kraju.
„W Polsce rejestruje się 200-300 zachorowań rocznie. Od wielu lat zachorowania ograniczone są do ok. 30 proc. obszaru Polski. Tereny endemiczne znajdują się głównie w województwach: podlaskim oraz warmińsko-mazurskim i pokrywają się z najwyższą liczbą przypadków KZM – odpowiednio ok. 45 proc. i 25 proc. wszystkich zgłoszonych zachorowań na KZM, a ponadto w województwach: mazowieckim, lubelskim, świętokrzyskim, małopolskim, opolskim i dolnośląskim, śląskim, wielkopolskim i zachodnio-pomorskim oraz w centralnej Polsce” – czytamy w najnowszym raporcie NIZP-PZH na temat występowania KZM w Polsce.
Autorzy raportu przyznają jednak, że powyższe dane dotyczące występowania KZM z pewnością są niedoszacowane. Dlaczego?
„Od lat utrzymuje się wysoki odsetek rozpoznań neuroinfekcji bez potwierdzenia etiologicznego, co skutkuje niedoszacowaniem rzeczywistej liczby zachorowań, a w konsekwencji zmniejszeniem czułości i swoistości nadzoru epidemiologicznego KZM” – czytamy we wspomnianym raporcie, co oznacza, że z różnych powodów, w większości stwierdzanych przypadków infekcji neurologicznych nie określa się tego, jaki konkretnie patogen je wywołał.
Z opracowania wynika, że w całej Europie obserwowany jest trend wzrostowy zachorowań na KZM, co jest efektem ekspansji terytorialnej kleszczy oraz wydłużenia okresu ich aktywności. Wiąże się to ze zmianami klimatycznymi, w tym przede wszystkim z globalnym ociepleniem.
Nie ma co jednak wpadać w panikę. Warto pamiętać, że nie wszystkie kleszcze są zakażone wirusem KZM. Naukowcy szacują, że w Polsce dotyczy to nie więcej niż co szóstego przedstawiciela tego gatunku.
Źródło informacji: Serwis Zdrowie
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