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Why wasn't I warned about encephalitis before travelling to Hungary - 2000

Question: Recently, while away on holiday in the heavily-forested north of Hungary, I was bitten by the kullancs, or forest tick. This resulted in prolonged illness and frightening visits to local hospitals, where mild encephalitis was diagnosed. I was extremely lucky to have sought advice at an early stage. A friend recently experienced the same problem closer to home in France, contracting a more serious form of the illness which lasted for months. Is this parasitic condition not worthy of more attention in common travel and medical guides, as I believe it is common in much of northern Europe and America.

Answer: Yes you're right there. Kullancs is the regional Hungarian name for a tick that inhabits the long grass and scrub that borders onto forests and the paths through the trees. These ticks are commonly found in most Central and Eastern European countries and are becoming more of a problem to walkers and ramblers.

The general scenario is that a hiker gets bitten by the tick when they are walking along these paths. The tick attatches its head and jaws into the skin and then a virus that infects the tick gets passed into the bloodstream. Not all the ticks that inhabit these areas have the virus, but you should assume that they do, if you are bitten, to be on the safe side.

The virus is known as an "arbovirus" and it is this that causes all the problems. To give the illness its full name, tick borne encephalitis, or TBE for short, the symptoms are in its title, that is encephalitis. Literally this means swelling of the brain which can come on even after a few days after the tick bite.

Symptoms start with a mild fever and headache, which can be controlled with simple analgesia, but if you find that these become worse and cannot be easily dulled by available medications then you need to get medical help quickly. As the encephalitis progresses the headache becomes incredibly severe and accompanied by nausea, vomiting and photophobia, which is inability to look into direct light. If left unchecked then paralysis and death are inevitable.

There is no real cure to this problem but doctors simply provide supportive measures to decrease the swelling on the brain until your own immunity can fight the problem. But before you all rush off and sell your hiking boots, there is a good vaccine against this problem. There is a long course with 2 injections spaced 1 month apart that is effective after the second shot. This lasts for 3 years, but if you are off on a hiking or camping holiday in a day or two then there is a quick TBE course. This is just 1 shot, works immediately but is only effective for a month.

I do recommend for anyone who is hiking or camping in these countries and Scandinavia too, that they get immunised as like your friend there can be long term problems from the arbovirus.

Finally, with my sensible doctors hat on, I'll mention prevention. The problem is at its height in the early Summer, so try to wear long trousers then if you are in the areas affected, and if you do get a tick then only remove it with tweezers from the head. Don't go trying cigarettes or plucking it out with your fingers as this will only make it discharge it's gut contents into your skin. Happy hiking.


Dr Jules Eden

Dr Jules Eden
MBBs BSc MRCGP




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Information published on this website is not a substitute for professional medical care or advice but should be used only as an aid in understanding current medical knowledge. A Doctor should always be consulted for any health problem or medical condition.

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