The main complains reported by TBE patients were headache 30/32 patients, fever 29/32 patients, nausea 12/32 patients, vertigo 8/32 patients, vomits 3/32 patients.
Patients diagnosed with meningitis had no focal neurological symptoms. All patients diagnosed with meningoencephalitis presented with consciousness disturbances. The main neurological symptoms in this group were: ataxia 6/16 patients, tremor 5/16 patients, paresis 4/16 patients, pyramidal symptoms 1/16 patients.
The laboratory parameters of patients are presented in Table 1.
Table 1
The laboratory parameters of patients included to the study
| Encephalitis | Meningitis |
Variable | Mean | SD | Mean | SD |
WBC (x 109/per microliter) | 8.48 | 3.5 | 9.18 | 3.007 |
CRP (mg/dl) | 5.35 | 6.125 | 5.51 | 8.424 |
AST (IU/L) | 26.93 | 12.929 | 24.75 | 17.613 |
ALT (IU/L) | 46.93 | 42.433 | 34.33 | 28.404 |
CSF I – cytosis (cells/µL) | 137.63 | 147.872 | 115.93 | 83.244 |
CSF I – polynuclear cells (cells/µL) | 69.25 | 151.195 | 54.4 | 60.422 |
CSF I – protein (mg/dL) | 60.19 | 22.466 | 73.94 | 28.707 |
CSF II – cytosis (cells/µL) | 23.71 | 21.670 | 44.25 | 24.981 |
CSF II – polynuclear cells (cells/µL) | 3.0 | 3.549 | 3.4 | 4.623 |
CSF II – protein (mg/dL) | 67.64 | 54.272 | 75.09 | 41.965 |
8/32 patients developed sequelae – mild cognitive disorders and persistent headache − 4 patients, paresis – 4 patients.
Mean YKL-40 concentration in CSF in sample 1 was significantly higher in both examined groups (Group I and II) than in CG (p < 0.05). It was also significantly higher in Group II than in Group I (p < 0.05) (Table 2).
Table 2
Concentration of YKL-40 in serum and CSF of patients with TBE in the form of encephalitis (Group I) and meningitis (Group II) before (Sample 1) and after treatment (Sample 2)
| Sample 1 Mean ± SD YKL-40 (ng/ml) | | Sample 2 Mean ± SD YKL-40 (ng/ml) | | p Sample 1 vs Sample 2 | |
| serum | CSF | serum | CSF | serum | CSF |
TBE | 102.38 ± 63.2 | 1475.37 ± 913.86 | 100.73 ± 84.96 | 827.68 ± 529.71 | s | < 0.05 |
Group I | 103.22 ± 80.95 | 1190.58 ± 982.51 | 99.99 ± 112.09 | 774.5 ± 632.5 | ns | ns |
Group II | 101.54 ± 41.24 | 1760.149 ± 766.545 | 101.48 ± 48.5 | 880.87 ± 416.91 | ns | < 0.05 |
CG | 91.39 ± 62.43 | 311.53 ± 240.59 | | | | |
p Group I vs. Group II | ns | < 0.05 | ns | ns | | |
p Group I vs. CG | ns | < 0.05 | | | | |
P Group II vs. CG | ns | < 0.05 | | | | |
ROC curve analysis indicates that YKL-40 protein concentration in CSF differentiates TBE patients from CG. At the cut-off at 783.87 ng/ml specificity is 100% and sensitivity 75%. AUC = 0.915, p < 0.05 (Fig. 1).
ROC curve analysis indicates that YKL-40 protein concentration in CSF differentiates meningitis and meningoencephalitis. At the cut-off 980.11 ng/ml specificity is 87.5% and sensitivity 62.5% AUC = 0.711, p < 0.05 (Fig. 2).
Serum concentration of YKL-40 did not differ in Sample 1 and 2 neither in meningitis nor in meningoencephalitis group.
CSF concentration of YKL-40 measured in sample 2 was significantly lower (p < 0.05) than in sample 1 in meningitis group while in meningoencephalitis group the result was nonsignificant.
The serum YKL-40 ratio in Group I was 1.23 ± 0.62 ng/ml and in Group II 1.11 ± 0.4 ng/ml. The result was non-significant.
The CSF YKL-40 ratio in Group I was significantly lower than in Group II (2.1 ± 2.13 vs 2.2 ± 0.79 ng/ml p < 0.05).
Comparison of sequelae group and other TBE patients did not show any statistically significant difference as far as YKL-40 concentrations in serum and CSF are concerned.
In the whole TBE group correlation between YKL-40 concentration and CSF protein concentration was observed (Sample 1: R = 0.39 p < 0.05, Sample 2 – R = 0.59 p < 0.05). Also YKL-40 serum concentration in Sample I correlated with WBC count at admission (R = 0.41 p < 0.05). YKL-40 CSF concentration correlated with neutrophils count in Sample 1 (Sample 1: R = 0.57 p < 0.05) and lymphocyte count in both samples (Sample 1: R = 0.62, Sample 2: R = 0.46 p < 0.05).