Tick-borne encephalitis and differential diagnosis

Abstract

Introduction: Tick-borne encephalitis (TBE) is an infection caused by the tick-borne encephalitis virus transmitted to humans by tick bites. The prevalence of TBE is between 10,000 and 15,000 cases annually and is comparable in Europe and Asia. About 10–20% of all infected persons are children. The vast majority of TBE cases, even up to 70–98% of them, are asymptomatic or undiagnosed. The main clinical symptoms are meningitis (present in 69%), meningoencephalitis (30%), and meningoencephalomyelitis (1%). About 2.1% of patients develop long-term neurological sequelae. Methods: The articles for our work were selected from three open-access databases. The databases were searched using keywords such as: “infection/epidemiology” + “tick bites/tick-borne encephalitis” + “clinical manifestation/pathogenesis/treatment” and “aseptic/viral/bacterial” + “encephalitis/meningitis”. Ultimately, 71 scientific articles and 8 websites, published between 1995 to 2023 were used. State of knowledge: TBE can be differentiated from diseases such as babesiosis, Lyme disease, southern tick-associated rash illness (STARI), chlamydiosis, ehrlichiosis, Colorado tick fever (CTF), Heartland virus (HRTV), Powassan virus (POWV), granulocytic anaplasmosis, tick-borne relapsing fever (TBRF), toxoplasmosis, tularemia, rickettsioses; or similar symptomatology: stroke, brucellosis, infectious mononucleosis (IM), yellow fever (YF), Japanese encephalitis (JE), other viral meningitis, encephalitis, spinal cord inflammation and aseptic meningitis. Conclusions: The differential diagnosis of TBE is extensive and should include a wide range of central nervous system infections caused by both other infectious agents and non-infectious diseases.

Keywords

• infection
• epidemiology
• differential diagnosis
• tick bites
• tick-borne encephalitis