title: Tick-borne encephalitis presenting as fever without localising signs--a case series.
abstract: BACKGROUND
  Tick-borne encephalitis (TBE) presents without neurologic symptoms in 19% in children less than 16 years in Switzerland (2000-2008). In these cases, fever can be the only leading manifestation.
  
  
  METHODS
  We report on four hospitalised children who had TBE and presented as fever without localising signs (FWLS) between 2000 and 2008 in an endemic area in Switzerland.
  
  
  CONCLUSIONS
  TBE infection has to be considered in the differential diagnosis of FWLS in endemic areas. Foremost, FWLS characterised by a biphasic fever course and accompanied by headache in patients in a reduced general condition. Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreported.
authors.affiliation: Department of Paediatrics, Triemli Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland. patrick_meyer@gmx.net
authors.forename: Patrick Michael
authors.initials: PM
authors.lastname: Meyer
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Philippe
authors.initials: P
authors.lastname: Goetschel
mesh_terms: D002648:Child; D002675:Child, Preschool; D004675:Encephalitis, Tick-Borne / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology