title: Diagnosis of acute deer tick virus encephalitis.
abstract: BACKGROUND
  Deer tick virus (DTV) is a tick-borne flavivirus that has only recently been appreciated as a cause of viral encephalitis. We describe the clinical presentation of a patient who had DTV encephalitis diagnosed before death and survived for 8 months despite severe neurologic dysfunction.
  
  
  METHODS
  Diagnosis was made from a cerebrospinal fluid specimen, using a flavivirus-specific polymerase chain-reaction assay followed by sequence confirmation, and the phylogeny was analyzed. Serologic testing, including plaque reduction neutralization testing, was also performed.
  
  
  RESULTS
  Molecular analysis indicated that the virus was closely related to 2 strains of DTV that had been detected in Ixodes scapularis ticks from Massachusetts in 1996 and in the brain of a patient from New York in 2007.
  
  
  CONCLUSIONS
  DTV encephalitis should be considered in the differential diagnosis of encephalitis in geographic areas that are endemic for Lyme disease.
authors.affiliation: Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA. marc_khoury@nymc.edu
authors.forename: Marc Y
authors.initials: MY
authors.lastname: El Khoury
authors.forename: Rene C
authors.initials: RC
authors.lastname: Hull
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Bryant
authors.forename: Kay L
authors.initials: KL
authors.lastname: Escuyer
authors.forename: Kirsten
authors.initials: K
authors.lastname: St George
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Wong
authors.forename: Aarathi
authors.initials: A
authors.lastname: Nagaraja
authors.forename: Laura
authors.initials: L
authors.lastname: Kramer
authors.forename: Alan P
authors.initials: AP
authors.lastname: Dupuis
authors.forename: Treta
authors.initials: T
authors.lastname: Purohit
authors.forename: Tushar
authors.initials: T
authors.lastname: Shah
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004669:Encephalitis Viruses, Tick-Borne / Q000302:isolation & purification*; D004675:Encephalitis, Tick-Borne / Q000134:cerebrospinal fluid* / Q000188:drug therapy; D017809:Fatal Outcome; D006801:Humans; D018884:Ixodes; D008279:Magnetic Resonance Imaging; D008297:Male; D009518:New York; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime