Tick borne encephalitis without cerebrospinal fluid pleocytosis.
BACKGROUND
Tick borne encephalitis is the most frequent vector-transmitted infectious disease of the central nervous system in Europe and Asia. The disease caused by European subtype of tick borne encephalitis virus has typically a biphasic clinical course with the second phase presenting as meningitis, meningoencephalitis, or meningoencephalomyelitis. Cerebrospinal fluid pleocytosis is considered a condition sine qua non for the diagnosis of neurologic involvement in tick borne encephalitis, which in routine clinical practice is confirmed by demonstration of serum IgM and IgG antibodies to tick borne encephalitis virus.


METHODS
Here we present a patient from Slovenia, an area highly endemic for tick borne encephalitis, with encephalitis but without cerebrospinal fluid pleocytosis in whom tick borne encephalitis virus infection of the central nervous system was demonstrated.


CONCLUSIONS
Cerebrospinal fluid pleocytosis is not mandatory in encephalitis caused by tick borne encephalitis virus. In daily clinical practice, in patients with neurologic symptoms/signs compatible with tick borne encephalitis and the risk of exposure to ticks in a tick borne encephalitis endemic region, the search for central nervous system infection with tick borne encephalitis virus is warranted despite the lack of cerebrospinal fluid pleocytosis.
Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia. dasa.stupica@kclj.si.
Daša
D
Stupica
Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia. franc.strle@kclj.si.
Franc
F
Strle
Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia. tatjana.avsic@mf.uni-lj.si.
Tatjana
T
Avšič-Županc
Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia. mateja.logar@kclj.si.
Mateja
M
Logar
Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia. blaz.pecavar@kclj.si.
Blaž
B
Pečavar
Institute of Pathophysiology, Faculty of Medicine Ljubljana, Zaloška 4, 2211, Ljubljana, Slovenia. fajko.bajrovic@mf.uni-lj.si.|Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia. fajko.bajrovic@mf.uni-lj.si.
Fajko F
FF
Bajrović
D000368:Aged; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D004669:Encephalitis Viruses, Tick-Borne / Q000276:immunology / Q000302:isolation & purification*; D004675:Encephalitis, Tick-Borne / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D005334:Fever / Q000209:etiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid; D007964:Leukocytosis / Q000175:diagnosis; D008297:Male; D017524:Slovenia
D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M