Last reviewed: 22 Feb 2023
Last updated: 01 Oct 2021
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- fatigue
- general malaise
- headache
- body pains
- nausea
- mild meningitis
- severe encephalitis
- altered mental state
More key diagnostic factors
Other diagnostic factors
- cranial and spinal nerve palsies
- vestibular/hearing defects
- seizures
- paresis
- arms, shoulders, and head muscles paralysis
Other diagnostic factors
Risk factors
- history of recent tick bite
- summer months
- occupational exposure
- outdoors activities
- recent consumption of raw (unpasteurised) milk or dairy products
- age ≥50 years
- bioterrorism
More risk factors
Diagnostic investigations
1st investigations to order
- FBC
- ESR
- CRP
- LFTs
- CT brain
- cerebrospinal fluid analysis
- cerebrospinal fluid/serum serology
More 1st investigations to order
Investigations to consider
- cerebrospinal fluid/serum reverse-transcription polymerase chain reaction
- MRI head
- EEG
More investigations to consider
Treatment algorithm
INITIAL
suspected viral aetiology
ACUTE
confirmed TBE
Contributors
Authors
Ashley M. Croft, MA, MBBS, MSc, DTM&H, FFPHM

School of Pharmacy and Biomedical Science
University of Portsmouth
Portsmouth
UK
Disclosures
AMC declares that he has no competing interests.
Peer reviewers
John Williams, MRCP, DTM&H, DipHIVMed
Consultant Infectious Diseases Physician
The James Cook University Hospital
Middlesbrough
UK
Disclosures
JW declares that he has no competing interests.
Charlie Easmon, MBBS, MRCP, MSc Public Health, DTM&H, DOccMed
Medical Director
Your Excellent Health Service
Honorary Lecturer
UCL
London
UK
Disclosures
CE runs a private travel clinic.
Differentials
- Aseptic meningitis
- Encephalopathy (toxic/metabolic)
- Status epilepticus
More DifferentialsGuidelines
- CDC Health Information for International Travel (the Yellow Book): viral hemorrhagic fevers
- Tickborne diseases abroad
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