Tick-borne encephalitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

Tick-borne encephalitis must be differentiated form other tick-borne diseases as well as infections induced by the different subtypes of tick-borne encephalitis virus (TBEV). TBEV also shares a common disease vector with many other tick-borne diseases, therefore a healthcare provider must recognize the potential for multiple co-infections. Found below are tables outlining the clinical manifestations of TBEV subtypes as well as commonly transmitted tick-borne diseases.

Differentiating between infections among TBEV subtypes

Three subtypes of tick-borne encephalitis are commonly responsible for infection. These subtypes and their specific clinical manifestations are outlined in the table below:

Subtype	Clinical manifestations
Siberian^[1]	May persist as a chronic disease. Less focal encephalitic forms Majority of cases present in meningeal forms May present itself as biphasic.
Far Eastern^[1]	Commonly present in focal encephalitic forms. Less meningeal forms Rarely in biphasic form
European^[1]	Commonly a biphasic illness. Clinical characteristic features of the second stage include meningitis, meningoencephalitis, meningoencephalomyelitis, and meningoencephaloradiculitis.

Differentiating between tick-borne encephalitis and other tick-borne diseases

Disease vectors responsible for the transmission of tick-borne encephalitis are commonly carriers of other tick-borne diseases. Therefore due to this common disease vector, a healthcare provider must recognize all potential co-infections. A healthcare provider must also be able to distinguish between the different tick-borne diseases and TBEV. Found below is a table of tick-borne diseases, including TBEV, and their typical clinical manifestations.

Disease	Symptoms
Tick-borne meningoencephalitis^[2]	Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Bacterial Infection
Borreliosis (Lyme Disease)^[3]	Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
Relapsing Fever^[4]	Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
Typhus (Rickettsia)
Rocky Mountain Spotted Fever	Fever, alterations in mental state, myalgia, rash, and headaches.
Helvetica Spotted Fever^[5]	Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis Anaplasmosis^[6]	Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia^[7]	Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.
Viral Infection
Colorado Tick Fever^[8]	Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever	Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat, petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis^[9]	Non-specific flu like symptoms.

References

↑ ^1.0 ^1.1 ^1.2 Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016.
↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.

[Enceph_Prime-1] 1.0 ^1.1 ^1.2 Tick-borne Encephalitis Virus: A General Overview. http://cdn.intechopen.com/pdfs-wm/20866.pdf. Accessed February 4, 2016.

[TBE_CDC”-2] General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015

[Lyme_CDC”-3] Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015

[TBRF_CDC”-4] Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015

[RMSF_CDC”-5] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015

[Ehrlichiosis_CDC”-6] Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015

[Tulameria_CDC”-7] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015

[GenTickDis_CDC”-8] General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015

[Babesiosis_CDC”-9] Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.

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