Differential Diagnosis

Tick-Born encephalitis, Japanese encephalitis, and St. Louis encephalitis have to be distinguished from other diseases of the central nervous system, especially from inflammatory diseases of the brain (other viral encephalitis, viral or bacterial meningitis, poliomyelitis, tuberculosis, Lyme disease). Because of the unspecific symptoms of these diseases, other Flavivirus infections should also be considered for differential diagnosis. In parts of the Far East where TBE is endemic the Omsk hemorrhagic fever is also endemic; in most areas where JE is also endemic dengue infections are occurring regularly as well; and since 1999, the West Nile virus is distributed in North America also in the same areas where SLE is present.

The following criteria indicate TBE:

A JE case is confirmed with one of the following laboratory diagnoses: isolation of the virus from tissues or detection of the virus nucleic acid in a sequenced RT-PCR from liquor;

Diagnostic detection of viral nucleic acid by PCR or virus by isolation from liquor and/or blood. Detection of specific viral antibodies of IgM or IgG type. Differentiation of JEV-specific antibodies from other anti-Flavivirus (yellow fever, dengue, West Nile, TBE, SLE)-directed antibodies could create difficulties in serology. A fourfold rise in the antibody titre in two follow-up serum samples is a strong indicator of an infection.

The following criteria indicate SLE:

Clinical image is compatible with the disease [headache, high temperature, neurological symptoms within the last 3 weeks before onset of disease, having been in the United States, Canada (Ontario), Trinidad, Jamaica, Panama, or Brazil-; and

A SLE case is confirmed with one of the following laboratory diagnoses: diagnostic detection of viral nucleic acid by PCR or virus by isolation from liquor and/or blood.[1'2'5'6'13'28] Detection of specific viral antibodies of IgM or IgG type. Differentiation of SLE virus-specific antibodies from other anti-Flavivirus (yellow fever, dengue, West Nile, TBE, SLE)-directed antibodies could create difficulties in serol-ogy. A fourfold rise in the antibody titre in two follow-up serum samples is a strong indicator of an infection.

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