Tick-Borne Encephalitis in the East Bohemia Region and its Microbiological Diagnostic Pitfalls

Authors: M. Svobodová 1,2;  P. Knížek 3;  R. Kračmarová 4;  V. Štěpánová 1;  M. Főrstl 1
Authors‘ workplace: Ústav klinické mikrobiologie FN a LF v Hradci Králové 1;  Oddělení klinické mikrobiologie, Pardubická krajská nemocnice, a. s. 2;  Infekční oddělení, Pardubická krajská nemocnice a. s. 3;  Infekční klinika FN a LF v Hradci Králové 4
Published in: Epidemiol. Mikrobiol. Imunol. 59, 2010, č. 3, s. 112-118


Aim of the study:
The analysis of cases of tick-borne encephalitis (TBE) laboratory diagnosed at the Department of Virology of the Institute of Clinical Microbiology of the University Hospital in Hradec Králové in 2003–2006 and comparison of the data from 2003–2006, 1999–2002 and 1995–1998. Another objective was to compare two routinely used ELISA (enzyme-linked immunosorbent assay) diagnostic kits for TBE.

Material and Methods:
The samples from 3,284 patients tested by the Department of Virology of the University Hospital in Hradec Králové in 2003–2006 were analyzed. The detection of the specific IgM and IgG antibodies in serum and cerebrospinal fluid specimens was performed using two ELISA diagnostic kits (Euroimmun, Germany, and Test-Line Ltd, Clinical Diagnostics, Czech Republic). Non-specific reactivity of IgM antibodies was only analyzed in 2004–2006.

In 2003–2006, TBE was diagnosed in 163 patients of the University Hospital in Hradec Králové aged from 3.5 months to 80 years. The number was by 48 cases (29 %) higher than that in 1995–1998 and by 36 cases (22 %) higher than that in 1999–2002. TBE was confirmed in 94 males (57.7 %) and 69 females (42.3 %). More than half of the patients were aged above 41 years (94/163, i.e. 57.6 %) and 60 patients (37 %) were older than 51 years. A biphasic course of infection was observed in 93/136 cases (68.4 %). As many as 101/136 patients (74 %) had a history of a tick bite, one patient reported the consumption of non-pasteurized milk. Thirty-eight (1.4 %) specimens showed non-specific reactivity of IgM antibodies. None of the cases showed cerebrospinal fluid reactivity in the absence of serum reactivity.

Increase in the diagnosed TBE cases was reported in 2003–2006 in the East Bohemia Region. It was due mainly to more severe clinical forms of TBE that were more frequent than the milder ones. The distribution of the confirmed TBE cases remained unchanged in terms of age and sex, but the seasonal peak moved from summer to autumn. ELISA proved suitable for use in the routine diagnosis of TBE. Both of the tested commercial kits are of good quality. Nevertheless, in view of possible non-specific reactivity of IgM antibodies, IgG antibodies need to be tested in both the first acute serum specimen and paired sera. The detection of antibodies in cerebrospinal fluid is unlikely to be of diagnostic benefit for TBE. Close cooperation between the attending physician and clinical microbiologist is crucial.

Key words:
tick-borne encephalitis – antibodies – enzyme-linked-immunosorbent assay (ELISA).


1. Daniel, M., Kříž, B., Danielová, V., Materna, J., Ruděnko, N. Výskyt viru klíšťové encefalitidy a klíšťat infikovaných borreliemi v horách. Zprávy CEM, 2004, 13, 12, s. 517–519.

2. Danielova, V., Daniel, M., Schwarzova, L., Materna, J., Rudenko, N., et al. Integration of a Tick-Borne Encephalitis Virus and Borrelia burgdorferi sensu lato into Mountain Ecosystems, Following a Shift in the Altitudinal Limit of Distribution of Their Vector, Ixodes ricinus (Krkonose Mountains, Czech Republic). Wien Med. Wochenschr, 2005, 155, p. 11–12, 289–294.

3. Günther, G., Haglund, M., Lindquist, L., Sköldenberg, B., Forsgren, M. Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long-term follow up related to clinical course and outcome. Clinical and Diagnostic Virology, 1997, 8, 2, p. 17–29.

4. Haglund, M., Günther, G. Tick-borne encephalitis – Pathogenesis, clinical course and long-term follow up. Vaccine, 2003, 21 (suppl. 1), 111–118.

5. Heinz, F. Tick-Borne Encephalitis: Rounding Out the Picture. Euro Surveill, 2008, 13, 17, p. 188–244.

6. Holzmann, H. Diagnosis of tick-borne encephalitis. Vaccine, 2003, 21 (Suppl 1), p. 36–40.

7. Chmelík, V. Klíšťová meningoencefalitida. Interní Med., 2007, 9, 7–8, p. 328–330.

8. Kaiser, R. Laboratory and Clinical Findings in Tick-Borne Encephalitis-Discrimination from Neuroborreliosis. Journal of Spirochetal and Tick-borne Diseases, 2000, 7, f. 10–15.

9. Kaiser, R. Tick-borne encefalitis (TBR) in Germany and clinical course of the disease. J. Med. Microbiol., 2002, 291 (Suppl 33), p. 58–61.

10. Kaiser, R., Holzmann, H. Laboratory findings in tick-borne encephalitis-correlation with clinical outcome. Infection, 2000, 28, 2, p. 65–67.

11. Kříž, B., Beneš, C., Daniel, M. Alimentární přenos klíšťové encefalitidy v České republice (1997–2008). Epidemiol. Mikrobiol. Imunol., 2009, 58, 2, s. 98–103.

12. Kunze, U., Baumhackl, U., Bretschneider, R., Chmelik, V., Grubeck–Loebenstein, B., et al. The Golden Agers and Tick-borne encephalitis. Conference report and position paper of the International Scientific Working Group on Tick-borne encephalitis. Wiener. Med. Wochenschr., 2005, 155, 11–12, 289–294.

13. Laiskonis, A., Mickiene, A. Tick-borne encephalitis in Eastern Europe. Medecine et Maladies Infectieuses, 2002, 32, r. 5, s. 203 – 211.

14. Marešová, V. Klíšťová meningoencefalitida. Pediatrie pro praxi, 2001, 1, s. 7–8.

15. Misic-Majerus, L., Bujic, N., Madaric, V., Avsic--Zupanic, T. Hepatitis caused by tick-borne meningoencephalitis virus (TBEV) – a rare clinical manifestation outside the central nervous system involvement. Acta Med. Croatia, 2005, 4, p. 347–52.

16. Prymula, R., Kosina P., Krausová J., Chlíbek R. Klíšťová meningoencefalitida a současné možnosti očkování. Vakcinologie, 2007, 1, s. 18–27.

17. Vene, S., Haglund, M., Lundkvist, A., Lindquist L., Forsgren, M. Study of the serological response after vaccination against tick-borne encephalitis in Sweden. Vaccine, 2007, 25, s. 366–372.

18. Votava, M. et al. Lékařská mikrobiologie speciální. 1. vyd. Brno: Neptun, 2003. 292 s. ISBN 80-902896-6-5.

Hygiene and epidemiology Medical virology Clinical microbiology

Article was published in

Epidemiology, Microbiology, Immunology

Issue 3

2010 Issue 3

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account