Tick-borne encephalitis (TBE) virus is a major cause of central nervous system infections in endemic countries. Here, we present clinical and laboratory characteristics of a large international cohort of patients with confirmed TBE using a uniform clinical protocol. Patients were recruited in eight centers from six European countries between 2010 and 2017. A detailed description of clinical signs and symptoms was recorded. The obtained information enabled a reliable classification in 553 of 555 patients: 207 (37.3%) had meningitis, 273 (49.2%) meningoencephalitis, 15 (2.7%) meningomyelitis, and 58 (10.5%) meningoencephalomyelitis; 41 (7.4%) patients had a peripheral paresis of extremities, 13 (2.3%) a central paresis of extremities, and 25 (4.5%) had single or multiple cranial nerve palsies. Five (0.9%) patients died during acute illness. Outcome at discharge was recorded in 298 patients. Of 176 (59.1%) patients with incomplete recovery, 80 (27%) displayed persisting symptoms or signs without recovery expectation. This study provides further evidence that TBE is a severe disease with a large proportion of patients with incomplete recovery. We suggest monitoring TBE in endemic European countries using a uniform protocol to record the full clinical spectrum of the disease.

Biology Centre of the Czech Academy of Sciences Institute of Parasitology Ceske Budejovice 370 01 Ceske Budejovice Czech Republic

Department of Children's Infectious Disease Faculty of Medicine and University Hospital Masaryk University 613 00 Brno Czech Republic

Department of General Paediatrics Medical University of Graz 8036 Graz Austria

Department of Infectious Disease and Travel Medicine University Hospital Plzeň and Faculty of Medicine in Pilsen Charles University 306 05 Plzeň Czech Republic

Department of Infectious Diseases and Febrile Conditions University Clinical Center Maribor 2000 Maribor Slovenia

Department of Infectious Diseases and Neuroinfections Medical University Bialystok 15 089 Bialystok Poland

Department of Infectious Diseases Faculty of Medicine Masaryk University Kamenice 753 5 625 00 Brno Czech Republic

Department of Infectious Diseases Hospital Ceske Budejovice 370 01 Ceske Budejovice Czech Republic

Department of Infectious Diseases Lithuanian University of Health Sciences 44307 Kaunas Lithuania

Department of Infectious Diseases University Medical Centre Ljubljana 1000 Ljubljana Slovenia

Department of Neurology and Neurosurgery Riga East University Hospital Riga Stradins University LV 1004 Riga Latvia

Department of Neurology Medical University of Graz 8036 Graz Austria

Department of Paediatrics Children Clinical University Hospital Riga Stradins University LV 1004 Riga Latvia

Deptartment of Infectious Diseases University Hospital Brno 625 00 Brno Czech Republic

Institute for Medical Informatics Statistics and Documentation Medical University of Graz 8036 Graz Austria

Veterinary Research Institute 621 00 Brno Czech Republic

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Editorial for the Special Issue: "Tick-Borne Encephalitis"

Serum matrix metalloproteinase-9 (MMP-9) as a biomarker in paediatric and adult tick-borne encephalitis patients

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