OBJECTIVES: The aim of the study was to evaluate the efficiency of molecular diagnostics of tick-borne encephalitis (TBE) and to correlate viral RNA (vRNA) detection with the clinical and laboratory data. METHODS: Clinical samples from 1125 patients from South Bohemia, Czech Republic, a highly endemic TBE region, were screened for TBE virus (TBEV) RNA by RT-qPCR. Samples included blood, serum, cerebrospinal fluid (CSF), and urine. RESULTS: TBEV RNA was detected in 14 patients with clinically proven TBE. TBEV RNA was most frequently detected in sera during early infection (11/37 patients tested, 29.7%) but decreased with rising IgG antibody response (3/228, 1.3%). Detection in CSF and urine was infrequent (1/30, 3.3% and 1/52, 1.9%, respectively). Additionally, five patients initially not diagnosed with TBE were retrospectively found to have TBEV RNA in serum, indicating possible underdiagnosis, particularly in mild or atypical presentations. The study also highlighted the diagnostic challenge of an immunocompromised patient whose delayed antibody response hindered timely diagnosis. In such cases, RT-qPCR could significantly shorten the diagnostic timeline. CONCLUSIONS: These findings underscore the value of early RNA detection in improving the diagnosis of TBE and may in the future facilitate the early administration of potential treatment, thereby improving patient outcomes.

Department of Infectious Diseases Hospital Ceske Budejovice B Nemcove 585 CZ 37001 Ceske Budejovice Czechia; Tropical and Infectious Diseases Unit Royal Liverpool University Hospital Prescot St Liverpool L7 8XP UK; Faculty of Social and Health Sciences University of South Bohemia Ceske Budejovice Czechia

Laboratory of Arbovirology Institute of Parasitology Biology Centre of the Czech Academy of Sciences Branisovska 31 CZ 37005 Ceske Budejovice Czechia

Laboratory of Arbovirology Institute of Parasitology Biology Centre of the Czech Academy of Sciences Branisovska 31 CZ 37005 Ceske Budejovice Czechia; Department of Infectious Diseases Hospital Ceske Budejovice B Nemcove 585 CZ 37001 Ceske Budejovice Czechia; Faculty of Science University of South Bohemia Branisovska 31 CZ 37005 Ceske Budejovice Czechia

Laboratory of Arbovirology Institute of Parasitology Biology Centre of the Czech Academy of Sciences Branisovska 31 CZ 37005 Ceske Budejovice Czechia; Faculty of Science University of South Bohemia Branisovska 31 CZ 37005 Ceske Budejovice Czechia

Laboratory of Arbovirology Institute of Parasitology Biology Centre of the Czech Academy of Sciences Branisovska 31 CZ 37005 Ceske Budejovice Czechia; Laboratory of Emerging Viral Infections Veterinary Research Institute Hudcova 296 CZ 62100 Brno Czechia

Laboratory of Arbovirology Institute of Parasitology Biology Centre of the Czech Academy of Sciences Branisovska 31 CZ 37005 Ceske Budejovice Czechia; Laboratory of Emerging Viral Infections Veterinary Research Institute Hudcova 296 CZ 62100 Brno Czechia; Department of Experimental Biology Faculty of Science Masaryk University Kamenice 735 CZ 62500 Brno Czechia

Laboratory of Virology Hospital Ceske Budejovice B Nemcove 585 CZ 37001 Ceske Budejovice Czechia

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