Tick-borne encephalitis presenting as fever without localising signs-a case series

Tick-borne encephalitis (TBE) presents without neurologic symptoms in 19% in children less than 16 years in Switzerland (2000-2008). In these cases, fever can be the only leading manifestation. We report on four hospitalised children who had TBE and presented as fever without localising signs (FWLS) between 2000 and 2008 in an endemic area in Switzerland. TBE infection has to be considered in the differential diagnosis of FWLS in endemic areas. Foremost, FWLS characterised by a biphasic fever course and accompanied by headache in patients in a reduced general condition. Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreported.