{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:13:29Z","timestamp":1783426409006,"version":"3.54.6"},"reference-count":13,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pfizer Luxembourg","award":["59-22\/2021\/0225"],"award-info":[{"award-number":["59-22\/2021\/0225"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Tick-borne encephalitis (TBE) is an endemic neuroinfectious disease prevalent in parts of Europe and is often associated with persistent neurological and cognitive sequelae. The aim of this study was to evaluate the long-term outcomes and predictors of post-encephalitic sequelae in adult patients with TBE in Latvia. Methods: A retrospective cohort with prospective follow-up was used that included 105 adult patients hospitalized with laboratory-confirmed TBE between 2018 and 2024. The patients\u2019 clinical and demographic data were extracted from medical records, and reassessments were performed \u22656 months after discharge using structured clinical and neurological evaluations for neurocognitive, subjective, and neurological sequelae. Disease severity was classified using the Mickien\u0117 and Bogovi\u010d criteria, and sequelae severity was defined according to the Bohr criteria for post-encephalitic syndrome (PES). Results: Sequelae were observed in 52\/105 (49.5%) patients and were more frequent in meningoencephalitis than in meningitis cases (18\/25 [72.0%] vs. 33\/77 [42.9%]). The most common persistent symptoms were impaired concentration (33\/52 [63.5%]), fatigue (29\/52 [55.8%]), and sleep disturbances (21\/52 [40.4%]). Neurological sequelae included tremor (23\/52 [44.2%]), vertigo (11\/52 [21.2%]), and hearing impairment (5\/52 [9.8%]). According to the Bohr criteria, most of the patients had mild sequelae (42\/52 [80.8%]), while 10\/52 [19.2%] had moderate sequelae; no severe cases were observed. In the multivariable analysis, increasing age was independently associated with greater sequelae severity (OR = 1.045 per year; 95% CI, 1.015\u20131.073; p = 0.003). Sex, comorbidities, biphasic disease, and length of hospital stay were not significant predictors. Acute neurological manifestations, particularly paresis (p = 0.002) and tremor (p = 0.019), were associated with worse outcomes. Although the disease severity scores correlated with sequelae in unadjusted analyses, neither the Mickien\u0117 nor the Bogovi\u010d classification independently predicted outcomes after adjustment. Conclusions: Nearly half of the hospitalized patients with TBE included in this study developed long-term sequelae, which were predominantly neurocognitive and mild in severity. Age was the primary independent predictor of worse outcomes, while acute neurological deficits such as paresis and tremor also indicated increased risk. These findings highlight the substantial burden of post-encephalitic syndrome and the need for structured long-term follow-up in TBE survivors.<\/jats:p>","DOI":"10.3390\/pathogens15070672","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:04:47Z","timestamp":1783418687000},"page":"672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Outcomes in Adult Patients with Tick-Borne Encephalitis in Latvia"],"prefix":"10.3390","volume":"15","author":[{"given":"D. P.","family":"Grosa","sequence":"first","affiliation":[{"name":"Neurology and Neurosurgery Department, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"},{"name":"Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4892-3763","authenticated-orcid":false,"given":"D.","family":"Zavadska","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"},{"name":"Children\u2019s Clinical University Hospital, LV-1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3242-1630","authenticated-orcid":false,"given":"Z.","family":"Freimane","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"},{"name":"Children\u2019s Clinical University Hospital, LV-1004 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Karele","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Karelis","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery Department, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"},{"name":"Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia"},{"name":"Research Group of the Tenured Professor in Neuroimmunology at the Department of Biology and Microbiology, Faculty of Medicine, R\u012bga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pustijanac, E., Bur\u0161i\u0107, M., Talapko, J., \u0160krlec, I., Me\u0161trovi\u0107, T., and Li\u0161nji\u0107, D. (2023). Tick-borne encephalitis virus: A comprehensive review of transmission, pathogenesis, epidemiology, clinical manifestations, diagnosis, and prevention. Microorganisms, 11.","DOI":"10.3390\/microorganisms11071634"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zavadska, D., Odzelevica, Z., Karelis, G., Liepina, L., Litauniece, Z.A., Bormane, A., Lucenko, I., Perevoscikovs, J., Bridina, L., and Veide, L. (2018). Tick-borne encephalitis: A 43-year summary of epidemiological and clinical data from Latvia (1973 to 2016). PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204844"},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (2024, May 14). Clinical Signs and Symptoms of Tick-Borne Encephalitis, Available online: https:\/\/www.cdc.gov."},{"key":"ref_4","first-page":"1171","article-title":"The long-term outcome of tick-borne encephalitis in Central Europe","volume":"9","author":"Stupica","year":"2018","journal-title":"Ticks Tick Borne Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1017\/S0950268818002005","article-title":"Sequelae of tick-borne encephalitis in retrospective analysis of 1072 patients","volume":"146","author":"Czupryna","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1007\/s15010-023-02023-w","article-title":"Recovery and sequelae in 523 adults and children with tick-borne encephalitis in Germany","volume":"51","author":"Nygren","year":"2023","journal-title":"Infection"},{"key":"ref_7","first-page":"563","article-title":"Tick-borne encephalitis","volume":"26","author":"Kaiser","year":"2012","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.antiviral.2019.01.014","article-title":"Tick-borne encephalitis in Europe and Russia: Review of pathogenesis, clinical features, therapy, and vaccines","volume":"164","author":"Borde","year":"2019","journal-title":"Antivir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"430","DOI":"10.12998\/wjcc.v3.i5.430","article-title":"Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and outcome","volume":"3","author":"Strle","year":"2015","journal-title":"World J. Clin. Cases"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1093\/cid\/cit458","article-title":"Case definitions, diagnostic algorithms, and priorities in encephalitis: Consensus statement of the International Encephalitis Consortium","volume":"57","author":"Venkatesan","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1086\/342059","article-title":"Tickborne encephalitis in an area of high endemicity in Lithuania: Disease severity and long-term prognosis","volume":"35","author":"Mickiene","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"841027","DOI":"10.1155\/2014\/841027","article-title":"Quantitative evaluation of the severity of acute illness in adult patients with tick-borne encephalitis","volume":"2014","author":"Bogovic","year":"2014","journal-title":"Biomed. Res. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0163-4453(85)91585-3","article-title":"Pneumococcal meningitis: An evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae","volume":"10","author":"Bohr","year":"1985","journal-title":"J. Infect."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/672\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:13:53Z","timestamp":1783422833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/672"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":13,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["pathogens15070672"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15070672","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}