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Volume 15
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10.3390/pathogens15060587
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Article

Underrecognized Tick-Borne Encephalitis in Serbia: Evidence from Patients with Suspected West Nile Virus Neuroinvasive Disease

by
Dragana Mijatović
1,2,†,
Ana Marija Radevska
3,†,
Dejan Jakimovski
4,5,
Lidija Popović-Dragonjić
4,6,7,
Biljana Popovska Jovičić
4,8,9,
Jagoda Gavrilović
4,8,9,
Siniša Sević
10,11,
Dajana Lendak
10,11,
Irina Stojanac
12,
Alejandro Cabezas-Cruz
13,
Andreas Pilz
14,
Tomás Cervantes Rincón
15,
Jasmine Oberti-Cantergiani
15,
Davide F. Robbiani
15 and
Pavle Banović
1,15,16,17,*
1
Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000 Novi Sad, Serbia
2
Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
3
Epidemiology and Biostatistics Task Force, Balkan Association for Vector-Borne Diseases, 21000 Novi Sad, Serbia
4
Clinical Medicine Task Force, Balkan Association for Vector-Borne Diseases, 21000 Novi Sad, Serbia
5
University Clinic for Infectious Diseases and Febrile Conditions, 1000 Skopje, North Macedonia
6
Clinic for Infectology, University Clinical Center, 18000 Niš, Serbia
7
Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
8
Clinic for Infectology, University Clinical Centre Kragujevac, 34000 Kragujevac, Serbia
9
Department of Infectious Diseases, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
10
Clinic for Infectious Diseases, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
11
Department of Infectious Diseases, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
12
Clinic for Neurology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
13
Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, F-94700 Maisons-Alfort, France
14
Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, 2304 Vienna, Austria
15
Institute for Research in Biomedicine, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland
16
Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
17
Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
 
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*
Author to whom correspondence should be addressed.
†
D.M. and A.M.R. contributed equally to this work.
Pathogens 2026, 15(6), 587; https://doi.org/10.3390/pathogens15060587 (registering DOI)
Submission received: 20 April 2026 / Revised: 26 May 2026 / Accepted: 28 May 2026 / Published: 29 May 2026
(This article belongs to the Special Issue Ticks and Tick-Borne Pathogens in a Changing World)
Versions Notes

Abstract

Tick-borne encephalitis (TBE) is an emerging vector-borne disease in Europe, but its epidemiology remains poorly defined in Serbia. In orthoflavivirus-endemic settings, diagnostic challenges may contribute to underrecognition of TBE, particularly among patients with suspected West Nile virus (WNV) infection. We conducted a multicenter retrospective study including patients hospitalized between 2018 and 2023 with suspected WNV neuroinvasive disease or viral encephalitis of unknown etiology. Serum samples were tested for TBEV-neutralizing antibodies using a microneutralization assay. Among 79 patients, TBEV-neutralizing antibodies were detected in four (5.1%). Most reactive cases occurred in patients initially classified as having suspected WNV-associated meningoencephalitis, while TBE had not been onsidered in the differential diagnosis at admission. These findings suggest that TBE may be underrecognized in Serbia and highlight the importance of confirmatory testing in orthoflavivirus-endemic settings. Strengthening clinical awareness and surveillance will be essential to better define the burden of TBE and inform prevention strategies.
Keywords: tick-borne encephalitis virus; West Nile virus; neuroinvasive disease; orthoflavivirus; Serbia; neutralization assay; serology; underdiagnosis tick-borne encephalitis virus; West Nile virus; neuroinvasive disease; orthoflavivirus; Serbia; neutralization assay; serology; underdiagnosis

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MDPI and ACS Style

Mijatović, D.; Radevska, A.M.; Jakimovski, D.; Popović-Dragonjić, L.; Popovska Jovičić, B.; Gavrilović, J.; Sević, S.; Lendak, D.; Stojanac, I.; Cabezas-Cruz, A.; et al. Underrecognized Tick-Borne Encephalitis in Serbia: Evidence from Patients with Suspected West Nile Virus Neuroinvasive Disease. Pathogens 2026, 15, 587. https://doi.org/10.3390/pathogens15060587

AMA Style

Mijatović D, Radevska AM, Jakimovski D, Popović-Dragonjić L, Popovska Jovičić B, Gavrilović J, Sević S, Lendak D, Stojanac I, Cabezas-Cruz A, et al. Underrecognized Tick-Borne Encephalitis in Serbia: Evidence from Patients with Suspected West Nile Virus Neuroinvasive Disease. Pathogens. 2026; 15(6):587. https://doi.org/10.3390/pathogens15060587

Chicago/Turabian Style

Mijatović, Dragana, Ana Marija Radevska, Dejan Jakimovski, Lidija Popović-Dragonjić, Biljana Popovska Jovičić, Jagoda Gavrilović, Siniša Sević, Dajana Lendak, Irina Stojanac, Alejandro Cabezas-Cruz, and et al. 2026. "Underrecognized Tick-Borne Encephalitis in Serbia: Evidence from Patients with Suspected West Nile Virus Neuroinvasive Disease" Pathogens 15, no. 6: 587. https://doi.org/10.3390/pathogens15060587

APA Style

Mijatović, D., Radevska, A. M., Jakimovski, D., Popović-Dragonjić, L., Popovska Jovičić, B., Gavrilović, J., Sević, S., Lendak, D., Stojanac, I., Cabezas-Cruz, A., Pilz, A., Cervantes Rincón, T., Oberti-Cantergiani, J., Robbiani, D. F., & Banović, P. (2026). Underrecognized Tick-Borne Encephalitis in Serbia: Evidence from Patients with Suspected West Nile Virus Neuroinvasive Disease. Pathogens, 15(6), 587. https://doi.org/10.3390/pathogens15060587

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