Patient 7 is a 53-year-old man who was visiting a cabin in the coastal area near Mandal. Symptoms began at the end of June, with fever, increasing headache, nausea, and vomiting. He was hospitalized on July 20, 2002. His liver enzymes were slightly raised. Computed tomographic scan was normal. Borrelia burgdorferi antibodies were detected in serum, without intrathecal production of Borrelia antibodies. Nucleic acids from herpes simplex virus, varicella-zoster virus, or enterovirus were not detected in CSF.
TBEV IgM and IgG antibodies were detected in serum samples, with high levels of IgM (OD 2.064 on July 22; OD 1.916 on July 30; and OD 1.499 on August 8) and rising IgG levels (OD 0.597 on July 22; OD 0.876 on July 30; and OD 1.993 on August 8). Cut-off values were 0.277-0.280 for IgM and 0.266-0.275 for IgG). Neutralization test antibody levels rose from <5 in serum taken July 21 to 10 in serum from November 25. Borderline values of TBEV antibodies were found in spinal fluid. During the first several months after illness onset, the patient had cognitive dysfunction but gradually returned to work.