Tick-borne encephalitis (TBE) virus is a major flavivirus causing central nervous system (CNS) infections in Europe and is also endemic in many parts of Asia. The European TBE virus subtype generally causes milder disease than Asian subtypes and will be the focus of this study. The mortality rate of TBE is below 1%, but around one-third of patients report incomplete recovery manifesting predominantly as headaches, fatigue, and cognitive difficulties. In autopsied patients with TBE, macroscopic swelling and hyperaemia and microscopic changes characterized by perivascular lymphocytic cuffing, microglial proliferation, neuronal loss, and neuronophagia were found throughout the CNS but were most concentrated in the cerebellum, brain stem, basal ganglia, thalamus, and spinal cord. TBE is treated with supportive measures and symptomatically.
We propose an international, multicentre, double-blind RCT assessing the potential benefit of dexamethasone 4 mg every 8 hours for 4 days over placebo. Participating centres would include medical centres throughout Europe where patients with TBE are hospitalized.