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The authors report 49 cases of mixed infection (
Lyme disease + tick-born encephalitis). All the patients were citizens of the Russian North-West. Clinically, there were symptoms of
Lyme disease (erythema) and tick-born encephalitis (serous meningitis, neuritides of the cranial and peripheral nerves). In patients with mixed infection in the presence of erythema symptoms of tick-born encephalitis were less evident. The diagnosis of
Lyme disease erythema-free form in combination with tick-born encephalitis may be made only by dynamic serological tests for both of these infections.