1
|
Ebinger A, Santos PD, Pfaff F, Dürrwald R, Kolodziejek J, Schlottau K, Ruf V, Liesche-Starnecker F, Ensser A, Korn K, Ulrich R, Fürstenau J, Matiasek K, Hansmann F, Seuberlich T, Nobach D, Müller M, Neubauer-Juric A, Suchowski M, Bauswein M, Niller HH, Schmidt B, Tappe D, Cadar D, Homeier-Bachmann T, Haring VC, Pörtner K, Frank C, Mundhenk L, Hoffmann B, Herms J, Baumgärtner W, Nowotny N, Schlegel J, Ulrich RG, Beer M, Rubbenstroth D. Lethal Borna disease virus 1 infections of humans and animals - in-depth molecular epidemiology and phylogeography. Nat Commun 2024; 15:7908. [PMID: 39256401 PMCID: PMC11387626 DOI: 10.1038/s41467-024-52192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
Borna disease virus 1 (BoDV-1) is the causative agent of Borna disease, a fatal neurologic disorder of domestic mammals and humans, resulting from spill-over infection from its natural reservoir host, the bicolored white-toothed shrew (Crocidura leucodon). The known BoDV-1-endemic area is remarkably restricted to parts of Germany, Austria, Switzerland and Liechtenstein. To gain comprehensive data on its occurrence, we analysed diagnostic material from suspected BoDV-1-induced encephalitis cases based on clinical and/or histopathological diagnosis. BoDV-1 infection was confirmed by RT-qPCR in 207 domestic mammals, 28 humans and seven wild shrews. Thereby, this study markedly raises the number of published laboratory-confirmed human BoDV-1 infections and provides a first comprehensive summary. Generation of 136 new BoDV-1 genome sequences from animals and humans facilitated an in-depth phylogeographic analysis, allowing for the definition of risk areas for zoonotic BoDV-1 transmission and facilitating the assessment of geographical infection sources. Consistent with the low mobility of its reservoir host, BoDV-1 sequences showed a remarkable geographic association, with individual phylogenetic clades occupying distinct areas. The closest genetic relatives of most human-derived BoDV-1 sequences were located at distances of less than 40 km, indicating that spill-over transmission from the natural reservoir usually occurs in the patient´s home region.
Collapse
Affiliation(s)
- Arnt Ebinger
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Pauline D Santos
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Florian Pfaff
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Ralf Dürrwald
- Robert Koch Institute, Department of Infectious Diseases, Unit 17 Influenza and Other Respiratory Viruses, National Reference Centre for Influenza, Berlin, Germany
| | - Jolanta Kolodziejek
- Institute of Virology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Kore Schlottau
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Viktoria Ruf
- Center for Neuropathology and Prion Research, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Friederike Liesche-Starnecker
- Department of Neuropathology, Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Armin Ensser
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Klaus Korn
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Reiner Ulrich
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Jenny Fürstenau
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Florian Hansmann
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Torsten Seuberlich
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniel Nobach
- Institute of Veterinary Pathology, Justus-Liebig-University Giessen, Giessen, Germany
- Chemical and Veterinary Analysis Agency Stuttgart (CVUAS), Fellbach, Germany
| | - Matthias Müller
- Bavarian Health and Food Safety Authority, Erlangen, Germany
| | | | - Marcel Suchowski
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Markus Bauswein
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Hans-Helmut Niller
- Institute for Medical Microbiology, Regensburg University, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Dennis Tappe
- Bernhard Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Daniel Cadar
- Bernhard Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Timo Homeier-Bachmann
- Institute of Epidemiology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Viola C Haring
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Kirsten Pörtner
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Christina Frank
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Lars Mundhenk
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Bernd Hoffmann
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Norbert Nowotny
- Institute of Virology, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Jürgen Schlegel
- Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University Munich, Munich, Germany
| | - Rainer G Ulrich
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Martin Beer
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Dennis Rubbenstroth
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
| |
Collapse
|
2
|
Pörtner K, Wilking H, Frank C, Stark K, Wunderlich S, Tappe D. Clinical analysis of Bornavirus Encephalitis cases demonstrates a small time window for Etiological Diagnostics and treatment attempts, a large case series from Germany 1996-2022. Infection 2024:10.1007/s15010-024-02337-3. [PMID: 39028389 DOI: 10.1007/s15010-024-02337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The emerging zoonotic Borna disease virus 1 (BoDV-1) and the variegated squirrel bornavirus 1 (VSBV-1) cause severe and fatal human encephalitis in Germany. We conducted the first systematic clinical analysis of acute, molecularly confirmed fatal bornavirus encephalitis cases comprising 21 BoDV-1 and four VSBV-1 patients to identify options for better diagnosis and timely treatment. METHODS Analyses were based on medical records and, for BoDV-1, on additional medical interviews with patients' relatives. RESULTS Disease onset was unspecific, often with fever and headache, inconsistently mixed with early fluctuating neurological symptoms, all rapidly leading to severe encephalopathy and progressive vigilance decline. Very shortly after seeking the first medical advice (median time interval 2 and 0 days for BoDV-1 and VSBV-1, respectively), all except one patient were hospitalised upon manifest neurological symptoms (median 10 and 16 days respectively after general symptom onset). Neurological symptoms varied, always progressing to coma and death. BoDV-1 and VSBV-1 patients required ventilation a median of three and five days, and died a median of 32 and 72 days, after hospitalisation. Death occurred mostly after supportive treatment cessation at different points in time based on poor prognosis. Disease duration therefore showed a wide, incomparable range. CONCLUSION The extremely rapid progression is the most obvious clinical characteristic of bornavirus encephalitis and the timeframe for diagnosis and targeted therapy is very short. Therefore, our results demand an early clinical suspicion based on symptomatology, epidemiology, imaging, and laboratory findings, followed by prompt virological testing as a prerequisite for any potentially effective treatment.
Collapse
Affiliation(s)
- Kirsten Pörtner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Hendrik Wilking
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany
| | - Christina Frank
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany
| | - Silke Wunderlich
- School of Medicine, Department of Neurology, Technical University of Munich, Munich, Germany
| | - Dennis Tappe
- Reference Laboratory for Bornaviruses, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
3
|
Allartz P, Hotop SK, Muntau B, Schlaphof A, Thomé-Bolduan C, Gabriel M, Petersen N, Lintzel M, Behrens C, Eggert P, Pörtner K, Steiner J, Brönstrup M, Tappe D. Detection of bornavirus-reactive antibodies and BoDV-1 RNA only in encephalitis patients from virus endemic areas: a comparative serological and molecular sensitivity, specificity, predictive value, and disease duration correlation study. Infection 2024; 52:59-71. [PMID: 37253816 PMCID: PMC10228883 DOI: 10.1007/s15010-023-02048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Human Borna disease virus (BoDV-1) encephalitis is an emerging disease in Germany. This study investigates the spectrum of human BoDV-1 infection, characterizes anti-BoDV-1-antibodies and kinetics, and compares laboratory test performances. METHODS Three hundred four encephalitis cases, 308 nation-wide neuropsychiatric conditions, 127 well-defined psychiatric cases from Borna disease-endemic areas, and 20 persons with contact to BoDV-1 encephalitis patients or animals were tested for BoDV-1 infections by serology and PCR. RESULTS BoDV-1 infections were only found in encephalitis patients with residence in, or recent travel to, virus-endemic areas. Antibodies were detected as early as 12 days after symptom onset. Serum antibody levels correlated with disease duration. Serology was ordered after 50% of the disease duration had elapsed, reflecting low awareness. BoDV-1-antibodies were of IgG1 subclass, and the epitope on BoDV-1 antigens was determined. Specificity of the indirect immunofluorescence antibody test (IFAT) and lineblot (LB) from serum and cerebrospinal fluid (CSF), as well as PCR testing from CSF, was 100%. Sensitivity, depending on first or all samples, reached 75-86% in serum and 92-94% in CSF for the IFAT, and 33-57% in serum and 18-24% in CSF for the LB. Sensitivity for PCR in CSF was 25-67%. Positive predictive values were 100% each, while negative predictive values were 99% (IFAT), 91-97% (LB), and 90% (PCR). CONCLUSIONS There is no hint that BoDV-1 causes other diseases than encephalitis in humans. Awareness has to be increased in virus-endemic areas. Tests are robust but lack sensitivity. Detection of IgG1 against specific peptides may facilitate diagnosis. Screening of healthy individuals is likely not beneficial.
Collapse
Affiliation(s)
- Petra Allartz
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | | | - Birgit Muntau
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Alexander Schlaphof
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Corinna Thomé-Bolduan
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Martin Gabriel
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Nadine Petersen
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Maren Lintzel
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Christoph Behrens
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Petra Eggert
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Kirsten Pörtner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, University Hospital Magdeburg, Magdeburg, Germany
| | - Mark Brönstrup
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), Site Hannover-Braunschweig, Braunschweig, Germany
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany.
| |
Collapse
|
4
|
Lourbopoulos A, Schnurbus L, Guenther R, Steinlein S, Ruf V, Herms J, Jahn K, Huge V. Case report: Fatal Borna virus encephalitis manifesting with basal brain and brainstem symptoms. Front Neurol 2024; 14:1305748. [PMID: 38333183 PMCID: PMC10850352 DOI: 10.3389/fneur.2023.1305748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024] Open
Abstract
Background Since the first report of fatal Borna virus-1 (BoDV-1) encephalitis in 2018, cases gradually increased. There is a lack of diagnostic algorithm, and there is no effective treatment so far. Case presentation We report an acute BoDV-1 encephalitis in a 77-year-old female with flu-like onset, rapid progression to word-finding difficulties, personality changes, global disorientation, diffuse cognitive slowness, and gait ataxia and further deterioration with fever, meningism, severe hyponatremia, epileptic seizures, cognitive decline, and focal cortical and cerebellar symptoms/signs. The extensive diagnostic workup (cerebrovascular fluid, serum, and MRI) for (meningo-)encephalitis was negative for known causes. Our empirical common antiviral, antimicrobial, and immunosuppressive treatment efforts failed. The patient fell into coma 5 days after admission, lost all brainstem reflexes on day 18, remained fully dependent on invasive mechanical ventilation thereafter and died on day 42. Brain and spinal cord autopsy confirmed an extensive, diffuse, and severe non-purulent, lymphocytic sclerosing panencephalomyelitis due to BoDV-1, affecting neocortical, subcortical, cerebellar, neurohypophysis, and spinal cord areas. Along with our case, we critically reviewed all reported BoDV-1 encephalitis cases. Conclusion The diagnosis of acute BoDV-1 encephalitis is challenging and delayed, while it progresses to fatal. In this study, we list all tried and failed treatments so far for future reference and propose a diagnostic algorithm for prompt suspicion and diagnosis.
Collapse
Affiliation(s)
- Athanasios Lourbopoulos
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Institute for Stroke and Dementia Research (ISD), LMU Munich University Hospital, Munich, Germany
| | - Lea Schnurbus
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Ricarda Guenther
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Susanne Steinlein
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Viktoria Ruf
- Center for Neuropathology and Prion Research, LMU, Munich, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU, Munich, Germany
| | - Klaus Jahn
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center of Vertigo and Balance Disorders (DSGZ), University of Munich (LMU), Munich, Germany
| | - Volker Huge
- Department of Neurology and Neurointensive Care, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Department of Anaesthesiology, LMU Munich University Hospital, Munich, Germany
| |
Collapse
|
5
|
Fürstenau J, Richter MT, Erickson NA, Große R, Müller KE, Nobach D, Herden C, Rubbenstroth D, Mundhenk L. Borna disease virus 1 infection in alpacas: Comparison of pathological lesions and viral distribution to other dead-end hosts. Vet Pathol 2024; 61:62-73. [PMID: 37431864 DOI: 10.1177/03009858231185107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Borna disease is a progressive meningoencephalitis caused by spillover of the Borna disease virus 1 (BoDV-1) to horses and sheep and has gained attention due to its zoonotic potential. New World camelids are also highly susceptible to the disease; however, a comprehensive description of the pathological lesions and viral distribution is lacking for these hosts. Here, the authors describe the distribution and severity of inflammatory lesions in alpacas (n = 6) naturally affected by this disease in comparison to horses (n = 8) as known spillover hosts. In addition, the tissue and cellular distribution of the BoDV-1 was determined via immunohistochemistry and immunofluorescence. A predominant lymphocytic meningoencephalitis was diagnosed in all animals with differences regarding the severity of lesions. Alpacas and horses with a shorter disease duration showed more prominent lesions in the cerebrum and at the transition of the nervous to the glandular part of the pituitary gland, as compared to animals with longer disease progression. In both species, viral antigen was almost exclusively restricted to cells of the central and peripheral nervous systems, with the notable exception of virus-infected glandular cells of the Pars intermedia of the pituitary gland. Alpacas likely represent dead-end hosts similar to horses and other spillover hosts of BoDV-1.
Collapse
Affiliation(s)
| | | | - Nancy A Erickson
- Freie Universität Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
6
|
Huhndorf M, Juhasz J, Wattjes MP, Schilling A, Schob S, Kaden I, Klaß G, Tappe D. Magnetic resonance imaging of human variegated squirrel bornavirus 1 (VSBV-1) encephalitis reveals diagnostic pattern indistinguishable from Borna disease virus 1 (BoDV-1) encephalitis but typical for bornaviruses. Emerg Microbes Infect 2023; 12:2179348. [PMID: 36757188 PMCID: PMC9980399 DOI: 10.1080/22221751.2023.2179348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Human bornavirus encephalitis is an emerging disease caused by the variegated squirrel bornavirus 1 (VSBV-1) and the Borna disease virus 1 (BoDV-1). While characteristic brain magnetic resonance imaging (MRI) changes have been described for BoDV-1 encephalitis, only scarce diagnostic data in VSBV-1 encephalitis exist. We systematically analysed brain MRI scans from all known VSBV-1 encephalitis patients. Initial and follow-up scans demonstrated characteristic T2 hyperintense lesions in the limbic system and the basal ganglia, followed by the brainstem. No involvement of the cerebellar cortex was seen. Deep white matter affection occurred in a later stage of the disease. Strict symmetry of pathologic changes was seen in 62%. T2 hyperintense areas were often associated with low T1 signal intensity and with mass effect. Sinusitis in three patients on the first MRI and an early involvement of the limbic system suggest an olfactory route of VSBV-1 entry. The viral spread could occur per continuitatem to adjacent anatomical brain regions or along specific neural tracts to more distant brain regions. The number and extent of lesions did not correlate with the length of patients' survivals. The overall pattern closely resembles that described for BoDV-1 encephalitis. The exact bornavirus species can thus not be deduced from imaging results alone, and molecular testing and serology should be performed to confirm the causative bornavirus. As VSBV-1 is likely of tropical origin, and MRI investigations are increasingly available globally, imaging techniques might be helpful to facilitate an early presumptive diagnosis of VSBV-1 encephalitis when molecular and/or serological testing is not available.
Collapse
Affiliation(s)
- Monika Huhndorf
- Clinic of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Juhasz
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Mike P. Wattjes
- Institut für diagnostische und interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Stefan Schob
- Universitätsklinik und Poliklinik für Radiologie Halle, Halle (Saale), Germany
| | - Ingmar Kaden
- BG Klinikum Bergmannstrost, Halle (Saale), Germany
| | | | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, Dennis Tappe Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
7
|
Pörtner K, Wilking H, Frank C, Böhmer MM, Stark K, Tappe D. Risk factors for Borna disease virus 1 encephalitis in Germany - a case-control study. Emerg Microbes Infect 2023; 12:e2174778. [PMID: 36748319 PMCID: PMC9980402 DOI: 10.1080/22221751.2023.2174778] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In 2018, Borna Disease Virus 1 (BoDV-1) was confirmed as a human zoonotic pathogen causing rare but fatal encephalitis in Germany. While diagnostic procedures and the clinical picture have been described, epidemiology remains mysterious. Though endemic areas and a natural reservoir host have been identified with the shrew Crocidura leucodon shedding virus in secretions, transmission events, routes and risk factors are unclear. We performed the first comprehensive epidemiological study, combining a large case series with the first case-control study: We interviewed family members of 20 PCR-confirmed BoDV-1 encephalitis cases deceased in 1996-2021 with a standardized questionnaire covering medical history, housing environment, profession, animal contacts, outdoor activities, travel, and nutrition. Cases' median age was 51 (range 11-79) years, 12/20 were female, and 18/20 lived in the federal state of Bavaria in Southeastern Germany. None had a known relevant pre-existing medical condition. None of the interviews yielded a transmission event such as direct shrew contact, but peridomestic shrew presence was confirmed in 13 cases supporting environmental transmission. Residency in rural areas endemic for animal BoDV-1 was the common denominator of all cases. A subsequent individually matched case-control study revealed residence close to nature in a stand-alone location or on the fringe of the settlement as a risk factor for disease in multivariable analysis with an adjusted OR of 10.8 (95% CI 1.3-89.0). Other variables including keeping cats were not associated with disease. Targeted prevention, future post-exposure-prophylaxis, and timely diagnosis remain challenging.
Collapse
Affiliation(s)
- Kirsten Pörtner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany affiliated with the ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden, Kirsten Pörtner Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Dennis Tappe Research Group Zoonoses, National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hendrik Wilking
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christina Frank
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Merle M. Böhmer
- Department of Infectious Disease Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany,Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Dennis Tappe
- Research Group Zoonoses, National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, Kirsten Pörtner Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Dennis Tappe Research Group Zoonoses, National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|