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Vollmuth Y, Jungbäck N, Mögele T, Schmidt-Graf F, Wunderlich S, Schimmel M, Rothe C, Stark L, Schlegel J, Rieder G, Richter T, Schaller T, Tappe D, Märkl B, Matiasek K, Liesche-Starnecker F. Comparative study of virus and lymphocyte distribution with clinical data suggests early high dose immunosuppression as potential key factor for the therapy of patients with BoDV-1 infection. Emerg Microbes Infect 2024; 13:2350168. [PMID: 38687703 PMCID: PMC11107860 DOI: 10.1080/22221751.2024.2350168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
ABSTRACTBorna disease virus 1 (BoDV-1) was just recently shown to cause predominantly fatal encephalitis in humans. Despite its rarity, bornavirus encephalitis (BVE) can be considered a model disease for encephalitic infections caused by neurotropic viruses and understanding its pathomechanism is of utmost relevance. Aim of this study was to compare the extent and distribution pattern of cerebral inflammation with the clinical course of disease, and individual therapeutic procedures. For this, autoptic brain material from seven patients with fatal BVE was included in this study. Tissue was stained immunohistochemically for pan-lymphocytic marker CD45, the nucleoprotein of BoDV-1, as well as glial marker GFAP and microglial marker Iba1. Sections were digitalized and counted for CD45-positive and BoDV-1-positive cells. For GFAP and Iba1, a semiquantitative score was determined. Furthermore, detailed information about the individual clinical course and therapy were retrieved and summarized in a standardized way. Analysis of the distribution of lymphocytes shows interindividual patterns. In contrast, when looking at the BoDV-1-positive glial cells and neurons, a massive viral involvement in the brain stem was noticeable. Three of the seven patients received early high-dose steroids, which led to a significantly lower lymphocytic infiltration of the central nervous tissue and a longer survival compared to the patients who were treated with steroids later in the course of disease. This study highlights the potential importance of early high-dose immunosuppressive therapy in BVE. Our findings hint at a promising treatment option which should be corroborated in future observational or prospective therapy studies.ABBREVIATIONS: BoDV-1: Borna disease virus 1; BVE: bornavirus encephalitis; Cb: cerebellum; CNS: central nervous system; FL: frontal lobe; GFAP: glial fibrillary acid protein; Hc: hippocampus; Iba1: ionized calcium-binding adapter molecule 1; Iba1act: general activation of microglial cells; Iba1nod: formation of microglial nodules; IL: insula; Me: mesencephalon; Mo: medulla oblongata; OL: occipital lobe; pASS: per average of 10 screenshots; patearly: patients treated with early high dose steroid shot; patlate: patients treated with late or none high dose steroid shot; Po: pons; So: stria olfactoria; Str: striatum.
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Affiliation(s)
- Yannik Vollmuth
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
- Institute of Pathology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nicola Jungbäck
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tatiana Mögele
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mareike Schimmel
- Department of Pediatrics and Adolescent Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Leonhard Stark
- Institute of Pathology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Jürgen Schlegel
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
- Institute of Pathology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Georg Rieder
- Department of Neurology, InnKlinikum, Altötting, Germany
| | - Thomas Richter
- Clinic of Pathology, Pathology Rosenheim, Rosenheim, Germany
| | - Tina Schaller
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Dennis Tappe
- National Laboratory for Bornaviruses, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bruno Märkl
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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2
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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.
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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
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3
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Bauswein M, Eid E, Eidenschink L, Schmidt B, Gessner A, Tappe D, Cadar D, Böhmer MM, Jockel L, van Wickeren N, Garibashvili T, Wiesinger I, Wendl C, Heckmann JG, Angstwurm K, Freyer M. Detection of virus-specific T cells via ELISpot corroborates early diagnosis in human Borna disease virus 1 (BoDV-1) encephalitis. Infection 2024:10.1007/s15010-024-02246-5. [PMID: 38607591 DOI: 10.1007/s15010-024-02246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Within endemic regions in southern and eastern Germany, Borna disease virus 1 (BoDV-1) causes rare zoonotic spill-over infections in humans, leading to encephalitis with a high case-fatality risk. So far, intra-vitam diagnosis has mainly been based on RT-qPCR from cerebrospinal fluid (CSF) and serology, both being associated with diagnostic challenges. Whilst low RNA copy numbers in CSF limit the sensitivity of RT-qPCR from this material, seroconversion often occurs late during the course of the disease. CASE PRESENTATION Here, we report the new case of a 40 - 50 year-old patient in whom the detection of virus-specific T cells via ELISpot corroborated the diagnosis of BoDV-1 infection. The patient showed a typical course of the disease with prodromal symptoms like fever and headaches 2.5 weeks prior to hospital admission, required mechanical ventilation from day three after hospitalisation and remained in deep coma until death ten days after admission. RESULTS Infection was first detected by positive RT-qPCR from a CSF sample drawn four days after admission (viral load 890 copies/mL). A positive ELISpot result was obtained from peripheral blood collected on day seven, when virus-specific IgG antibodies were not detectable in serum, possibly due to previous immune adsorption for suspected autoimmune-mediated encephalitis. CONCLUSION This case demonstrates that BoDV-1 ELISpot serves as additional diagnostic tool even in the first week after hospitalisation of patients with BoDV-1 encephalitis.
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Affiliation(s)
- Markus Bauswein
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany.
| | - Ehab Eid
- Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | - Lisa Eidenschink
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Consiliary Laboratory for Bornaviruses, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Merle M Böhmer
- Bavarian Health and Food Safety Authority, Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany
| | - Laura Jockel
- Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | - Nora van Wickeren
- Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | | | - Isabel Wiesinger
- Institute of Neuroradiology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | - Christina Wendl
- Institute of Neuroradiology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | | | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany
| | - Martin Freyer
- Department of Neurology, Klinikum Landshut, Landshut, Germany
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4
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Böhmer MM, Haring VC, Schmidt B, Saller FS, Coyer L, Chitimia-Dobler L, Dobler G, Tappe D, Bonakdar A, Ebinger A, Knoll G, Eidenschink L, Rohrhofer A, Niller HH, Katz K, Starcky P, Beer M, Ulrich RG, Rubbenstroth D, Bauswein M. One Health in action: Investigation of the first detected local cluster of fatal borna disease virus 1 (BoDV-1) encephalitis, Germany 2022. J Clin Virol 2024; 171:105658. [PMID: 38447459 DOI: 10.1016/j.jcv.2024.105658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Zoonotic Borna disease virus 1 (BoDV-1) causes fatal encephalitis in humans and animals. Subsequent to the detection of two paediatric cases in a Bavarian municipality in Germany within three years, we conducted an interdisciplinary One Health investigation. We aimed to explore seroprevalence in a local human population with a risk for BoDV-1 exposure as well as viral presence in environmental samples from local sites and BoDV-1 prevalence within the local small mammal population and its natural reservoir, the bicoloured white-toothed shrew (Crocidura leucodon). METHODS The municipality's adult residents participated in an anonymised sero-epidemiological study. Potential risk factors and clinical symptoms were assessed by an electronic questionnaire. Small mammals, environmental samples and ticks from the municipality were tested for BoDV-1-RNA. Shrew-derived BoDV-1-sequences together with sequences of the two human cases were phylogenetically analysed. RESULTS In total, 679 citizens participated (response: 41 %), of whom 38 % reported shrews in their living environment and 19 % direct shrew contact. No anti-BoDV-1 antibodies were detected in human samples. BoDV-1-RNA was also undetectable in 38 environmental samples and 336 ticks. Of 220 collected shrews, twelve of 40 C. leucodon (30%) tested BoDV-1-RNA-positive. BoDV-1-sequences from the previously diagnosed two paediatric patients belonged to two different subclades, that were also present in shrews from the municipality. INTERPRETATION Our data support the interpretation that human BoDV-1 infections are rare even in endemic areas and primarily manifest as severe encephalitis. Sequence analysis linked both previous paediatric human infections to the local shrew population, but indicated independent infection sources. FUNDING The project was partly financed by funds of the German Federal Ministry of Education and Research (grant numbers: 01KI2005A, 01KI2005C, 01KI1722A, 01KI1722C, 01KI2002 to MaBe, DR, RGU, DT, BS) as well as by the ReForM-A programme of the University Hospital Regensburg (to MaBa) and by funds of the Bavarian State Ministry of Health, Care and Prevention, project "Zoonotic Bornavirus Focal Point Bavaria - ZooBoFo" (to MaBa, MaBe, BS, MMB, DR, PS, RGU).
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Affiliation(s)
- Merle M Böhmer
- Bavarian Health and Food Safety Authority, Munich, Germany; Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Bornavirus-Focal Point Bavaria, Germany.
| | - Viola C Haring
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Barbara Schmidt
- Bornavirus-Focal Point Bavaria, Germany; Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany; Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | | | - Liza Coyer
- Bavarian Health and Food Safety Authority, Munich, Germany; ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | | | | | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Consiliary Laboratory for Bornaviruses, Germany
| | - Andrea Bonakdar
- Local Health Authority, county Mühldorf am Inn, Mühldorf am Inn, Germany
| | - Arnt Ebinger
- University Medicine Greifswald, Greifswald, Germany
| | - Gertrud Knoll
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Lisa Eidenschink
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Anette Rohrhofer
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Hans Helmut Niller
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Philip Starcky
- Bavarian Health and Food Safety Authority, Munich, Germany; Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Martin Beer
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Rainer G Ulrich
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Dennis Rubbenstroth
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Markus Bauswein
- Bornavirus-Focal Point Bavaria, Germany; Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
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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.
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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.
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6
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Bauswein M, Knoll G, Schmidt B, Gessner A, Hemmer B, Flaskamp M. No evidence of an association of multiple sclerosis (MS) with Borna disease virus 1 (BoDV-1) infections in patients within an endemic region: a retrospective pilot study. Infection 2024; 52:243-247. [PMID: 37814203 PMCID: PMC10810949 DOI: 10.1007/s15010-023-02099-4] [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: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Borna disease virus 1 (BoDV-1) causes rare human infections within endemic regions in southern and eastern Germany. The infections reported to date have been linked to severe courses of encephalitis with high mortality and mostly irreversible symptoms. Whether BoDV-1 could act as a trigger for other neurological conditions, is, however, incompletely understood. OBJECTIVES AND METHODS In this study, we addressed the question of whether the presentation of a clinically isolated syndrome (CIS) or of multiple sclerosis (MS) might be associated with a milder course of BoDV-1 infections. Serum samples of 100 patients with CIS or MS diagnosed at a tertiary neurological care center within an endemic region in southern Germany and of 50 control patients suffering from headache were retrospectively tested for BoDV-1 infections. RESULTS In none of the tested sera, confirmed positive results of anti-BoDV-1-IgG antibodies were retrieved. Our results support the conclusion that human BoDV-1 infections primarily lead to severe encephalitis with high mortality.
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Affiliation(s)
- Markus Bauswein
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany.
| | - Gertrud Knoll
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Martina Flaskamp
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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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.
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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
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8
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Riccò M, Zanella I, Satta E, Ranzieri S, Corrado S, Marchesi F, Peruzzi S. BoDV-1 Infection in Children and Adolescents: A Systematic Review and Meta-Analysis. Pediatr Rep 2023; 15:512-531. [PMID: 37755407 PMCID: PMC10534910 DOI: 10.3390/pediatric15030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Borna disease virus 1 (BoDV-1) can cause a severe human syndrome characterized by meningo-myeloencephalitis. The actual epidemiology of BoDV-1 remains disputed, and our study summarized prevalence data among children and adolescents (<18-year-old). Through systematic research on three databases (PubMed, EMBASE, MedRxiv), all studies, including seroprevalence rates for BoDV-1 antigens and specific antibodies, were retrieved, and their results were summarized. We identified a total of six studies for a total of 2692 subjects aged less than 18 years (351 subjects sampled for BoDV-1 antibodies and 2557 for antigens). A pooled seroprevalence of 6.09% (95% Confidence Interval [95% CI] 2.14 to 16.17) was eventually calculated for BoDV-1 targeting antibodies and 0.76% (95% CI 0.26 to 2.19) for BoDV-1 antigens. Both estimates were affected by substantial heterogeneity. Seroprevalence rates for BoDV-1 in children and adolescents suggested that a substantial circulation of the pathogen does occur, and as infants and adolescents have relatively scarce opportunities for being exposed to hosts and animal reservoirs, the potential role of unknown vectors cannot be ruled out.
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Affiliation(s)
- Matteo Riccò
- Occupational Health and Safety Service on the Workplace/Servizio di Prevenzione e Sicurezza Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Ilaria Zanella
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (I.Z.); (E.S.); (S.R.); (F.M.)
| | - Elia Satta
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (I.Z.); (E.S.); (S.R.); (F.M.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (I.Z.); (E.S.); (S.R.); (F.M.)
| | - Silvia Corrado
- ASST Rhodense, Dipartimento Della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Garbagnate Milanese, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (I.Z.); (E.S.); (S.R.); (F.M.)
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL—IRCCS di Reggio Emilia, 42016 Guastalla, Italy;
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Ulrich RG, Drewes S, Haring V, Panajotov J, Pfeffer M, Rubbenstroth D, Dreesman J, Beer M, Dobler G, Knauf S, Johne R, Böhmer MM. [Viral zoonoses in Germany: a One Health perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03709-0. [PMID: 37261460 DOI: 10.1007/s00103-023-03709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic and the increasing occurrence of monkeypox (mpox) diseases outside Africa have illustrated the vulnerability of populations to zoonotic pathogens. In addition, other viral zoonotic pathogens have gained importance in recent years.This review article addresses six notifiable viral zoonotic pathogens as examples to highlight the need for the One Health approach in order to understand the epidemiology of the diseases and to derive recommendations for action by the public health service. The importance of environmental factors, reservoirs, and vectors is emphasized, the diseases in livestock and wildlife are analyzed, and the occurrence and frequency of diseases in the population are described. The pathogens selected here differ in their reservoirs and the role of vectors for transmission, the impact of infections on farm animals, and the disease patterns observed in humans. In addition to zoonotic pathogens that have been known in Germany for a long time or were introduced recently, pathogens whose zoonotic potential has only lately been shown are also considered.For the pathogens discussed here, there are still large knowledge gaps regarding the transmission routes. Future One Health-based studies must contribute to the further elucidation of their transmission routes and the development of prevention measures. The holistic approach does not necessarily include a focus on viral pathogens/diseases, but also includes the question of the interaction of viral, bacterial, and other pathogens, including antibiotic resistance and host microbiomes.
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Affiliation(s)
- Rainer G Ulrich
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland.
| | - Stephan Drewes
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland
| | - Viola Haring
- Institut für neue und neuartige Tierseuchenerreger, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Südufer 10, 17493, Greifswald-Insel Riems, Deutschland
| | - Jessica Panajotov
- Fachgruppe Viren in Lebensmitteln, Bundesinstitut für Risikobewertung, Berlin, Deutschland
| | - Martin Pfeffer
- Institut für Tierhygiene und Öffentliches Veterinärwesen, Universität Leipzig, Leipzig, Deutschland
| | - Dennis Rubbenstroth
- Institut für Virusdiagnostik, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | | | - Martin Beer
- Institut für Virusdiagnostik, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | - Gerhard Dobler
- Abteilung Virologie und Rickettsiologie, Institut für Mikrobiologie der Bundeswehr, München, Deutschland
| | - Sascha Knauf
- Institut für Internationale Tiergesundheit/One Health, Friedrich-Loeffler-Institut, Bundesforschungsinstitut für Tiergesundheit, Greifswald-Insel Riems, Deutschland
| | - Reimar Johne
- Fachgruppe Viren in Lebensmitteln, Bundesinstitut für Risikobewertung, Berlin, Deutschland
| | - Merle M Böhmer
- Landesinstitut Gesundheit II - Task Force Infektiologie, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), München, Deutschland
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke Universität, Magdeburg, Deutschland
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