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Transboundary and emerging diseases2020; doi: 10.1111/tbed.13556

Borna disease outbreak with high mortality in an alpaca herd in a previously unreported endemic area in Germany.

Abstract: Borna disease virus 1 (BoDV-1) is the causative agent of Borna disease, an often fatal neurologic condition of domestic mammals, including New World camelids, in endemic areas in Central Europe. Recently, BoDV-1 gained further attention by the confirmation of fatal zoonotic infections in humans. Although Borna disease and BoDV-1 have been described already over the past decades, comprehensive reports of Borna disease outbreaks in domestic animals employing state-of-the-art diagnostic methods are missing. Here, we report a series of BoDV-1 infections in a herd of 27 alpacas (Vicugna pacos) in the federal state of Brandenburg, Germany, which resulted in eleven fatalities (41%) within ten months. Clinical courses ranged from sudden death without previous clinical signs to acute or chronic neurologic disease with death occurring after up to six months. All animals that underwent necropsy exhibited a non-suppurative encephalitis. In addition, six apparently healthy seropositive individuals were identified within the herd, suggesting subclinical BoDV-1 infections. In infected animals, BoDV-1 RNA and antigen were mainly restricted to the central nervous system and the eye, and sporadically detectable in large peripheral nerves and neuronal structures in other tissues. Pest control measures on the farm resulted in the collection of a BoDV-1-positive bicoloured white-toothed shrew (Crocidura leucodon), while all other trapped small mammals were negative. A phylogeographic analysis of BoDV-1 sequences from the alpacas, the shrew and BoDV-1-positive equine cases from the same region in Brandenburg revealed a previously unreported endemic area of BoDV-1 cluster 4 in North-Western Brandenburg. In conclusion, alpacas appear to be highly susceptible to BoDV-1 infection and display a highly variable clinical picture ranging from peracute death to subclinical forms. In addition to horses and sheep, they can serve as sensitive sentinels used for the identification of endemic areas.
Publication Date: 2020-03-29 PubMed ID: 32223069DOI: 10.1111/tbed.13556Google Scholar: Lookup
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  • Journal Article

Summary

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The research focuses on an outbreak of Borna disease, caused by Borna disease virus 1 (BoDV-1), among an alpaca herd in an area of Germany previously unrecognized as an endemic zone. Over ten months, this disease led to a high mortality rate, with 41% of the herd dying, while also revealing variable clinical manifestations in the animals.

Research Goals and Scope

  • The study intended to document and analyze a series of BoDV-1 infections in an alpaca herd in Brandenburg, Germany, where Borna disease outbreaks had not been previously reported.
  • The research aimed to identify the agent of the disease, study the progression of the disease, and understand its clinical manifestations.
  • Another goal was to identify the carrier of the disease and establish the phylogeography of the BoDV-1 virus within the region.

Borna Disease Outbreak in Alpacas

  • Over ten months, 27 alpacas were infected with BoDV-1, leading to eleven fatalities, which corresponds to a fatality rate of 41% within the herd.
  • The clinical manifestations of the disease varied among the alpacas. While some died without any active disease symptoms, others showed acute or chronic neurologic disease symptoms and died after up to six months.
  • Non-suppurative encephalitis was found in all animals that underwent necropsy.
  • While most infected animals either died or exhibited symptoms, six seropositive alpacas did not show any symptoms, indicating subclinical BoDV-1 infections.

Identification of BoDV-1 and Its Carrier

  • In the infected animals, BoDV-1 RNA and antigen were primarily found in the central nervous system and the eye and were sporadically detectable in large peripheral nerves and neuronal structures in other tissues.
  • Pest control measures led to the discovery of BoDV-1 in a bicolor white-toothed shrew, indicating that the shrew can be a possible carrier of the virus.

Phylogeographic Analysis

  • The researchers performed a phylogeographic analysis of BoDV-1 sequences from the alpacas and the shrew, along with BoDV-1-positive equine cases from the same region in Brandenburg.
  • This analysis revealed a previously unreported endemic area of BoDV-1 cluster 4 in North-Western Brandenburg.

Conclusion

  • The study found that alpacas can be highly susceptible to BoDV-1 infection, with clinical manifestations ranging from acute death to subclinical forms of the disease.
  • It concluded that in addition to other animals such as horses and sheep, alpacas could be used as sensitive sentinels to identify endemic zones for BoDV-1.

Cite This Article

APA
Schulze V, Große R, Fürstenau J, Forth LF, Ebinger A, Richter MT, Tappe D, Mertsch T, Klose K, Schlottau K, Hoffmann B, Höper D, Mundhenk L, Ulrich RG, Beer M, Müller KE, Rubbenstroth D. (2020). Borna disease outbreak with high mortality in an alpaca herd in a previously unreported endemic area in Germany. Transbound Emerg Dis. https://doi.org/10.1111/tbed.13556

Publication

ISSN: 1865-1682
NlmUniqueID: 101319538
Country: Germany
Language: English

Researcher Affiliations

Schulze, Vanessa
  • Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Große, Reinhard
  • Clinic for Ruminants and Swine, Freie Universität Berlin, Berlin, Germany.
Fürstenau, Jenny
  • Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany.
Forth, Leonie F
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Ebinger, Arnt
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Richter, Madita T
  • Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany.
Tappe, Dennis
  • Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Mertsch, Tanja
  • Veterinary practice Mertsch, Kyritz, Germany.
Klose, Kristin
  • Institute of Veterinary Pathology, Leipzig University, Leipzig, Germany.
Schlottau, Kore
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Hoffmann, Bernd
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Höper, Dirk
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Mundhenk, Lars
  • Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany.
Ulrich, Rainer G
  • Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Beer, Martin
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.
Müller, Kerstin-Elisabeth
  • Clinic for Ruminants and Swine, Freie Universität Berlin, Berlin, Germany.
Rubbenstroth, Dennis
  • Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.

Grant Funding

  • ZooBoCo, grant no. 01KI1722A / Bundesministerium fu00fcr Bildung und Forschung

References

This article includes 57 references
  1. Altmann D, Kronberger H, Schüppel K-F, Lippmann R, Altmann I. Bornasche Krankheit (Meningo-encephalitis simplex enzootica equorum) bei Neuwelttylopoden und Equiden. Verhber Erkrg Zootiere 18, 127-132.
  2. Bilzer T, Planz O, Lipkin WI, Stitz L. Presence of CD4+ and CD8+ T cells and expression of MHC class I and MHC class II antigen in horses with Borna disease virus-induced encephalitis. Brain Pathology 5, 223-230.
  3. Bilzer T, Stitz L. Immune-mediated brain atrophy. CD8+ T cells contribute to tissue destruction during Borna disease. Journal of Immunology 153, 818-823.
  4. Boos GS, Nobach D, Failing K, Eickmann M, Herden C. Optimization of RNA extraction protocol for long-term archived formalin-fixed paraffin-embedded tissues of horses. Experimental and Molecular Pathology 110, 104289.
  5. Bourg M, Herzog S, Encarnacao JA, Nobach D, Lange-Herbst H, Eickmann M, Herden C. Bicolored white-toothed shrews as reservoir for Borna disease virus, Bavaria, Germany. Emerging Infectious Diseases 19, 2064-2066.
    doi: 10.3201/eid1912.131076google scholar: lookup
  6. Burgin CJ, He K. Family Soricidae (Shrews). In D. E. Wilson, & R. A. Mittermeier (Eds.), Handbook of the Mammals of the World: Insectivores, Sloths and Colugos, (pp. 332-551. Cerdanyola del Vallès, Spain: Lynx Edicions.
  7. Caplazi P, Melzer K, Goetzmann R, Rohner-Cotti A, Bracher V, Zlinszky K, Ehrensperger F. Borna disease in Switzerland and in the principality of Liechtenstein. Schweizer Archiv Fur Tierheilkunde 141, 521-527.
  8. Carbone KM, Duchala CS, Griffin JW, Kincaid AL, Narayan O. Pathogenesis of Borna disease in rats: Evidence that intra-axonal spread is the major route for virus dissemination and the determinant for disease incubation. Journal of Virology 61, 3431-3440.
  9. Coras R, Korn K, Kuerten S, Huttner HB, Ensser A. Severe bornavirus-encephalitis presenting as Guillain-Barre-syndrome. Acta Neuropathologica 137, 1017-1019.
  10. Dürrwald R, Kolodziejek J, Herzog S, Nowotny N. Meta-analysis of putative human bornavirus sequences fails to provide evidence implicating Borna disease virus in mental illness. Reviews in Medical Virology 17, 181-203.
  11. Dürrwald R, Kolodziejek J, Weissenböck H, Nowotny N. The bicolored white-toothed shrew Crocidura leucodon (HERMANN 1780) is an indigenous host of mammalian Borna disease virus. PLoS ONE 9, e93659.
  12. Dürrwald R, Nowotny N, Beer M, Kuhn JH. Infections caused by Bornaviruses. In D. D. Richman, R. J. Whitley, & F. G. Hayden (Eds.), Clinical Virology, 4th ed. (pp. 1395-1407). Sterling, VA: American Society for Microbiology.
  13. Enbergs HK, Vahlenkamp TW, Kipar A, Müller H. Experimental infection of mice with Borna disease virus (BDV): Replication and distribution of the virus after intracerebral infection. Journal of Neurovirology 7, 272-277.
    doi: 10.1080/13550280152403317google scholar: lookup
  14. Forth LF, Scholes SFE, Pesavento PA, Jackson K, Mackintosh A, Carson A, Beer M. Novel picornavirus in lambs with severe encephalomyelitis. Journal of Neurovirology 25, 963-967.
    doi: 10.3201/eid2505.181573google scholar: lookup
  15. Gauly M, Vaughan J, Cebra C. Neuweltkameliden: Haltung, Zucht. Erkrankungen. Georg Thieme Verlag.
  16. Heinig A. Zur experimentellen Infektion von Pferden und Schafen mit dem Virus der Bornaschen Krankheit. Archiv Für Experimentelle Veterinärmedizin 18, 753-766.
  17. Herzog S, Kompter C, Frese K, Rott R. Replication of Borna disease virus in rats: Age-dependent differences in tissue distribution. Medical Microbiology and Immunology 173, 171-177.
    doi: 10.1007/bf02122108google scholar: lookup
  18. Hilbe M, Herrsche R, Kolodziejek J, Nowotny N, Zlinszky K, Ehrensperger F. Shrews as reservoir hosts of borna disease virus. Emerging Infectious Diseases 12, 675-677.
    doi: 10.3201/eid1204.051418google scholar: lookup
  19. Hoffmann B, Depner K, Schirrmeier H, Beer M. A universal heterologous internal control system for duplex real-time RT-PCR assays used in a detection system for pestiviruses. Journal of Virological Methods 136, 200-209.
  20. Jacobsen B, Algermissen D, Schaudien D, Venner M, Herzog S, Wentz E, Herden C. Borna disease in an adult alpaca stallion (Lama pacos). Journal of Comparative Pathology 143, 203-208.
  21. Katz JB, Alstad D, Jenny AL, Carbone KM, Rubin SA, Waltrip RW. Clinical, serologic, and histopathologic characterization of experimental Borna disease in ponies. Journal of Veterinary Diagnostic Investigation 10, 338-343.
  22. Kobera R. Bornaerkrankung und Kuhpocken bei Alpakas. International New World Camelid Meeting, pp. 18-19. Justus-Liebig-University Gießen, Gießen, Germany.
  23. Kobera R, Pöhle D. Case reports in South American camelids in Germany. In: M. Gerken, & C. Renieri (Eds.), Proceedings of the 4th European Symposium on South American Camelids and DECAMA European Seminar (p. 151). Göttingen, Germany: Wageningen Academic Publishers.
  24. Kolodziejek J, Dürrwald R, Herzog S, Ehrensperger F, Lussy H, Nowotny N. Genetic clustering of Borna disease virus natural animal isolates, laboratory and vaccine strains strongly reflects their regional geographical origin. Journal of General Virology 86, 385-398.
    doi: 10.1099/vir.0.80587-0google scholar: lookup
  25. Korn K, Coras R, Bobinger T, Herzog SM, Lucking H, Stohr R, Ensser A. Fatal encephalitis associated with borna disease virus 1. New England Journal of Medicine 379, 1375-1377.
    doi: 10.1056/nejmc1800724google scholar: lookup
  26. Krapp F. Crocidura leucodon (Herrmann, 1780) - Feldspitzmaus. In J. Niethammer, & F. Krapp (Eds.), Handbuch der Säugetiere Europas [Handbook of European mammals] (pp. 465-484). Wiesbaden, Germany: Aula Verlag GmbH.
  27. Kupke A, Becker S, Wewetzer K, Ahlemeyer B, Eickmann M, Herden C. Intranasal Borna disease virus (BoDV-1) infection: Insights into initial steps and potential contagiosity. International Journal of Molecular Sciences 20, 1318.
    doi: 10.3390/ijms20061318google scholar: lookup
  28. Liesche F, Ruf V, Zoubaa S, Kaletka G, Rosati M, Rubbenstroth D, Schlegel J. The neuropathology of fatal encephalomyelitis in human Borna virus infection. Acta Neuropathologica 138, 653-665.
  29. Lipkin WI, Briese T, Hornig M. Borna disease virus - fact and fantasy. Virus Research 162, 162-172.
  30. Matthias D. Weitere Untersuchungen zur Borna´schen Krankheit der Pferde und Schafe. Archiv Für Experimentelle Veterinärmedizin 12, 920-947.
  31. Mayr A, Danner K. Persistent infections caused by Borna virus. Infection 2, 64-69.
    doi: 10.1007/bf01642023google scholar: lookup
  32. Metzler A, Ehrensperger F, Danner K. Bornavirus-Infektion bei Schafen: Verlaufsuntersuchungen nach spontaner Infektion, unter besonderer Berücksichtigung der Antikörperkinetik im Serum und Liquor Cerebrospinalis. Schweizer Archiv Für Tierheilkund 121, 37-48.
  33. Metzler A, Frei U, Danner K. Virologically confirmed outbreak of Borna's disease in a Swiss herd of sheep. Schweizer Archiv Für Tierheilkund 118, 483-492.
  34. Morales JA, Herzog S, Kompter C, Frese K, Rott R. Axonal transport of Borna disease virus along olfactory pathways in spontaneously and experimentally infected rats. Medical Microbiology and Immunology 177, 51-68.
    doi: 10.1007/bf00189527google scholar: lookup
  35. Niller HH, Angstwurm K, Rubbenstroth D, Schlottau K, Ebinger A, Giese S, Schmidt B. Zoonotic spillover infections with Borna disease virus 1 leading to fatal human encephalitis, 1999-2019: An epidemiological investigation. The Lancet Infectious Diseases 20(4), 467-477.
  36. Nitzschke E. Untersuchungen über die experimentelle Bornavirus-Infektion bei der Ratte. Zentralblatt Für Veterinärmedizin Reihe B 10, 470-527.
  37. Nobach D, Bourg M, Herzog S, Lange-Herbst H, Encarnacao JA, Eickmann M, Herden C. Shedding of infectious Borna disease virus 1 in living bicolored white-toothed shrews. PLoS ONE 10, e0137018.
  38. Priestnall SL, Schöniger S, Ivens PA, Eickmann M, Brachthäuser L, Kehr K, Herden C. Borna disease virus infection of a horse in Great Britain. Veterinary Record 168, 380b.
    doi: 10.1136/vr.c6405google scholar: lookup
  39. Puorger ME, Hilbe M, Müller JP, Kolodziejek J, Nowotny N, Zlinszky K, Ehrensperger F. Distribution of Borna disease virus antigen and RNA in tissues of naturally infected bicolored white-toothed shrews, Crocidura leucodon, supporting their role as reservoir host species. Veterinary Pathology 47, 236-244.
    doi: 10.1177/0300985809351849google scholar: lookup
  40. Richt JA, Pfeuffer I, Christ M, Frese K, Bechter K, Herzog S. Borna disease virus infection in animals and humans. Emerging Infectious Diseases 3, 343-352.
    doi: 10.3201/eid0303.970311google scholar: lookup
  41. Richt JA, Rott R. Borna disease virus: A mystery as an emerging zoonotic pathogen. The Veterinary Journal 161, 24-40.
    doi: 10.1053/tvjl.2000.0533google scholar: lookup
  42. Richt JA, Stitz L, Wekerle H, Rott R. Borna disease, a progressive meningoencephalomyelitis as a model for CD4+ T cell-mediated immunopathology in the brain. The Journal of Experimental Medicine 170, 1045-1050.
    doi: 10.1084/jem.170.3.1045google scholar: lookup
  43. Rott R, Becht H. Natural and experimental Borna disease in animals. Current Topics in Microbiology and Immunology 190, 17-30.
  44. Rubbenstroth D, Schlottau K, Schwemmle M, Rissland J, Beer M. Human bornavirus research: Back on track!. PLoS Path 15, e1007873.
  45. Scheuch M, Höper D, Beer M. RIEMS: A software pipeline for sensitive and comprehensive taxonomic classification of reads from metagenomics datasets. BMC Bioinformatics 16, 69.
    doi: 10.1186/s12859-015-0503-6google scholar: lookup
  46. Schlegel M, Ali HS, Stieger N, Groschup MH, Wolf R, Ulrich RG. Molecular identification of small mammal species using novel cytochrome b gene-derived degenerated primers. Biochemical Genetics 50, 440-447.
    doi: 10.1007/s10528-011-9487-8google scholar: lookup
  47. Schlottau K, Forth L, Angstwurm K, Höper D, Zecher D, Liesche F, Beer M. Fatal encephalitic Borna disease virus 1 in solid-organ transplant recipients. New England Journal of Medicine 379, 1377-1379.
    doi: 10.1056/nejmc1803115google scholar: lookup
  48. Schmidt J. Die Bornakrankheit des Pferdes. 55 Jahre Forschung und Lehre. Archiv Für Experimentelle Veterinärmedizin 6, 177-187.
  49. Schüppel K-F, Kinne J, Reinacher M. Bornavirus-Antigennachweis bei Alpakas (Lama pacos) sowie bei einem Faultier (Choloepus didactylus) und einem Zwergflusspferd (Choeropsis liberiensis). Verhber Erkrg Zootiere 36, 189-194.
  50. Stitz L, Bilzer T, Planz O. The immunopathogenesis of Borna disease virus infection. Frontiers in Bioscience 7, d541-555.
  51. Tappe D, Frank C, Offergeld R, Wagner-Wiening C, Stark K, Rubbenstroth D, Wilking H. Low prevalence of Borna disease virus 1 (BoDV-1) IgG antibodies in humans from areas endemic for animal Borna disease of Southern Germany. Scientific Reports 9, 20154.
  52. Toussaint JF, Sailleau C, Breard E, Zientara S, De Clercq K. Bluetongue virus detection by two real-time RT-qPCRs targeting two different genomic segments. Journal of Virological Methods 140, 115-123.
  53. Vahlenkamp TW, Konrath A, Weber M, Muller H. Persistence of Borna disease virus in naturally infected sheep. Journal of Virology 76, 9735-9743.
  54. Weissenböck H, Bago Z, Kolodziejek J, Hager B, Palmetzhofer G, Dürrwald R, Nowotny N. Infections of horses and shrews with bornaviruses in Upper Austria: A novel endemic area of Borna disease. Emerging Microbes & Infections 6, e52.
    doi: 10.1038/emi.2017.36google scholar: lookup
  55. Wylezich C, Papa A, Beer M, Höper D. A versatile sample processing workflow for metagenomic pathogen detection. Scientific Reports 8, 13108.
  56. Zimmermann V, Rinder M, Kaspers B, Staeheli P, Rubbenstroth D. Impact of antigenic diversity on laboratory diagnosis of Avian bornavirus infections in birds. Journal of Veterinary Diagnostic Investigation 26, 769-777.
    doi: 10.1177/1040638714547258google scholar: lookup
  57. Zwick W, Seifried O, Witte J. Experimentelle Untersuchungen über die seuchenhafte Gehirn- und Rückenmarksentzündung der Pferde (Bornasche Krankheit). Zeitschrift Für Infektionskrankheiten, Parasitäre Krankheiten Und Hygiene Der Haustiere 30, 42-136.

Citations

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  1. 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 Jun;66(6):599-616.
    doi: 10.1007/s00103-023-03709-0pubmed: 37261460google scholar: lookup
  2. 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 2023 May 30;:1-13.
    doi: 10.1007/s15010-023-02048-1pubmed: 37253816google scholar: lookup
  3. Grosse L, Lieftüchter V, Vollmuth Y, Hoffmann F, Olivieri M, Reiter K, Tacke M, Heinen F, Borggraefe I, Osterman A, Forstner M, Hübner J, von Both U, Birzele L, Rohlfs M, Schomburg A, Böhmer MM, Ruf V, Cadar D, Muntau B, Pörtner K, Tappe D. First detected geographical cluster of BoDV-1 encephalitis from same small village in two children: therapeutic considerations and epidemiological implications.. Infection 2023 Feb 23;:1-16.
    doi: 10.1007/s15010-023-01998-wpubmed: 36821024google scholar: lookup
  4. Matiasek K, Pfaff F, Weissenböck H, Wylezich C, Kolodziejek J, Tengstrand S, Ecke F, Nippert S, Starcky P, Litz B, Nessler J, Wohlsein P, Baumbach C, Mundhenk L, Aebischer A, Reiche S, Weidinger P, Olofsson KM, Rohdin C, Weissenbacher-Lang C, Matt J, Rosati M, Flegel T, Hörnfeldt B, Höper D, Ulrich RG, Nowotny N, Beer M, Ley C, Rubbenstroth D. Mystery of fatal 'staggering disease' unravelled: novel rustrela virus causes severe meningoencephalomyelitis in domestic cats.. Nat Commun 2023 Feb 4;14(1):624.
    doi: 10.1038/s41467-023-36204-wpubmed: 36739288google scholar: lookup
  5. Dürrwald R, Kolodziejek J, Oh DY, Herzog S, Liebermann H, Osterrieder N, Nowotny N. Vaccination against Borna Disease: Overview, Vaccine Virus Characterization and Investigation of Live and Inactivated Vaccines.. Viruses 2022 Dec 2;14(12).
    doi: 10.3390/v14122706pubmed: 36560710google scholar: lookup
  6. Tappe D, Pörtner K, Frank C, Wilking H, Ebinger A, Herden C, Schulze C, Muntau B, Eggert P, Allartz P, Schuldt G, Schmidt-Chanasit J, Beer M, Rubbenstroth D. Investigation of fatal human Borna disease virus 1 encephalitis outside the previously known area for human cases, Brandenburg, Germany - a case report.. BMC Infect Dis 2021 Aug 10;21(1):787.
    doi: 10.1186/s12879-021-06439-3pubmed: 34376142google scholar: lookup
  7. Eisermann P, Rubbenstroth D, Cadar D, Thomé-Bolduan C, Eggert P, Schlaphof A, Leypoldt F, Stangel M, Fortwängler T, Hoffmann F, Osterman A, Zange S, Niller HH, Angstwurm K, Pörtner K, Frank C, Wilking H, Beer M, Schmidt-Chanasit J, Tappe D. Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018-2020.. Emerg Infect Dis 2021 May;27(5):1371-1379.
    doi: 10.3201/eid2705.204490pubmed: 33900167google scholar: lookup
  8. Küchler L, Rüfli I, Koch MC, Hierweger MM, Kauer RV, Boujon CL, Hilbe M, Oevermann A, Zanolari P, Seuberlich T, Gurtner C. Astrovirus-Associated Polioencephalomyelitis in an Alpaca.. Viruses 2020 Dec 30;13(1).
    doi: 10.3390/v13010050pubmed: 33396858google scholar: lookup