Detection of virus-specific T cells via ELISpot corroborates early diagnosis in human Borna disease virus 1 (BoDV-1) encephalitis

• Published in: Infection 2024-10, Vol.52 (5), p.1663-1670
• Main Authors: Bauswein, Markus, Eid, Ehab, Eidenschink, Lisa, Schmidt, Barbara, Gessner, André, Tappe, Dennis, Cadar, Dániel, Böhmer, Merle M., Jockel, Laura, van Wickeren, Nora, Garibashvili, Tamara, Wiesinger, Isabel, Wendl, Christina, Heckmann, Josef G., Angstwurm, Klemens, Freyer, Martin
• Format: Article
• Language: English
• Subjects: Adsorption; Borna disease; Borna virus; Case Report; Cerebrospinal fluid; Diagnosis; Encephalitis; Enzyme-linked immunosorbent assay; Family Medicine; General Practice; Health risks; Immune adsorption; Immunoglobulin G; Infectious Diseases; Internal Medicine; Lymphocytes; Lymphocytes T; Mechanical properties; Mechanical ventilation; Medicine; Medicine & Public Health; Peripheral blood; Seroconversion; Serology; Viruses; Zoonoses
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-024-02246-5

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.