Borna Disease Virus (liver transplant)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
First report of donor-derived Borna disease virus 1 (BDV1) through kidneys and liver transplantation.
Time to detection: 
Post-transplantation day 112 (kidney recipient 1, R1), 80 (kidney recipient 2, R2) and 98 (liver recipient, R3)
Alerting signals, symptoms, evidence of occurrence: 
R1 and R2 received antithymocyte globulin in addition to other immunosuppressive medications. Progressive, ascending, flaccid, sensorimotor tetraparesis developed in both patients, starting at post-transplantation days 112 (R1) and 80 (R2), leading to irreversible coma. Neuroimaging revealed encephalitis in R2 and diffuse cerebral atrophy in both patients. R1 died on post-transplantation day 208, R2 died on post-transplantation day 179. R3: on post-transplantation day 98 developed facial palsy, anomia and cognitive deficits. Magnetic resonance imaging revealed a leukoencephalopathy. R3 is currently in remission from the disease and has optic nerve atrophy.
Demonstration of imputability or root cause: 
A 70-year-old, white, male individual from the Bavarian region of southern Germany donated 2 kidneys and liver. The donor had no signs or symptoms of neurologic disease or of an active infectious process. The source and state of the infection of the donor remain unclear (no information on donor samples) . The phylogenetic analysis between a brain-biopsy specimen from R1 and a cluster of partial genome sequences of BDV 1 field isolates originating from shrews and horses in Bavaria showed a 99.3 to 99.7% nucleotide identity. An identical BDV 1 sequence was generated from formalin-fixed, paraffin-embedded brain tissue from R2. Bornavirus-specific antibody titers in serum and CSF were detected in R3.
Imputability grade: 
2 Probable
Suggest new keywords: 
cerebral atrophy, leukoencephalopathy., optic nerve atrophy
Suggest references: 
1) Schlottau et al. Fatal Encephalitic Borna Disease Virus 1 in Solid-Organ Transplant Recipients. N Engl J Med. 2018 Oct 4;379(14):1377-1379 2) Schlottau et al. Variegated Squirrel Bornavirus 1 in Squirrels, Germany and the Netherlands. Emerg Infect Dis. 2017 Mar;23(3):477-481 3) Hoffmann B, et al. A Variegated Squirrel Bornavirus Associated with Fatal Human Encephalitis. N Engl J Med. 2015 Jul 9;373(2):154-62
Please clone for liver Create new Adverse Occurrence type: Borna disease virus (EP) Need key words, expert comments, any detail on liver? details about the molecular analysis? If accurate, then imputabioity is proven (IUL).. Was the virus detected in CSF and brain or?
Expert comments for publication: 
In 2015, a novel zoonotic bornavirus, the variegated squirrel bornavirus 1 (VSBV-1), was found in tissue samples from the central nervous system of 3 fatal human cases of encephalitis. The patients were breeders of variegated squirrels and an almost identical bornavirus sequence was detected in 1 contact squirrel kept by one of the breeders. Phylogenetic analysis classified VSBV-1 as a unique member of a new species of the genus Bornavirus. The attached references provide more details.