<!DOCTYPE article
PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD with MathML3 v1.3 20210610//EN" "JATS-archivearticle1-3-mathml3.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="1.3" xml:lang="en" article-type="brief-report"><?properties open_access?><processing-meta base-tagset="archiving" mathml-version="3.0" table-model="xhtml" tagset-family="jats"><restricted-by>pmc</restricted-by></processing-meta><front><journal-meta><journal-id journal-id-type="nlm-ta">Emerg Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Emerg Infect Dis</journal-id><journal-id journal-id-type="publisher-id">EID</journal-id><journal-title-group><journal-title>Emerging Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1080-6040</issn><issn pub-type="epub">1080-6059</issn><publisher><publisher-name>Centers for Disease Control and Prevention</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">37081716</article-id><article-id pub-id-type="pmc">10124629</article-id><article-id pub-id-type="publisher-id">23-0172</article-id><article-id pub-id-type="doi">10.3201/eid2905.230172</article-id><article-categories><subj-group subj-group-type="heading"><subject>Dispatch</subject></subj-group><subj-group subj-group-type="article-type"><subject>Dispatch</subject></subj-group><subj-group subj-group-type="TOC-title"><subject>Rustrela Virus as Putative Cause of Nonsuppurative Meningoencephalitis in Lions</subject></subj-group></article-categories><title-group><article-title>Rustrela Virus as Putative Cause of Nonsuppurative Meningoencephalitis in Lions</article-title><alt-title alt-title-type="running-head">Rustrela Virus in Lions</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>de le Roi</surname><given-names>Madeleine</given-names></name></contrib><contrib contrib-type="author"><name><surname>Puff</surname><given-names>Christina</given-names></name></contrib><contrib contrib-type="author"><name><surname>Wohlsein</surname><given-names>Peter</given-names></name></contrib><contrib contrib-type="author"><name><surname>Pfaff</surname><given-names>Florian</given-names></name></contrib><contrib contrib-type="author"><name><surname>Beer</surname><given-names>Martin</given-names></name></contrib><contrib contrib-type="author"><name><surname>Baumg&#x000e4;rtner</surname><given-names>Wolfgang</given-names></name></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Rubbenstroth</surname><given-names>Dennis</given-names></name></contrib><aff id="aff1">University of Veterinary Medicine Hannover Foundation, Hannover, Germany (M. de le Roi, C. Puff, P. Wohlsein, W. Baumg&#x000e4;rtner); </aff><aff id="aff2">Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany (F. Pfaff, M. Beer, D. Rubbenstroth)</aff></contrib-group><author-notes><corresp id="cor1">Address for correspondence: Dennis Rubbenstroth, Friedrich-Loeffler-Institut, S&#x000fc;dufer 10, 17493 Greifswald-Insel Riems, Germany; email: <email xlink:href="Dennis.Rubbenstroth@fli.de">Dennis.Rubbenstroth@fli.de</email></corresp></author-notes><pub-date pub-type="ppub"><month>5</month><year>2023</year></pub-date><volume>29</volume><issue>5</issue><fpage>1042</fpage><lpage>1045</lpage><permissions><copyright-year>2023</copyright-year><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/" specific-use="textmining" content-type="ccbylicense">https://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>Emerging Infectious Diseases is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.</license-p></license></permissions><abstract><p>Retrospective investigation of archived tissue samples from 3 lions displaying nonsuppurative meningoencephalitis and vasculitis led to the detection of rustrela virus (RusV). We confirmed RusV antigen and RNA in cortical neurons, axons, astrocytes and Purkinje cells by reverse transcription quantitative PCR, immunohistochemistry, and in situ hybridization.</p></abstract><kwd-group kwd-group-type="author"><title>Keywords: </title><kwd>rustrela virus</kwd><kwd>Rubivirus</kwd><kwd><italic>Rubivirus strelense</italic></kwd><kwd>lions</kwd><kwd>viruses</kwd><kwd>meningoencephalitis</kwd><kwd>retrospective study</kwd><kwd>meningitis/encephalitis</kwd><kwd>Germany</kwd></kwd-group><kwd-group kwd-group-type="author"><kwd><italic>Suggested citation for this article</italic>: de le Roi M</kwd><kwd>Puff C</kwd><kwd>Wohlsein P</kwd><kwd>Pfaff F</kwd><kwd>Beer M</kwd><kwd>Baumg&#x000e4;rtner W</kwd><kwd>et al. Rustrela virus as putative cause of nonsuppurative meningoencephalitis in lions. Emerg Infect Dis. 2023 May [<italic>date cited</italic>]. <ext-link xlink:href="https://doi.org/10.3201/eid2905.230172" ext-link-type="uri">https://doi.org/10.3201/eid2905.230172</ext-link></kwd></kwd-group></article-meta></front><body><p>Until recently, rubella virus (RuV), an RNA virus with single-stranded RNA genome of positive orientation, was considered the only virus of the genus <italic>Rubivirus</italic> and the family <italic>Matonaviridae</italic> (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>&#x02013;<xref rid="R3" ref-type="bibr"><italic>3</italic></xref>). Two close relatives of RuV, designated rustrela virus (RusV) and ruhugu virus (RuhV), were discovered in animals in 2020. RusV was demonstrated to cause nonsuppurative meningoencephalitis in a range of zoo animals in Germany (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>,<xref rid="R5" ref-type="bibr"><italic>5</italic></xref>). Furthermore, RusV was detected in domestic cats (<italic>Felis catus</italic>) showing clinical signs of staggering disease in Germany, Austria, and Sweden (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>). Wild yellow-necked field mice (<italic>Apodemus flavicollis</italic>) and wood mice (<italic>Apodemus sylvaticus</italic>) are assumed to be reservoir hosts of RusV (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>,<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>).</p><p>In the 1970s and 1980s, a series of fatal nonsuppurative encephalitis cases of undetermined cause had occurred in lions (<italic>Panthera leo</italic>) and tigers (<italic>Panthera tigris</italic>) kept in zoological gardens in Germany (<xref rid="R7" ref-type="bibr"><italic>7</italic></xref>,<xref rid="R8" ref-type="bibr"><italic>8</italic></xref>). We reinvestigated cases of 3 lions with nonsuppurative meningoencephalitis of unknown etiology from the 1980s for the presence of RusV.</p><p>The etiology of meningoencephalitides remains undetermined in many cases (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>,<xref rid="R9" ref-type="bibr"><italic>9</italic></xref>); a possible explanation is that conventional methods based on the recognition of virus-specific proteins and nucleic acids did not detect viral variants. Immunohistochemical detection of double-stranded RNA (dsRNA) is considered a virus-sensing tool irrespective of the particular virus (<xref rid="R10" ref-type="bibr"><italic>10</italic></xref>). Therefore, we assessed the applicability of antibodies sensing dsRNA as an alternative virus detection method.</p><sec sec-type="other1"><title>The Study</title><p>We retrospectively investigated 3 lions for the presence of RusV. The lions were identified in 2 zoos in northern and western Germany; they exhibited neurologic signs and nonsuppurative meningoencephalitis. Lion 1 died in 1980 in a zoo in Lower Saxony, whereas lions 2 and 3 were submitted for pathological examination in 1989 by a zoo in North Rhine-Westphalia. All 3 lions displayed a mild, multifocal, lymphohistiocytic meningoencephalitis and vasculitis (<xref rid="F1" ref-type="fig">Figure 1</xref>, panel A) and occasional glial nodules. Inflammatory infiltrates were most prominent in the cerebral gray matter and less prominent in cerebral white matter, cerebellum, and meninges. The spinal cord was not available for analysis. We tested archived formalin-fixed, paraffin-embedded (FFPE) tissues for the presence of RusV RNA and antigen by quantitative reverse transcription PCR (qRT-PCR), in situ hybridization (ISH) and immunohistochemistry (IHC). We included FFPE tissues originating from 8 lions without nonsuppurative meningoencephalitis (lions 4&#x02013;11) as controls (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref>).</p><fig position="float" id="F1" fig-type="figure"><label>Figure 1</label><caption><p>Histopathologic, immunohistochemical, and in situ hybridization findings in the cerebrum of a lion tested positive for rustrela virus (RusV) by quantitative reverse transcription PCR. A) Histopathologic analysis of cerebral sample from lion 3 indicated lymphohistiocytic meningoencephalitis and vasculitis. B) Immunohistochemistry analysis showed RusV antigen in cortical neurons and their processes. Cytoplasmic granular immunoreactivity is visible (inset). C) In situ hybridization revealed RusV RNA in cortical neurons; we observed cytoplasmic granular-positive signal (inset). Scale bars indicate 50 &#x000b5;m.</p></caption><graphic xlink:href="23-0172-F1" position="float"/></fig><p>FFPE brain samples from lions 1&#x02013;3 tested positive for RusV RNA by the broadly reactive qRT-PCR assay panRusV-2 (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>). Cycle quantification (Cq) values were 29&#x02013;38. We detected no RusV RNA in central nervous system (CNS) samples from any of the 8 control animals (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref> Table 1).</p><p>We determined a partial host-genome RusV sequence 409 bp long for all 3 RusV-positive animals by Sanger sequencing of overlapping RT-PCR products (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref>). The sequences shared 97.8% nucleotide identity; phylogenetic analysis revealed all 3 sequences to form a single clade together with the sequence from a domestic cat in Hannover, Lower Saxony, in 2017 (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>). Of note, this subclade was more closely related to sequences from cats with staggering disease in Austria than to sequences from zoo animals, domestic cats, and wild rodents in northeastern Germany (<xref rid="F2" ref-type="fig">Figure 2</xref>).</p><fig position="float" id="F2" fig-type="figure"><label>Figure 2</label><caption><p>Phylogenetic analysis and spatial distribution of rustrela virus infections in Europe. A) Maximum-likelihood phylogenetic tree of partial rustrela virus (RusV) sequences (409 nt, representing genome positions 100&#x02013;508 of donkey-derived RusV reference genome, GenBank accession no. MN552442.2). Only bootstrap values at major branches are shown in the phylogenetic tree. RusV sequence names are shown in the format host/ISO 1366 code of location (federal, state, country)/animal ID/year. The tree was produced using IQ-TREE version 2.2.0; transition model 2 plus empirical frequency plus gamma 4 with 1,000 bootstrap replicates. Bold text indicates sequences from this study. Scale bar indicates substitutions per site. B) Mapping of the geographic origin of RusV-positive animals in Europe. Colors represent the phylogenetic clades of the sequences. Diamonds represent lions; circles, domestic cats; triangles, other zoo animals; squares, <italic>Apodemus</italic> spp. rodents. Symbols in gray boxes represent individuals from the same or very close locations. AUT, Austria; BE,&#x000a0;Berlin; DEU/GER, Germany; MV,&#x000a0;Mecklenburg&#x02013;Western Pomerania; NI,&#x000a0;Lower Saxony; NW,&#x000a0;North Rhine&#x02013;Westphalia; SWE,&#x000a0;Sweden.</p></caption><graphic xlink:href="23-0172-F2" position="float"/></fig><p>IHC investigation for the presence of RusV capsid antigen using monoclonal antibody 2H11B1 (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>) revealed multifocal, cytoplasmic, granular reactions, predominantly in cerebral cortical perikarya and their axons, in few astrocytes as well as in Purkinje cells of all 3 PCR-positive lions (<xref rid="F1" ref-type="fig">Figure 1</xref>, panel B). Likewise, we detected RusV-specific RNA using a newly designed ISH probe (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref>) in the brains of lions 2 and 3, but not of lion 1. We found viral RNA as a cytoplasmic granular signal in cortical perikarya (<xref rid="F1" ref-type="fig">Figure 1</xref>, panel C). We observed RusV-specific capsid antigen and RNA in cerebral cortical neurons adjacent to perivascular infiltrates and also in neurons in more distant areas not associated with inflammatory changes. Neither IHC nor ISH revealed positive signals in any of the examined peripheral organs of the 3 RusV-positive animals and RusV-negative lion 7 (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref> Table 1) or in the CNS of control animals. IHC staining for dsRNA using the dsRNA antibodies K1 and J2 (<xref rid="R11" ref-type="bibr"><italic>11</italic></xref>) provided positive results in the CNS of all tested animals (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref> Table 1). Immunolabeling with anti-dsRNA antibody 9D5 (<xref rid="R11" ref-type="bibr"><italic>11</italic></xref>) remained negative for all 3 RusV-positive animals, whereas the RusV-negative lions 7 and 9 tested positive (<xref rid="SD1" ref-type="supplementary-material">Appendix</xref> Table 1).</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>The results of this study strongly indicate RusV as the potential cause of fatal lymphohistiocytic meningoencephalitis in lions from Germany in the 1980s. The animals were reported to have had neurologic disorders characterized by fever, depression, ataxia, and prolapse of the tongue (<xref rid="R7" ref-type="bibr"><italic>7</italic></xref>). These clinical and histopathological findings are similar to those described previously for RusV-infected zoo animals and domestic cats (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>&#x02013;<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>); they also resemble RuV-induced encephalitis in humans (<xref rid="R12" ref-type="bibr"><italic>12</italic></xref>).</p><p>A partial colocalization of RusV antigen and RNA detection with histopathologic lesions has been observed previously (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>,<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>). Although the pathogenesis of RusV infection has not been elucidated, a virally triggered immune response that remains present even after focal virus clearance may provide an explanation for this phenomenon (<xref rid="R13" ref-type="bibr"><italic>13</italic></xref>). In addition, vasculitis caused by a type III hypersensitivity reaction should be considered.</p><p>The lack of viral antigen and RNA in organs other than the CNS of the infected lions is consistent with previous findings in RusV-infected zoo animals of other species, in which RusV RNA was predominantly detected in the CNS and only sporadically in other organs (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>,<xref rid="R5" ref-type="bibr"><italic>5</italic></xref>). These results indicate a strong neurotropism of RusV also in lions.</p><p>In this study, we consistently detected RusV RNA and antigen in the affected animals using 3 independent methods (qRT-PCR, ISH, and IHC). The lack of viral RNA detection by ISH in the brain of lion 1, positive by qRT-PCR, could be a result of lower sensitivity of ISH (<xref rid="R14" ref-type="bibr"><italic>14</italic></xref>) or of a higher degree of RNA degradation in this &#x0003e;40-year-old sample. Furthermore, the crosslinking of proteins caused by formalin has been shown to influence the quality and accessibility of DNA or RNA in FFPE material (<xref rid="R15" ref-type="bibr"><italic>15</italic></xref>).</p><p>Immunohistochemical investigation for dsRNA revealed positive results in the brains of all investigated lions, regardless of their RusV infection status. Although it is possible that the RusV-negative lions were infected by other neurotropic RNA viruses, this scenario appears unlikely because no CNS lesions were observed in control animals 4&#x02013;11. Thus, this method appears unsuitable for reliable detection of viral dsRNA in the brains of lions and perhaps other animals.</p><p>In summary, our study reveals that RusV was present in northern and western Germany in the 1980s. Detecting RusV in lions indicates an even broader host range of RusV, encompassing a variety of different species (<xref rid="R1" ref-type="bibr"><italic>1</italic></xref>,<xref rid="R4" ref-type="bibr"><italic>4</italic></xref>&#x02013;<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>) and suggests that other wild and captive felids may be susceptible to RusV infection. As described previously (<xref rid="R6" ref-type="bibr"><italic>6</italic></xref>), fulfilling Henle-Koch&#x02019;s postulates by experimental reproduction of the disease has not been possible because of lack of RusV isolates. Nevertheless, the association between RusV detection and disease demonstrated in this study, combined with previous studies on RusV infections in zoo animals and domestic cats, strongly suggests RusV as a causative agent of meningoencephalitis in lions.</p></sec><sec sec-type="supplementary-material"><supplementary-material id="SD1" position="float" content-type="local-data"><caption><title>Appendix</title><p>Additional information on rustrela virus as putative cause of nonsuppurative meningoencephalitis in lions.</p></caption><media xlink:href="23-0172-Techapp-s1.pdf" id="d64e325" position="anchor"/></supplementary-material></sec></body><back><ack><title>Acknowledgments</title><p>We thank Julia Baskas, Petra Gr&#x000fc;nig, Jana-Svea Harre, Claudia Herrmann, Weda Hoffmann, Kerstin Rohn, Kerstin Sch&#x000f6;ne, Caroline Sch&#x000fc;tz, Philip Starcky, Kathrin Steffen, Danuta Waschke, and Melanie Woischnik for technical assistance. We are also grateful to Andrea Aebischer for providing the RusV-specific monoclonal antibody 2H11B1.</p><p>This work was in part supported by the Deutsche Forschungsgemeinschaft (DFG; German Research Foundation; -398066876/GRK 2485/1-VIPER-GRK) and by the German Federal Ministry of Education and Research, project RubiZoo (grant no. 01KI2111).</p></ack><bio id="d64e331"><p>Ms. de le Roi is a PhD student in the Department of Pathology at the University of Veterinary Medicine Hannover Foundation, Hannover, Germany. Her research field focuses on alternative virus detection methods.</p></bio><ref-list><title>References </title><ref id="R1"><label>1. </label><mixed-citation publication-type="journal"><string-name><surname>Pfaff</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Breithaupt</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Rubbenstroth</surname>
<given-names>D</given-names></string-name>, <string-name><surname>Nippert</surname>
<given-names>S</given-names></string-name>, <string-name><surname>Baumbach</surname>
<given-names>C</given-names></string-name>, <string-name><surname>Gerst</surname>
<given-names>S</given-names></string-name>, <etal>et al.</etal>
<article-title>Revisiting rustrela virus: new cases of encephalitis and a solution to the capsid enigma.</article-title>
<source>Microbiol Spectr</source>. <year>2022</year>;<volume>10</volume>:<elocation-id>e0010322</elocation-id>. <pub-id pub-id-type="doi">10.1128/spectrum.00103-22</pub-id><pub-id pub-id-type="pmid">35384712</pub-id></mixed-citation></ref><ref id="R2"><label>2. </label><mixed-citation publication-type="journal"><string-name><surname>Mankertz</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Chen</surname>
<given-names>MH</given-names></string-name>, <string-name><surname>Goldberg</surname>
<given-names>TL</given-names></string-name>, <string-name><surname>H&#x000fc;bschen</surname>
<given-names>JM</given-names></string-name>, <string-name><surname>Pfaff</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Ulrich</surname>
<given-names>RG</given-names></string-name>; <collab>Ictv Report Consortium</collab>. <article-title>ICTV virus taxonomy profile: <italic>Matonaviridae</italic> 2022.</article-title>
<source>J Gen Virol</source>. <year>2022</year>;<volume>103</volume>. <comment>In press</comment>. <pub-id pub-id-type="doi">10.1099/jgv.0.001817</pub-id><pub-id pub-id-type="pmid">36748520</pub-id></mixed-citation></ref><ref id="R3"><label>3. </label><mixed-citation publication-type="journal"><string-name><surname>Parkman</surname>
<given-names>PD</given-names></string-name>, <string-name><surname>Buescher</surname>
<given-names>EL</given-names></string-name>, <string-name><surname>Artenstein</surname>
<given-names>MS</given-names></string-name>. <article-title>Recovery of rubella virus from army recruits.</article-title>
<source>Proc Soc Exp Biol Med</source>. <year>1962</year>;<volume>111</volume>:<fpage>225</fpage>&#x02013;<lpage>30</lpage>. <pub-id pub-id-type="doi">10.3181/00379727-111-27750</pub-id><pub-id pub-id-type="pmid">13941530</pub-id></mixed-citation></ref><ref id="R4"><label>4. </label><mixed-citation publication-type="journal"><string-name><surname>Bennett</surname>
<given-names>AJ</given-names></string-name>, <string-name><surname>Paskey</surname>
<given-names>AC</given-names></string-name>, <string-name><surname>Ebinger</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Pfaff</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Priemer</surname>
<given-names>G</given-names></string-name>, <string-name><surname>H&#x000f6;per</surname>
<given-names>D</given-names></string-name>, <etal>et al.</etal>
<article-title>Relatives of rubella virus in diverse mammals.</article-title>
<source>Nature</source>. <year>2020</year>;<volume>586</volume>:<fpage>424</fpage>&#x02013;<lpage>8</lpage>. <pub-id pub-id-type="doi">10.1038/s41586-020-2812-9</pub-id><pub-id pub-id-type="pmid">33029010</pub-id></mixed-citation></ref><ref id="R5"><label>5. </label><mixed-citation publication-type="journal"><string-name><surname>Voss</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Schlieben</surname>
<given-names>P</given-names></string-name>, <string-name><surname>Gerst</surname>
<given-names>S</given-names></string-name>, <string-name><surname>Wylezich</surname>
<given-names>C</given-names></string-name>, <string-name><surname>Pfaff</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Langner</surname>
<given-names>C</given-names></string-name>, <etal>et al.</etal>
<article-title>Rustrela virus infection - An emerging neuropathogen of red-necked wallabies (<italic>Macropus rufogriseus</italic>).</article-title>
<source>Transbound Emerg Dis</source>. <year>2022</year>;<volume>69</volume>:<fpage>4016</fpage>&#x02013;<lpage>21</lpage>. <pub-id pub-id-type="doi">10.1111/tbed.14708</pub-id><pub-id pub-id-type="pmid">36135593</pub-id></mixed-citation></ref><ref id="R6"><label>6. </label><mixed-citation publication-type="journal"><string-name><surname>Matiasek</surname>
<given-names>K</given-names></string-name>, <string-name><surname>Pfaff</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Weissenb&#x000f6;ck</surname>
<given-names>H</given-names></string-name>, <string-name><surname>Wylezich</surname>
<given-names>C</given-names></string-name>, <string-name><surname>Kolodziejek</surname>
<given-names>J</given-names></string-name>, <string-name><surname>Tengstrand</surname>
<given-names>S</given-names></string-name>, <etal>et al.</etal>
<article-title>Mystery of fatal &#x02018;staggering disease&#x02019; unravelled: novel rustrela virus causes severe meningoencephalomyelitis in domestic cats.</article-title>
<source>Nat Commun</source>. <year>2023</year>;<volume>14</volume>:<fpage>624</fpage>. <pub-id pub-id-type="doi">10.1038/s41467-023-36204-w</pub-id><pub-id pub-id-type="pmid">36739288</pub-id></mixed-citation></ref><ref id="R7"><label>7. </label><mixed-citation publication-type="journal"><string-name><surname>Truyen</surname>
<given-names>U</given-names></string-name>, <string-name><surname>Stockhofe-Zurwieden</surname>
<given-names>N</given-names></string-name>, <string-name><surname>Kaaden</surname>
<given-names>OR</given-names></string-name>, <string-name><surname>Pohlenz</surname>
<given-names>J</given-names></string-name>. <article-title>A case report: encephalitis in lions. Pathological and virological findings.</article-title>
<source>Dtsch Tierarztl Wochenschr</source>. <year>1990</year>;<volume>97</volume>:<fpage>89</fpage>&#x02013;<lpage>91</lpage>.<pub-id pub-id-type="pmid">2311536</pub-id></mixed-citation></ref><ref id="R8"><label>8. </label><mixed-citation publication-type="journal"><string-name><surname>Flyr</surname>
<given-names>K</given-names></string-name>. <article-title>Encephalomyelitis bei Gro&#x000df;katzen.</article-title>
<source>Dtsch Tierarztl Wochenschr</source>. <year>1973</year>;<volume>80</volume>:<fpage>393</fpage>&#x02013;<lpage>416</lpage>.<pub-id pub-id-type="pmid">4580756</pub-id></mixed-citation></ref><ref id="R9"><label>9. </label><mixed-citation publication-type="journal"><string-name><surname>Nessler</surname>
<given-names>J</given-names></string-name>, <string-name><surname>Wohlsein</surname>
<given-names>P</given-names></string-name>, <string-name><surname>Junginger</surname>
<given-names>J</given-names></string-name>, <string-name><surname>Hansmann</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Erath</surname>
<given-names>J</given-names></string-name>, <string-name><surname>S&#x000f6;bbeler</surname>
<given-names>F</given-names></string-name>, <etal>et al.</etal>
<article-title>Meningoencephalomyelitis of unknown origin in cats: a case series describing clinical and pathological findings.</article-title>
<source>Front Vet Sci</source>. <year>2020</year>;<volume>7</volume>:<fpage>291</fpage>. <pub-id pub-id-type="doi">10.3389/fvets.2020.00291</pub-id><pub-id pub-id-type="pmid">32671104</pub-id></mixed-citation></ref><ref id="R10"><label>10. </label><mixed-citation publication-type="journal"><string-name><surname>Koyama</surname>
<given-names>S</given-names></string-name>, <string-name><surname>Ishii</surname>
<given-names>KJ</given-names></string-name>, <string-name><surname>Coban</surname>
<given-names>C</given-names></string-name>, <string-name><surname>Akira</surname>
<given-names>S</given-names></string-name>. <article-title>Innate immune response to viral infection.</article-title>
<source>Cytokine</source>. <year>2008</year>;<volume>43</volume>:<fpage>336</fpage>&#x02013;<lpage>41</lpage>. <pub-id pub-id-type="doi">10.1016/j.cyto.2008.07.009</pub-id><pub-id pub-id-type="pmid">18694646</pub-id></mixed-citation></ref><ref id="R11"><label>11. </label><mixed-citation publication-type="journal"><string-name><surname>St&#x000f6;rk</surname>
<given-names>T</given-names></string-name>, <string-name><surname>de le Roi</surname>
<given-names>M</given-names></string-name>, <string-name><surname>Haverkamp</surname>
<given-names>AK</given-names></string-name>, <string-name><surname>Jesse</surname>
<given-names>ST</given-names></string-name>, <string-name><surname>Peters</surname>
<given-names>M</given-names></string-name>, <string-name><surname>Fast</surname>
<given-names>C</given-names></string-name>, <etal>et al.</etal>
<article-title>Analysis of avian Usutu virus infections in Germany from 2011 to 2018 with focus on dsRNA detection to demonstrate viral infections.</article-title>
<source>Sci Rep</source>. <year>2021</year>;<volume>11</volume>:<fpage>24191</fpage>. <pub-id pub-id-type="doi">10.1038/s41598-021-03638-5</pub-id><pub-id pub-id-type="pmid">34921222</pub-id></mixed-citation></ref><ref id="R12"><label>12. </label><mixed-citation publication-type="journal"><string-name><surname>Frey</surname>
<given-names>TK</given-names></string-name>. <article-title>Neurological aspects of rubella virus infection.</article-title>
<source>Intervirology</source>. <year>1997</year>;<volume>40</volume>:<fpage>167</fpage>&#x02013;<lpage>75</lpage>. <pub-id pub-id-type="doi">10.1159/000150543</pub-id><pub-id pub-id-type="pmid">9450233</pub-id></mixed-citation></ref><ref id="R13"><label>13. </label><mixed-citation publication-type="journal"><string-name><surname>Zdora</surname>
<given-names>I</given-names></string-name>, <string-name><surname>Raue</surname>
<given-names>J</given-names></string-name>, <string-name><surname>S&#x000f6;bbeler</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Tipold</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Baumg&#x000e4;rtner</surname>
<given-names>W</given-names></string-name>, <string-name><surname>Nessler</surname>
<given-names>JN</given-names></string-name>. <article-title>Case report: Lympho-histiocytic meningoencephalitis with central nervous system vasculitis of unknown origin in three dogs.</article-title>
<source>Front Vet Sci</source>. <year>2022</year>;<volume>9</volume>:<elocation-id>944867</elocation-id>. <pub-id pub-id-type="doi">10.3389/fvets.2022.944867</pub-id><pub-id pub-id-type="pmid">36090171</pub-id></mixed-citation></ref><ref id="R14"><label>14. </label><mixed-citation publication-type="journal"><string-name><surname>Pfankuche</surname>
<given-names>VM</given-names></string-name>, <string-name><surname>Hahn</surname>
<given-names>K</given-names></string-name>, <string-name><surname>Bodewes</surname>
<given-names>R</given-names></string-name>, <string-name><surname>Hansmann</surname>
<given-names>F</given-names></string-name>, <string-name><surname>Habierski</surname>
<given-names>A</given-names></string-name>, <string-name><surname>Haverkamp</surname>
<given-names>AK</given-names></string-name>, <etal>et al.</etal>
<article-title>Comparison of different in situ hybridization techniques for the detection of various RNA and DNA viruses.</article-title>
<source>Viruses</source>. <year>2018</year>;<volume>10</volume>:<fpage>384</fpage>. <pub-id pub-id-type="doi">10.3390/v10070384</pub-id><pub-id pub-id-type="pmid">30037026</pub-id></mixed-citation></ref><ref id="R15"><label>15. </label><mixed-citation publication-type="journal"><string-name><surname>Bodewes</surname>
<given-names>R</given-names></string-name>, <string-name><surname>van Run</surname>
<given-names>PR</given-names></string-name>, <string-name><surname>Sch&#x000fc;rch</surname>
<given-names>AC</given-names></string-name>, <string-name><surname>Koopmans</surname>
<given-names>MP</given-names></string-name>, <string-name><surname>Osterhaus</surname>
<given-names>AD</given-names></string-name>, <string-name><surname>Baumg&#x000e4;rtner</surname>
<given-names>W</given-names></string-name>, <etal>et al.</etal>
<article-title>Virus characterization and discovery in formalin-fixed paraffin-embedded tissues.</article-title>
<source>J Virol Methods</source>. <year>2015</year>;<volume>214</volume>:<fpage>54</fpage>&#x02013;<lpage>9</lpage>. <pub-id pub-id-type="doi">10.1016/j.jviromet.2015.02.002</pub-id><pub-id pub-id-type="pmid">25681526</pub-id></mixed-citation></ref></ref-list></back></article>