Heartland bandavirus

Last updated
Heartland bandavirus
Virus classification Red Pencil Icon.png
(unranked): Virus
Realm: Riboviria
Kingdom: Orthornavirae
Phylum: Negarnaviricota
Class: Ellioviricetes
Order: Bunyavirales
Family: Phenuiviridae
Genus: Bandavirus
Species:
Heartland bandavirus
Synonyms [1]
  • Heartland virus
  • Heartland banyangvirus

Heartland bandavirus, sometimes called Heartland virus (HRTV), is a tick-borne phlebovirus of the Bhanja virus serocomplex discovered in 2009. The lone star tick transmits the virus to people when feeding on blood. As of 2017, only five states in the Central United States have reported 20 human infections, namely Arkansas, Indiana, Missouri, Oklahoma, and Tennessee; symptoms resemble those of two other tick-borne infections ehrlichiosis and anaplasmosis. The reservoir host is unknown, but deer, raccoon, coyotes, and moose in 13 different states have antibody titers against the virus. By 2023 over 50 human infections were reported in at least eleven states. [2] [3]

Contents

History

The Heartland virus (HRTV) was discovered in 2009 in northwestern Missouri by Dr. Scott Folk of Heartland Regional Medical Center in St. Joseph, Missouri. [4] The virus was first proven to infect humans in June 2009 when two farmers, living 60 miles (97 km) apart, presented with fever, fatigue, diarrhea, thrombocytopenia, and leukopenia. [5] The Lone Star Tick transmits the virus to people when feeding on blood.

Classification

The Heartland virus is part of the Bunyavirales order of viruses which contain 3 segments of −ssRNA. The genus of the virus is Phlebovirus and the species is the Heartland virus. [6]

Transmission

In 2013, researchers from the CDC and Missouri Western State University first isolated the Heartland virus (HRTV) from the Lone Star Tick ( Amblyomma americanum ). [6] [7] As of 2013 work continued to identify the reservoir host, [6] as HRTV has not been isolated from any wild or domestic animals though many white-tailed deer and raccoon from northwestern Missouri had antibodies to HRTV, suggesting that they may be hosts.

In a 2015 retrospective study using convenience samples of different wild animal sera deer, raccoon, coyotes, and moose had antibodies against HRTV. They lived in thirteen states: Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Missouri, North Carolina, Tennessee, Texas, but also New Hampshire, Maine and Vermont. The infections could have occurred as early as 2003, based on the estimated ages of affected deer. Since the Lone Star tick does not occur in northern New England it is assumed that a second type of tick can carry HRTV. [8]

Infection

Signs and symptoms

Signs and symptoms include fever in excess of 100.4 °F (38 °C), lethargy (weakness), headaches, muscle pain (myalgia), loss of appetite, nausea, diarrhea, weight loss, joint pain (arthralgia), low white blood cell count (leukopenia) and easy bruising due to a low platelet count (thrombocytopenia). Elevated liver transaminases may also be present. [9]

Risk factors

All known human cases have been reported from five U.S. states: Arkansas, Indiana, Missouri, Oklahoma, and Tennessee. Most people infected were spending time outdoors in regions where ticks are endemic. Most infections are diagnosed between May and September. People usually report having been bitten by a tick within two weeks prior to seeking health care.[ citation needed ]

Diagnosis

Diagnosis is through the elimination of other causes of infectious diseases with related symptoms like ehrlichiosis and anaplasmosis or if the patient fails to respond to treatment with the antibiotic doxycycline. RT-PCR may then be used to detect viral ssRNA in the blood. Antibody titers against the virus may also be used to indicate infection with the Heartland virus. [10]

Treatment

Treatment is non-specific. Antibiotics are not useful against viruses. Intravenous fluid administration and medications for the relief of pain are currently the best options. [11]

Prevention

When planning to spend time outdoors in areas where the virus is known or suspected to be harbored by ticks, it is recommended that one cover the body completely with long sleeves and pants, and to avoid bushy and wooded areas. Although ticks are not consistently repelled by DEET-containing repellents, insect repellents should still be applied to one's body and gear. It is recommended that one perform thorough tick checks after being outside, and to remove any tick immediately. If a tick is found, one should remove the tick by the head, preferably with a pair of fine-tipped tweezers. Squeezing the abdomen of a tick while it is attached can force viruses and bacteria into the wound, increasing the chance of infection. Crushing an unattached tick will also release bacteria and viruses from its abdomen, which may then be able to enter a wound or burrow through the skin.[ citation needed ]

Human cases

More than 20 human infections have been reported in the United States, [12] but given the obscurity of the disease, the true number of cases is suspected to be substantially larger.

Heartland virus cases
YearLocationDeathsCases
2009Northwestern Missouri02
2012–2013 [10] Missouri, Tennessee [13] 16
2014Missouri, [14] Oklahoma [15] 13
2017Northwestern Arkansas, [12] Indiana [16] 03
2023Maryland/Virginia [17] 11

Related Research Articles

Ehrlichiosis is a tick-borne disease of dogs usually caused by the rickettsial agent Ehrlichia canis. Ehrlichia canis is the pathogen of animals. Humans can become infected by E. canis and other species after tick exposure. German Shepherd Dogs are thought to be susceptible to a particularly severe form of the disease; other breeds generally have milder clinical signs. Cats can also be infected.

Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents transmitted by tick bites. They are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. The economic impact of tick-borne diseases is considered to be substantial in humans, and tick-borne diseases are estimated to affect ~80 % of cattle worldwide.

<i>Bunyavirales</i> Order of RNA viruses

Bunyavirales is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods, plants, protozoans, and vertebrates. It is the only order in the class Ellioviricetes. The name Bunyavirales derives from Bunyamwera, where the original type species Bunyamwera orthobunyavirus was first discovered. Ellioviricetes is named in honor of late virologist Richard M. Elliott for his early work on bunyaviruses.

<span class="mw-page-title-main">Tick-borne encephalitis</span> Medical condition

Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The disease most often manifests as meningitis, encephalitis or meningoencephalitis. Myelitis and spinal paralysis also occurs. In about one third of cases sequelae, predominantly cognitive dysfunction, persist for a year or more.

<i>Phlebovirus</i> Genus of viruses

Phlebovirus is one of twenty genera of the family Phenuiviridae in the order Bunyavirales. The genus contains 66 species. It derives its name from Phlebotominae, the vectors of member species Naples phlebovirus, which is said to be ultimately from the Greek phlebos, meaning "vein". The proper word for "vein" in ancient Greek is however phleps (φλέψ).

<i>Anaplasma phagocytophilum</i> Species of bacterium

Anaplasma phagocytophilum is a Gram-negative bacterium that is unusual in its tropism to neutrophils. It causes anaplasmosis in sheep and cattle, also known as tick-borne fever and pasture fever, and also causes the zoonotic disease human granulocytic anaplasmosis.

Powassan virus (POWV) is a Flavivirus transmitted by ticks, found in North America and in the Russian Far East. It is named after the town of Powassan, Ontario, where it was identified in a young boy who eventually died from it. It can cause encephalitis, an infection of the brain. No approved vaccine or antiviral drug exists. Prevention of tick bites is the best precaution.

<span class="mw-page-title-main">Anaplasmosis</span> Medical condition

Anaplasmosis is a tick-borne disease affecting ruminants, dogs, and horses, and is caused by Anaplasma bacteria. Anaplasmosis is an infectious but not contagious disease. Anaplasmosis can be transmitted through mechanical and biological vector processes. Anaplasmosis can also be referred to as "yellow bag" or "yellow fever" because the infected animal can develop a jaundiced look. Other signs of infection include weight loss, diarrhea, paleness of the skin, aggressive behavior, and high fever.

<span class="mw-page-title-main">Ehrlichiosis</span> Medical condition

Ehrlichiosis is a tick-borne bacterial infection, caused by bacteria of the family Anaplasmataceae, genera Ehrlichia and Anaplasma. These obligate intracellular bacteria infect and kill white blood cells.

<i>Ixodes scapularis</i> Species of tick

Ixodes scapularis is commonly known as the deer tick or black-legged tick, and in some parts of the US as the bear tick. It was also named Ixodes dammini until it was shown to be the same species in 1993. It is a hard-bodied tick found in the eastern and northern Midwest of the United States as well as in southeastern Canada. It is a vector for several diseases of animals, including humans and is known as the deer tick owing to its habit of parasitizing the white-tailed deer. It is also known to parasitize mice, lizards, migratory birds, etc. especially while the tick is in the larval or nymphal stage.

<i>Amblyomma americanum</i> Species of tick

Amblyomma americanum, also known as the lone star tick, the northeastern water tick, or the turkey tick, is a type of tick indigenous to much of the eastern United States and Mexico, that bites painlessly and commonly goes unnoticed, remaining attached to its host for as long as seven days until it is fully engorged with blood. It is a member of the phylum Arthropoda, class Arachnida. The adult lone star tick is sexually dimorphic, named for a silvery-white, star-shaped spot or "lone star" present near the center of the posterior portion of the adult female shield (scutum); adult males conversely have varied white streaks or spots around the margins of their shields.

Ehrlichia chaffeensis is an obligate intracellular, Gram-negative species of Rickettsiales bacteria. It is a zoonotic pathogen transmitted to humans by the lone star tick. It is the causative agent of human monocytic ehrlichiosis.

<span class="mw-page-title-main">Human granulocytic anaplasmosis</span> Medical condition

Human granulocytic anaplasmosis (HGA) is a tick-borne, infectious disease caused by Anaplasma phagocytophilum, an obligate intracellular bacterium that is typically transmitted to humans by ticks of the Ixodes ricinus species complex, including Ixodes scapularis and Ixodes pacificus in North America. These ticks also transmit Lyme disease and other tick-borne diseases.

<span class="mw-page-title-main">Human monocytotropic ehrlichiosis</span> Medical condition

Human monocytotropic ehrlichiosis is a form of ehrlichiosis associated with Ehrlichia chaffeensis. This bacterium is an obligate intracellular pathogen affecting monocytes and macrophages.

Ehrlichiosis ewingii infection is an infectious disease caused by an intracellular bacteria, Ehrlichia ewingii. The infection is transmitted to humans by the tick, Amblyomma americanum. This tick can also transmit Ehrlichia chaffeensis, the bacteria that causes human monocytic ehrlichiosis (HME).

Ehrlichia canis is an obligate intracellular bacterium that acts as the causative agent of ehrlichiosis, a disease most commonly affecting canine species. This pathogen is present throughout the United States, South America, Asia, Africa and recently in the Kimberley region of Australia. First defined in 1935, E. canis emerged in the United States in 1963 and its presence has since been found in all 48 contiguous United States. Reported primarily in dogs, E. canis has also been documented in felines and humans, where it is transferred most commonly via Rhipicephalus sanguineus, the brown dog tick.

Ehrlichia Wisconsin HM543746 is an unnamed tick bacterium that spread through Minnesota and Wisconsin in 2009 and is similar to Ehrlichia muris.

Borrelia miyamotoi is a bacterium of the spirochete phylum in the genus Borrelia. A zoonotic organism, B. miyamotoi can infect humans through the bite of several species of hard-shell Ixodes ticks, the same kind of ticks that spread B. burgdorferi, the causative bacterium of Lyme disease. Ixodes ticks are also the primary vector in the spread of babesiosis and anaplasmosis.

Lone star bandavirus is a highly divergent bunyavirus, which is carried and transmitted by the lone star tick, Amblyomma americanum. This is the same vector that transmits the SFTS virus, and the newly discovered Bhanja and Heartland viruses.

<span class="mw-page-title-main">Bourbon virus</span> Species of virus

Bourbon virus is an RNA virus in the genus Thogotovirus of the family Orthomyxoviridae, which is similar to Dhori virus and Batken virus. It was first identified in 2014 in a man from Bourbon County, Kansas, United States, who died after being bitten by ticks. The case is the eighth report of human disease associated with a thogotovirus globally, and the first in the Western hemisphere. As of May 2015, a case was discovered in Stillwater, Oklahoma and relatively little is known about the virus. No specific treatment or vaccine is available. The virus is suspected to be transmitted by ticks or insects, and avoidance of bites is recommended to reduce risk of infection. In June 2017 a 58-year-old female Missouri State Park employee died from an infection of the Bourbon virus after it had been misdiagnosed for a significant period of time.

References

  1. Maes, Piet; Kuhn, Jens H. (31 August 2018). "Expansion of the order Bunyavirales" (docx). International Committee on Taxonomy of Viruses (ICTV). Retrieved 20 December 2019. Heartland banyangvirus: derived from Heartland virus (and genus Banyangvirus)
  2. Ed Cara (24 Feb 2023) U.S. Man's Death Suggests Deadly Tick Virus Is Spreading to New Regions
  3. Sichen Liu, et. al. (May 2023) Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States
  4. Knox, Richard (29 August 2012). "Mysterious New 'Heartland Virus' Discovered in Missouri". Shots: NPR's Health Blog. NPR. Retrieved 2012-08-30.
  5. Grady, Denise (2012-09-03). "New Virus Tied to Ticks Poses Puzzle for Doctors". New York Times. Retrieved 2012-09-07.
  6. 1 2 3 Schnirring, Lisa (2013-07-22). "Researchers trace novel Heartland virus to Missouri ticks". CIDRAP. Retrieved 2013-07-23.
  7. Harry M. Savage; Marvin S. Godsey Jr.; Amy Lambert; Nickolas A. Panella; Kristen L. Burkhalter; Jessica R. Harmon; R. Ryan Lash; David C. Ashley; William L. Nicholson (22 July 2013). "First Detection of Heartland Virus (Bunyaviridae: Phlebovirus) from Field Collected Arthropods". Am J Trop Med Hyg. 89 (3): 445–452. doi:10.4269/ajtmh.13-0209. PMC   3771279 . PMID   23878186.
  8. Riemersma KK, Komar N. Heartland Virus Neutralizing Antibodies in Vertebrate Wildlife, United States, 2009–2014. Emerg Infect Dis. 2015 Oct;21(10):1830–3. doi : 10.3201/eid2110.150380
  9. Laura K. McMullan; Scott M. Folk; Aubree J. Kelly; Adam MacNeil; Cynthia S. Goldsmith; Maureen G. Metcalfe; Brigid C. Batten; César G. Albariño; Sherif R. Zaki; Pierre E. Rollin; William L. Nicholson; Stuart T. Nichol (2012-08-30). "A New Phlebovirus Associated with Severe Febrile Illness in Missouri". New England Journal of Medicine. 367 (9): 834–841. doi: 10.1056/NEJMoa1203378 . PMID   22931317.
  10. 1 2 Pastula, DM; Turabelidze, G; Yates, KF; Jones, TF; Lambert, AJ; Panella, AJ; Kosoy, OI; Velez, JO; Fisher, M; Staples, E (Mar 2014). "Notes from the field: Heartland virus disease - United States, 2012–2013". MMWR Morb Mortal Wkly Rep. 63 (12): 270–1. PMC   5779346 . PMID   24670929.
  11. CDC Media relations CDC Reports More Cases of Heartland Virus Disease CDC press release, 27 March 2014
  12. 1 2 "Case of Heartland virus found in Arkansas resident". Arkansas Department of Health. July 7, 2017. Retrieved July 7, 2017.
  13. Muehlenbachs A, Fata CR, Lambert AJ, Paddock CD, Velez JO, Blau DM, Staples JE, Karlekar MB, Bhatnagar J, Nasci RS, Zaki SR.Heartland Virus–Associated Death in Tennessee Clin Infect Dis. 2014 Sep 15;59(6):845–50. doi : 10.1093/cid/ciu434
  14. TEDDYE SNELL Taking up arms against Heartland disease, Tahlequah Daily Press, June 18, 2014
  15. Associated Press Rare Heartland virus kills man in Oklahoma CBS News, May 28, 2014
  16. Indiana State Department of Health two cases of Heartland virus confirmed in Indiana, 7/11/2017
  17. Liu, Sichen; Kannan, Suraj; Meeks, Monica; Sanchez, Sandra; Girone, Kyle W.; Broyhill, James C.; Martines, Roosecelis Brasil; Bernick, Joshua; Flammia, Lori; Murphy, Julia; Hills, Susan L.; Burkhalter, Kristen L.; Laven, Janeen J.; Gaines, David; Hoffmann, Christopher J. (May 2023). "Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States". Emerging Infection Diseases. 29 (5). doi:10.3201/eid2905.221488.