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Emergency: requires immediate attention
Bourbon virus disease
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Bourbon virus disease

Contributors: Daniel Yanes MD, Mukesh Patel MD, Zaw Min MD, FACP, Susan Burgin MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Bourbon virus is a recently discovered RNA virus in the genus Thogotovirus that has been associated with a fatal febrile illness. It was first recognized in a patient in Bourbon County, Kansas, in 2014. Since then, there have been a limited number of cases identified in the Midwest and southern United States. It is unknown whether the virus is present in other areas of the United States.

Thogotoviruses are thought to be transmitted by tick or other insect bites. The index patient with Bourbon virus had numerous tick bites days prior to developing his illness. Studies of ticks in eastern Kansas have suggested that Amblyomma americanum is the primary vector for Bourbon virus.

Because so few cases of Bourbon virus infection have been identified, the understanding of the clinical manifestations of infection will likely continue to evolve with further study. Per the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), symptoms associated with Bourbon virus infection include fever, fatigue, an exanthematous rash early in the disease course, headache and myalgia, and nausea and vomiting. Leukopenia and thrombocytopenia are also reported. Other laboratory findings include transaminitis, hypokalemia, and hyponatremia. Acute kidney injury and lactic acidosis may occur as the disease progresses.

The first documented infection developed in a previously healthy adult male who had known tick bites several days prior to the onset of nausea, weakness, and diarrhea. Fever, chills, headache, myalgias, arthralgias, and anorexia followed the next day, and by the fourth day, the patient became obtunded. Fever was persistent through at least the ninth day of illness, and the patient developed heart failure, respiratory failure, metabolic acidosis, acute kidney injury, and eventual cardiac arrest resulting in death. There are milder cases of Bourbon virus infection, and not all patients diagnosed with the infection have died.

Codes

ICD10CM:
A85.2 – Arthropod-borne viral encephalitis, unspecified

SNOMEDCT:
68843000 – Disease caused by Arthropod

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The clinical presentation and laboratory findings of Bourbon virus infection are nonspecific and may occur with numerous infectious and noninfectious diseases. Several tickborne bacterial diseases may present similarly.

Infections:
Noninfectious diseases:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:09/12/2019
Last Updated:09/12/2019
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Emergency: requires immediate attention
Bourbon virus disease
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A medical illustration showing key findings of Bourbon virus disease : Diarrhea, Fatigue, Fever, Nausea/vomiting, Tick bite, Anorexia, WBC decreased, PLT decreased, Maculopapular rash
Copyright © 2022 VisualDx®. All rights reserved.