Heartland virus disease
While the transmission of Heartland virus from ticks to humans has yet to be confirmed, detection of Heartland virus in field-collected ticks supports the role of ticks and subsequent bites in the development of disease in humans.
Fever is universally present in reported cases. The most common symptoms include fatigue and anorexia. Other symptoms include headache, nausea, myalgia, arthralgia, and diarrhea. Thrombocytopenia and leukopenia are commonly noted at presentation. Leukopenia can be progressive, and mild neutropenia has occurred. Progressive transaminitis without coagulopathy appears to be common. Mild anemia and hyponatremia have also been noted.
Complications of Heartland virus infection that may have contributed to death in one elderly patient include hypoxia and respiratory failure, hypotension, progressive cytopenia, acute kidney injury, gastrointestinal bleeding from gastric ulcers, and persistent encephalopathy.
A93.8 – Other specified arthropod-borne viral fevers
35620001 – Disease caused by Phlebovirus
- Ehrlichiosis – Look for the presence of morulae on blood smear.
- Rocky Mountain spotted fever – Morbilliform rash often present.
- Anaplasmosis – Look for the presence of morulae on blood smear.
- Severe fever and thrombocytopenia syndrome virus – A related and clinically similar infection that occurs in China.
- West Nile fever – Cytopenia and transaminitis are less common.
- Malaria – Elicit a careful travel history; labs may suggest evidence of hemolysis. Thick and thin Giemsa stains and rapid malaria tests can verify the diagnosis of malaria.
- Hemophagocytic lymphohistiocytosis (HLH) – Fever, cytopenia, and transaminitis are typical. HLH may be genetic or acquired, usually secondary to infection (Epstein-Barr virus most commonly), malignancy, or autoimmune disease. Hyperferritinemia is suggestive of HLH.
- Adult-onset Still disease – An autoimmune disease that shares many common features with many infections including sepsis. Ferritin is usually very elevated.