Medicine:Heartland virus

From HandWiki
Short description: Tick-borne human pathogen


Heartland virus
Virus classification e
(unranked): Virus
Realm: Riboviria
Kingdom: Orthornavirae
Phylum: Negarnaviricota
Class: Ellioviricetes
Order: Bunyavirales
Family: Phenuiviridae
Genus: Bandavirus
Species:
Bandavirus heartlandense
Synonyms[1]
  • Heartland virus
  • Heartland bandavirus
  • Heartland banyangvirus

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 2022, there has been 60 cases of Heartland virus reported in 14 U.S. states including Arkansas, Indiana, Missouri, Oklahoma, North Carolina, Georgia, Illinois, Iowa, Kansas, New York, Pennsylvania, Virginia, Kentucky, and Tennessee.[2] 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.[3][4]

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.[5] 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.[6] The Lone Star Tick transmits the virus to people when feeding on blood.

Classification

The Heartland virus is part of the Bunyaviricetes class of viruses which contain 3 segments of −ssRNA. The genus of the virus is Bandavirus and the species is the Bandavirus heartlandense.[7][8] Segmented RNA consists of  three parts described as Small (S), Medium (M), and Large (L) segments. Small segment encodes the nucleocapsid, medium segment encodes a polypeptide cleaved into two surface glycoproteins (Gc and Gn) vital for viral entry, and large segment encodes the RNA-dependant RNA polymerase.[9] The Gc glycoprotein found in the Heartland virus forms into a fusion protein conformation similar to the severe fever with thrombocytopenia syndrome virus (SFTSV).[9] SFTSV is a tick-borne virus seen in East Asia with similar clinical symptoms as the Heartland virus.[10]

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).[7][11] As of 2013, work continued to identify the reservoir host,[7] as HRTV has not been isolated from any wild or domestic animals, though many white-tailed deer and raccoons from northwestern Missouri had antibodies to HRTV, suggesting that they may be hosts.

In a 2015 retrospective study, convenience samples of wild animal sera from deer, raccoons, coyotes, and moose had antibodies against HRTV. They lived in thirteen states: Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Missouri, North Carolina, Tennessee, Texas, 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.[12]

Infection

Signs and symptoms

Signs and symptoms include fever over 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.[13]

Risk factors

Individuals with outdoor (e.g., walking, camping, gardening) exposure in areas where Lone Star tick is endemic were the most affected.[14] Majority of illness onset started between May and September, coinciding with peak tick activity.[2] Tick bites were reported two weeks before symptom onset.[14]

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.[15]Serological testing is very important.[16] These include microsphere immunoassays (MIAs) for IgM and IgG immunoglobulins against HRTV which were developed indicating a 95% sensitivity and specificity differentiating between past and recent infections.[16]

Treatment

Treatment for HRTV is currently only supportive as no antiviral drugs and vaccines have been approved yet.[17] Primary management involves intravenous fluids and pain relief medications.[17] It had been demonstrated that antiviral therapies showed promise in animal models specifically ribonucleoside analog 4’fluororidine showed protection against HRTV in mice by decreasing viral loads when administered after disease onset.[17] Ribavirin and favipiravir both showed efficacy, with favipiravir being a more promising candidate for treatment.[18]

Prevention

Prevention of HRTV infection focuses on reducing tick exposure in places where virus is present. Recommended measure includes wearing pants and long sleeves to cover body, avoid wooded/bushy areas, applying insect repellents even though DEET-based repellents might not be helpful in repelling ticks.[19] Tick checks are crucial when individual has outdoor exposure.[19] Any attached ticks must be immediately removed using fine-tipped tweezers.[19] Crushing unattached ticks should be avoided to prevent release of pathogens which could enter skin. Currently no vaccine is available however multi-epitope vaccine designed through molecular modeling and immunoinformatics show promising results, but further studies are needed before clinical use.[19]    

Ecology

The primary vector for HRTV is the lone star tick (Amblyomma americanum) which exhibited transstadial and vertical transmission of the virus.[20] White-tailed deer and raccoons showed significant seroprevalence for HRTV antibodies indicating their role as an important reservoirs or maintenance hosts.[20] Climate change and land-use changes have caused the lone star tick to move northeastward increasing human exposure to HRTV.[21] Warming temperatures and habitat destruction increased tick population and shifts in distribution shaping epidemiological trends of HRTV by expanding places where ticks and reservoirs co-exist.[21]

Human cases

As of November 2022, there has been 60 cases of Heartland virus reported in 14 U.S. states including Arkansas, Indiana, Missouri, Oklahoma, North Carolina, Georgia, Illinois, Iowa, Kansas, New York, Pennsylvania, Virginia, Kentucky, and Tennessee.[2]

Heartland virus cases
Year Location Deaths Cases
2009 Northwestern Missouri 0 2
2012–2013[15] Missouri, Tennessee[22] 1 6
2014 Missouri,[23] Oklahoma[24] 1 3
2017 Northwestern Arkansas,[25] Indiana [26] 0 3
2023 Maryland/Virginia[27] 1 1

References

  1. ↑ Maes, Piet; Kuhn, Jens H. (31 August 2018). "Expansion of the order Bunyavirales" (in en) (docx). https://ictv.global/ictv/proposals/2018.017M.A.v4.Bunyavirales_2fam5gen.zip. "Heartland banyangvirus: derived from Heartland virus (and genus Banyangvirus)" 
  2. ↑ 2.0 2.1 2.2 CDC (2025-12-30). "Data and Maps for Heartland" (in en-us). https://www.cdc.gov/heartland-virus/data-maps/index.html. 
  3. ↑ Ed Cara (24 Feb 2023) U.S. Man's Death Suggests Deadly Tick Virus Is Spreading to New Regions
  4. ↑ Sichen Liu, et. al. (May 2023) Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States
  5. ↑ Knox, Richard (29 August 2012). "Mysterious New 'Heartland Virus' Discovered in Missouri". Shots: NPR's Health Blog (NPR). https://www.npr.org/blogs/health/2012/08/29/160272241/mysterious-new-heartland-virus-discovered-in-missouri. 
  6. ↑ Grady, Denise (2012-09-03). "New Virus Tied to Ticks Poses Puzzle for Doctors". New York Times. https://www.nytimes.com/2012/09/04/health/research/new-tick-borne-heartland-virus-has-scientists-puzzled.html. 
  7. ↑ 7.0 7.1 7.2 Schnirring, Lisa (2013-07-22). "Researchers trace novel Heartland virus to Missouri ticks". CIDRAP. http://www.cidrap.umn.edu/news-perspective/2013/07/researchers-trace-novel-heartland-virus-missouri-ticks. 
  8. ↑ "Taxon Details: Bandavirus heartlandense". International Committee on Taxonomy of Viruses. https://ictv.global/taxonomy/taxondetails?taxnode_id=202506607&taxon_name=Bandavirus%20heartlandense. 
  9. ↑ 9.0 9.1 Zhu, Yaohua; Wu, Yan; Chai, Yan; Qi, Jianxun; Peng, Ruchao; Feng, Wen-Hai; Gao, George Fu (14 December 2017). García-Sastre, Adolfo. ed. "The Postfusion Structure of the Heartland Virus Gc Glycoprotein Supports Taxonomic Separation of the Bunyaviral Families Phenuiviridae and Hantaviridae" (in en). Journal of Virology 92 (1). doi:10.1128/JVI.01558-17. ISSN 0022-538X. PMID 29070692. 
  10. ↑ Brault, Aaron C.; Savage, Harry M.; Duggal, Nisha K.; Eisen, Rebecca J.; Staples, J. Erin (2018-09-14). "Heartland Virus Epidemiology, Vector Association, and Disease Potential" (in en). Viruses 10 (9): 498. doi:10.3390/v10090498. ISSN 1999-4915. PMID 30223439. PMC 6164824. https://www.mdpi.com/1999-4915/10/9/498. 
  11. ↑ Harry M. Savage; Marvin S. Godsey Jr.; Amy Lambert; Nickolas A. Panella; Kristen L. Burkhalter; Jessica R. Harmon; R. Ryan Lash; David C. Ashley et al. (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. PMID 23878186. 
  12. ↑ 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
  13. ↑ Laura K. McMullan; Scott M. Folk; Aubree J. Kelly; Adam MacNeil; Cynthia S. Goldsmith; Maureen G. Metcalfe; Brigid C. Batten; César G. Albariño et al. (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. 
  14. ↑ 14.0 14.1 Staples, J Erin; Pastula, Daniel M; Panella, Amanda J; Rabe, Ingrid B; Kosoy, Olga I; Walker, William L; Velez, Jason O; Lambert, Amy J et al. (2020-05-01). "Investigation of Heartland Virus Disease Throughout the United States, 2013–2017" (in en). Open Forum Infectious Diseases 7 (5). doi:10.1093/ofid/ofaa125. ISSN 2328-8957. PMID 32478118. PMC 7246346. https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofaa125/5819209. 
  15. ↑ 15.0 15.1 Pastula, DM; Turabelidze, G; Yates, KF; Jones, TF; Lambert, AJ; Panella, AJ; Kosoy, OI; Velez, JO et al. (Mar 2014). "Notes from the field: Heartland virus disease - United States, 2012–2013". MMWR Morb Mortal Wkly Rep 63 (12): 270–1. PMID 24670929. PMC 5779346. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6312a4.htm. 
  16. ↑ 16.0 16.1 Basile, Alison Jane; Horiuchi, Kalanthe; Goodman, Christin H.; Kosoy, Olga; Panella, Amanda J.; Velez, Jason O.; Pastula, Daniel M.; Brault, Aaron C. et al. (2021-01-01). "Development of diagnostic microsphere-based immunoassays for Heartland virus". Journal of Clinical Virology 134. doi:10.1016/j.jcv.2020.104693. ISSN 1386-6532. https://www.sciencedirect.com/science/article/pii/S1386653220304352. 
  17. ↑ 17.0 17.1 17.2 "Modeling Heartland virus disease in mice and therapeutic intervention with 4'-fluorouridine". J Virol 98 (4). 16 April 2024. doi:10.1128/jvi.00132-24. PMID 38511932. 
  18. ↑ Fujii, Hikaru; Tani, Hideki; Egawa, Kazutaka; Taniguchi, Satoshi; Yoshikawa, Tomoki; Fukushi, Shuetsu; Yamada, Souichi; Harada, Shizuko et al. (2022-07-28). "Susceptibility of Type I Interferon Receptor Knock-Out Mice to Heartland Bandavirus (HRTV) Infection and Efficacy of Favipiravir and Ribavirin in the Treatment of the Mice Infected with HRTV" (in en). Viruses 14 (8): 1668. doi:10.3390/v14081668. ISSN 1999-4915. PMID 36016290. PMC 9416051. https://www.mdpi.com/1999-4915/14/8/1668. 
  19. ↑ 19.0 19.1 19.2 19.3 "Sage Journals: Discover world-class research" (in en). doi:10.1089/vim.2025.0004. https://journals.sagepub.com/action/cookieAbsent. 
  20. ↑ 20.0 20.1 Brault, Aaron C.; Savage, Harry M.; Duggal, Nisha K.; Eisen, Rebecca J.; Staples, J. Erin (2018-09-14). "Heartland Virus Epidemiology, Vector Association, and Disease Potential" (in en). Viruses 10 (9): 498. doi:10.3390/v10090498. ISSN 1999-4915. PMID 30223439. PMC 6164824. https://www.mdpi.com/1999-4915/10/9/498. 
  21. ↑ 21.0 21.1 Rochlin, Ilia; Kenney, Joan; Little, Eliza; Molaei, Goudarz (2025-02-06). "Public health significance of the white-tailed deer (Odocoileus virginianus) and its role in the eco-epidemiology of tick- and mosquito-borne diseases in North America" (in en). Parasites & Vectors 18 (1): 43. doi:10.1186/s13071-025-06674-6. ISSN 1756-3305. PMID 39915849. PMC 11803971. https://doi.org/10.1186/s13071-025-06674-6. 
  22. ↑ 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
  23. ↑ TEDDYE SNELL Taking up arms against Heartland disease, Tahlequah Daily Press, June 18, 2014
  24. ↑ Associated Press Rare Heartland virus kills man in Oklahoma CBS News, May 28, 2014
  25. ↑ "Case of Heartland virus found in Arkansas resident". July 7, 2017. http://www.arkansas.gov/health/newsroom/index.php?do:newsDetail=1&news_id=1330. 
  26. ↑ Indiana State Department of Health two cases of Heartland virus confirmed in Indiana, 7/11/2017
  27. ↑ Liu, Sichen; Kannan, Suraj; Meeks, Monica; Sanchez, Sandra; Girone, Kyle W.; Broyhill, James C.; Martines, Roosecelis Brasil; Bernick, Joshua et al. (May 2023). "Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States". Emerging Infectious Diseases 29 (5): 992–996. doi:10.3201/eid2905.221488. PMID 36821867. PMC 10124632. https://wwwnc.cdc.gov/eid/article/29/5/22-1488_article. 

Template:Tick-borne diseases and infestations

Wikidata ☰ Q70627232 entry



Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Heartland_virus&oldid=4305949"