Heartland virus is an emerging tick-borne disease that can be fatal. Now, investigators have identified the Heartland virus in the Maryland and Virginia region – an area where the virus is not widely recognized.
In their article “Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States,”¹ Liu and colleagues describe the fatal case of a man in his 60’s who acquired the Heartland virus in either Maryland or Virginia.
Case presentation
The man was admitted to the hospital in November 2021 with a fever, diarrhea, dyspnea, myalgias, and malaise which had been ongoing for 5 days. He had a history of a splenectomy, hypertension, remote trauma, coronary artery disease, and hypertension.
The patient did not recall a tick bite and did not have an erythema migrans rash.
“The range of [Heartland virus] could be expanding in the United States.”
Delayed diagnosis of Heartland virus
“An arboviral disease was the leading diagnostic consideration, but limited availability of commercial diagnostic testing for tickborne diseases delayed diagnosis,” wrote Liu et al.
The man was treated clinically for a tick-borne infection with doxycycline.
“Two days later, on day 7 after symptom onset, the patient returned to the emergency department with confusion, an unsteady gait, and new fecal and urinary incontinence,” according to the authors.
He subsequently developed encephalopathy, low sodium, abnormal liver function tests, and fatigue.
Fatal outcome
“He had acute respiratory failure, renal failure, and a cardiac arrest. He was transitioned to comfort care and died on day 13 after symptom onset,” wrote Liu et al.
An autopsy revealed that the heart, spleen, kidney, and liver samples were positive for Heartland virus.
The Virginia Department of Health conducted a drag of the man’s property and found 193 Lone Star ticks. However, none of the ticks contained HRTV.
Tick-borne diseases identified by the CDC
- Anaplasmosis
- Babesiosis
- Borrelia mayonii
- Borrelia miyamotoi
- Bourbon virus
- Colorado tick fever
- Ehrlichiosis
- Heartland virus
- Lyme disease
- Powassan disease
- Rocky Mountain spotted fever (RMSF)
- STARI (Southern tick-associated rash illness)
- Tick-borne relapsing fever (TBRF)
- Tularemia
- 364D rickettsiosis (Rickettsia phillipi, proposed)
Frequently Asked Questions
What is Heartland virus?
Heartland virus is an emerging tick-borne disease transmitted by Lone Star ticks. It can cause severe illness and death, especially in immunocompromised patients.
What are Heartland virus symptoms?
Symptoms include fever, diarrhea, dyspnea, myalgias, malaise, confusion, unsteady gait, and encephalopathy. The illness can progress to multi-organ failure.
Where is Heartland virus found?
Originally identified in the Midwest, Heartland virus has now been found in the Mid-Atlantic region (Maryland and Virginia), suggesting its range is expanding.
Is there treatment for Heartland virus?
There is no specific treatment or vaccine for Heartland virus. Supportive care is the primary approach. Early recognition is critical.
References:
- Liu S, Kannan S, Meeks M, et al. Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States. Emerg Infect Dis. Feb 23 2023;29(5)doi:10.3201/eid2905.221488
- Diseases Transmitted by Ticks. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/diseases/index.html Last accessed 2/26/23.
