24917656

PMC4608028

Background

Heartland virus (HRTV) is a tick-borne phlebovirus recently described in Missouri that is associated with fever, leukopenia and thrombocytopenia. The virus has also been detected in Ambylommaamericanum ticks.

Methods and Results

Here we report the first fatal case of HRTV disease in an 80 year-old Tennessee resident. He was hospitalized with fever, confusion, leukopenia, and thrombocytopenia and developed multi-organ failure and hemorrhage. A tick-borne illness was suspected and testing for ehrlichiosis was negative. He died on hospital day 15 and autopsy specimens were tested for various pathogens as part of an unexplained death evaluation. HRTV antigens were detected in post-mortem spleen and lymph nodes by immunohistochemistry, and HRTV was detected in pre-mortem blood by RT-PCR and by isolation in cell culture.

Conclusions

This case demonstrates that HRTV infection can cause severe disease and death and expands the geographic range of HRTV within the United States.

CDC Public Access

CC999999/Intramural CDC HHS/United States