Clinical Features and Diagnosis of Heartland Virus Disease

Key points

  • Heartland virus disease is a tickborne illness associated with fever, leukopenia, and thrombocytopenia.
  • Molecular and serologic testing can be performed at CDC to diagnosis Heartland virus disease.
  • Contact your state or local health department for assistance with diagnostic testing.
Doctor listening to a patient's heart with a stethoscope.


Heartland virus is a Bandavirus first discovered as a cause of human illness in 2009 in Missouri. It is an RNA virus that is transmitted by the Lone Star tick (Amblyomma americanum). It is most similar to severe fever with thrombocytopenia syndrome (SFTS) virus, which has been identified in Asia and is transmitted by ticks.

Heartland virus disease cases have been identified in adults, most of whom had illness onset during May–September. Most patients reported exposure to ticks in the two weeks prior to illness onset. As of November 2022, more than 60 cases of Heartland virus disease have been identified in states in eastern, southeastern, and south-central United States.

Signs and symptoms

Initial symptoms of Heartland virus disease are very similar to those of ehrlichiosis, which include fever, fatigue, anorexia, nausea and diarrhea. Cases have also had leukopenia, thrombocytopenia, and mild to moderate elevation of liver transaminases. Heartland virus infection has rarely been associated with severe disease, including hemophagocytic lymphohistiocytosis, and death in patients with immunocompromising conditions or multiple comorbidities. Heartland virus disease should be considered in patients being treated for ehrlichiosis who do not readily respond to treatment with doxycycline.

Diagnostic testing

Molecular and serologic testing for Heartland virus infection can be performed at CDC. There are no commercially available tests for Heartland virus infection in the United States.

Please contact your state or local health department if you have a patient with an acute illness that might be compatible with Heartland virus disease. They can assist you with determining if samples should be sent to the CDC Arbovirus Diagnostic Laboratory for further testing. Specimens should be submitted to CDC through state health departments. All results will be sent from CDC to the appropriate state health department.