Clinical and Lab Evaluations

Heartland virus is a Phlebovirus first discovered as a cause of human illness in 2009 in Missouri. It is an RNA virus that is believed to be 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 believed to be transmitted by ticks. Other phleboviruses include Rift Valley fever virus, which is transmitted by mosquitoes, and several viruses transmitted by sandflies, including Toscana virus and sandfly fever Sicilian virus.

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 disease should be considered in patients being treated for ehrlichiosis who do not respond to treatment with doxycycline.

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 July 2017, more than 30 cases of Heartland virus disease have been identified in states in the Midwestern and southern United States.

There is no routine testing available for Heartland virus infections. However, protocols are in place to allow people to be tested for evidence of Heartland virus RNA and IgM and IgG antibodies. Please contact your state health department if you have a patient with an acute illness that may be compatible with Heartland virus disease.