- James M Hughes, MD
James M Hughes, MD
- Professor of Medicine and Public Health
- Emory University
Most emerging viruses originate in animals and are vector-borne or zoonotic diseases. Issues related to Heartland virus, Bourbon virus, variegated squirrel bornavirus, and Oropouche virus are reviewed here. Issues related to other emerging viruses, such as Ebola virus, Zika virus, and Chikungunya virus, are discussed separately. (See "Clinical manifestations and diagnosis of Ebola virus disease" and "Zika virus infection: An overview" and "Chikungunya fever".)
HEARTLAND VIRUS DISEASE
Heartland virus is a member of the genus Phlebovirus in the family Bunyavirus .
Heartland virus has been isolated from leukocytes, and virions can be visualized in infected cells by electron microscopy [1,2]. Viral antigens have been identified by immunohistochemical staining in large mononuclear cells in bone marrow aspirates . Viral antigens have also been detected in postmortem spleen and mediastinal and mesenteric lymph nodes, and the virus has been detected in a postmortem blood sample by reverse-transcription polymerase chain reaction (RT-PCR) and isolation in cell culture .
Epidemiology — The virus was initially described in 2012; subsequently, a small number of human cases have been reported in Missouri, Oklahoma, and Tennessee [1,3-5]. The cases all occurred among men over 50 years of age who reported spending several hours outside each day, and most patients had a history of tick bite within two weeks prior to symptoms. Onset of illness occurred between May and September [1,3,4].
Transmission — Transmission of Heartland virus is likely tickborne. The virus has been detected via polymerase chain reaction and culture among nymphs of the lone star tick (Amblyomma americanum), which is found in a broad geographic area extending from Texas to Maine (figure 1 and figure 2) . The vertebrate host has not been definitively identified; neutralizing antibodies to Heartland virus have been observed in raccoons, deer, horses, moose, coyotes, dogs, and opossums [7,8].
- McMullan LK, Folk SM, Kelly AJ, et al. A new phlebovirus associated with severe febrile illness in Missouri. N Engl J Med 2012; 367:834.
- Goldsmith CS, Ksiazek TG, Rollin PE, et al. Cell culture and electron microscopy for identifying viruses in diseases of unknown cause. Emerg Infect Dis 2013; 19:886.
- Muehlenbachs A, Fata CR, Lambert AJ, et al. Heartland virus-associated death in tennessee. Clin Infect Dis 2014; 59:845.
- Pastula DM, Turabelidze G, Yates KF, et al. Notes from the field: Heartland virus disease - United States, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:270.
- Oklahoma State Department of Health. Oklahoma State Health Department Confirms First Case and Death of Heartland Virus, May 24, 2014. https://www.ok.gov/health/Organization/Office_of_Communications/News_Releases/2014_News_Releases/Oklahoma_State_Health_Department_Confirms_First_Case_and_Death_of_Heartland_Virus.html (Accessed on March 01, 2016).
- Savage HM, Godsey MS Jr, Lambert A, et al. First detection of heartland virus (Bunyaviridae: Phlebovirus) from field collected arthropods. Am J Trop Med Hyg 2013; 89:445.
- Riemersma KK, Komar N. Heartland Virus Neutralizing Antibodies in Vertebrate Wildlife, United States, 2009-2014. Emerg Infect Dis 2015; 21:1830.
- Bosco-Lauth AM, Panella NA, Root JJ, et al. Serological investigation of heartland virus (Bunyaviridae: Phlebovirus) exposure in wild and domestic animals adjacent to human case sites in Missouri 2012-2013. Am J Trop Med Hyg 2015; 92:1163.
- Liu Q, He B, Huang SY, et al. Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis. Lancet Infect Dis 2014; 14:763.
- Wormser GP, Pritt B. Update and Commentary on Four Emerging Tick-Borne Infections: Ehrlichia muris-like Agent, Borrelia miyamotoi, Deer Tick Virus, Heartland Virus, and Whether Ticks Play a Role in Transmission of Bartonella henselae. Infect Dis Clin North Am 2015; 29:371.
- Kansas Department of Health and Environment. KDHE News Release: KDHE and CDC Investigate New Virus - Bourbon virus is thought to be transmitted through mosquito or tick bites, December 22, 2014. http://www.kdheks.gov/news/web_archives/2014/12222014.htm (Accessed on March 01, 2016).
- Kosoy OI, Lambert AJ, Hawkinson DJ, et al. Novel thogotovirus associated with febrile illness and death, United States, 2014. Emerg Infect Dis 2015; 21:760.
- Lambert AJ, Velez JO, Brault AC, et al. Molecular, serological and in vitro culture-based characterization of Bourbon virus, a newly described human pathogen of the genus Thogotovirus. J Clin Virol 2015; 73:127.
- Hoffmann B, Tappe D, Höper D, et al. A Variegated Squirrel Bornavirus Associated with Fatal Human Encephalitis. N Engl J Med 2015; 373:154.
- European Centre for Disease Prevention and Control. Rapid Risk Assessment: New bornavirus strain detected in the EU, 25 February 2015. http://ecdc.europa.eu/en/publications/Publications/new-bornavirus-strain-detected-EU-rapid-risk-assessment.pdf (Accessed on March 01, 2016).
- Vasconcelos PF, Calisher CH. Emergence of Human Arboviral Diseases in the Americas, 2000-2016. Vector Borne Zoonotic Dis 2016; 16:295.
- ANDERSON CR, SPENCE L, DOWNS WG, AITKEN TH. Oropouche virus: a new human disease agent from Trinidad, West Indies. Am J Trop Med Hyg 1961; 10:574.
- Pinheiro FP, Travassos da Rosa AP, Travassos da Rosa JF, et al. Oropouche virus. I. A review of clinical, epidemiological, and ecological findings. Am J Trop Med Hyg 1981; 30:149.
- Tesh RB. The emerging epidemiology of Venezuelan hemorrhagic fever and Oropouche fever in tropical South America. Ann N Y Acad Sci 1994; 740:129.
- Mourãão MP, Bastos MS, Gimaqu JB, et al. Oropouche fever outbreak, Manaus, Brazil, 2007-2008. Emerg Infect Dis 2009; 15:2063.
- Carpenter S, Groschup MH, Garros C, et al. Culicoides biting midges, arboviruses and public health in Europe. Antiviral Res 2013; 100:102.
- Watts DM, Phillips I, Callahan JD, et al. Oropouche virus transmission in the Amazon River basin of Peru. Am J Trop Med Hyg 1997; 56:148.
- Mourão MP, Bastos Mde S, Figueiredo RM, et al. Arboviral diseases in the Western Brazilian Amazon: a perspective and analysis from a tertiary health & research center in Manaus, State of Amazonas. Rev Soc Bras Med Trop 2015; 48 Suppl 1:20.
- Battle FV, Turner EC. The Insects of Virginia No. 3: A systematic review of the genus Culicoides (Diptera: Ceratopogonidae) in Virginia with a geographic catalog of the species occurring in the eastern United States north of Florida. Virginia Polytechnic Institute and State University, Blacksburg, VA 1971. http://www.vmnh.net/content/uploads/PDF/Research_and_Collections/The_Insects_of_Virginia/The_Insects_of_Virginia_No_3.pdf (Accessed on September 28, 2016).
- World Health Organization. Oropouche virus disease - Peru. 2016. http://www.who.int/csr/don/03-june-2016-oropouche-peru/en/ (Accessed on August 16, 2016).
- Bastos Mde S, Figueiredo LT, Naveca FG, et al. Identification of Oropouche Orthobunyavirus in the cerebrospinal fluid of three patients in the Amazonas, Brazil. Am J Trop Med Hyg 2012; 86:732.