Clinical Information

Heartland virus (HRTV) disease is an emerging zoonosis, transmitted to humans through the bite of infected Amblyomma americanum (Lone Star) ticks. HRTV possesses a single-stranded negative-sense RNA genome encoded on small, medium, and large segments. HRTV is a member of the Bandavirus genus, which includes other arthropod-borne viruses (arboviruses), such as severe fever with thrombocytopenia syndrome virus (SFTSV). Reports of human HRTV disease are relatively rare with fewer than 100 cases reported to date, most from the Central, Southern, and Northeastern United States. Symptoms generally occur within 2 weeks of a tick bite and may include non-specific symptoms such as headache, fever, fatigue, anorexia, nausea, diarrhea, and muscle or joint pain. Leukopenia, thrombocytopenia, and elevation of liver transaminases are also common laboratory findings. Rarely, multisystem organ failure and death occur. While there is no targeted antiviral therapy and treatment is entirely supportive care, diagnosis is important for several reasons, including the ability to discontinue empiric antibiotics and to provide prognostic information for patients and families.

Detection of HRTV nucleic acid in cerebrospinal fluid (CSF) is a marker for central nervous system infection caused by this virus. Importantly, the period of time that the virus can be detected in serum and CSF is brief. Therefore, molecular testing should be performed within the first week following onset of symptoms. After this time, serologic testing is the preferred method for diagnosis of HRTV infection. Serologic testing is currently only available through the Centers for Disease Control and Prevention.