Novel Clinical and Pathologic Findings in a Heartland Virus-Associated Death

Abstract

We describe an investigation into a Heartland virus (HRTV)-associated death in Tennessee with novel clinical and pathologic findings. HRTV can cause rapidly fatal, widely disseminated infection with multisystem organ failure in patients without substantial comorbidities. We identified viral antigen in multiple organ tissues where it was not detected previously.

Keywords: emerging infections; heartland virus; tickborne disease; viral infections.

Figure 1

Novel histopathologic findings and immunolocalization of viral antigens in Heartland virus (HRTV) attributed fatality. (A) Heart: focus of lymphocytic myocarditis. (C) Liver: steatosis, focal hepatocellular necrosis, and Kupffer cell hyperplasia. (E) Testis: congestion and focal hemorrhage. (G) Brain, thalamus: gliosis, edema, and necrosis. HRTV antigen detected in myocardium (B), macrophages and Kupffer cells in liver (D), interstitial and connective tissue fibroblasts, and rarely in seminiferous tubules in testis (F), and glial cells in brain (H). Routine hematoxylin and eosin stain: A, C, E, G. Immunoalkaline phosphate staining, naphthol fast red substrate with light hematoxylin counterstain: B, D, F, H. Magnifications (scale bar measurements): A, 100 μm; B, 60 μm; C, 60 μm; D, 60 μm; E, 300 μm; F, 200 μm; G, 200 μm; H, 60 μm.