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. 2023 May;29(5):992-996.
doi: 10.3201/eid2905.221488. Epub 2023 Feb 23.

Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States

Sichen Liu, Suraj Kannan, Monica Meeks, Sandra Sanchez, Kyle W Girone, James C Broyhill, Roosecelis Brasil Martines, Joshua Bernick, Lori Flammia, Julia Murphy, Susan L Hills, Kristen L Burkhalter, Janeen J Laven, David Gaines, Christopher J Hoffmann

Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States

Sichen Liu et al. Emerg Infect Dis. 2023 May.

Abstract

Heartland virus (HRTV) disease is an emerging tickborne illness in the midwestern and southern United States. We describe a reported fatal case of HRTV infection in the Maryland and Virginia region, states not widely recognized to have human HRTV disease cases. The range of HRTV could be expanding in the United States.

Keywords: Heartland virus; United States; Virginia; emerging infections; hemophagocytic lymphohistiocytosis; mid-Atlantic; parasites; tick-borne illness; vector-borne infections; viruses; zoonoses.

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Figures

Figure 1
Figure 1
Postmortem autopsy findings in a fatal case of heartland virus disease acquired in the mid-Atlantic region, United States. A) Hematoxylin and eosin stain of patient accessory spleen; arrow indicates congestion with hemophagocytic histiocytes. Scale bar indicates 50 μm. B) Hematoxylin and eosin stain showing pulmonary hyperinflammation, including pleural thickening and adhesions, and pulmonary fibrosis, edema, and calcifications. Scale bar indicates 125 μm.
Figure 2
Figure 2
Viral immunostaining of samples from a fatal case of heartland virus disease acquired in the mid-Atlantic region, United States. Heartland virus antigen was detected in multiple organs. A) Mononuclear interstitial inflammatory cell of myocardium. Original magnification ×20. B) Periportal macrophages and Kupffer cells in liver. Original magnification ×20. C) Large hematopoietic cells of spleen. Original magnification ×20. D) Inflammatory interstitial cells of kidney. Original magnification ×40.
See this image and copyright information in PMC

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Supplementary concepts