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New phlebovirus identified in Missouri
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Researchers from the CDC have reported a new phlebovirus that was associated with severe febrile illness in two patients in Missouri.
According to the researchers, common findings between the patients were leukopenia with moderate neutropenia, thrombocytopenia and elevated hepatic aminotransferase levels. They found that the illness was similar to tickborne severe fever with thrombocytopenia syndrome virus (SFTSV), and that laboratory results, symptoms and tick bite occurrence are similar to ehrlichiosis infections.
In June 2009, a 57-year-old man developed fever the day after removing a tick from his abdomen. Other symptoms that developed included severe fatigue, headache, anorexia, nausea and nonbloody diarrhea. The patient was admitted to the hospital with a temperature of 37.9 degrees C. Laboratory tests showed a low platelet count of 115,000 cells per cubic millimeter and a low white cell count of 1,900 cells per cubic millimeter.
Over his 10-day hospitalization, he progressed from moderate to severe thrombocytopenia. On days 6 and 7, his platelet count was 40,000 cells per cubic millimeter. Blood tests done at the CDC were negative for Ehrlichia chaffeensis, E. ewingii and rickettsiae of the spotted fever group. The patient was placed on 100 mg IV doxycycline twice-daily for suspected ehrlichiosis.
A 67-year-old man with a history of tick bites was hospitalized after 4 days of fever, fatigue and anorexia. Other symptoms included myalgia, dry cough and nonbloody diarrhea. Upon hospital admission, his temperature was 38.1 degrees C. Laboratory tests showed a low platelet count of 78,000 cells per cubic millimeter and a low white cell count of 2,100 cells per cubic millimeter
Over his 12-day hospitalization, he also progressed to severe thrombocytopenia, as his platelet count reached 34,000 cells per cubic millimeter on days 5 and 6. Blood tests done at the CDC were negative for E. chaffeensis and ehrlichia and anaplasma species. The patient was initially treated with IV piperacillin-tazobactam, then switched to ceftriaxone on day 2, and then to 100 mg oral doxycycline twice daily on day 3 for suspected ehrlichiosis.
Although the illness was similar to SFTSV, there were no coagulation abnormalities except for the low platelet count. Although there have been reports of person-to-person transmission of SFTSV upon exposure to infected blood, it is not determined whether this novel virus can be transmitted between humans.
“The incidence of infection with the novel virus and range of disease severity are currently unknown,” the researchers wrote. “Given the largely nonspecific symptoms observed, this virus could be a more common cause of human illness than is currently recognized. Epidemiologic and ecologic studies are needed to identify disease burden, risk factors for infection and natural hosts of this new virus.”
Disclosure: The researchers report no relevant financial disclosures.
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