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Novel Thogotovirus identified in Kansas
A novel Thogotovirus species was identified in a man from eastern Kansas with presumed tickborne illness, who died 11 days after illness onset, CDC researchers reported.
The proposed name for the species is the Bourbon virus, after the patient’s county of residence.
“The discovery of the Bourbon virus, in addition to recent discoveries of tick-associated Heartland and severe fever with thrombocytopenia syndrome viruses, suggests that the public health burden of these pathogens has been underestimated,” the researchers wrote in Emerging Infectious Diseases. “As nonselective molecular methods of pathogen identification become more widely used, ideally in combination with classical microbiologic techniques, it is anticipated that similar discoveries will be made in the future.”
The previously healthy man, aged older than 50 years, presented for medical care in late spring due to a history of tick bite, fever and fatigue. His primary care physician prescribed doxycycline for presumed tickborne illness. The next day, he was taken to the hospital by ambulance due to reduced consciousness. Initial laboratory findings were leukopenia, lymphopenia, thrombocytopenia, mild hyponatremia, hypokalemia, a slightly increased level of blood urea nitrogen and increased levels of aspartate aminotransferase and alanine aminotransferase. He was admitted for dehydration, syncope and possible tickborne illness, given IV fluids and was treated with doxycycline.
Figure 1. The newly discovered Bourbon virus is named after a patient's county of residence
Source:CDC
Malaise and anorexia persisted and he developed periodic fevers. After transfer to a tertiary care center, the patient was febrile and had nontender left axillary lymphadenopathy, a diffuse maculopapular rash on his chest, abdomen and back, petechiae on his soft palate and lower extremities and bibasilar crackles in the lung fields. The thrombocytopenia worsened, and his aspartate aminotransferase level increased. A computed tomography scan showed trace pleural effusions, bibasilar atelectasis and multiple prominent abdominal lymph nodes. A chest radiograph showed pulmonary venous congestion and interstitial edema, and an echocardiogram showed global hypokinesis.
He began to experience renal failure and he was intubated due to acute respiratory distress syndrome. He developed ventricular tachycardia and eventual pulseless electrical activity. After multiple resuscitations, and a decision to withdraw care, he died shortly after being extubated.
The CDC evaluated the man’s blood and serum by RT-PCR. The results were negative for Heartland virus, but they identified the presence of another virus, consistent with the family Orthomyxoviridae. A phylogenetic analysis suggested the virus was closely related to the Dhori virus and the Batken virus.
“It is currently not known how many human infections and disease cases might be attributable to this novel pathogen,” the researchers wrote. “Work is planned to identify additional human infections with this novel virus, as well as to explore its potential geographic distribution.”
Disclosure: The researchers report no relevant disclosures.