title: Heartland virus-associated death in tennessee.
abstract: BACKGROUND
  Heartland virus (HRTV) is a tick-borne phlebovirus recently described in Missouri that is associated with fever, leukopenia, and thrombocytopenia. The virus has also been detected in Ambylomma americanum ticks.
  
  
  METHODS
  Here we report the first fatal case of HRTV disease in an 80-year-old Tennessee resident. He was hospitalized with fever, confusion, leukopenia, and thrombocytopenia and developed multiorgan failure and hemorrhage. A tick-borne illness was suspected and testing for ehrlichiosis was negative. He died on hospital day 15, and autopsy specimens were tested for various pathogens as part of an unexplained death evaluation.
  
  
  RESULTS
  HRTV antigens were detected in postmortem spleen and lymph nodes by immunohistochemistry, and HRTV was detected in premortem blood by reverse transcription polymerase chain reaction and by isolation in cell culture.
  
  
  CONCLUSIONS
  This case demonstrates that HRTV infection can cause severe disease and death and expands the geographic range of HRTV within the United States.
authors.affiliation: Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Atis
authors.initials: A
authors.lastname: Muehlenbachs
authors.affiliation: Department of Pathology.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Fata
authors.affiliation: Arbovirus Diseases Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Lambert
authors.affiliation: Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.affiliation: Arbovirus Diseases Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: Jason O
authors.initials: JO
authors.lastname: Velez
authors.affiliation: Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Blau
authors.affiliation: Arbovirus Diseases Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: J Erin
authors.initials: JE
authors.lastname: Staples
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mohana B
authors.initials: MB
authors.lastname: Karlekar
authors.affiliation: Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.affiliation: Arbovirus Diseases Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Nasci
authors.affiliation: Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000369:Aged, 80 and over; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010217:Phlebotomus Fever / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D016856:Phlebovirus / Q000145:classification; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012307:Risk Factors; D012703:Serotyping; D013714:Tennessee
keywords: Heartland virus; autopsy; pathology; tick-borne illness; unexplained death