News Scan for Jun 11, 2014

Report profiles first fatal Heartland virus case

A recently published case report on the nation's first death from Heartland virus, in an 80-year-old man who had been reported as Tennessee's first case, sheds light on the clinical profile and hints that older people who have underlying complications may be more vulnerable to complications from the disease.

Researchers from the US Centers for Disease Control and Prevention and Vanderbilt University reported their findings Jun 9 in Clinical Infectious Diseases (CID).

The man's illness was first noted in a Mar 28 report in Morbidity and Mortality Weekly Report. The CID report, however, contains several more details about his illness, along with autopsy findings.

The patient lived on a farm in central Tennessee and was active outdoors. He had a history of tick bites, and his wife found one on him 2 weeks before he got sick in July 2013. The man had a history of chronic obstructive pulmonary disease and heavy alcohol use. Symptoms when he sought care in his local emergency department included weakness, frequent falls, altered mental status, and fever.

His lab profile over the course of his hospitalization was marked by hemorrhagic manifestations and multiple organ failure, and he died 15 days after he was hospitalized. Tests on autopsy samples were negative for Ehrlichia, Anaplasma, spotted fever group Rickettsia, and Leptospira species. The team wrote that the clinical history and negative tests raised suspicions that the man was infected with Heartland virus, which was detected at autopsy in his lymph nodes and spleen.

Researchers concluded that the man's age, weakened immune system, and chronic medical conditions probably predisposed him to a more severe illness and fatal outcome, similar to a pattern seen in China among patients who have severe fever and thrombocytopenia syndrome virus infections. They said the clinical course of Heartland virus infection mimics severe Ehrlichia chaffeensis infection, but patients don't improve with doxycycline treatment.

Genetic analysis of the virus showed enough divergence from Missouri strains to suggest that the virus has been circulating in Tennessee ticks for some time. The findings expand the geographic range of the disease—which is believed to spread through lone star ticks—beyond Missouri where the first cases were detected.

In late May Oklahoma health officials reported the state's first case, which also proved fatal, raising the number of infections so far to 10, 2 of them fatal.
Jun 9 Clin Infect Dis abstract
Mar 27 CIDRAP News scan "
CDC reports 6 more cases of Heartland virus infection"
May 27 CIDRAP News scan "
Oklahoma reports fatal Heartland virus case"


Porcine epidemic diarrhea virus confirmed in Colombia

Colombia has reported its first outbreaks of porcine epidemic diarrhea virus (PEDV), which have affected more than 3,000 swine in 45 holdings in various parts of the country, according to a Jun 9 report filed with the World Organization for Animal Health (OIE).

Of 18,552 susceptible commercial and backyard pigs, 3,328 were infected with PEDV and 1,054 died, for an 18% morbidity rate and a 32% case-fatality rate. The outbreaks started in March with diarrhea and deaths in piglets and continued through May. Forty-two of the outbreaks have been in Cundinamarca and Huila departments in the central part of the country.

Authorities have implemented surveillance and control measures, including quarantine, disinfection of premises, enhanced biosecurity steps, and control of animal movement.

The report said morbidity and mortality rates are lower than those observed in other countries such as the United States, Canada, and Mexico, and farms' production levels have rebounded in less than 2 weeks.
Jun 9 OIE report

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