Mary Wilson
Well-known member
Published September 4, 2024
N Engl J Med 2024;391:821-831
DOI: 10.1056/NEJMoa2313722
VOL. 391 NO. 9
Authors: Xiao-Ai Zhang, Ph.D., Yi-Dan Ma, B.S., Yun-Fa Zhang, M.Sc., Zhen-Yu Hu, B.S., Jing-Tao Zhang, B.S., Shuo Han, M.Sc., Gang Wang, B.S., +16, and Wei Liu, M.D.
Abstract
BACKGROUND
In June 2019, a patient presented with persistent fever and multiple organ dysfunction after a tick bite at a wetland park in Inner Mongolia. Next-generation sequencing in this patient revealed an infection with a previously unknown orthonairovirus, which we designated Wetland virus (WELV).
METHODS
We conducted active hospital-based surveillance to determine the prevalence of WELV infection among febrile patients with a history of tick bites. Epidemiologic investigation was performed. The virus was isolated, and its infectivity and pathogenicity were investigated in animal models.
RESULTS
WELV is a member of the orthonairovirus genus in the Nairoviridae family and is most closely related to the tickborne Hazara orthonairovirus genogroup. Acute WELV infection was identified in 17 patients from Inner Mongolia, Heilongjiang, Jilin, and Liaoning, China, by means of reverse-transcriptase–polymerase-chain-reaction assay. These patients presented with nonspecific symptoms, including fever, dizziness, headache, malaise, myalgia, arthritis, and back pain and less frequently with petechiae and localized lymphadenopathy. One patient had neurologic symptoms. Common laboratory findings were leukopenia, thrombocytopenia, and elevated d-dimer and lactate dehydrogenase levels. Serologic assessment of convalescent-stage samples obtained from 8 patients showed WELV-specific antibody titers that were 4 times as high as those in acute-phase samples. WELV RNA was detected in five tick species and in sheep, horses, pigs, and Transbaikal zokors (Myospalax psilurus) sampled in northeastern China. The virus that was isolated from the index patient and ticks showed cytopathic effects in human umbilical-vein endothelial cells. Intraperitoneal injection of the virus resulted in lethal infections in BALB/c, C57BL/6, and Kunming mice. The Haemaphysalis concinna tick is a possible vector that can transovarially transmit WELV.
CONCLUSIONS
A newly discovered orthonairovirus was identified and shown to be associated with human febrile illnesses in northeastern China.
https://www.nejm.org/doi/full/10.1056/NEJMoa2313722
N Engl J Med 2024;391:821-831
DOI: 10.1056/NEJMoa2313722
VOL. 391 NO. 9
Authors: Xiao-Ai Zhang, Ph.D., Yi-Dan Ma, B.S., Yun-Fa Zhang, M.Sc., Zhen-Yu Hu, B.S., Jing-Tao Zhang, B.S., Shuo Han, M.Sc., Gang Wang, B.S., +16, and Wei Liu, M.D.
Abstract
BACKGROUND
In June 2019, a patient presented with persistent fever and multiple organ dysfunction after a tick bite at a wetland park in Inner Mongolia. Next-generation sequencing in this patient revealed an infection with a previously unknown orthonairovirus, which we designated Wetland virus (WELV).
METHODS
We conducted active hospital-based surveillance to determine the prevalence of WELV infection among febrile patients with a history of tick bites. Epidemiologic investigation was performed. The virus was isolated, and its infectivity and pathogenicity were investigated in animal models.
RESULTS
WELV is a member of the orthonairovirus genus in the Nairoviridae family and is most closely related to the tickborne Hazara orthonairovirus genogroup. Acute WELV infection was identified in 17 patients from Inner Mongolia, Heilongjiang, Jilin, and Liaoning, China, by means of reverse-transcriptase–polymerase-chain-reaction assay. These patients presented with nonspecific symptoms, including fever, dizziness, headache, malaise, myalgia, arthritis, and back pain and less frequently with petechiae and localized lymphadenopathy. One patient had neurologic symptoms. Common laboratory findings were leukopenia, thrombocytopenia, and elevated d-dimer and lactate dehydrogenase levels. Serologic assessment of convalescent-stage samples obtained from 8 patients showed WELV-specific antibody titers that were 4 times as high as those in acute-phase samples. WELV RNA was detected in five tick species and in sheep, horses, pigs, and Transbaikal zokors (Myospalax psilurus) sampled in northeastern China. The virus that was isolated from the index patient and ticks showed cytopathic effects in human umbilical-vein endothelial cells. Intraperitoneal injection of the virus resulted in lethal infections in BALB/c, C57BL/6, and Kunming mice. The Haemaphysalis concinna tick is a possible vector that can transovarially transmit WELV.
CONCLUSIONS
A newly discovered orthonairovirus was identified and shown to be associated with human febrile illnesses in northeastern China.
https://www.nejm.org/doi/full/10.1056/NEJMoa2313722