Giuseppe
Emeritus
[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]
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Original Article
A New Phlebovirus Associated with Severe Febrile Illness in Missouri
Laura K. McMullan, Ph.D., Scott M. Folk, M.D., Aubree J. Kelly, M.S., Adam MacNeil, Ph.D., Cynthia S. Goldsmith, M.G.S., Maureen G. Metcalfe, B.S., Brigid C. Batten, M.P.H., C?sar G. Albari?o, Ph.D., Sherif R. Zaki, M.D., Ph.D., Pierre E. Rollin, M.D., William L. Nicholson, Ph.D., and Stuart T. Nichol, Ph.D.
N Engl J Med 2012; 367:834-841, August 30, 2012
Two men from northwestern Missouri independently presented to a medical facility with fever, fatigue, diarrhea, thrombocytopenia, and leukopenia, and both had been bitten by ticks 5 to 7 days before the onset of illness. Ehrlichia chaffeensis was suspected as the causal agent but was not found on serologic analysis, polymerase-chain-reaction (PCR) assay, or cell culture. Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus. Although Koch's postulates have not been completely fulfilled, we believe that this phlebovirus, which is novel in the Americas, is the cause of this clinical syndrome.
The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the CDC.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. McMullan and Folk contributed equally to this article.
We thank Christopher Paddock and Jana Ritter for their consultation on histopathological and immunohistochemical analyses, Amy Denison for extraction and quality assessment of nucleic acids from bone marrow?biopsy samples, Mike Flint and Anita McElroy for discussions and editorial assistance in the preparation of the manuscript, and Ute Str?her and the Viral Special Pathogens Branch diagnostics group for providing ELISA data on viral IgG.
Source Information
From the Viral Special Pathogens Branch (L.K.M., A.M., C.G.A., P.E.R., S.T.N.) and the Infectious Disease Pathology Branch (C.S.G., M.G.M., B.C.B., S.R.Z.), Division of High-Consequence Pathogens and Pathology, and the Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases (A.J.K., W.L.N.), Centers for Disease Control and Prevention, Atlanta; and Heartland Regional Medical Center, St. Joseph, MO (S.M.F).
Address reprint requests to Dr. Nichol at the Viral Special Pathogens Branch MS G14 or to Dr. Nicholson at the Rickettsial Zoonoses Branch MS G13, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS G-14, Atlanta, GA 30333, or at snichol@cdc.gov or wnicholson@cdc.gov.
-A New Phlebovirus Associated with Severe Febrile Illness in Missouri
Laura K. McMullan, Ph.D., Scott M. Folk, M.D., Aubree J. Kelly, M.S., Adam MacNeil, Ph.D., Cynthia S. Goldsmith, M.G.S., Maureen G. Metcalfe, B.S., Brigid C. Batten, M.P.H., C?sar G. Albari?o, Ph.D., Sherif R. Zaki, M.D., Ph.D., Pierre E. Rollin, M.D., William L. Nicholson, Ph.D., and Stuart T. Nichol, Ph.D.
N Engl J Med 2012; 367:834-841, August 30, 2012
Two men from northwestern Missouri independently presented to a medical facility with fever, fatigue, diarrhea, thrombocytopenia, and leukopenia, and both had been bitten by ticks 5 to 7 days before the onset of illness. Ehrlichia chaffeensis was suspected as the causal agent but was not found on serologic analysis, polymerase-chain-reaction (PCR) assay, or cell culture. Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus. Although Koch's postulates have not been completely fulfilled, we believe that this phlebovirus, which is novel in the Americas, is the cause of this clinical syndrome.
The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the CDC.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. McMullan and Folk contributed equally to this article.
We thank Christopher Paddock and Jana Ritter for their consultation on histopathological and immunohistochemical analyses, Amy Denison for extraction and quality assessment of nucleic acids from bone marrow?biopsy samples, Mike Flint and Anita McElroy for discussions and editorial assistance in the preparation of the manuscript, and Ute Str?her and the Viral Special Pathogens Branch diagnostics group for providing ELISA data on viral IgG.
Source Information
From the Viral Special Pathogens Branch (L.K.M., A.M., C.G.A., P.E.R., S.T.N.) and the Infectious Disease Pathology Branch (C.S.G., M.G.M., B.C.B., S.R.Z.), Division of High-Consequence Pathogens and Pathology, and the Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases (A.J.K., W.L.N.), Centers for Disease Control and Prevention, Atlanta; and Heartland Regional Medical Center, St. Joseph, MO (S.M.F).
Address reprint requests to Dr. Nichol at the Viral Special Pathogens Branch MS G14 or to Dr. Nicholson at the Rickettsial Zoonoses Branch MS G13, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS G-14, Atlanta, GA 30333, or at snichol@cdc.gov or wnicholson@cdc.gov.
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