Secondary hemophagocytic lymphohistiocytosis due to Heartland virus

Ahlers, Carolyn G; Matthews, Harrison; Perez, Reinaldo; Naggie, Susanna

doi:10.1136/bcr-2022-253082

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…The following were excluded from the analysis: articles published in languages other than English; case reports not providing an appropriate amount of information, or where the diagnosis was not certain; and those reporting non-human subjects. The final number of articles included was 69, which resulted in a total number of 98 patients ( Figure 1 ) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , ...…”

Section: Methodsmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis (HLH) in Patients with Tick-Borne Illness: A Scoping Review of 98 Cases

Jevtic,

da Silva,

Haylock

et al. 2024

Infectious Disease Reports

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Hemophagocytic lymphohistiocytosis (HLH) secondary to tick-borne infections is a rare but potentially life-threatening syndrome. We performed a scoping review according to PRISMA guidelines to systematically analyze the existing literature on the topic. A total of 98 patients were included, with a mean age of 43.7 years, of which 64% were men. Most cases, 31%, were reported from the USA. Immunosuppression was present in 21.4%, with the most common cause being previous solid organ transplantation. Constitutional symptoms were the most common, observed in 83.7% of the patients, while fever was reported in 70.4% of cases. Sepsis was present in 27.6%. The most common laboratory abnormalities in this cohort were thrombocytopenia in 81.6% of patients, while anemia, leukopenia, and leukocytosis were observed in 75.5%, 55.1%, and 10.2%, respectively. Liver enzyme elevation was noted in 63.3% of cases. The H-score was analyzed in 64 patients, with the mean value being 209, and bone marrow analysis was performed in 61.2% of patients. Ehrlichia spp. was the main isolated agent associated with HLH in 45.9%, followed by Rickettsia spp. in 14.3% and Anaplasma phagocytophilum in 12.2%. Notably, no patient with Powassan virus infection or Lyme borreliosis developed HLH. The most common complications were acute kidney injury (AKI) in 35.7% of patients, shock with multiple organ dysfunction in 22.5%, encephalopathy/seizure in 20.4%, respiratory failure in 16.3%, and cardiac complications in 7.1% of patients. Treatment included antibiotic therapy alone in 43.9%, while 5.1% of patients were treated with immunosuppressants alone. Treatment with both antibiotics and immunosuppressants was used in 51% of patients. Appropriate empiric antibiotics were used in 62.2%. In 43.9% of cases of HLH due to tick-borne disease, patients received only antimicrobial therapy, and 88.4% of those recovered completely without the need for immunosuppressive therapy. The mortality rate in our review was 16.3%, and patients who received inappropriate or delayed empiric therapy had a worse outcome. Hence, we suggest empiric antibiotic treatment in patients who are suspected of having HLH due to tick-borne disease or in whom diagnostic uncertainty persists due to diagnostic delay in order to minimize mortality.

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Section: Methodsmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis (HLH) in Patients with Tick-Borne Illness: A Scoping Review of 98 Cases

Jevtic,

da Silva,

Haylock

et al. 2024

Infectious Disease Reports

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“…The typical signalment for HRTV cases is an adult male over the age of 40-though most cases are over the age of 60, often with preexisting comorbidities-an outdoor lifestyle including farming, camping, or hunting, and very likely a history of tick exposure [1,19,44,[60][61][62][63][64][65][66][67]. Clinical presentations are those which may mimic other regional tick-borne diseases most commonly seen in the summer months, such as Ehrlichia, Rickettsia, and Babesia, and include a short history of fever (≥38 • C), headache, fatigue, myalgia, nausea, anorexia, and non-bloody diarrhea.…”

Section: Clinical Findings Differential Diagnosis Treatment and Progn...mentioning

confidence: 99%

“…Initial clinical evaluation often uncovers a mild to moderate leukopenia (1000-3000 cells/µL), influenced primarily by low neutrophil counts, and a mild thrombocytopenia (60-120,000/µL) [1,19,44,[60][61][62][63][64][65][66][67]. Mild hyponatremia may be evident on metabolic panels, as well as mildly elevated alanine and aspartate aminotransferase levels.…”

Section: Clinical Findings Differential Diagnosis Treatment and Progn...mentioning

confidence: 99%

“…Potential, though less likely, differentials may include influenza, COVID-19, locally endemic fungal (e.g., Blastomyces and Histoplasma) or bacterial (e.g., Coxiella or Francisella) infections, and bone marrow neoplasia/dysplasia/aplasia syndromes. Molecular or serologic diagnostics targeting these agents and processes, including bone marrow aspirate [1,62,66], can be helpful in ruling in or out HRTV infection. Based on the wide range of differentials, treatment often begins empirically with tetracyclines or other antibiotics that effectively target bacterial tick-borne agents [1,60,63,69].…”

Section: Clinical Findings Differential Diagnosis Treatment and Progn...mentioning

confidence: 99%

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Heartland Virus: An Evolving Story of an Emerging Zoonotic and Vector-Borne Disease

Mantlo,

Haley

2023

Zoonotic Diseases

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Heartland virus (HRTV) is an emerging tick-borne bandavirus that is capable of causing severe disease characterized by acute thrombocytopenia and lymphopenia. The virus is endemic to the eastern United States and is carried by the Lone Star tick (Amblyomma americanum). Since its discovery in 2009, at least 60 human infections have been recorded across this area, with an overall 5–10% estimated mortality rate. All infections reported thus far have occurred following a known tick bite or exposure to tick-infested areas, but the possibility of nosocomial transmission has not been ruled out. Despite relatively high rates of seroprevalence among certain wildlife species such as white-tailed deer, the reservoir species for HRTV remains unknown, as the virus has never been isolated from any mammalian wildlife species. Furthermore, how the virus is transmitted to its vector species in nature remains unknown, though laboratory studies have confirmed both horizontal and vertical transmission of HRTV in A. americanum. In addition, the recent 2017 introduction of the Asian longhorned tick (Haemaphysalis longicornis) to the US has raised concerns about possible spillover of HRTV into a new tick species that has been confirmed to be a competent vector for HRTV in the laboratory. Thus, an increased awareness of its clinical presentation is needed, and further research is urgently required to establish the natural transmission cycle and develop new countermeasures for this novel zoonotic pathogen.

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