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Volume 24, Number 5—May 2018
Dispatch

Heartland Virus and Hemophagocytic Lymphohistiocytosis in Immunocompromised Patient, Missouri, USA

Abigail L. CarlsonComments to Author , Daniel M. Pastula, Amy J. Lambert, J. Erin Staples, Atis Muehlenbachs, George Turabelidze, Charles S. Eby, Jesse Keller, Brian Hess, Richard S. Buller, Gregory A. Storch, Kathleen Byrnes, Louis Dehner, Nigar Kirmani, and F. Matthew Kuhlmann
Author affiliations: Veterans Affairs St. Louis Health Care System, St. Louis, Missouri, USA (A.L. Carlson); Washington University School of Medicine, St. Louis (A.L. Carlson, C.S. Eby, J. Keller, B. Hess, R.S. Buller, G.A. Storch, K. Byrnes, L. Dehner, N. Kirmani, F.M. Kuhlmann); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.M. Pastula, A.J. Lambert, J.E. Staples); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.M. Pastula, A. Muehlenbachs); Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA (G. Turabelidze)

Main Article

Table 2

Infectious disease testing of immunocompromised patient after symptom onset, Missouri, USA*

PSOD Test and sample type Result
6
 Aerobic culture, urine
 Nonsignificant growth
7 Rickettsia SFG IgG, serum 1:64 (normal <1:64)
Rickettsia SFG IgM, serum <1:64 (normal <1:64)
HIV 1, 2 antibody, serum Negative
Epstein-Barr viral capsid antibody, IgM, serum
 Nonreactive
8 Aerobic and anaerobic culture, blood × 2 No growth
Ehrlichia and Anaplasma PCR, blood Negative
Enterovirus RT-PCR, CSF Negative
Cytomegalovirus PCR, CSF Negative
West Nile virus IgG, CSF Negative
West Nile virus IgM, CSF Negative
Cryptococcal antigen, CSF Negative
Fungal culture, CSF No growth
Aerobic culture, CSF No growth
Fungal culture, blood
 No growth
9 Aerobic culture, tracheal aspirate Aspergillus terreus
Aerobic culture, urine No growth
Aerobic and anaerobic culture, blood × 2
 No growth
10 Aerobic and anaerobic culture, blood × 2 No growth
Acid-fast bacilli culture, blood No growth
Fungal culture, blood No growth
Ehrlichia and Anaplasma PCR, blood Negative
Cytomegalovirus PCR, blood Not detected
Histoplasma antigen, urine Negative
Aspergillus galactomannan antigen, blood Negative
Rickettsia SFG IgG, serum <1:64 (normal <1:64)
Rickettsia SFG IgM, serum
 <1:64 (normal <1:64)
11
 Aerobic culture, tracheal aspirate
 ≥100,000 colonies/mL Stenotrophomonas maltophilia; ≥100,000 colonies/mL yeast
14
 Heartland virus RT-PCR, blood
 Positive
20 Aerobic and anaerobic culture, blood Candida albicans
Fungal culture, blood No growth
Cytomegalovirus PCR, blood
 Not detected
Autopsy Heartland virus RT-PCR, blood Positive
Heartland virus RT-PCR, lymph node Positive
Heartland virus RT-PCR, spleen Positive

*Positive findings are in boldface type. CSF, cerebrospinal fluid; HIV, human immunodeficiency virus; PSOD, post–symptom onset day; RT-PCR, reverse transcription PCR; SFG, spotted fever group.

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Page created: April 17, 2018
Page updated: April 17, 2018
Page reviewed: April 17, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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