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Volume 29, Number 5—May 2023
Dispatch

Fatal Case of Heartland Virus Disease Acquired in the Mid-Atlantic Region, United States

Sichen Liu1, Suraj Kannan1, Monica Meeks, Sandra Sanchez, Kyle W. Girone, James C. Broyhill, Roosecelis Brasil Martines, Joshua Bernick, Lori Flammia, Julia Murphy, Susan L. Hills, Kristen L. Burkhalter, Janeen J. Laven, David Gaines, and Christopher J. HoffmannComments to Author 
Author affiliations: National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA (S. Liu); Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (S. Kannan, M. Meeks, S. Sanchez, C.J. Hoffman); Virginia Department of Health, Richmond, Virginia, USA (K.W. Girone, J.C. Broyhill, J. Bernick, L. Flammia, J. Murphy, D. Gaines); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.B. Martines); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (S.L. Hills, K.L. Burkhalter, J.J. Laven)

Main Article

Table

Laboratory findings in a fatal case of heartland virus disease acquired in the mid-Atlantic region, United States*

Test Reference range Days after symptom onset
5 7 9 11 13
Temperature, °C
 35.5–38.3
 36.8
 38.5
 38.5
 39.1
 36.9
Blood cell counts
Leukocyte count, × 103 cells/μL 4.50–11.00 2.4 3.7 3.5 2.48 3.25
Absolute neutrophil count, cells/μL 1.50–7.80 ND ND ND 0.99 0.88
Absolute lymphocyte count, cells/μL 1.10–4.80 ND ND ND 1.22 1.76
Hemoglobin, g/dL 13.9–16.3 14.5 14.9 14.6 14.4 11.7
Platelets, × 103/μL
 150–350
 178
 106
 82
 59
 61
Blood chemistry test results
Sodium, mmol/L 135–148 126 115 120 129 136
Potassium, mmol/L 3.5–5.1 3.7 3.3 4.2 4.4 4.4
Carbon dioxide, mmol/L 21–31 22 22 20 17 18
Anion gap, mmol/L 7–16 13 15 12 12 11
Blood urea nitrogen, mg/dL 7–22 12 12 16 26 68
Creatinine, mg/dL 0.6–1.3 1.0 1.3 1.2 1.4 4.4
Aspartate aminotransferase, units/L <37 45 359 434 590 617
Alanine aminotransferase, units/L <40 46 238 262 209 156
Alkaline phosphatase, units/L
 30–120
 69
 64
 53
 67
 89
Cerebrospinal fluid test results
Leukocyte count, cells/mm3 0–5 ND 2 ND ND ND
Glucose, mg/dL 40–70 ND 80 ND ND ND
Protein, mg/dL
 12–60
 ND
 58
 ND
 ND
 ND
Cardiac test results
Troponin I, ng/mL <0.04 ND ND ND 0.21 0.38
Troponin T, high sensitivity, ng/L 0–19 14 22 30 ND ND
Pro-BNP, pg/mL
 5–125
 ND
 ND
 ND
 4,258
 ND
Lipid panel test results
Cholesterol, total, mg/dL <200 ND ND ND 69 ND
Triglycerides, mg/dL
 <150
 ND
 ND
 ND
 147
 ND
Other test results
D-dimer, mg/L 0.00–0.49 ND ND 2.72 3.71 ND
Creatine kinase, U/L 24–195 ND ND ND 8,727 11,083
Lactic acid, mmol/L 0.5–2.0 1.6 1.8 ND 2.5 2.4
Lactate dehydrogenase, U/L 118–273 ND ND 1,412 1,709 ND
Ferritin, ng/mL 30–400 ND ND ND 47,445 174,957
Fibrinogen, mg/dL 170–422 ND ND 199 224 170
C-reactive protein, mg/dL <0.5 ND 1.2 0.6 0.5 ND
Interleukin 2 receptor, pg/mL 532–1,891 ND ND ND 9,390 ND

*BNP, B-type natriuretic peptide; ND, not done.

Main Article

1These first authors contributed equally to this article.

Page created: February 17, 2023
Page updated: April 19, 2023
Page reviewed: April 19, 2023
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