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Phleboviruses are found in many areas of the world and are transmitted to humans via bites from infected sandflies, mosquitoes, or ticks.
In 2009, two Missouri farmers were hospitalized with fever, leukopenia, and thrombocytopenia (NEJM JW Infect Dis Sep 5 2012). A novel phlebovirus, Heartland virus (Hv), was found to be the cause of their syndrome, and the vector was thought to be the Lone Star tick, Amblyomma americanum.
In 2012–2013, six additional Hv disease cases were reported (5 in Missouri, 1 in Tennessee). All six patients had fever, leukopenia, and thrombocytopenia; five of them also reported anorexia and fatigue, and four reported headache, nausea, myalgia, or arthralgia. Four of these six patients were hospitalized, and one with mu…