Chester County Medicine Summer 2021 - 20

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Heartland Virus Disease:
a relatively new tick-borne disease
BY JOHN P. MAHER, MD, MPH
t is not surprising that healthcare professionals, like most everyone
in the nation and around the globe, are engrossed in the
global pandemic of the SARS-CoV-2 virus and its clinical disease
manifestation of COVID-19. For over a year now we have all been
awash in the " information glut " about that disease - its origins, clinical
signs and symptoms, mutations/variants, proposed treatments,
and the various preventive measures (masks, social distancing, and
the several vaccines).
Our emails, journals, virtual conferences, TV and news media
I
articles are chock full of it, to the point, almost, that one could
easily forget that there are other medical and health care issues of
importance which still need consideration. This is especially true in
the field of infectious diseases. " All that glitters is not gold, " and not
every febrile or dyspneic patient has COVID-19.
In a sense, Mother Nature resembles one of those night club
magicians whose legerdemain and prestidigitation skills seem all
the more magical when he pulls a rabbit out of a hat or a live dove
seemingly out of the thin air - until later when we realize that the
key element was his ability to distract attention from the hand
which is actually preparing to produce the illusion (the " art of
misdirection " ).
So, with our clinical experience, and/or our epidemiological
training, we keep looking around and asking " what else is going
on, that we don't want to miss? " Here in Southeastern PA, we have
good historical reason to be watchful in that manner. In the early
1980s, the epizootic of animal rabies started slowly, almost under
the radar, but within months was rapidly spreading across this area
from southwest to northeast. Remember how quickly the HIV/
AIDS virus spread through the nation. Similarly, SARS-1 took only
a few months to go global; WNV spread across the country in about
a year, and Lyme Disease went from New England to the entire
nation in about 4 years.
Of particular note to this author, is the growing spectrum of vector
borne diseases. In 2018, the CDC reported that " vector-borne
diseases (VBDs) cause significant morbidity and mortality each year
in the US, " with over 700,000 cases of diseases carried by ticks, mosquitoes
and fleas reported to the CDC between 2004 - 2018.
They stated that " the number of cases has been increasing annually,
with two major trends: (1.) a steady increase in tick-borne diseases,
and (2.) increasing intermittent outbreaks of mosquito-borne
ARBOvirus cases. It is no doubt true that a large majority of the
total case numbers of TBDs reflects all the Lyme Disease reports
from around the nation. Nevertheless, the data do also show that all
the other TBDs besides LD showed significant increases as well.
Anaplasmosis
Babesiosis
Table 1: TBDs occurring in the US
Powassan disease
Rickettsia parkeri
Borrelia mayoni
Borrelia miyamotoi
Bourbon virus
Rocky Mountain Spotted Fever
Southern Tick-associated Rash Illness
(STARI)
Tick-borne relapsing fever
Colorado tick fever virus Tularemia
Ehrlichiosis
Lyme Disease
Source: cdc.gov/ticks/diseases/index.html
64D Rickettsiosis (R. phillipi?)
Heartland virus
Figure 1: Heartland virus
disease cases by state, as of
January 2021
20 CHESTER COUNTY Medicine | SUMMER 2021
https://chestercms.org/index.html http://www.cdc.gov/ticks/diseases/index.html
Chester County Medicine Summer 2021

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