Discovery of Bourbon Virus Raises Many Questions

December 24, 2014

The discovery of a new virus implicated in the death of a Kansas farmer this past June raises many questions about its host, prevalence, spectrum of disease, and ultimately its treatment and prevention, according to an infectious disease expert who treated the patient.

Yesterday, the Kansas Department of Health and Environment announced the first known case of the so-called Bourbon virus, named after the Kansas county where the unidentified patient had lived. His symptoms — fever, low red and white blood cell counts, elevated liver enzymes, and loss of appetite — suggested a tick-borne illness such as ehrlichiosis or the Heartland virus, but test results were negative. A laboratory with the Centers for Disease Control and Prevention in Fort Collins, Colorado, finally determined that the virus was one never seen before in the Western hemisphere.

The Bourbon virus belongs to the orthomyxovirus family and possesses a genome similar to that of such viruses in Eastern Europe, Africa, and Asia, said Dana Hawkinson, MD, an infectious disease physician at the University of Kansas Hospital, who cared for the Kansas farmer. The virus appears to be tick-borne, but that has not been proven yet.

"We suspect it's been around for a while," Dr Hawkinson told Medscape Medical News. "We haven't been able to identify it until now."

Public health authorities intend to test other patients in Kansas who have experienced symptoms resembling those of the Bourbon virus and whose condition defied diagnosis to determine whether they also were infected with the new virus. The results will help answer how prevalent the virus is, said Dr Hawkinson, an assistant professor of infectious diseases at the University of Kansas School of Medicine. Epidemiologists may go so far as to test healthy individuals for the presence of antibodies to the Bourbon virus, he said.

The Centers for Disease Control and Prevention will collect and test ticks to determine whether they are the virus' host.

Future studies also will look at the virus on a molecular level to determine how it interacts with the human body and how that led to the death of the Kansas farmer. Dr Hawkinson said that on the basis of one case, the spectrum of disease for the Bourbon virus is unknown. It is possible some individuals might experience a milder version of the illness that sent an otherwise healthy man to the hospital, where his condition progressed to lung and kidney failure and shock. The answers to these questions could lead to the development of a vaccine for Bourbon virus and a treatment, said Dr Hawkinson. He also anticipates development of a commercial laboratory test for the Bourbon virus that would become a routine screening tool.

Then there is a question of how a virus with roots in Africa, Asia, and Europe landed in the American Midwest.

"A lot of different organisms find their way to different parts of the world," Dr Hawkinson said.

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