A new phlebovirus associated with severe febrile illness in Missouri

N Engl J Med. 2012 Aug 30;367(9):834-41. doi: 10.1056/NEJMoa1203378.


Two men from northwestern Missouri independently presented to a medical facility with fever, fatigue, diarrhea, thrombocytopenia, and leukopenia, and both had been bitten by ticks 5 to 7 days before the onset of illness. Ehrlichia chaffeensis was suspected as the causal agent but was not found on serologic analysis, polymerase-chain-reaction (PCR) assay, or cell culture. Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus. Although Koch's postulates have not been completely fulfilled, we believe that this phlebovirus, which is novel in the Americas, is the cause of this clinical syndrome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Animals
  • Antibodies, Viral / blood
  • Bone Marrow / virology
  • Bunyaviridae Infections / virology*
  • Fever / etiology
  • Genome, Viral
  • Humans
  • Immunoglobulin A / blood
  • Leukocytes / virology
  • Male
  • Middle Aged
  • Missouri
  • Phlebovirus / classification*
  • Phlebovirus / genetics
  • Phlebovirus / isolation & purification
  • Phylogeny
  • RNA, Viral / analysis
  • Tick-Borne Diseases / virology


  • Antibodies, Viral
  • Immunoglobulin A
  • RNA, Viral