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Molecular genomic characterization of tick- and human-derived severe fever with thrombocytopenia syndrome virus isolates from South Korea. PLoS Negl Trop Dis 2017; 11:e0005893. [PMID: 28937979 PMCID: PMC5627960 DOI: 10.1371/journal.pntd.0005893] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/04/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne viral disease caused by the SFTS virus (SFTSV) from Bunyaviridae that is endemic in East Asia. However, the genetic and evolutionary characteristics shared between tick- and human-derived Korean SFTSV strains are still limited. METHODOLOGY/PRINCIPAL FINDINGS In this study we identify, for the first time, the genome sequence of a tick (Haemaphysalis longicornis)-derived Korean SFTSV strain (designated as KAGWT) and compare this virus with recent human SFTSV isolates to identify the genetic variations and relationships among SFTSV strains. The genome of the KAGWT strain is consistent with the described genome of other members of the genus Phlebovirus with 6,368 nucleotides (nt), 3,378 nt, and 1,746 nt in the Large (L), Medium (M) and Small (S) segments, respectively. Compared with other completely sequenced human-derived Korean SFTSV strains, the KAGWT strain had highest sequence identities at the nucleotide and deduced amino acid level in each segment with the KAGWH3 strain which was isolated from SFTS patient within the same region, although there is one unique amino acid substitution in the Gn protein (A66S). Phylogenetic analyses of complete genome sequences revealed that at least four different genotypes of SFTSV are co-circulating in South Korea, and that the tick- and human-derived Korean SFTSV strains (genotype B) are closely related to one another. Although we could not detect reassortant, which are commonly observed in segmented viruses, further large-scale surveillance and detailed genomic analysis studies are needed to better understand the molecular epidemiology, genetic diversity, and evolution of SFTSV. CONCLUSIONS/SIGNIFICANCE Full-length sequence analysis revealed a clear association between the genetic origins of tick- and human-derived SFTSV strains. While the most prevalent Korean SFTSV is genotype B, at least four different genotypes of SFTSV strains are co-circulating in South Korea. These findings provide information regarding the molecular epidemiology, genetic diversity, and evolution of SFTSV in East Asia.
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152
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Two confirmed cases of severe fever with thrombocytopenia syndrome with pneumonia: implication for a family cluster in East China. BMC Infect Dis 2017; 17:537. [PMID: 28774267 PMCID: PMC5541732 DOI: 10.1186/s12879-017-2645-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) was first reported in China in 2011. Human-to-human transmission of the virus occurred occasionally in family clusters. However, pneumonia as an onset syndrome was not common in most SFTS cases. Our aim is to report a family cluster of SFTS with clinical manifestation of pneumonia in Shanghai. Methods Epidemiologic investigations were conducted when a family cluster of severe fever with thrombocytopenia syndrome virus (SFTSV) infection was identified in Shanghai in June 2016. Samples were collected from two secondary cases and two close contacts with fever. SFTSV was detected by Real-Time reverse transcription polymerase chain reaction (RT-PCR). Results There were two confirmed STFS cases and one potential index case. The potential index case became ill on 21 May and died on 31 May. Case A had onset from 4 to 23 June and case B from 8 June to 25 June. All the three cases experienced pneumonia at the early stage of SFTSV infection. Three (3) out of thirty two (32) close contacts had symptoms of fever or cough but were detected STFSV negative by real-time RT-PCR. According to epidemiologic investigations, the potential index case had outdoor activities on a nearby hill. A tick bite could have been the reason for the SFTSV infection in the potential index case as ticks were found both in grassland or shrubs on the hill and also found on mice caught in her house. Both cases A and B had provided bedside care for the potential index case without any protection and had contacted with blood and other body fluids. Conclusion It was a family cluster of SFTSV infection imported from Jiangsu province located in the east of China. We suggested to become alert to atypical SFTSV infected cases.
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Huang D, Jiang Y, Liu X, Wang B, Shi J, Su Z, Wang H, Wang T, Tang S, Liu H, Hu Z, Deng F, Shen S. A Cluster of Symptomatic and Asymptomatic Infections of Severe Fever with Thrombocytopenia Syndrome Caused by Person-to-Person Transmission. Am J Trop Med Hyg 2017; 97:396-402. [PMID: 28722592 DOI: 10.4269/ajtmh.17-0059] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel phlebovirus that was identified to be the etiological pathogen of the emerging infectious disease, severe fever with thrombocytopenia syndrome (SFTS). SFTSV could be transmitted through tick bite. Transmission of SFTSV among humans has also been reported mainly through direct blood contact. In July 2014, a cluster of six suspected SFTS cases occurred in Shandong Province, China. In this cluster, both symptomatic and asymptomatic persons were included. By analyzing the clinical data and results of laboratory tests, and conducting the epidemiological interviews with the cases and their families, risk factors responsible for the transmission were evaluated. The findings suggested that SFTSV transmission among humans may cause asymptomatic infection via personal contact without blood exposure.
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Affiliation(s)
- Deyu Huang
- Department of Infectious Diseases, Qilu hospital of Shandong University, Qingdao, People's Republic of China.,Department of infectious Diseases, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Yueping Jiang
- Department of infectious Diseases, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Xiaoping Liu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Bo Wang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Junming Shi
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Zhan Su
- Department of hematology, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Hui Wang
- Department of infectious Diseases, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Ting Wang
- Department of infectious Diseases, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Shuang Tang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Hanyun Liu
- Department of infectious Diseases, Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Zhihong Hu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Fei Deng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Shu Shen
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
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154
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Chen Y, Jia B, Liu Y, Huang R, Chen J, Wu C. Risk factors associated with fatality of severe fever with thrombocytopenia syndrome: a meta-analysis. Oncotarget 2017; 8:89119-89129. [PMID: 29179504 PMCID: PMC5687674 DOI: 10.18632/oncotarget.19163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 01/03/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome is an emerging life-threatening infectious disease identified in 2009. Given high case-fatality rate among patients with severe fever with thrombocytopenia syndrome, identification of the risk factors at acute phase associated with fatality is crucial for treatment. Therefore, we aimed to meta-analytically evaluate risk factors of fatal clinical outcome of severe fever with thrombocytopenia syndrome. 238 fatal cases and 873 non-fatal cases from 12 studies were included in this meta-analysis. Elder age and high viral load were significantly associated with fatal clinical outcome. Further, severe fever with thrombocytopenia syndrome patients with fatal clinical outcome had significantly reduced level of albumin and platelet count, higher level of serum alanine aminotransferase, aspirate aminotransferase, lactic acid dehydrogenase and creatinine phosphokinase, and prolonged activated partial thromboplastin time, comparing with mild patients. These disturbed parameters function as predictors to warn fatal clinical outcome of the disease. Moreover, ribavirin has a minimal impact to alleviate disease progression of severe fever with thrombocytopenia syndrome. In conclusion, our finding demonstrates a panel of factors associated with fatality of SFTS disease, which have important implications during clinical practice.
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Affiliation(s)
- Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bei Jia
- Department of Infectious Disease, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu Province, China
| | - Yong Liu
- Department of Experimental Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Rui Huang
- Department of Infectious Disease, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu Province, China
| | - Junhao Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Chao Wu
- Department of Infectious Disease, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu Province, China
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Sizikova TE, Lebedev VN, Pantukhov VB, Borisevich SV. Severe fever with thrombocytopenia syndrome: the disease, caused by the novel phlebovirus. Vopr Virusol 2017; 62:60-65. [PMID: 36494929 DOI: 10.18821/0507-4088-2017-62-2-60-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 12/13/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a new virus (SFTS virus) reported to be endemic to central and northeastern parts of China. SFTS virus, which is classified into the genus Phlebovirus (the Bunyaviridae family), is suspected to be a tick-borne virus owing to evidence in two species of ticks: Haemaphysalis longicornis and Rhipicephalus microplus. SFTS virus is detected among many species of domestic animals in China. The clinical symptoms of SFTS include fever, thrombocytopenia, leucocytopenia, gastrointestinal symptoms, neural symptoms, bleeding tendency. The fatality rate of SFTS is 6-30%. Person-to-person transmission of SFTS virus is possible through blood contact. Clinical and epidemiological studies of SFTS, the cases of SFTS outside China, person-to-person transmission of SFTS virus, evolutionary and molecular analysis of the emergent SFTS virus, and risk assessment of human infection with a novel phlebovirus are considered in this review.
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156
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Occupational Severe Fever With Thrombocytopenia Syndrome Following Needle-Stick Injury. Infect Control Hosp Epidemiol 2017; 38:760-762. [PMID: 28397631 DOI: 10.1017/ice.2017.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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157
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Li P, Tong ZD, Li KF, Tang A, Dai YX, Yan JB. Seroprevalence of severe fever with thrombocytopenia syndrome virus in China: A systematic review and meta-analysis. PLoS One 2017; 12:e0175592. [PMID: 28399161 PMCID: PMC5388504 DOI: 10.1371/journal.pone.0175592] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/28/2017] [Indexed: 02/04/2023] Open
Abstract
Objective Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus-SFTSV. The seroprevalence of anti-SFTSV antibodies including immunoglobulin G (IgG) and immunoglobulin M (IgM), specific to SFTSV in the general population has been investigated in various epidemiological studies with inconsistent results. Here, we clarify this discrepancy and reach a more comprehensive result by mean of a meta-analysis. Methods All relevant articles were searched in the electronic databases (PubMed, Web of science, Embase, Chinese National Knowledge Infrastructure database, Chinese Wanfang database) up to November 2016. The pooled seroprevalence and 95% confidence intervals (95% CIs) were calculated by random- or fixed- model on the basis of heterogeneity. Results In total, 21 studies containing 23,848 blood samples from 7 provinces were included in this meta-analysis. The minimum and maximum reported seroprevalences of SFTSV among humans in China were 0.23% and 9.17%, respectively. The overall pooled seroprevalence of SFTSV antibodies was 4.3% (95%CI: 3.2%-5.5%). The pooled prevalence was 5.9% (95%CI: 4.7%-7.0%) in Zhejiang province, 4.9% (95%CI: 4.1–5.8%) in Anhui province, 3.9% (95%CI: 1.3%-6.4%) in Shandong province, and 0.7% (95%CI: 0.2%-1.1%) in Jiangsu province. Stratified by occupation, the pooled prevalence of farmer was 6.1% (95%CI: 3.4%-8.9%) and others (mainly are students) was 3.3% (95%CI: 2.4%-4.2%). Additionally, seroprevalence of SFTSV in people who lived in the same village with the patient were higher than that of people who lived in a different village. Seropositive rates in sampling years after 2012 were higher than that before 2012. The prevalence of SFTSV did not differ by age or gender. Sensitive analysis by omitting one study at a time indicated the results of the pooled seroprevalence were robust. Conclusions Seroprevalence of SFTSV among healthy population in central and eastern China is high. Surveillance efforts on mild or asymptomatic infections among endemic persons are needed.
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Affiliation(s)
- Peng Li
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
| | - Zhen-Dong Tong
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- * E-mail: (ZDT); (JBY)
| | - Ke-Feng Li
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
| | - An Tang
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
| | - Ya-Xin Dai
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
| | - Jian-Bo Yan
- Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- Zhejiang Provincial Key Laboratory of Health Risk Factors for Seafood, Zhoushan Municipal Center for Disease Control and Prevention, Zhoushan, Zhejiang, P.R. China
- * E-mail: (ZDT); (JBY)
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158
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He M, Wang J, Chen L, Liu J, Zeng P. The Impact of Emerging Infectious Diseases on Chinese Blood Safety. Transfus Med Rev 2017; 31:94-101. [PMID: 27923518 PMCID: PMC7126663 DOI: 10.1016/j.tmrv.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/19/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022]
Abstract
Emerging infectious diseases (EIDs) have always been one of the major threats to public health. Although the implementation of mandatory testing for 4 classical transfusion-transmitted infectious-human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis-has reduced the transfusion risk of these pathogens, the potential threat of various EID agents and their constantly evolving variants to blood safety in China is not fully understood. This review presents 9 representative EID agents that are autochthonous and epidemic nationally or regionally in China. The epidemiologic status and distribution of these EID agents among donors and/or healthy populations are summarized. The potential risks of these EID agents to blood safety are discussed. The review also explores strategies to strengthen hemovigilance systems and studies to further evaluate the impact of EID agents on blood safety.
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Affiliation(s)
- Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Limin Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jing Liu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peibin Zeng
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
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159
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Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the SFTS virus (SFTSV), a novel phlebovirus reported to be endemic to China in 2011. In Japan, the first SFTS patient was identified during the autumn of 2012; since then, over 100 SFTS patients have been reported. The SFTSV has been identified throughout Japan over the past two years; however, SFTS patients are specifically localized to western Japan. The clinical symptoms of SFTS include fever, thrombocytopenia, leukocytopenia, gastrointestinal symptoms, and various other symptoms, including muscular symptoms, neurological abnormalities, and coagulopathy. SFTS is often accompanied by hemophagocytic syndrome. The histopathological findings are characterized by necrotizing lymphadenitis, with infiltration of the virus-infected cells to the local lymph nodes. Pathophysiological analyses of SFTS include studies regarding the kinetics of cytokine production and immune responses in patients with SFTS and in SFTSV-infection animal models. This article aimed to survey the history of SFTS in Japan and to review the clinical, epidemiological, and virological aspects of SFTS and SFTSV infection.
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160
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Zhang XA, Li S, Ching J, Yang ZD, Cui N, Zhang PH, Hu JG, Liu W. A sensitive and specific rapid diagnostic test for severe fever with thrombocytopenia syndrome virus. J Infect 2017; 74:517-519. [PMID: 28188817 DOI: 10.1016/j.jinf.2017.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Sabrina Li
- Coyote Bioscience Company, Beijing, PR China
| | - Jesus Ching
- Coyote Bioscience Company, Beijing, PR China; Coyote Bioscience Company, District of Columbia, United States
| | - Zhen-Dong Yang
- The 154 Hospital, People's Liberation Army, Xinyang, PR China
| | - Ning Cui
- The 154 Hospital, People's Liberation Army, Xinyang, PR China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Jian-Gong Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China.
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161
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Jia Z, Wu X, Wang L, Li X, Dai X, Liang M, Cao S, Kong Y, Liu J, Li Y, Wang J. Identification of a candidate standard strain of severe fever with thrombocytopenia syndrome virus for vaccine quality control in China using a cross-neutralization assay. Biologicals 2017; 46:92-98. [PMID: 28173977 DOI: 10.1016/j.biologicals.2017.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is caused by a phlebovirus of the Bunyaviridae family, which is designated as SFTS virus (SFTSV). To our knowledge, no efficient SFTSV vaccine exists. Here, we report the identification of a standard virus strain for the eight major SFTSV strains circulating in China for use in evaluating the SFTSV vaccine. Rabbits were immunized with the SFTSV strains and the cross-neutralization capacities of SFTSV anti-sera were determined in microculture cytopathic effect (CPE)-inhibition assays. The mean cross-neutralization capacity of the eight SFTSV anti-sera ranged from 62.4 to 142.6%, compared to autologous strains. The HB29 strain demonstrated strong cross-reactivity with heterologous antibodies, and 33 serum samples from SFTS patients efficiently neutralized HB29, suggesting its broad cross-reactivity. In addition, HB29 demonstrated good replication in Vero and MRC-5 cells (8.0 and 6.0 lg 50% cell culture-infectious dose/mL, respectively) and significant CPE, which satisfied the requirements for a standard virus strain. The HB29 isolate was proven identical to the reported HB29 strain by DNA sequencing, and showed high homology in the S segments with other SFTSV strains (94.8-99.7%). Our results suggest that HB29 may be the best candidate standard strain for use in SFTS vaccine development in China.
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Affiliation(s)
- Zheng Jia
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Xiaohong Wu
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Ling Wang
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Xiuling Li
- Beijing Institute of Biological Products Co., Ltd., Beijing 101111, PR China
| | - Xinxian Dai
- Beijing Institute of Biological Products Co., Ltd., Beijing 101111, PR China
| | - Mifang Liang
- Key Laboratory for Medical Virology, NHFPC, National Institute for Viral Disease Control and Prevention, China CDC, Beijing 102206, PR China
| | - Shouchun Cao
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Yan Kong
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Jingjing Liu
- National Institutes for Food and Drug Control, Beijing 100050, PR China
| | - Yuhua Li
- National Institutes for Food and Drug Control, Beijing 100050, PR China.
| | - Junzhi Wang
- National Institutes for Food and Drug Control, Beijing 100050, PR China.
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162
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Lv Q, Zhang H, Tian L, Zhang R, Zhang Z, Li J, Tong Y, Fan H, Carr MJ, Shi W. Novel sub-lineages, recombinants and reassortants of severe fever with thrombocytopenia syndrome virus. Ticks Tick Borne Dis 2017; 8:385-390. [PMID: 28117273 DOI: 10.1016/j.ttbdis.2016.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/30/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) has been continuously circulating in Eastern Asia in recent years, without the availability of effective vaccines or antiviral drugs, posing a serious threat to public health, particularly in the central-eastern provinces of China. In this study, we isolated and sequenced four new SFTSV strains from Shandong Province identified in 2015. Phylogenetic analysis, with all publicly available L, M and S gene segments, revealed that the four newly described SFTSV strains belonged to genotype C3. In addition, our phylogenetic analyses also identified two potentially novel sub-lineages of SFTSV, tentatively named C6 and J4. Our comprehensive analysis revealed twenty recombination events in fourteen SFTSV genomes and recombination events were found in the S gene segment for the first time. A total of twenty-six strains were probable SFTSV reassortants, including sixteen which were previously unidentified. We further characterised the genetic constellation of these putative reassortants and classified them into twelve different reassortment forms. Our study revealed multiple evolutionary forces acting on SFTSV, responsible for the increasing genetic diversity of this agent, which could potentially alter the antigenicity and pathogenicity of the virus. This calls for an urgent need for intensified surveillance and the development of vaccines and antiviral drugs against this high-consequence pathogen.
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Affiliation(s)
- Qiang Lv
- Institute of Pathogen Biology, Taishan Medical College, Taian, Shandong 271000, China
| | - Hong Zhang
- The Affiliated Hospital of Taishan Medical University, Taian, Shandong 271000, China
| | - Lei Tian
- The 88 Hospital of The Chinese People's Liberation Army, Taian, Shandong 271000, China
| | - Ruiling Zhang
- Institute of Pathogen Biology, Taishan Medical College, Taian, Shandong 271000, China
| | - Zhenjie Zhang
- Institute of Pathogen Biology, Taishan Medical College, Taian, Shandong 271000, China
| | - Juan Li
- Institute of Pathogen Biology, Taishan Medical College, Taian, Shandong 271000, China
| | - Yigang Tong
- Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Hang Fan
- Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Michael J Carr
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 001-0020, Japan; National Virus Reference Laboratory, University College Dublin, Belfield, Dublin 4, Ireland
| | - Weifeng Shi
- Institute of Pathogen Biology, Taishan Medical College, Taian, Shandong 271000, China.
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163
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Emergence of New Tickborne Infections. EMERGING ZOONOSES 2017. [PMCID: PMC7122411 DOI: 10.1007/978-3-319-50890-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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164
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Hwang J, Kang JG, Oh SS, Chae JB, Cho YK, Cho YS, Lee H, Chae JS. Molecular detection of severe fever with thrombocytopenia syndrome virus (SFTSV) in feral cats from Seoul, Korea. Ticks Tick Borne Dis 2017; 8:9-12. [DOI: 10.1016/j.ttbdis.2016.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 07/19/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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165
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Choi SJ, Park SW, Bae IG, Kim SH, Ryu SY, Kim HA, Jang HC, Hur J, Jun JB, Jung Y, Chang HH, Kim YK, Yi J, Kim KH, Hwang JH, Kim YS, Jeong HW, Song KH, Park WB, Kim ES, Oh MD. Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015. PLoS Negl Trop Dis 2016; 10:e0005264. [PMID: 28033338 PMCID: PMC5226827 DOI: 10.1371/journal.pntd.0005264] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/11/2017] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was recently identified in China, South Korea and Japan. The objective of the study was to evaluate the epidemiologic and clinical characteristics of SFTS in South Korea. METHODS/PRINCIPAL FINDINGS SFTS is a reportable disease in South Korea. We included all SFTS cases reported to the Korea Centers for Disease Control and Prevention (KCDC) from January 2013 to December 2015. Clinical information was gathered by reviewing medical records, and epidemiologic characteristics were analyzed using both KCDC surveillance data and patient medical records. Risk factors for mortality in patients with SFTS were assessed. A total of 172 SFTS cases were reported during the study period. SFTS occurred throughout the country, except in urban areas. Hilly areas in the eastern and southeastern regions and Jeju island (incidence, 1.26 cases /105 person-years) were the main endemic areas. The yearly incidence increased from 36 cases in 2013 to 81 cases in 2015. Most cases occurred from May to October. The overall case fatality ratio was 32.6%. The clinical progression was similar to the 3 phases reported in China: fever, multi-organ dysfunction, and convalescence. Confusion, elevated C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS. Two outbreaks of nosocomial SFTS transmission were observed. CONCLUSIONS SFTS is an endemic disease in South Korea, with a nationwide distribution and a high case-fatality ratio. Confusion, elevated levels of C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS.
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Affiliation(s)
- Seong Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Younghee Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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166
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Kato H, Yamagishi T, Shimada T, Matsui T, Shimojima M, Saijo M, Oishi K. Epidemiological and Clinical Features of Severe Fever with Thrombocytopenia Syndrome in Japan, 2013-2014. PLoS One 2016; 11:e0165207. [PMID: 27776187 PMCID: PMC5077122 DOI: 10.1371/journal.pone.0165207] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/07/2016] [Indexed: 01/12/2023] Open
Abstract
Although severe fever with thrombocytopenia syndrome (SFTS) was first reported from Japan in 2013, the precise clinical features and the risk factors for SFTS have not been fully investigated in Japan. Ninety-six cases of severe fever with thrombocytopenia syndrome (SFTS) were notified through the national surveillance system between April 2013 and September 2014 in Japan. All cases were from western Japan, and 82 cases (85%) had an onset between April and August. A retrospective observational study of the notified SFTS cases was conducted to identify the clinical features and laboratory findings during the same period. Of 96 notified cases, 49 (51%) were included in this study. Most case-patients were of advanced age (median age 78 years) and were retired or unemployed, or farmers. These case-patients had a history of outdoor activity within 2 weeks before the onset of illness. The median serum C-reactive protein concentration was slightly elevated at admission. Fungal infections such as invasive aspergilosis were found in 10% of these case-patients. Hemophagocytosis was observed in 15 of the 18 case-patients (83%) whose bone marrow samples were available. Fifteen cases were fatal, giving a case-fatality proportion of 31%. The proportion of neurological abnormalities and serum concentrations of lactate dehydrogenase and aspartate aminotransferase were significantly higher in the fatal cases than in the nonfatal cases during hospitalization. Appearance of neurological abnormality may be useful for predicting the prognosis in SFTS patients.
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Affiliation(s)
- Hirofumi Kato
- Feild Epidemiology Training Program (FETP), National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan
- Division of Global Infectious Diseases, Department of Infection and Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Takuya Yamagishi
- Infectious Disease Surveillance Center, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Tomoe Shimada
- Infectious Disease Surveillance Center, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
| | - Kazunori Oishi
- Division of Global Infectious Diseases, Department of Infection and Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious diseases, Shinjuku, Tokyo, Japan
- * E-mail:
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167
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Park SW, Ryou J, Choi WY, Han MG, Lee WJ. Epidemiological and Clinical Features of Severe Fever with Thrombocytopenia Syndrome During an Outbreak in South Korea, 2013-2015. Am J Trop Med Hyg 2016; 95:1358-1361. [PMID: 27928084 PMCID: PMC5154450 DOI: 10.4269/ajtmh.16-0251] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/13/2016] [Indexed: 11/10/2022] Open
Abstract
Since the first reported case of severe fever with thrombocytopenia syndrome (SFTS) in South Korea in 2013, between 2013 and 2015, we collected 1,697 serum samples from suspected patients who experienced symptoms of SFTS. We performed reverse transcriptase polymerase chain reaction using total RNA extracted from the patients' sera. When viral RNA was detected in the sera, SFTS was diagnosed. Among the 1,697 samples, 170 were positive for SFTS virus. We then analyzed the epidemiologic features of these 170 cases. As a result, we found that the annual number of cases increased steadily. However, the annual case fatality rate exhibited a downward trend. The majority of patients were aged ≥ 60 years, and most cases occurred during May–October in the eastern and southern parts of the country. These results may be useful for effective SFTS control by describing the clinical and epidemiologic features of the disease in South Korea.
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Affiliation(s)
- Sun-Whan Park
- Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Jungsang Ryou
- Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Woo-Young Choi
- Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Myung-Guk Han
- Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Won-Ja Lee
- Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
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168
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Factors associated with Severe Fever with Thrombocytopenia Syndrome infection and fatal outcome. Sci Rep 2016; 6:33175. [PMID: 27605309 PMCID: PMC5015071 DOI: 10.1038/srep33175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is emerging in China and the incidence increased year by year. In this study, we conducted case control study to explore factors associated with SFTS virus (SFTSV) infection and fatal outcome. In the study of factors associated with SFTSV infection, a total of 216 individuals participated the study, including 72 cases and 144 matched controls. There were significant differences in proportion of history of tick bite and breeding domestic animals between cases and controls. Of note, individuals who were unclear whether they had been bitten by ticks had the highest risk of SFTSV infection and odds ratio (OR) was 10.222. In the study of factors associated with SFTS fatal outcome, a total of 129 cases participated the study including 16 deaths and 113 survivors. Significant differences were observed in body mass index (BMI), intervals from illness onset to confirmation, and proportion of gingival hemorrhage between deaths and survivors, whose ORs of these factors were 3.903, 1.996, and 3.826, respectively. Our results suggest that all patients with fever, thrombocytopenia and leukocytopenia in SFTS endemic areas should be suspected of SFTS, even they don’t have history of tick bite, and more intense treatment should be administered to patients with abnormal BMI before laboratory parameters are detected.
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169
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Shin J, Kwon D, Youn SK, Park JH. Characteristics and Factors Associated with Death among Patients Hospitalized for Severe Fever with Thrombocytopenia Syndrome, South Korea, 2013. Emerg Infect Dis 2016; 21:1704-10. [PMID: 26402575 PMCID: PMC4593431 DOI: 10.3201/eid2110.141928] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Surveillance for this emerging disease should be expanded to the outpatient setting. In South Korea, nationwide surveillance for severe fever with thrombocytopenia syndrome (SFTS) began during 2013. Among 301 surveillance cases, 35 hospitalized case-patients in 25 areas were confirmed by using virologic testing, and 16 (46%) case-patients subsequently died. The SFTS cases occurred during May–November and peaked during June (9 cases, 26%). The incidence of SFTS was higher in the southern regions of South Korea. Age and neurologic symptoms, including decreased level of consciousness and slurred speech, were heavily associated with death; neurologic symptoms during the first week after disease onset were also associated with death. Although melena was common among patients who died, no other hemorrhagic manifestations were substantively more common among those who died. No effective treatments, including ribavirin, were identified. Expansion of SFTS surveillance to include the outpatient sector and development of an antibody test would enhance completeness of SFTS detection in South Korea.
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170
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Yun SM, Lee YJ, Choi W, Kim HC, Chong ST, Chang KS, Coburn JM, Klein TA, Lee WJ. Molecular detection of severe fever with thrombocytopenia syndrome and tick-borne encephalitis viruses in ixodid ticks collected from vegetation, Republic of Korea, 2014. Ticks Tick Borne Dis 2016; 7:970-978. [PMID: 27211914 DOI: 10.1016/j.ttbdis.2016.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/03/2016] [Accepted: 05/03/2016] [Indexed: 12/30/2022]
Abstract
Ticks play an important role in transmission of arboviruses responsible for emerging infectious diseases, and have a significant impact on human, veterinary, and wildlife health. In the Republic of Korea (ROK), little is known about information regarding the presence of tick-borne viruses and their vectors. A total of 21,158 ticks belonging to 3 genera and 6 species collected at 6 provinces and 4 metropolitan areas in the ROK from March to October 2014 were assayed for selected tick-borne pathogens. Haemaphysalis longicornis (n=17,570) was the most numerously collected, followed by Haemaphysalis flava (n=3317), Ixodes nipponensis (n=249), Amblyomma testudinarium (n=11), Haemaphysalis phasiana (n=8), and Ixodes turdus (n=3). Ticks were pooled (adults 1-5, nymphs 1-30, and larvae 1-50) and tested by one-step reverse transcription polymerase chain reaction (RT-PCR) or nested RT-PCR for the detection of severe fever with thrombocytopenia virus (SFTSV), tick-borne encephalitis virus (TBEV), Powassan virus (POWV), Omsk hemorrhagic fever virus (OHFV), and Langat virus (LGTV). The overall maximum likelihood estimation (MLE) [estimated numbers of viral RNA positive ticks/1000 ticks] for SFTSV and TBEV was 0.95 and 0.43, respectively, while, all pools were negative for POWV, OHFV, and LGTV. The purpose of this study was to determine the prevalence of SFTSV, TBEV, POWV, OHFV, and LGTV in ixodid ticks collected from vegetation in the ROK to aid our understanding of the epidemiology of tick-borne viral diseases. Results from this study emphasize the need for continuous tick-based arbovirus surveillance to monitor the emergence of tick-borne diseases in the ROK.
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Affiliation(s)
- Seok-Min Yun
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do (Province), 28159, Republic of Korea
| | - Ye-Ji Lee
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do (Province), 28159, Republic of Korea
| | - WooYoung Choi
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do (Province), 28159, Republic of Korea
| | - Heung-Chul Kim
- 5th Medical Detachment, 168th Multifunctional Medical Battalion, 65th Medical Brigade, Unit 15247, APO AP, 96205-5247, USA
| | - Sung-Tae Chong
- 5th Medical Detachment, 168th Multifunctional Medical Battalion, 65th Medical Brigade, Unit 15247, APO AP, 96205-5247, USA
| | - Kyu-Sik Chang
- Division of Medical Entomology, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do (Province), 28159, Republic of Korea
| | - Jordan M Coburn
- Carl R. Darnall Army Medical Center, Department of Preventive Medicine, 76022 Crockett Street, Ft Hood, TX 76544, USA
| | - Terry A Klein
- Public Health Command District-Korea (Provisional), 65th Medical Brigade, Unit 15281, APO AP, 96205-5281, USA
| | - Won-Ja Lee
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do (Province), 28159, Republic of Korea.
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171
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Jeong EJ, Song JY, Lim CS, Lee I, Park MS, Choi MJ, Jeon JH, Kang SH, Jung BK, Yoon JG, Hyun HJ, Noh JY, Cheong HJ, Kim WJ. Viral shedding from diverse body fluids in a patient with severe fever with thrombocytopenia syndrome. J Clin Virol 2016; 80:33-5. [PMID: 27135388 DOI: 10.1016/j.jcv.2016.04.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne disease characterized by high fever, thrombocytopenia, leukopenia, and multiple organ failure and is caused by a novel bunyavirus. Human-to-human transmission has been reported previously, but the mode of transmission has not been clarified thoroughly. STUDY DESIGN We identified a case of a 73-year-old woman with SFTS and performed a semi-quantitative real-time reverse transcription PCR (real-time RT-PCR) assay on her blood, tracheal aspirate, gastric aspirate and urine to detect SFTS virus (SFTSV). RESULTS During 7-day hospitalization, all the serum samples showed positive Ct values lower than 35 in both the S and M segments, suggesting the presence of the SFTSV RNA. After initiation of plasma exchange, serum SFTSV load markedly decreased, but still remained positive. The SFTS viral RNA was also detected in other body fluids, including tracheal aspirate and gastric aspirate. CONCLUSION These results suggest that droplet transmission can occur through close contact with infected patients.
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Affiliation(s)
- Eun Ju Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea.
| | - Chae Seung Lim
- Department of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Gurodongro, Gurogu, Seoul, Republic of Korea.
| | - Ilseob Lee
- Department of Microbiology and the Institute for Viral Diseases, Korea University College of Medicine, Seoul, Republic of Korea
| | - Man-Seong Park
- Department of Microbiology and the Institute for Viral Diseases, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Ho Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong Hui Kang
- Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, Daejon, Republic of Korea
| | - Bo Kyeung Jung
- Department of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Gurodongro, Gurogu, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hak Jun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
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Zhang L, Sun J, Yan J, Lv H, Chai C, Sun Y, Shao B, Jiang J, Chen Z, Kortekaas J, Zhang Y. Antibodies against severe fever with thrombocytopenia syndrome virus in healthy persons, China, 2013. Emerg Infect Dis 2016; 20:1355-7. [PMID: 25061813 PMCID: PMC4111193 DOI: 10.3201/eid2008.131796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In June 2013, a subclinical infection with severe fever with thrombocytopenia syndrome virus (SFTSV) was detected in Zhejiang Province, China, prompting seroprevalence studies in 6 districts within the province. Of 986 healthy persons tested, 71 had IgG antibodies against SFTSV. This finding suggests that most natural infections with SFTSV are mild or subclinical.
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173
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Kitao A, Ieki R, Takatsu H, Tachibana Y, Nagae M, Hino T, Nakaji H, Shimojima M, Saijo M, Okayama M, Kenzaka T. Severe fever with thrombocytopenia syndrome presenting as hemophagocytic syndrome: two case reports. SPRINGERPLUS 2016; 5:361. [PMID: 27064451 PMCID: PMC4803711 DOI: 10.1186/s40064-016-2010-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
Introduction Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first reported in China in 2011. However, it is now endemic in Japan, and the SFTS viruses in Japan and China have evolved independently. Its fatality rate is 26.5 % in Japan, and the viral load is related to morbidity. Case description We encountered two patients with SFTS. Case 1 is a 72-year-old woman who visited our hospital owing to severe fatigue, diarrhea, and nausea. Her consciousness level score on the Glasgow Coma Scale was 14 points, and her serum lactate dehydrogenase level was 646 IU/L. Case 2 is an 82-year-old woman who visited our hospital owing to diarrhea and general fatigue. Her consciousness level score on the Glasgow Coma Scale was 11 points, and her serum lactate dehydrogenase level was 935 IU/L. Discussion and evaluation Both patients had hemophagocytic syndrome and presented with similar symptoms. Although both were treated with similar drug regimens, their clinical courses were different: after treatment, the 72-year-old woman survived whereas the 82-year-old woman died. In addition to age, the two patients differed in terms of time between symptom onset and treatment initiation, consciousness level, viral load, and extent of elevation of liver enzyme levels. Conclusions The viral load, which is a predictor of morbidity, was associated with the level of consciousness and the serum lactate dehydrogenase level, both of which might be useful for predicting death in patients with SFTS.
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Affiliation(s)
- Akihito Kitao
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan ; Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryuji Ieki
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan ; Department of Respiratory Disease, Public Toyooka Hospital, Toyooka, Japan
| | - Hiroki Takatsu
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Yuki Tachibana
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Masaaki Nagae
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Takuya Hino
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Hitoshi Nakaji
- Department of General Medicine, Public Toyooka Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan ; Department of Respiratory Disease, Public Toyooka Hospital, Toyooka, Japan
| | - Masayuki Shimojima
- Department of Virology 1, National Institute of Infectious Disease, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology 1, National Institute of Infectious Disease, Tokyo, Japan
| | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo Japan
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Yang ZD, Hu JG, Lu QB, Guo CT, Cui N, Peng W, Wang LY, Qin SL, Wang HY, Zhang PH, Zhang XA, Liu W, Cao WC. The prospective evaluation of viral loads in patients with severe fever with thrombocytopenia syndrome. J Clin Virol 2016; 78:123-8. [PMID: 27062673 DOI: 10.1016/j.jcv.2016.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS), caused by novel bunyavirus (SFTSV) is a potentially fatal disease that was first identified in China. Person to person transmission through contact with blood or body fluids was considered as an important infection route. OBJECTIVES The study is designed to investigate the longitudinal viral loads following SFTSV infection and to identify factors affecting viral shedding in SFTS patients. METHODS A prospective, observational study was performed on 208 laboratory-confirmed SFTSV infected patients in Xinyang, Henan Province. Sequential serum samples were collected on admission and during the hospitalization for quantification of SFTSV RNA by real-time RT-PCR. RESULTS The viral RNA was undetectable in 55.6% of the patients on admission into the hospital, becoming detectable in most cases until three days and attained maximum level on six days after disease onset. This was followed by an obvious decrease thereafter, but maintained detectable for over 20 days. Viral load was independently predictable of severe disease outcome throughout the hospitalization. Viral load of >10(7)copies/mL was predictable of fatal outcome. The serum levels of PLT, WBC, LDH, AST and CK were significantly associated with viral loads level. CONCLUSIONS The diagnosis of SFTSV infection based on PCR test should be performed at least three days after disease onset. Peaking viral loads were attained around six days after disease, posing a highest risk of human-to-human transmission.
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Affiliation(s)
- Zhen-Dong Yang
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Jian-Gong Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Qing-Bin Lu
- School of Public Health, Peking University, Beijing 100191, PR China.
| | - Chen-Tao Guo
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Ning Cui
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Wei Peng
- The Shangcheng County People's Hospital, Shangcheng, PR China
| | - Li-Yuan Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Shu-Li Qin
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Hong-Yu Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
| | - Wu-Chun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
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Phylogeographic analysis of severe fever with thrombocytopenia syndrome virus from Zhoushan Islands, China: implication for transmission across the ocean. Sci Rep 2016; 6:19563. [PMID: 26806841 PMCID: PMC4726339 DOI: 10.1038/srep19563] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/10/2015] [Indexed: 11/08/2022] Open
Abstract
From June 2011 to August 2014, 21 cases of infection by severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) were confirmed in Zhoushan Islands in the Eastern coast of China. To identify the source of SFTSV in Zhoushan Islands, the whole SFTSV genomes were amplified and sequenced from 17 of 21 patients. The L, M, and S genomic segments of these SFTSV strains were phylogenetically analyzed together with those of 188 SFTSV strains available from GenBank. Phylogenetic analysis demonstrated SFTSV could be classified into six genotypes. The genotypes F, A, and D were dominant in mainland China. Additionally, seven types of SFTSV genetic reassortants (abbreviated as AFA, CCD, DDF, DFD, DFF, FAF, and FFA for the L, M and S segments) were identified from 10 strains in mainland China. Genotype B was dominant in Zhoushan Islands, Japan and South Korea, but not found in mainland China. Phylogeographic analysis also revealed South Korea possible be the origin area for genotype B and transmitted into Japan and Zhoushan islands in the later part of 20(th) century. Therefore, we propose that genotype B isolates were probable transmitted from South Korea to Japan and Zhoushan Islands.
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Yun SM, Song BG, Choi W, Roh JY, Lee YJ, Park WI, Han MG, Ju YR, Lee WJ. First Isolation of Severe Fever with Thrombocytopenia Syndrome Virus from Haemaphysalis longicornis Ticks Collected in Severe Fever with Thrombocytopenia Syndrome Outbreak Areas in the Republic of Korea. Vector Borne Zoonotic Dis 2016; 16:66-70. [PMID: 26745758 PMCID: PMC4742983 DOI: 10.1089/vbz.2015.1832] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease that is endemic to China, Japan, and the Republic of Korea (ROK). In this study, 8313 ticks collected from SFTS outbreak areas in the ROK in 2013 were used to detect the SFTS virus (SFTSV). A single SFTSV was isolated in cell culture from one pool of Haemaphysalis longicornis ticks collected from Samcheok-si, Gangwon Province, in the ROK. Phylogenetic analysis showed that the SFTSV isolate was clustered with the SFTSV strain from Japan, which was isolated from humans. To the best of our knowledge, this is the first isolation in the world of SFTSV in ticks collected from vegetation.
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Affiliation(s)
- Seok-Min Yun
- 1 Division of Arboviruses, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Bong Gu Song
- 2 Division of Medical Entomology, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - WooYoung Choi
- 1 Division of Arboviruses, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Jong Yul Roh
- 2 Division of Medical Entomology, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Ye-Ji Lee
- 1 Division of Arboviruses, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Won Il Park
- 2 Division of Medical Entomology, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Myung Guk Han
- 1 Division of Arboviruses, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Young Ran Ju
- 2 Division of Medical Entomology, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
| | - Won-Ja Lee
- 1 Division of Arboviruses, National Institute of Health , Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
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Needle-Stick Injury Caused by a Patient With Severe Fever With Thrombocytopenia Syndrome in Korea. Infect Control Hosp Epidemiol 2016; 37:368-9. [DOI: 10.1017/ice.2015.322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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178
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Cheng J, Li H, Jie S. Association of the Serum Angiotensin II Level with Disease Severity in Severe Fever with Thrombocytopenia Syndrome Patients. Intern Med 2016; 55:895-900. [PMID: 27086801 DOI: 10.2169/internalmedicine.55.5296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel Bunyavirus. Recent data suggest that the physiological balance of multiple proinflammatory cytokines is substantially changed in cases of severe fever with thrombocytopenia syndrome virus (SFTSV) infection, and the inflammatory response probably plays an important role in disease progression. Angiotensin II is an important active substance of the renin-angiotensin system, and studies have demonstrated that angiotensin II is involved in key events in the inflammatory process and can regulate inflammatory cell responses. METHODS In order to elucidate the role of angiotensin II in the pathogenesis of SFTS, we collected serum samples from SFTS patients in the acute or convalescent phase and tested the angiotensin II levels using an enzyme-linked immunosorbent assay as well as SFTSV viral RNA with real-time reverse-transcriptase polymerase chain reaction. Furthermore, we explored possible correlations between the angiotensin II levels and clinical parameters in SFTS patients. RESULTS Our data showed that the serum level of angiotensin II was significantly increased in the acute phase compared with that seen in the convalescent phase and the healthy controls, while there were no significant differences between the convalescent cases and healthy controls (p>0.05). A correlation analysis demonstrated that the level of angiotensin II positively correlated with the SFTS viral RNA load. The angiotensin II levels were also found to be correlated with clinical parameters indicating impairments in organ functions. Moreover, we also found that the angiotensin II levels were significantly increased in the severe cases versus the non-severe cases (p<0.001). CONCLUSION The serum angiotensin II levels in SFTS patients may be used to stratify the disease severity and are possibly predictive of disease outcomes.
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Affiliation(s)
- Jiamei Cheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
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Uehara N, Yano T, Ishihara A, Saijou M, Suzuki T. Fatal Severe Fever with Thrombocytopenia Syndrome: An Autopsy Case Report. Intern Med 2016; 55:831-8. [PMID: 27041174 DOI: 10.2169/internalmedicine.55.5262] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
UNLABELLED As of June 2014, among six patients who had severe fever with thrombocytopenia syndrome (SFTS) at our hospital, an 83-year-old man died despite receiving appropriate critical care. An autopsy revealed extensive ischemic damage of the intra-abdominal organs, including the liver, spleen, stomach and gut, due to severe celiac atherosclerotic stenosis and superior mesenteric arterial thrombosis. Many SFTS virus nucleoprotein antigen-immunoreactive cells were detected in a paraaortic node, where necrotizing lymphadenitis was seen, and in the spleen. Fewer such cells were seen in the liver, bone marrow and adrenals. CONCLUSION Atherosclerosis, in addition to hemophagocytic lymphohistiocytosis syndrome, can be lethal in elderly SFTS patients.
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Affiliation(s)
- Natsumi Uehara
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Japan
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180
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Jiao Y, Qi X, Liu D, Zeng X, Han Y, Guo X, Shi Z, Wang H, Zhou M. Experimental and Natural Infections of Goats with Severe Fever with Thrombocytopenia Syndrome Virus: Evidence for Ticks as Viral Vector. PLoS Negl Trop Dis 2015; 9:e0004092. [PMID: 26485390 PMCID: PMC4618997 DOI: 10.1371/journal.pntd.0004092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 08/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome virus (SFTSV), the causative agent for the fatal life-threatening infectious disease, severe fever with thrombocytopenia syndrome (SFTS), was first identified in the central and eastern regions of China. Although the viral RNA was detected in free-living and parasitic ticks, the vector for SFTSV remains unsettled. Methodology/Principal Findings Firstly, an experimental infection study in goats was conducted in a bio-safety level-2 (BSL-2) facility to investigate virus transmission between animals. The results showed that infected animals did not shed virus to the outside through respiratory or digestive tract route, and the control animals did not get infected. Then, a natural infection study was carried out in the SFTSV endemic region. A cohort of naïve goats was used as sentinel animals in the study site. A variety of daily samples including goat sera, ticks and mosquitoes were collected for viral RNA and antibody (from serum only) detection, and virus isolation. We detected viral RNA from free-living and parasitic ticks rather than mosquitoes, and from goats after ticks’ infestation. We also observed sero-conversion in all members of the animal cohort subsequently. The S segment sequences of the two recovered viral isolates from one infected goat and its parasitic ticks showed a 100% homology at the nucleic acid level. Conclusions/Significance In our natural infection study, close contact between goats does not appear to transmit SFTSV, however, the naïve animals were infected after ticks’ infestation and two viral isolates derived from an infected goat and its parasitic ticks shared 100% of sequence identity. These data demonstrate that the etiologic agent for goat cohort’s natural infection comes from environmental factors. Of these, ticks, especially the predominant species Haemaphysalis longicornis, probably act as vector for this pathogen. The findings in this study may help local health authorities formulate and focus preventive measures to contain this infection. Severe fever with thrombocytopenia syndrome virus (SFTSV), a newly identified bunyavirus, has been found to circulate in mainland China, South Korea, and Japan since 2009. This virus is the etiologic agent for an emerging fatal hemorrhagic fever, severe fever with thrombocytopenia syndrome (SFTS) with high fatality. Although ticks have been implicated as the primary host vector indicated by epidemiological surveys, their role in transmitting this virus to the susceptible hosts, including humans, has not been validated. In this study, we conducted experimental and natural infections of goats with SFTSV to explore the role of ticks for this pathogen’s transmission. In the experimental infection study, we have not found any viral transmission within the cohort by close contact between animals. However, in the natural infection study, every member of a naïve goat cohort was observed to get infected sequentially when they were farmed in a SFTSV-endemic site. We detected viral RNA from free-living and parasitic ticks rather than mosquitoes, and from goats after ticks’ infestation. We also observed sero-conversion in all members of the animal cohort subsequently. More importantly, in the natural infection study, two virus strains isolated from one infected goat and its parasitic ticks showed identical S segment sequences of the viral genome. All these findings indicate that ticks, especially the dominant species Haemaphysalis longicornis, probably act as viral vector for this emerging pathogen, SFTSV.
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Affiliation(s)
- Yongjun Jiao
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Xian Qi
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Dapeng Liu
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Xiaoyan Zeng
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Yewu Han
- Xuyi County Center for Disease Prevention and Control, Huai-an, China
| | - Xiling Guo
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Zhiyang Shi
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Hua Wang
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Minghao Zhou
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
- * E-mail:
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181
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Fang LQ, Liu K, Li XL, Liang S, Yang Y, Yao HW, Sun RX, Sun Y, Chen WJ, Zuo SQ, Ma MJ, Li H, Jiang JF, Liu W, Yang XF, Gray GC, Krause PJ, Cao WC. Emerging tick-borne infections in mainland China: an increasing public health threat. THE LANCET. INFECTIOUS DISEASES 2015; 15:1467-1479. [PMID: 26453241 PMCID: PMC4870934 DOI: 10.1016/s1473-3099(15)00177-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/18/2015] [Accepted: 07/07/2015] [Indexed: 12/30/2022]
Abstract
Since the beginning of the 1980s, 33 emerging tick-borne agents have been identified in mainland China, including eight species of spotted fever group rickettsiae, seven species in the family Anaplasmataceae, six genospecies in the complex Borrelia burgdorferi sensu lato, 11 species of Babesia, and the virus causing severe fever with thrombocytopenia syndrome. In this Review we have mapped the geographical distributions of human cases of infection. 15 of the 33 emerging tick-borne agents have been reported to cause human disease, and their clinical characteristics have been described. The non-specific clinical manifestations caused by tick-borne pathogens present a major diagnostic challenge and most physicians are unfamiliar with the many tick-borne diseases that present with non-specific symptoms in the early stages of the illness. Advances in and application of modern molecular techniques should help with identification of emerging tick-borne pathogens and improve laboratory diagnosis of human infections. We expect that more novel tick-borne infections in ticks and animals will be identified and additional emerging tick-borne diseases in human beings will be discovered.
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Affiliation(s)
- Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Kun Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xin-Lou Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Song Liang
- College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Yang Yang
- College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Hong-Wu Yao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Ruo-Xi Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Ye Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Wan-Jun Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shu-Qing Zuo
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Mai-Juan Ma
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Jia-Fu Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - X Frank Yang
- Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA
| | | | - Peter J Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Wu-Chun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- Correspondence to: Prof Wu-Chun Cao, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Fengtai District, Beijing 100071, China
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182
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Gong Z, Gu S, Zhang Y, Sun J, Wu X, Ling F, Shi W, Zhang P, Li D, Mao H, Zhang L, Wen D, Zhou B, Zhang H, Huang Y, Zhang R, Jiang J, Lin J, Xia S, Chen E, Chen Z. Probable aerosol transmission of severe fever with thrombocytopenia syndrome virus in southeastern China. Clin Microbiol Infect 2015; 21:1115-20. [PMID: 26255811 DOI: 10.1016/j.cmi.2015.07.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/20/2022]
Abstract
Some clusters of severe fever with thrombocytopenia syndrome virus (SFTSV) infection were reported in China as of 2010. However, to date, there has been no epidemiologic evidence of aerosol transmission of SFTSV. Epidemiologic investigations were conducted after a cluster of 13 cases of SFTSV in May 2014. A total of 13 cases, including 11 confirmed cases and one clinically diagnosed case, were identified besides the case of the index patient. The index patient experienced onset of SFTSV on 23 April and died on 1 May. The patients with secondary cases had onset from 10 to 16 May, peaking on 13 May. Moreover, eight secondary cases occurred in family members of the index patient, and the other five cases occurred in neighbors of the index patient. According to epidemiologic investigations, patients 1, 3, 4, 5, 6, 7, 9 and 12 contracted the disease through contact with blood of the index patient. Notably, patients 8 and 10 did not have a history of contact with the blood of the index patient, but they stayed in the mourning hall for hours. SFTSV could be transmitted from person to person by direct contact and/or aerosol transmission, and it is important to consider aerosol transmission as a possible transmission route.
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Affiliation(s)
- Z Gong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - S Gu
- Anji Centre for Disease Control and Prevention, Anji, China
| | - Y Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - J Sun
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - X Wu
- Anji Centre for Disease Control and Prevention, Anji, China
| | - F Ling
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - W Shi
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - P Zhang
- Huzhou Municipal Centre for Disease Control and Prevention, Huzhou, China
| | - D Li
- National Institute for Viral Disease Control and Prevention, Beijing, China
| | - H Mao
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - L Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - D Wen
- Huzhou Municipal Centre for Disease Control and Prevention, Huzhou, China
| | - B Zhou
- Anji Centre for Disease Control and Prevention, Anji, China
| | - H Zhang
- Anji Centre for Disease Control and Prevention, Anji, China
| | - Y Huang
- Anji Centre for Disease Control and Prevention, Anji, China
| | - R Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - J Jiang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - J Lin
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - S Xia
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China.
| | - E Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China.
| | - Z Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China.
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183
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Yu F, Du Y, Huang X, Ma H, Xu B, Adungo F, Hayasaka D, Buerano CC, Morita K. Application of recombinant severe fever with thrombocytopenia syndrome virus nucleocapsid protein for the detection of SFTSV-specific human IgG and IgM antibodies by indirect ELISA. Virol J 2015; 12:117. [PMID: 26239826 PMCID: PMC4524020 DOI: 10.1186/s12985-015-0350-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/27/2015] [Indexed: 11/15/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease that was first reported in China in 2011. It is caused by SFTS virus (SFTSV) which is a member of the Phlebovirus genus in the Bunyaviridae family. SFTSV has been classified as a BSL3 pathogen. There is a need to develop safe and affordable serodiagnostic methods for proper clinical management of infected patients. Methods The full length nucleocapsid (N) gene of SFTSV Yamaguchi strain was amplified by RT-PCR and cloned to an expression vector pQE30. The recombinant (r) SFTSV-N protein was expressed by using Escherichia coli (E. coli) expression system and purified under native conditions. rSFTSV-N protein based indirect IgG and IgM enzyme linked immunosorbent assay (ELISA) systems were established to detect specific human IgG and IgM antibodies, respectively. One hundred fifteen serum samples from clinically suspected-SFTS patients were used to evaluate the newly established systems and the results were compared with the total antibody detecting sandwich ELISA system. Results The native form of recombinant (r) SFTSV-N protein was expressed and purified. Application of the rSFTSV-N protein based indirect IgG ELISA to the 115 serum samples showed results that perfectly matched those of the total antibody sandwich ELISA with a sensitivity and specificity of 100 %. The rSFTSV-N protein based indirect IgM ELISA missed 8 positive samples that were detected by the total antibody sandwich ELISA. The sensitivity and specificity of rSFTSV-N-IgM capture ELISA were 90.59 and 100 %, respectively. Conclusions The rSFTSV-N protein is highly immunoreactive and a good target for use as an assay antigen in laboratory diagnosis. Its preparation is simpler in comparison with that used for the total antibody sandwich system. Our rSFTSV-N protein-based IgG and IgM ELISA systems have the advantage of distinguishing two types of antibodies and require small volume of serum sample only. They are safe to use for diagnosis of SFTS virus infection and especially fit in large-scale epidemiological investigations.
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Affiliation(s)
- Fuxun Yu
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12- 4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Yanhua Du
- Henan Center for Disease Control and Prevention, Zhengzhou, China.
| | - Xueyong Huang
- Henan Center for Disease Control and Prevention, Zhengzhou, China.
| | - Hong Ma
- Henan Center for Disease Control and Prevention, Zhengzhou, China.
| | - Bianli Xu
- Henan Center for Disease Control and Prevention, Zhengzhou, China.
| | - Ferdinard Adungo
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12- 4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Daisuke Hayasaka
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12- 4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Corazon C Buerano
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12- 4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12- 4, Sakamoto, Nagasaki, 852-8523, Japan.
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184
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Genetic Susceptibility Is One of the Determinants for Severe Fever with Thrombocytopenia Syndrome Virus Infection and Fatal Outcome: An Epidemiological Investigation. PLoS One 2015. [PMID: 26207638 PMCID: PMC4514768 DOI: 10.1371/journal.pone.0132968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in China and case-fatality rate of SFTS is very high (approximately 10%). However, genetic susceptibility for SFTS virus (SFTSV) infection and fatal outcome of SFTSV infection in humans are unclear. In this study, we investigated the clinical, laboratory and epidemiological features of SFTS in a cluster of three sisters who died of SFTSV infection between late April and mid-May 2014. Before disease onset, two of the sisters (Case A and case B) had common exposure history for ticks by working together in a field to pick tea leaves from April 8 to April 12. The third sister (Case C) did not live or work together with case A and B, but had ticks in her living environment. SFTSV RNA sequences were amplified from three cases were not identical, suggesting that the three sisters were most likely infected with SFTSV through tick bite rather than through person-to-person transmission of SFTSV. The sequence of SFTSV from case C was identical to SFTSV sequences from 3 groups of ticks collected around the residential area of case C. Seroprevalence of SFTSV IgG antibody among healthy population in the area where the patients resided was 4.05% (3/74). The majority of SFTSV infections were mild cases and all three sisters died of SFTSV infection suggested that they were highly susceptible to SFTSV. Our findings indicated that genetic susceptibility was a risk factor for SFTSV infection and fatal outcome.
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185
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Shimojima M, Fukushi S, Tani H, Yoshikawa T, Fukuma A, Taniguchi S, Suda Y, Maeda K, Takahashi T, Morikawa S, Saijo M. Effects of ribavirin on severe fever with thrombocytopenia syndrome virus in vitro. Jpn J Infect Dis 2015; 67:423-7. [PMID: 25410555 DOI: 10.7883/yoken.67.423] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a disease with a high case fatality rate that is caused by infection with the recently identified tick-borne SFTS virus (SFTSV), for which there are no specific countermeasures. We examined the effects of ribavirin and mizoribine, which are nucleoside analogue drugs with broad antiviral activities, on SFTSV proliferation in vitro. When 3 cell lines were treated with these drugs before and during infection with a Chinese SFTSV strain, the 99% effective concentrations (EC99) of ribavirin were 19-64 μg/ml (78-262 μM); in contrast, the EC99 of mizoribine was >500 μg/ml (1,929 μM). Similar levels of inhibitory effects of ribavirin were observed with 4 Japanese SFTSV strains. However, when Vero cells were treated with ribavirin 3 days after inoculation, the inhibitory effect was dramatically decreased, indicating that ribavirin did not effectively reduce virus production in pre-infected cells. These results suggest that ribavirin could be used as post-exposure prophylaxis for the prevention of SFTS.
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Affiliation(s)
- Masayuki Shimojima
- Special Pathogens Laboratory, Department of Virology I, National Institute of Infectious Diseases
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186
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Park JG. Severe fever with thrombocytopenia syndrome presenting as acute hepatic failure. Clin Exp Emerg Med 2015; 2:137-140. [PMID: 27752587 PMCID: PMC5052864 DOI: 10.15441/ceem.15.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 11/23/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is characterized by fever, thrombocytopenia, leukopenia, and altered consciousness, which may also involve multi-organ failure. Initially SFTS mortality was as high as 30%, when diagnosis remained unclear. We present a case of a 53-year- old man with SFTS presenting with acute hepatic failure. On admission, he presented with confusion, elevated serum liver enzyme and ammonia levels, whose serum markers were negative for acute viral hepatitis. He was diagnosed with SFTS based on reverse transcription-polymerase chain reaction identification of the SFTS virus M segment. Percutaneous liver biopsy was performed to identify the degree and extent of necroinflammation and patient prognosis. After recovery, he was followed-up for 12 months with no SFTS-related sequelae. A discordance in severity between biopsy findings and clinical course could explain the rapid clinical improvement. Atypical presentations with multi-organ failure can delay timely diagnosis and management of infected patients.
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187
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Wu Y, Gao GF. Severe fever with thrombocytopenia syndrome virus expands its borders. Emerg Microbes Infect 2015; 2:e36. [PMID: 26038472 PMCID: PMC3697302 DOI: 10.1038/emi.2013.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ying Wu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences , Beijing 100101, China
| | - George F Gao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences , Beijing 100101, China ; Chinese Center for Disease Control and Prevention , Beijing 102206, China
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188
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Shinohara N, Matsumoto C, Chatani M, Uchida S, Yoshikawa T, Shimojima M, Satake M, Tadokoro K. Efficacy of the Mirasol pathogen reduction technology system against severe fever with thrombocytopenia syndrome virus (SFTSV). Vox Sang 2015; 109:417-9. [PMID: 26031768 DOI: 10.1111/vox.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/30/2015] [Accepted: 04/30/2015] [Indexed: 11/27/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is a tickborne virus in the Bunyaviridae family. This virus has recently been found in China, Japan and Korea. The risk of transfusion-transmitted SFTSV infection (TTI-SFTSV) is a concern because person-to-person transmission resulting from contact with SFTSV-contaminated blood has been reported. Therefore, we investigated the efficacy of the Mirasol pathogen reduction technology (PRT) system for inactivating SFTSV in vitro. The Mirasol PRT system achieved a > 4.11 log10 reduction value (LRV) for SFTSV. In conclusion, we showed that the Mirasol PRT system could potentially be used to reduce the risk of TTI-SFTSV.
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Affiliation(s)
- N Shinohara
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - C Matsumoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - M Chatani
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - S Uchida
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - T Yoshikawa
- Special Pathogens Laboratory, Department of Virology I, National Institute of Infectious Diseases, Musashimurayama-shi, Tokyo, Japan
| | - M Shimojima
- Special Pathogens Laboratory, Department of Virology I, National Institute of Infectious Diseases, Musashimurayama-shi, Tokyo, Japan
| | - M Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - K Tadokoro
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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189
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Avšič-Županc T. New vector-transmitted pathogens. Clin Microbiol Infect 2015; 21:611-3. [PMID: 25936580 DOI: 10.1016/j.cmi.2015.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- T Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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190
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Liu K, Zhou H, Sun RX, Yao HW, Li Y, Wang LP, Di Mu, Li XL, Yang Y, Gray GC, Cui N, Yin WW, Fang LQ, Yu HJ, Cao WC. A national assessment of the epidemiology of severe fever with thrombocytopenia syndrome, China. Sci Rep 2015; 5:9679. [PMID: 25902910 PMCID: PMC4407178 DOI: 10.1038/srep09679] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/12/2015] [Indexed: 01/18/2023] Open
Abstract
First discovered in rural areas of middle-eastern China in 2009, severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis affecting hundreds of cases reported in China each year. Using the national surveillance data from 2010 to 2013, we conducted this retrospective epidemiological study and risk assessment of SFTS in China. We found that the incidence of SFTS and its epidemic areas are continuing to grow, but the case fatality rate (CFR) has steadily decreased. SFTS most commonly affected elderly farmers who acquired infection between May and July in middle-eastern China. However, other epidemiological characteristics such as incidence, sex ratio, CFR, and seasonality differ substantially across the affected provinces, which seem to be consistent with local agricultural activities and the seasonal abundance of ticks. Spatial scan statistics detected three hot spots of SFTS that accounted for 69.1% of SFTS cases in China. There was a strong association of SFTS incidence with temporal changes in the climate within the clusters. Multivariate modeling identified climate conditions, elevation, forest coverage, cattle density, and the presence of Haemaphysalis longicornis ticks as independent risk factors in the distribution of SFTS, based on which a predicted risk map of the disease was derived.
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Affiliation(s)
- Kun Liu
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China
| | - Hang Zhou
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Ruo-Xi Sun
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.,Anhui Medical University, Hefei, 230032, P. R. China
| | - Hong-Wu Yao
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Li-Ping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Di Mu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Xin-Lou Li
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China
| | - Yang Yang
- Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, 32311, Florida, USA
| | - Gregory C Gray
- Duke University School of Medicine, Durham, 27710, North Carolina, USA
| | - Ning Cui
- The 154 Hospital, People's Liberation Army, Xinyang, 464000, P.R. China
| | - Wen-Wu Yin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Li-Qun Fang
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China
| | - Hong-Jie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China
| | - Wu-Chun Cao
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China
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191
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Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is characterized by sudden onset of fever, leukopenia, thrombocytopenia, and gastrointestinal tract symptoms and approximately 12% of patients die from disseminated intravascular coagulation and/or multiple organ failures. Agent of the disease is a novel bunyavirus SFTS virus, and is transmitted by bite of a possible vector tick, Haemaphysalis longicornis, and through direct contact with virus-containing patient body fluids, or through unknown routes. SFTS case reports have been limited in China, and more than two thousand cases were reported in 2011 and 2012. In late 2012, a woman living in Yamaguchi prefecture in Japan showed symptoms reminiscent of those of SFTS and died 6 days after the onset of symptoms. Virus was isolated from her acute serum in Vero cells and a next generation-sequencing identified it as SFTS virus. SFTS viral genome and proteins were detected in the patient's serum. Based on the first demonstration of SFTS in Japan, a retrospective study started. Until March of 2013, totally 8 patients were diagnosed as having SFTS and the most early case was in 2005. Phylogenetic analysis of virus sequences revealed that Japanese isolates form an independent branch distinct from Chinese isolates, indicating that SFTS has been present not only in China but also in Japan.
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192
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Severe fever with thrombocytopenia syndrome: a newly discovered emerging infectious disease. Clin Microbiol Infect 2015; 21:614-20. [PMID: 25769426 DOI: 10.1016/j.cmi.2015.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a newly discovered emerging infectious disease that has recently become epidemic in Asia. The causative agent of SFTS is a novel phlebovirus in the family Bunyaviridae, designated SFTS virus (SFTSV). SFTS clinically presents with high fever, thrombocytopenia, leukocytopenia, gastrointestinal disorders, and multi-organ dysfunction, with a high viral load and a high case-fatality rate. In human infection, SFTSV targets microphages, replicates in the spleen of infected mice, and causes thrombocytopenia and a cytokine storm. The tick disseminates virus to humans and animals, forming a special transmission model in nature. Person-to-person transmission though direct contact with patient blood has been frequently reported. Measurements of viral RNA and antibodies have been established for diagnosis, but vaccines and specific therapeutics are not available so far.
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193
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SUN JM, ZHANG Y, GONG ZY, ZHANG L, LV HK, LIN JF, CHAI CL, LING F, LIU SL, GU SP, ZHU ZH, ZHENG XH, LAN YQ, DING F, HUANG WZ, XU JR, CHEN EF, JIANG JM. Seroprevalence of severe fever with thrombocytopenia syndrome virus in southeastern China and analysis of risk factors. Epidemiol Infect 2015; 143:851-6. [PMID: 24866248 PMCID: PMC4411641 DOI: 10.1017/s0950268814001319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/27/2014] [Accepted: 05/04/2014] [Indexed: 12/02/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) has been prevalent for some time in China and it was first identified in 2010. However, the seroprevalence of SFTSV in the general population in southeastern China and risk factors associated with the infection are currently unclear. Blood samples were collected from seven counties across Zhejiang province and tested for the presence of SFTSV-specific IgG antibodies by ELISA. A total of 1380 blood samples were collected of which 5·51% were seropositive for SFTSV with seroprevalence varying significantly between sites. Seroprevalence of SFTSV in people who were family members of the patient, lived in the same village as the patient, or lived in a different village than the patient varied significantly. There was significant difference in seroprevalence between participants who bred domestic animals and participants who did not. Domestic animals are probably potential reservoir hosts and contact with domestic animals may be a transmission route of SFTSV.
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Affiliation(s)
- J. M. SUN
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Y.J. ZHANG
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Z. Y. GONG
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - L. ZHANG
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - H. K. LV
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - J. F. LIN
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - C. L. CHAI
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - F. LING
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - S. L. LIU
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - S. P. GU
- Anji Centre for Disease Control and Prevention, Anji, China
| | - Z. H. ZHU
- Yiwu Centre for Disease Control and Prevention, Yiwu, China
| | - X. H. ZHENG
- Xianju Centre for Disease Control and Prevention, Xianju, China
| | - Y. Q. LAN
- Lishui Centre for Disease Control and Prevention, Lishui, China
| | - F. DING
- Haining Centre for Disease Control and Prevention, Haining, China
| | - W. Z. HUANG
- Pujiang Centre for Disease Control and Prevention, Pujiang, China
| | - J. R. XU
- Xiangshan Centre for Disease Control and Prevention, Xiangshan, China
| | - E. F. CHEN
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - J. M. JIANG
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
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194
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Yi X, Li W, Li H, Jie S. Circulating regulatory T cells in patients with severe fever with thrombocytopenia syndrome. Infect Dis (Lond) 2015; 47:294-301. [PMID: 25712790 DOI: 10.3109/00365548.2014.987812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease caused by SFTS virus (SFTSV). Immunologic factors have been proved to be related to the occurrence and development of SFTS; however, their role still remains to be further elucidated. METHODS Samples from 30 patients with laboratory-confirmed SFTS and 15 healthy controls were subjected to flow cytometry to detect the proportion of CD4+/total lymphocytes, CD4 + CD25+/CD4 + cells and CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in circulating blood and to evaluate their potential function in the development of SFTS. RESULTS The data showed that a reduced proportion of CD4+/total lymphocytes and CD4 + CD25+/CD4 + cells was observed in patients with SFTS compared with healthy controls. In contrast, the percentage of CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in the patients in the SFTS group was significantly elevated. Furthermore, we investigated the dynamic changes of the circulating regulatory T cells (Tregs) in patients with SFTS at different stages. The results showed that the proportion of CD4+/total lymphocytes and CD4 + CD25+/CD4 + cells in the non-severe group was prominently higher than that in patients with severe SFTS. Conversely, the proportion of CD4 + CD25+ Foxp3+/CD4 + CD25+ cells was lower in the non-severe group than in the severe group. Additionally, the circulating Tregs reverted to normal ranges during the convalescent phase of SFTSV infection. Moreover, the Tregs level correlated with various clinical parameters. CONCLUSION We demonstrated that SFTSV infection resulted in a robust circulating Treg response in patients with SFTS. Our investigation suggested that the proportions of CD4+/total lymphocytes and CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in circulating blood could serve as sensitive indices to evaluate the changes in Tregs in SFTS and predict the progression of SFTS.
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195
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Kim WY, Choi W, Park SW, Wang EB, Lee WJ, Jee Y, Lim KS, Lee HJ, Kim SM, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Nosocomial transmission of severe fever with thrombocytopenia syndrome in Korea. Clin Infect Dis 2015; 60:1681-3. [PMID: 25694652 DOI: 10.1093/cid/civ128] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/03/2015] [Indexed: 11/13/2022] Open
Abstract
Of the 27 healthcare workers (HCWs) who had contact with a fatally ill patient with severe thrombocytopenia syndrome in Korea (SFTS), 4 who were involved in cardiopulmonary resuscitation complained of fever and were diagnosed with SFTS via seroconversion. Exposure to respiratory secretions, blood, or gowns soiled by body fluids was significantly associated with infection of HCWs.
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Affiliation(s)
- Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - WooYoung Choi
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do
| | - Sun-Whan Park
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do
| | - Eun Byeol Wang
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do
| | - Won-Ja Lee
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do
| | - Youngmee Jee
- Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do
| | - Kyoung Soo Lim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyun-Jung Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun-Mi Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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196
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Ye L, Shang X, Wang Z, Hu F, Wang X, Xiao Y, Zhao X, Liu S, He F, Li F, Wang C, Jiang J, Lin J. A case of severe fever with thrombocytopenia syndrome caused by a novel bunyavirus in Zhejiang, China. Int J Infect Dis 2015; 33:199-201. [PMID: 25677726 DOI: 10.1016/j.ijid.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/29/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022] Open
Abstract
Two typical symptoms of severe fever with thrombocytopenia syndrome (SFTS) are fever and thrombocytopenia. Here we report a laboratory confirmed SFTS case with no fever during the entire hospitalization period, in Daishan County, Zhejiang Province, China. A 77-year-old woman was admitted to hospital with symptoms including nausea, retching, and anorexia. Laboratory tests revealed thrombocytopenia, leukopenia, and liver and brain damage. The case was later confirmed as a novel bunyavirus infection. Epidemiological investigations revealed that she had no history of tick bites or skin damage, and no known exposure to persons with a similar illness in the area prior to illness onset. The patient was hospitalized for 15 days, and during the whole admission period, she did not experience any fever. The patient recovered and was discharged.
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Affiliation(s)
- Ling Ye
- Daishan County Center for Disease Control and Prevention, Daishan, China
| | - Xiaopeng Shang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhongfa Wang
- Daishan County Center for Disease Control and Prevention, Daishan, China
| | - Fengjiao Hu
- Ningbo Municipal Center for Disease and Prevention, Ningbo, China
| | - Xinyi Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yuanyuan Xiao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xuefei Zhao
- Ningbo Municipal Center for Disease and Prevention, Ningbo, China
| | - Shelan Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Fan He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Fudong Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Chengwei Wang
- Daishan County Center for Disease Control and Prevention, Daishan, China
| | - Jianmin Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
| | - Junfen Lin
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
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197
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Lei XY, Liu MM, Yu XJ. Severe fever with thrombocytopenia syndrome and its pathogen SFTSV. Microbes Infect 2015; 17:149-54. [DOI: 10.1016/j.micinf.2014.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 12/20/2022]
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198
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Age is a critical risk factor for severe fever with thrombocytopenia syndrome. PLoS One 2014; 9:e111736. [PMID: 25369237 PMCID: PMC4219771 DOI: 10.1371/journal.pone.0111736] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease in East Asia. SFTS is a tick borne hemorrhagic fever caused by SFTSV, a new bunyavirus named after the syndrome. We investigated the epidemiology of SFTS in Laizhou County, Shandong Province, China. Methods We collected serum specimens of all patients who were clinically diagnosed as suspected SFTS cases in 2010 and 2011 in Laizhou County. The patients' serum specimens were tested for SFTSV by real time fluorescence quantitative PCR (RT-qPCR). We collected 1,060 serum specimens from healthy human volunteers by random sampling in Laizhou County in 2011. Healthy persons' serum specimens were tested for specific SFTSV IgG antibody by ELISA. Results 71 SFTS cases were diagnosed in Laizhou County in 2010 and 2011, which resulted in the incidence rate of 4.1/100,000 annually. The patients ranged from 15 years old to 87 years old and the median age of the patients were 59 years old. The incidence rate of SFTS was significantly higher in patients over 40 years old and fatal cases only occurred in patients over 50 years old. 3.3% (35/1,060) of healthy people were positive to SFTSV IgG antibody. The SFTSV antibody positive rate was not significantly different among people at different age groups. Conclusion Our results revealed that seroprevalence of SFTSV in healthy people in Laizhou County was not significantly different among age groups, but SFTS patients were mainly elderly people, suggesting that age is the critical risk factor or determinant for SFTS morbidity and mortality.
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199
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A cluster of person-to-person transmission cases caused by SFTS virus in Penglai, China. Clin Microbiol Infect 2014; 21:274-9. [PMID: 25687766 DOI: 10.1016/j.cmi.2014.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/25/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022]
Abstract
An emerging infectious disease, severe fever with thrombocytopenia syndrome (SFTS), was identified to be associated with a novel SFTS virus (SFTSV). Transmission of the disease among humans has been described, but clinical impact factors and transmission mechanisms still need further study. An outbreak of person-to-person transmission of SFTS in a cluster of nine patients that occurred in an SFTS endemic area, Penglai County, Shandong province, China, was investigated. We found that the onset date of all eight secondary SFTS patients ranged from 7 to 13 days after exposure to the corpse of the index patient, and clinical incubation time was mostly focused on 9-10 days (n = 6). The two dead patients, including the index patient and one secondary infected patient, presented unusually high levels of viral load (6 × 10(8-9) copies/mL), low levels of platelets count (<55 × 10(9)/L), and significant increase of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase values in the second week, and died on day 10 or 11 after disease onset. Genetic sequencing revealed 100% homology among virus strains isolated from the index patient and five secondary patients. Risk factors assessment of the person-to-person transmission revealed that the major exposure factor was blood contact without personal protection equipment. Information from this study provided solid references of SFTS incubation time, clinical and laboratory parameters related to SFTS severity and outcome, and biosafety issues for preventing person-to-person transmission or nosocomial infection of SFTSV.
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200
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Discrimination of novel bunyavirus infection using routine laboratory test. Clin Microbiol Infect 2014; 21:204.e1-7. [PMID: 25658566 DOI: 10.1016/j.cmi.2014.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/25/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
The wide epidemic and high case fatality rate have made severe fever with thrombocytopenia syndrome (SFTS) a significant public health problem. The diagnosis and discrimination of SFTS virus (SFTSV) infection at an early stage of the disease is important for treatment choice. A prospective study was performed in an SFTS reference hospital during 2011-2013. Suspected SFTS patients were recruited and prospectively observed. Comparison between SFTSV-positive and -negative patients was made to identify the parameters that were related to positive detection by discriminant and classification tree analysis. A total of 538 SFTSV-positive and 396 negative patients were recruited and observed. Multiple logistic regression models demonstrated the significant parameters associated with positive detection, including decreased platelet counts and elevated aspartate aminotransferase (AST) level during the first stage (1∼4 days), decreased white blood cell and platelet counts, elevated creatine kinase (CK) and AST levels during the second stage (5∼7 days), and older age, decreased consciousness and elevated CK and AST during the third stage (8-11 days). The classification trees disclosed that the significant predictors for positive SFTSV detection were AST >50.6 U/L and AST/alanine transaminase (ALT) >1.3 at the first stage, CK >257 U/L or 57.7 U/L < CK ≤98.5 U/L with AST/ALT >1.6 at the second stage, as well as CK >630.7 U/L or 114.3 U/L < CK ≤630.7 U/L with decreased consciousness at the third stage. In making the clinically probable diagnosis of SFTS, the supplementation of AST and CK evaluations might remarkably improve the diagnostic capacity of routine laboratory tests, while the leukopenia is of limited use.
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