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Shan D, Chen W, Liu G, Zhang H, Chai S, Zhang Y. Severe fever with thrombocytopenia syndrome with central nervous system symptom onset: a case report and literature review. BMC Neurol 2024; 24:158. [PMID: 38730325 PMCID: PMC11084135 DOI: 10.1186/s12883-024-03664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a natural focal disease transmitted mainly by tick bites, and the causative agent is SFTS virus (SFTSV). SFTS can rapidly progress to severe disease, with multiple-organ failure (MOF) manifestations such as shock, respiratory failure, disseminated intravascular coagulation (DIC) and death, but cases of SFTS patients with central nervous system (CNS) symptoms onset and marked persistent involuntary shaking of the perioral area and limbs have rarely been reported. CASE PRESENTATION A 69-year-old woman with fever and persistent involuntary shaking of the perioral area and limbs was diagnosed with SFTS with CNS symptom onset after metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and peripheral blood identified SFTSV. The patient developed a cytokine storm and MOF during the course of the disease, and after aggressive antiviral, glucocorticoid, and gamma globulin treatments, her clinical symptoms improved, her laboratory indices returned to normal, and she had a good prognosis. CONCLUSION This case gives us great insight that when patients with CNS symptoms similar to those of viral encephalitis combined with thrombocytopenia and leukopenia are encountered in the clinic, it is necessary to consider the possibility of SFTS involving the CNS. Testing for SFTSV nucleic acid in CSF and blood (mNGS or polymerase chain reaction (PCR)) should be carried out, especially in critically ill patients, and treatment should be given accordingly.
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Affiliation(s)
- Dawei Shan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Gang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Huimin Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Shuting Chai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Zhang S, Wang J, Zhang Q, Pan Y, Zhang Z, Geng Y, Jia B, Li Y, Xiong Y, Yan X, Li J, Wang H, Wu C, Huang R. Association of liver function and prognosis in patients with severe fever with thrombocytopenia syndrome. PLoS Negl Trop Dis 2024; 18:e0012068. [PMID: 38626222 PMCID: PMC11051684 DOI: 10.1371/journal.pntd.0012068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/26/2024] [Accepted: 03/12/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVES Severe fever with thrombocytopenia syndrome (SFTS) is an epidemic emerging infectious disease with high mortality rate. We investigated the association between liver injury and clinical outcomes in patients with SFTS. METHODS A total of 291 hospitalized SFTS patients were retrospectively included. Cox proportional hazards model was adopted to identify risk factors of fatal outcome and Kaplan-Meier curves were used to estimate cumulative risks. RESULTS 60.1% of patients had liver injury at admission, and the median alanine transaminase, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBil) levels were 76.4 U/L, 152.3 U/L, 69.8 U/L and 9.9 μmol/L, respectively. Compared to survivors, non-survivors had higher levels of AST (253.0 U/L vs. 131.1 U/L, P < 0.001) and ALP (86.2 U/L vs. 67.9 U/L, P = 0.006), higher proportion of elevated ALP (20.0% vs. 4.4%, P < 0.001) and liver injury (78.5% vs. 54.9%, P = 0.001) at admission. The presence of liver injury (HR 2.049, P = 0.033) at admission was an independent risk factor of fatal outcome. CONCLUSIONS Liver injury was a common complication and was strongly associated with poor prognosis in SFTS patients. Liver function indicators should be closely monitored for SFTS patients.
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Affiliation(s)
- Shaoqiu Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
| | - Qun Zhang
- Department of Infectious Diseases, Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu, China
| | - Yifan Pan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhiyi Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yu Geng
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Bei Jia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yuanyuan Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yali Xiong
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huali Wang
- Department of General Practice, Nanjing Second Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Oh B, Park SC, Yang MS, Yang D, Ham G, Tark D, You MJ, Oh SI, Kim B. Difference in Intraspecies Transmissibility of Severe Fever with Thrombocytopenia Syndrome Virus Depending on Abrogating Type 1 Interferon Signaling in Mice. Viruses 2024; 16:401. [PMID: 38543766 PMCID: PMC10974630 DOI: 10.3390/v16030401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne zoonotic disease, is caused by infection with SFTS virus (SFTSV). A previous study reported that human-to-human direct transmission of SFTSV can occur. However, potential animal-to-animal transmission of SFTSV without ticks has not been fully clarified. Thus, the objective of this study was to investigate potential mice-to-mice transmission of SFTSV by co-housing three groups of mice [i.e., wild-type mice (WT), mice injected with an anti-type I interferon-α receptor-blocking antibody (IFNAR Ab), and mice with knockout of type I interferon-α receptor (IFNAR KO)] as spreaders or recipients with different immune competence. As a result, co-housed IFNAR Ab and IFNAR KO mice showed body weight loss with SFTS viral antigens detected in their sera, extracorporeal secretions, and various organs. Based on histopathology, white pulp atrophy in the spleen was observed in all co-housed mice except WT mice. These results obviously show that IFNAR Ab and IFNAR KO mice, as spreaders, exhibited higher transmissibility to co-housed mice than WT mice. Moreover, IFNAR KO mice, as recipients, were more susceptible to SFTSV infection than WT mice. These findings suggest that type I interferon signaling is a pivotal factor in mice intraspecies transmissibility of SFTSV in the absence of vectors such as ticks.
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Affiliation(s)
- Byungkwan Oh
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Seok-Chan Park
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Myeon-Sik Yang
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Daram Yang
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Gaeul Ham
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Dongseob Tark
- Laboratory for Infectious Disease Prevention, Korea Zoonosis Research Institute, Jeonbuk National University, 820-120, Hana-ro, Iksan 54531, Republic of Korea;
| | - Myung Jo You
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Sang-Ik Oh
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Bumseok Kim
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
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Kim EH, Park SJ. Emerging Tick-Borne Dabie bandavirus: Virology, Epidemiology, and Prevention. Microorganisms 2023; 11:2309. [PMID: 37764153 PMCID: PMC10536723 DOI: 10.3390/microorganisms11092309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Severe Fever with Thrombocytopenia Syndrome (SFTS), caused by Dabie bandavirus (SFTSV), is an emerging infectious disease first identified in China. Since its discovery, infections have spread throughout East Asian countries primarily through tick bites but also via transmission between animals and humans. The expanding range of ticks, the primary vectors for SFTSV, combined with migration patterns of tick-carrying birds, sets the stage for the global spread of this virus. SFTSV rapidly evolves due to continuous mutation and reassortment; currently, no approved vaccines or antiviral drugs are available. Thus, the threat this virus poses to global health is unmistakable. This review consolidates the most recent research on SFTSV, including its molecular characteristics, transmission pathways through ticks and other animals, as well as the progress in antiviral drug and vaccine development, encompassing animal models and clinical trials.
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Affiliation(s)
- Eun-Ha Kim
- Center for Study of Emerging and Re-Emerging Viruses, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea;
| | - Su-Jin Park
- Division of Life Science, Research Institute of Life Science, Gyeongsang National University, Jinju 52828, Republic of Korea
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Shuto H, Komiya K, Usagawa Y, Yamasue M, Fushimi K, Hiramatsu K, Kadota JI. Corticosteroid Therapy for Patients With Severe Fever With Thrombocytopenia Syndrome: A Nationwide Propensity Score-Matched Study in Japan. Open Forum Infect Dis 2023; 10:ofad418. [PMID: 37577113 PMCID: PMC10414805 DOI: 10.1093/ofid/ofad418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening infectious disease for which no effective treatment strategy has been established. Although corticosteroids (CSs) are widely administered to patients with SFTS, their efficacy remains uncertain. This study aimed to assess the impact of CS therapy on the in-hospital mortality of patients with SFTS. Methods In this nationwide observational study using the Japanese Diagnosis Procedure Combination database, patients hospitalized for SFTS from April 2013 to March 2021 were reviewed. We compared patients who were treated with CSs to those who were treated without them after propensity score matching to adjust for their background, disease severity, and combination therapy. Results We included 494 patients with SFTS, and 144 pairs of them were analyzed after propensity score matching. No significant difference in the 30-day mortality (19% vs 15%, P = .272) and the number of survival days (log-rank test, P = .392) was found between the CS treatment group and the non-CS treatment group. However, in subgroup analyses, the CS treatment group tended to have better survival among patients with impaired consciousness on admission and/or shock status within 7 days after admission. Conclusions CS therapy does not seem effective for all patients with SFTS; however, the impact might be altered by disease severity assessed by the consciousness level and shock status. A large-scale interventional study is required to determine its efficacy, especially for critically ill patients with SFTS.
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Affiliation(s)
- Hisayuki Shuto
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Research Center for Global and Local Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yuko Usagawa
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Mari Yamasue
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Research Center for Global and Local Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Jun-ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Yang K, Chen J, Chen Z, Zheng Y. Risk Factors for Death in Patients with Severe Fever with Thrombocytopenia Syndrome. Am J Trop Med Hyg 2023; 109:94-100. [PMID: 37253446 PMCID: PMC10324000 DOI: 10.4269/ajtmh.22-0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 06/01/2023] Open
Abstract
To establish a Cox regression model predicting risk factors for mortality in patients with severe fever with thrombocytopenia syndrome (SFTS), a total of 109 SFTS patients treated at The Second Hospital of Nanjing between June 2016 and October 2020 were included in this study. The patients were categorized into survival (n = 82) and death (n = 27) groups, and the clinical manifestations on admission and laboratory examination were collected. The factors associated with the mortality risk of SFTS patients were explored by univariate and binary logistic regression analyses. The receiver operating characteristic curve was used to evaluate the predictive value of independent influencing factors and the STFS scoring system. Univariate screening showed that the putative influencing factors were age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, invasive mechanical ventilation, continuous renal replacement therapy, application of vasoactive medications, absolute count of lymphocytes, count of platelets, and levels of albumin and D-dimer (P < 0.05). Binary logistic regression showed that age (P = 0.042), APACHE II score (P = 0.030), and vasoactive medications (P = 0.035) were independent risk factors in SFTS patients. The combined prediction equation for the mortality risk of SFTS patients was "Combined predictor = age + 3.162 × APACHE II score + 22.306 × vasoactive medications," and the predictive value of combined predictor was greater than that of age (P = 0.004) or APACHE II score (P < 0.001). The combination of age, APACHE II score, and vasoactive medications had the highest ability to predict the risk of death. The STFS scoring system could make the clinical application of independent risk factors feasible.
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Affiliation(s)
- Kai Yang
- Department of Intensive Care Unit, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Chen
- Department of Intensive Care Unit, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiyi Chen
- Department of Intensive Care Unit, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yishan Zheng
- Department of Intensive Care Unit, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
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A ten-year assessment of the epidemiological features and fatal risk factors of hospitalized severe fever with thrombocytopenia syndrome in Eastern China. Epidemiol Infect 2022; 150:e131. [PMID: 35726737 PMCID: PMC9306006 DOI: 10.1017/s0950268822001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) virus has caused a large number of human infections since discovered in 2009. This study elucidated epidemiological features and fatal risk factors of SFTS cases accumulated up to ten years in Taizhou, a coastal prefecture of Zhejiang Province in Eastern China. A total of 188 hospitalised SFTS cases (including 40 deaths) reported to Taizhou Center for Disease Control and Prevention (CDC) during 2011–2020 were enrolled in the study. In the past decade, the annual incidence of SFTS increased over the years (P < 0.001) along with an expanding epidemic area, and the case fatality of hospitalised cases has remained high (21.3%). Although most cases occurred in hilly areas, a coastal island had the highest incidence and case fatality. The majority of cases were over the age of 60 years (72.3%), and both incidence and case fatality of SFTS increased with age. Multivariate logistic regression analysis showed that age (OR 7.47, 95% CI 1.32–42.33; P = 0.023), and haemorrhagic manifestations including petechiae (OR 7.76, 95% CI 1.17–51.50; P = 0.034), gingival haemorrhage (OR 5.38, 95% CI 1.25–23.15; P = 0.024) and melena (OR 5.75, 95% CI 1.18–28.07; P = 0.031) were significantly associated with the death of SFTS cases. Five family clusters identified were farmers, among four of which the index patients were female with a history of hypertension. Based on the study, age is a critical risk factor for incidence and case fatality of SFTS. With an increased annual incidence over the last ten years, SFTS remains a public health threat that should not be ignored. Further study is needed to look at the natural foci in the coastal islands.
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Utsunomiya Nishimizu R, Shiota S, Ishii T, Sano K, Suzuki T, Hasegawa H, Miyazaki E. Plasma Exchange Did Not Reduce Viral Load in a Recovered Case of Severe Fever with Thrombocytopenia Syndrome. Intern Med 2022; 61:253-256. [PMID: 34334561 PMCID: PMC8851190 DOI: 10.2169/internalmedicine.7075-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the SFTS virus (SFTSV). There is no specific treatment for SFTS, although several reports have indicated that plasma exchange (PE) can be an effective therapy for severe SFTS. However, whether or not PE can reduce the viral load is unclear. We herein report a woman with SFTS who had her SFTSV viral load measured just before and after PE. While the patient recovered, there was no significant difference in the SFTSV viral load after PE. Our results confirmed that PE itself does not reduce the SFTSV viral load.
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Affiliation(s)
- Rie Utsunomiya Nishimizu
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Seiji Shiota
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Toshihiro Ishii
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
| | - Kaori Sano
- Department of Pathology, National Institute of Infectious Diseases, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Japan
| | - Hideki Hasegawa
- Department of Pathology, National Institute of Infectious Diseases, Japan
| | - Eishi Miyazaki
- Department of General Medicine, Oita University Faculty of Medicine, Japan
- Center for Community Medicine, Oita University Faculty of Medicine, Japan
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Kim M, Oh H, Heo ST, Song SW, Lee KH, Kang MJ, Yoo JR. The Evaluation of Surrogate Laboratory Parameters for Predicting the Trend of Viral Loads in Patients with Severe Fever with Thrombocytopenia Syndrome: Cross-Correlation Analysis of Time Series. Infect Chemother 2022; 54:470-482. [PMID: 36196606 PMCID: PMC9533152 DOI: 10.3947/ic.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is a correlation between the severe fever with thrombocytopenia syndrome (SFTS) viral load and disease severity; however, measurement of viral load is difficult in general laboratory and it takes time to obtain a viral load value. Here, the laboratory parameters for predicting the dynamic changes in SFTS viral load were identified. In addition, we tried to evaluate a specific time point for the early determination of clinical deterioration using dynamic change of laboratory parameters. Materials and Methods This observational study included SFTS patients in Korea (2013 - 2020). Cross-correlation analysis at lagged values was used to determine the temporal correlation between the SFTS viral loads and time-series variables. Fifty-eight SFTS patients were included in the non-severe group (NSG) and 11 in the severe group (SG). Results In the cross-sectional analyses, 10 parameters -white blood cell, absolute neutrophil cell, lymphocyte, platelet, activated partial thromboplastin time (aPTT), C-reactive protein, aspartate aminotransferase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), and creatine phosphokinase (CPK)- were assessed within 30 days from the onset of symptoms; they exhibited three different correlation patterns: (1) positive, (2) positive with a time lag, and (3) negative. A prediction score system was developed for predicting SFTS fatality based on age and six laboratory variables -platelet, aPTT, AST, ALT, LDH, and CPK- in 5 days after the onset of symptoms; this scoring system had 87.5% sensitivity and 86.0% specificity (95% confidence interval: 0.831 - 1.00, P <0.001). Conclusion Three types of correlation patterns between the dynamic changes in SFTS viral load and laboratory parameters were identified. The dynamic changes in the viral load could be predicted using the dynamic changes in these variables, which can be particularly helpful in clinical settings where viral load tests cannot be performed. Also, the proposed scoring system could provide timely treatment to critical patients by rapidly assessing their clinical course.
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Affiliation(s)
- Misun Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Hyunjoo Oh
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Keun Hwa Lee
- Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea
| | - Myeong Jin Kang
- Department of Nursing, Jeju National University Hospital, Jeju, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
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Zhan L, Huang K, Xia W, Chen J, Wang L, Lu J, Wang J, Lin J, Wu W. The Diagnosis of Severe Fever with Thrombocytopenia Syndrome Using Metagenomic Next-Generation Sequencing: Case Report and Literature Review. Infect Drug Resist 2022; 15:83-89. [PMID: 35046673 PMCID: PMC8760998 DOI: 10.2147/idr.s345991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an infectious disease caused by a bunyaviridae virus. Its main clinical manifestation is fever with thrombocytopenia, which may be accompanied by other clinical symptoms. Here, we report a patient diagnosed with SFTS using metagenomic next‑generation sequencing (mNGS). Case Presentation A 56-year-old female patient was hospitalized with intermittent diarrhea and fever. She visited a local clinic for treatment, but instead of improving, the symptoms progressed to unconsciousness. Diagnosis Using mNGS, we isolated the bunyaviridae virus and several other pathogens from the patient’s blood samples to confirm the diagnosis. Interventions The patient was treated with symptomatic and supportive therapy, including intravenous human γ-globulin (20 g/d), platelet transfusion, platelet elevation (subcutaneous injection of recombinant human thrombopoietin, 15,000 IU), white blood cell elevation (subcutaneous injection of recombinant human granulocyte colony-stimulating factor, 200 ug, qd); and antibiotic (cefoperazone sodium and tazobactam sodium, 2 g, q8h), antiviral (ganciclovir, 250 mg, q12h), and antifungal therapy (voriconazole for injection, 0.2 g, q12h). After ten days of treatment, the patient’s condition gradually improved. Conclusion Compared to traditional detection methods, mNGS has many advantages. It can quickly identify the pathogen when the patient’s clinical manifestations are complex and difficult to diagnose, resulting in the formulation of an effective treatment.
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Affiliation(s)
- Liying Zhan
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Kai Huang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Wenfang Xia
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jingdi Chen
- Department of Orthopedics, The Airborne Military Hospital, Wuhan, Hubei, People’s Republic of China
| | - Lu Wang
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jiaming Lu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jing Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jun Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Wei Wu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Correspondence: Wei Wu; Jun Lin Email ;
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11
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Vectors, Hosts, and the Possible Risk Factors Associated with Severe Fever with Thrombocytopenia Syndrome. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2021; 2021:8518189. [PMID: 34777671 PMCID: PMC8580678 DOI: 10.1155/2021/8518189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/26/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a disease caused by infection with the SFTS virus (SFTSV). SFTS has become a crucial public health concern because of the heavy burden, lack of vaccines, effective therapies, and high-fatality rate. Evidence suggests that SFTSV circulates between ticks and animals in nature and is transmitted to humans by tick bites. In particular, ticks have been implicated as vectors of SFTSV, where domestic or wild animals may play as the amplifying hosts. Many studies have identified antigens and antibodies against SFTSV in various animals such as sheep, goats, cattle, and rodents. Besides, person-to-person transmission through contact with blood or mucous of an infected person has also been reported. In this study, we reviewed the literature and summarized the vectors and hosts associated with SFTS and the possible risk factors.
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12
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Fei X, Fang K, Ni X, Ren WH. Risk Factors of Neurological Complications in Severe Fever Patients with Thrombolytic Syndrome: A Single-Center Retrospective Study in China. Med Sci Monit 2021; 27:e932836. [PMID: 34744159 PMCID: PMC8588710 DOI: 10.12659/msm.932836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome is a serious insect-borne infectious disease caused by the Huaiyangshanbanyang virus. We conducted a retrospective study to identify risk factors for neurological complications caused by the virus. Material/Methods We included 121 patients who had severe fever with thrombocytopenia syndrome and were admitted to our hospital from 2013 to 2020. Patients’ laboratory test results and clinical data were collected. Univariate and multivariate regression were used for statistical analysis. Results Patients with neurological complications had higher mortality rates and longer hospital stays and disease duration than did patients without neurological complications. The neurological symptoms with the highest incidence rates were involuntary tremors (tongue and mandible), cognitive disorder, and limb tremors. Patients with neurological complications had a higher incidence of abnormal heart rhythms. Subcutaneous bleeding, pulmonary rales, percentage of neutrophils, increased lactate dehydrogenase and C-reactive protein levels, and decreased chloride ion concentration were closely related to the occurrence of neurological complications. The significant decrease in chloride ion concentration within 1 to 5 days of disease onset may be a risk factor for predicting the occurrence of neurological complications in patients with severe fever with thrombocytopenia syndrome. Conclusions Early monitoring of subcutaneous bleeding, pulmonary rales, electrocardiogram changes, and biochemical indicators in patients with severe fever with thrombocytopenia syndrome can predict the occurrence of neurological complications.
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Affiliation(s)
- Xiao Fei
- Department of Infectious Diseases, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland).,Department of Infectious Diseases, Yidu Central Hospital of Weifang Affiliated to Weifang Medical University, Weifang, Shandong, China (mainland)
| | - Kai Fang
- Department of Vertigo Medicine, Qingzhou Hospital Affiliated to Shandong First Medical University, Weifang, Shandong, China (mainland)
| | - Xiuying Ni
- Department of Infectious Diseases, Yidu Central Hospital of Weifang Affiliated to Weifang Medical University, Weifang, Shandong, China (mainland)
| | - Wan-Hua Ren
- Department of Infectious Diseases, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
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13
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Wang B, He Z, Yi Z, Yuan C, Suo W, Pei S, Li Y, Ma H, Wang H, Xu B, Guo W, Huang X. Application of a decision tree model in the early identification of severe patients with severe fever with thrombocytopenia syndrome. PLoS One 2021; 16:e0255033. [PMID: 34329338 PMCID: PMC8324211 DOI: 10.1371/journal.pone.0255033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is a serious infectious disease with a fatality of up to 30%. To identify the severity of SFTS precisely and quickly is important in clinical practice. Methods From June to July 2020, 71 patients admitted to the Infectious Department of Joint Logistics Support Force No. 990 Hospital were enrolled in this study. The most frequently observed symptoms and laboratory parameters on admission were collected by investigating patients’ electronic records. Decision trees were built to identify the severity of SFTS. Accuracy and Youden’s index were calculated to evaluate the identification capacity of the models. Results Clinical characteristics, including body temperature (p = 0.011), the size of the lymphadenectasis (p = 0.021), and cough (p = 0.017), and neurologic symptoms, including lassitude (p<0.001), limb tremor (p<0.001), hypersomnia (p = 0.009), coma (p = 0.018) and dysphoria (p = 0.008), were significantly different between the mild and severe groups. As for laboratory parameters, PLT (p = 0.006), AST (p<0.001), LDH (p<0.001), and CK (p = 0.003) were significantly different between the mild and severe groups of SFTS patients. A decision tree based on laboratory parameters and one based on demographic and clinical characteristics were built. Comparing with the decision tree based on demographic and clinical characteristics, the decision tree based on laboratory parameters had a stronger prediction capacity because of its higher accuracy and Youden’s index. Conclusion Decision trees can be applied to predict the severity of SFTS.
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Affiliation(s)
- Bohao Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhiquan He
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Zhijie Yi
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chun Yuan
- Joint Logistics Support Force NO.990 Hospital, Xinyang, China
| | - Wenshuai Suo
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shujun Pei
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Hongxia Ma
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Haifeng Wang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Bianli Xu
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Wanshen Guo
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Xueyong Huang
- College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
- * E-mail:
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14
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Kobayashi Y, Kato H, Yamagishi T, Shimada T, Matsui T, Yoshikawa T, Kurosu T, Shimojima M, Morikawa S, Hasegawa H, Saijo M, Oishi K. Severe Fever with Thrombocytopenia Syndrome, Japan, 2013-2017. Emerg Infect Dis 2021; 26:692-699. [PMID: 32186502 PMCID: PMC7101122 DOI: 10.3201/eid2604.191011] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted an epidemiologic study of severe fever with thrombocytopenia syndrome (SFTS) in Japan during 2013–2017. Of 303 cases reported during that period, 133 (44%) were included in this study. The median time between onset of illness and diagnosis of SFTS shortened, from 11.5 to 3.0 days, but the case-fatality rate remained high, at 27%. In 64 patients (48%), a close contact with companion animals was reported within 2 weeks of disease onset. Of these 64 patients, 40 were surveyed further, and we confirmed that 3 had direct contact with body fluids of ill companion animals; 2 had direct contact with the saliva of an ill feral cat or pet dog. These patients reported no history of tick bite, suggesting that ill companion animals might be a source of SFTS virus transmission. Direct contact with the body fluids of ill companion animals should be avoided.
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15
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Moming A, Shi S, Shen S, Qiao J, Yue X, Wang B, Ding J, Hu Z, Deng F, Zhang Y, Sun S. Fine mapping epitope on Glycoprotein-Gn from Severe Fever with Thrombocytopenia Syndrome Virus. PLoS One 2021; 16:e0248005. [PMID: 33651850 PMCID: PMC7924767 DOI: 10.1371/journal.pone.0248005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV) was recently identified as a tick-borne pathogen that threat to human health. Since 2010, many countries including China, South Korea, and Japan have reported Human SFTS caused by SFTSV infection. The glycoprotein encoded by the SFTSV M gene is the major antigenic component on the viral surface, and responsible for the viral entry, which makes it an important viral antigen and a clinical diagnostic target. The present study aimed to map linear B cell epitopes (BCEs) on the N-terminal glycoprotein (Gn) from SFTSV strain WCH/97/HN/China/2011 using the modified biosynthetic peptide method. Five fine epitopes (E1, 196FSQSEFPD203; E2, 232GHSHKII238; E3, 256VCYKEGTGPC265; E4, 285FCKVAG290, and E5, 316SYGGM320) were identified using the rabbit antisera. Western blot analysis showed that all the five epitopes interacted with the positive serum of sheep that had been naturally infected with SFTSV. Three-dimensional structural modeling analysis showed that all identified BCEs were located on the surface of the SFTSV-Gn and contained flexible loops. The sequence alignment revealed high conservation of the identified BCEs among 13 SFTSV strains from different lineage. These mapped epitopes will escalate the understanding of the epitope distribution and pathogenic mechanism of SFTSV, and could provide a basis for the development of a SFTSV multi-epitope detection antigen.
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Affiliation(s)
- Abulimiti Moming
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China
| | - Shen Shi
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shu Shen
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Jie Qiao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Xihong Yue
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Bo Wang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Juntao Ding
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China
| | - Zhihong Hu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Fei Deng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
- * E-mail: (FD); (YZ); (SS)
| | - Yujiang Zhang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, China
- * E-mail: (FD); (YZ); (SS)
| | - Surong Sun
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China
- * E-mail: (FD); (YZ); (SS)
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16
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Suemori K, Saijo M, Yamanaka A, Himeji D, Kawamura M, Haku T, Hidaka M, Kamikokuryo C, Kakihana Y, Azuma T, Takenaka K, Takahashi T, Furumoto A, Ishimaru T, Ishida M, Kaneko M, Kadowaki N, Ikeda K, Sakabe S, Taniguchi T, Ohge H, Kurosu T, Yoshikawa T, Shimojima M, Yasukawa M. A multicenter non-randomized, uncontrolled single arm trial for evaluation of the efficacy and the safety of the treatment with favipiravir for patients with severe fever with thrombocytopenia syndrome. PLoS Negl Trop Dis 2021; 15:e0009103. [PMID: 33617533 PMCID: PMC7899362 DOI: 10.1371/journal.pntd.0009103] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a bunyavirus infection with high mortality. Favipiravir has shown effectiveness in preventing and treating SFTS virus (SFTSV) infection in animal models. A multicenter non-randomized, uncontrolled single arm trial was conducted to collect data on the safety and the effectiveness of favipiravir in treatment of SFTS patients. All participants received favipiravir orally (first-day loading dose of 1800 mg twice a day followed by 800 mg twice a day for 7–14 days in total). SFTSV RT-PCR and biochemistry tests were performed at designated time points. Outcomes were 28-day mortality, clinical improvement, viral load evolution, and adverse events (AEs). Twenty-six patients were enrolled, of whom 23 were analyzed. Four of these 23 patients died of multi-organ failure within one week (28-day mortality rate: 17.3%). Oral favipiravir was well tolerated in the surviving patients. AEs (abnormal hepatic function and insomnia) occurred in about 20% of the patients. Clinical symptoms improved in all patients who survived from a median of day 2 to day10. SFTSV RNA levels in the patients who died were significantly higher than those in the survivors (p = 0.0029). No viral genomes were detectable in the surviving patients a median of 8 days after favipiravir administration. The 28-day mortality rate in this study was lower than those of the previous studies in Japan. The high frequency of hepatic dysfunction as an AE was observed. However, it was unclear whether this was merely a side effect of favipiravir, because liver disorders are commonly seen in SFTS patients. The results of this trial support the effectiveness of favipiravir for patients with SFTS. Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne virus infection caused by Dabie bandavirus (formerly SFTS virus, SFTSV), which belongs to the Bandavirus genus of the Phenuiviridae family. The case fatality rate of patients with SFTS is high ranging from 16.2% to 47%. SFTS is endemic to East and Southeast Asia. Favipiravir, an antiviral agent with an inhibitory activity on the RNA-dependent RNA polymerase, inhibited replication of SFTSV in vitro and in vivo. It was suggested that favipiravir treatment lowered the case fatality rate of patients with SFTS by approximately 10% in comparison with those reported so far through epidemiological survey in Japan. People living in the SFTS-endemic regions can not escape from the risk of being infected with SFTSV. Favipiravir might be an effective drug for treatment of patients with SFTS and reduces the mortality and morbidity of patients with SFTS.
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Affiliation(s)
- Koichiro Suemori
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
- * E-mail:
| | - Atsushi Yamanaka
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Daisuke Himeji
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Masafumi Kawamura
- Division of Internal Medicine, Kochi Prefectural Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Takashi Haku
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Chinatsu Kamikokuryo
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Taichi Azuma
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Katsuto Takenaka
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toru Takahashi
- Department of Hematology, Yamaguchi Grand Medical Center, Hofu, Japan
| | - Akitsugu Furumoto
- Division of Infectious Diseases, Department of Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Toshiyuki Ishimaru
- Department of Infectious Diseases, The Japanese Red Cross Fukuoka Hospital, Hakata, Japan
| | - Masayuki Ishida
- Department of Infectious Diseases, Chikamori Hospital, Kochi, Kochi, Japan
| | - Masahiko Kaneko
- Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan
| | | | - Kenichi Ikeda
- Department of Internal Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Ise Red Cross Hospital, Ise, Japan
| | - Tomohiro Taniguchi
- Division of General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Takeshi Kurosu
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Masaki Yasukawa
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
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17
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Wang X, Lin L, Zhao Z, Zhou W, Ge Z, Shen Y, Wang L, Zhang W, Song R, Tian D, Wen J, Cui S, Yu X, Feng Y, Liu Y, Qiang C, Duan J, Ma Y, Li X, Fan T, Zhao Y, Chen Z. The predictive effect of the platelet-to-lymphocyte ratio (PLR) and the neutrophil-to-lymphocyte ratio (NLR) on the risk of death in patients with severe fever with thrombocytopenia syndrome (SFTS): a multi-center study in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:208. [PMID: 33708835 PMCID: PMC7940944 DOI: 10.21037/atm-20-4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Severe fever with thrombocytopenia syndrome is caused by infection with the severe fever with thrombocytopenia syndrome virus. Methods Between April 2011 and December 2019, data on consecutive patients who were diagnosed with severe fever with thrombocytopenia syndrome were prospectively collected from five medical centers in China. The score of the death risk model was correlated with the platelet-to-lymphocyte ratio and the neutrophil-to-lymphocyte ratio. Multivariable Cox analyses were used to identify the independent factors associated with mortality. Results During the study period, 763 patients were diagnosed with severe fever with thrombocytopenia syndrome; 415 of these patients were enrolled in our study. We found that the neutrophil-to-lymphocyte ratio of the group that died was significantly higher on admission (P=0.007) than that of the group that survived, and the neutrophil-to-lymphocyte ratio showed a positive correlation with the score of the death risk model. Multivariate Cox regression suggested that a neutrophil-to-lymphocyte ratio greater than 5.4 was an independent risk factor for survival time (HR=6.767, P=0.011). Platelet-to-lymphocyte ratio did not show a special role in this study. Conclusions A neutrophil-to-lymphocyte ratio greater than 5.4 can increase the risk of death and decrease the survival time of patients. In summary, the neutrophil-to-lymphocyte ratio provides a supplementary means for effectively managing severe fever with thrombocytopenia syndrome (SFTS).
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Affiliation(s)
- Xiankun Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Ling Lin
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Zhenghua Zhao
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Wei Zhou
- Department of Infectious Diseases, Dalian sixth people's hospital, Dalian, China
| | - Zirou Ge
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Lin Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Wei Zhang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Rui Song
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Di Tian
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Jing Wen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Shuping Cui
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Xiaoli Yu
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Yang Feng
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Yuanni Liu
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Chunqian Qiang
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Jianping Duan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yanli Ma
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Xingwang Li
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Tianli Fan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhihai Chen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
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18
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Zhang Y, Song R, Shen Y, Zhao Y, Zhao Z, Fan T, Yang X, Wang L, Zhang W, Chen C, Tian D, Wang Y, Wen J, Ge Z, Yu X, Liu L, Feng Y, Duan J, Ma Y, Li X, Zeng H, Chen Z, Zhu L. High Levels of Circulating Cell-free DNA Are Associated With a Poor Prognosis in Patients With Severe Fever With Thrombocytopenia Syndrome. Clin Infect Dis 2021; 70:1941-1949. [PMID: 31240319 DOI: 10.1093/cid/ciz553] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The extensive geographical distribution and high mortality rate of severe fever with thrombocytopenia syndrome (SFTS) have made it an important threat to public health. Neutrophil extracellular traps (NETs) can be activated by a variety of pathogens and are associated with thrombocytopenia in viral infections. We aimed to identify NET production and its predictive value for disease progression and prognosis in patients with SFTS. METHODS A prospective study was performed with a multicenter cohort of patients with SFTS (n = 112) to quantify serum NET levels. Three markers of NETs-namely, cell-free DNA (cfDNA), myeloperoxidase-DNA complexes, and lactoferrin-DNA complexes-were measured with PicoGreen double-stranded DNA assays and enzyme-linked immunosorbent assays. Receiver operating characteristic curves and multivariate regression analyses were performed to calculate the predictive value of cfDNA levels. RESULTS SFTS was characterized by pronounced NET formation. The serum levels of NETs changed dynamically during disease progression, with an inverse pattern of the trends of platelet and neutrophil levels. High cfDNA levels were strongly associated with multiple pathological processes, including coagulopathy, myocardial damage, liver dysfunction, and the development of encephalopathy. A high level of cfDNA (>711.7 ng/mL) at the time of the initial diagnosis predicted severe illness in patients with SFTS (odds ratio, 8.285 [95% confidence interval, 2.049-33.503]; P = .003). CONCLUSIONS This study has a high degree of clinical impact for identification of cfDNA as a useful predictive biomarker of clinical outcomes of SFTS.
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Affiliation(s)
- Yue Zhang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Emerging Infectious Diseases, Capital Medical University, China
| | - Rui Song
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, China
| | - Zhenghua Zhao
- Department of Infectious Diseases, Taian City Central Hospital, China
| | - Tianli Fan
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, China
| | - Xiaoyu Yang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Emerging Infectious Diseases, Capital Medical University, China
| | - Lin Wang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Wei Zhang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Chong Chen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Di Tian
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Ying Wang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Jing Wen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Ziruo Ge
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Xiaoli Yu
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, China
| | - Li Liu
- Department of Infectious Diseases, Taian City Central Hospital, China
| | - Yang Feng
- Department of Infectious Diseases, Taian City Central Hospital, China
| | - Jianping Duan
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, China
| | - Yanli Ma
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, China
| | - Xingwang Li
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Hui Zeng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Emerging Infectious Diseases, Capital Medical University, China
| | - Zhihai Chen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, China
| | - Liuluan Zhu
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, China.,Beijing Key Laboratory of Emerging Infectious Diseases, Capital Medical University, China
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Li J, Li S, Yang L, Cao P, Lu J. Severe fever with thrombocytopenia syndrome virus: a highly lethal bunyavirus. Crit Rev Microbiol 2020; 47:112-125. [PMID: 33245676 DOI: 10.1080/1040841x.2020.1847037] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel bunyavirus. Since 2007, SFTS disease has been reported in China with high fatality rate up to 30%, which drew high attention from Centre for Disease Control and Prevention and government. SFTSV is endemic in the centra l and eastern China, Korea and Japan. There also have been similar cases reported in Vietnam. The number of SFTSV infection cases has a steady growth in these years. As SFTSV could transmitted from person to person, it will expose the public to infectious risk. In 2018 annual review of the Blueprint list of priority diseases, World Health Organisation has listed SFTSV infection as prioritised diseases for research and development in emergency contexts. However, the pathogenesis of SFTSV remains largely unclear. Currently, there are no specific therapeutics or vaccines to combat infections of SFTSV. This review discusses recent findings of epidemiology, transmission pathway, pathogenesis and treatments of SFTS disease.
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Affiliation(s)
- Jing Li
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Shen Li
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Li Yang
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Pengfei Cao
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Jianhong Lu
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
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20
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He Z, Wang B, Li Y, Du Y, Ma H, Li X, Guo W, Xu B, Huang X. Severe fever with thrombocytopenia syndrome: a systematic review and meta-analysis of epidemiology, clinical signs, routine laboratory diagnosis, risk factors, and outcomes. BMC Infect Dis 2020; 20:575. [PMID: 32758175 PMCID: PMC7409422 DOI: 10.1186/s12879-020-05303-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with the high case-fatality rate, and lack of vaccines. We aimed to systematically analysed the epidemiological characteristics, clinical signs, routine laboratory diagnosis, risk factors, and outcomes. Methods Documents on SFTS were collected by searching the Chinese National Knowledge Infrastructure, Wan Fang Data, PubMed, Embase, and Web of Science databases from 2011 to 2018. Meta-analysis was performed by using Review Manager and Stata software. Results Twenty-five articles involving 4143 cases were included. Diarrhea (odds ratio (OR) =1.60, 95% confidence interval (CI): 1.06 to 2.42, P = 0.02), and vomiting (OR = 1.56, 95% CI: 1.01 to 2.39, P = 0.04) on admission were associated with the fatal outcomes of SFTS. Compared to patients with mild symptoms, patients with severe symptoms had significantly elevated levels of lactic acid dehydrogenase (standard mean difference (SMD) =1.27, 95% CI: 0.59 to 1.94), alanine aminotransferase (SMD = 0.55, 95% CI: 0.24 to 0.85), aspirate aminotransferase (SMD = 1.01, 95% CI: 0.69 to 1.32), and creatine kinase (SMD = 1.04, 95% CI: 0.74 to 1.33) but had reduced platelet counts (SMD = -0.87, 95% CI: − 1.16 to − 0.58) and albumin levels (SMD = -1.00, 95% CI: − 1.32 to − 0.68). The risk factors for poor prognosis included age (mean difference (MD) =6.88, 95% CI: 5.41 to 8.35) and farming (OR = 2.01, 95% CI: 1.06 to 3.80). For the risk factors of contracting SFTS, the incidence of SFTS related to tick bites was 24% [95% CI: 0.18 to 0.31]. The pooled case-fatality rate of SFTS patients was 18% [95% CI: 0.16 to 0.21]. Conclusions China is the country with the highest incidence of SFTS. May to July was the peak of the epidemic, and farmers were a high-risk group. The risk factor for SFTS included age (poor prognosis) and tick bites (contracting SFTS). Patients with severe diarrhea and vomiting symptoms on admission should be noted. Clinicians could use routine laboratory parameters and clinical symptoms as references for clinically suspected cases, classification of SFTS, and timely treatment, especially in basic hospitals.
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Affiliation(s)
- Zhiquan He
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bohao Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Yanhua Du
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Hongxia Ma
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Xingle Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Wanshen Guo
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Bianli Xu
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Xueyong Huang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China. .,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China.
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21
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Akagi K, Miyazaki T, Oshima K, Umemura A, Shimada S, Morita K, Senju H, Tashiro M, Takazono T, Saijo T, Kurihara S, Sekino M, Yamamoto K, Imamura Y, Izumikawa K, Yanagihara K, Uda A, Morikawa S, Yoshikawa T, Kurosu T, Shimojima M, Saijo M, Mukae H. Detection of viral RNA in diverse body fluids in an SFTS patient with encephalopathy, gastrointestinal bleeding and pneumonia: a case report and literature review. BMC Infect Dis 2020; 20:281. [PMID: 32295538 PMCID: PMC7160946 DOI: 10.1186/s12879-020-05012-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that commonly has a lethal course caused by the tick-borne Huaiyangshan banyang virus [former SFTS virus (SFTSV)]. The viral load in various body fluids in SFTS patients and the best infection control measure for SFTS patients have not been fully established. CASE PRESENTATION A 79-year-old man was bitten by a tick while working in the bamboo grove in Nagasaki Prefecture in the southwest part of Japan. Due to the occurrence of impaired consciousness, he was referred to Nagasaki University Hospital for treatment. The serum sample tested positive for SFTSV-RNA in the genome amplification assay, and he was diagnosed with SFTS. Furthermore, SFTSV-RNA was detected from the tick that had bitten the patient. He was treated with multimodal therapy, including platelet transfusion, antimicrobials, antifungals, steroids, and continuous hemodiafiltration. His respiration was assisted with mechanical ventilation. On day 5, taking the day on which he was hospitalized as day 0, serum SFTSV-RNA levels reached a peak and then decreased. However, the cerebrospinal fluid collected on day 13 was positive for SFTSV-RNA. In addition, although serum SFTSV-RNA levels decreased below the detectable level on day 16, he was diagnosed with pneumonia with computed tomography. SFTSV-RNA was detected in the bronchoalveolar lavage fluid on day 21. By day 31, he recovered consciousness completely. The pneumonia improved by day 51, but SFTSV-RNA in the sputum remained positive for approximately 4 months after disease onset. Strict countermeasures against droplet/contact infection were continuously conducted. CONCLUSIONS Even when SFTSV genome levels become undetectable in the serum of SFTS patients in the convalescent phase, the virus genome remains in body fluids and tissues. It may be possible that body fluids such as respiratory excretions become a source of infection to others; thus, careful infection control management is needed.
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Affiliation(s)
- Kazumasa Akagi
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Respiratory Medicine, Nagasaki Prefecture Shimabara Hospital, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. .,Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kazuhiro Oshima
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Internal Medicine, Goto Central Hospital, Nagasaki, Japan
| | - Asuka Umemura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo, Japan
| | - Satoshi Shimada
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomomi Saijo
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Shintaro Kurihara
- Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Uda
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigeru Morikawa
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takeshi Kurosu
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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22
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Wang L, Wan G, Shen Y, Zhao Z, Lin L, Zhang W, Song R, Tian D, Wen J, Zhao Y, Yu X, Liu L, Feng Y, Liu Y, Qiang C, Duan J, Ma Y, Liu Y, Liu Y, Chen C, Ge Z, Li X, Chen Z, Fan T, Li W. A nomogram to predict mortality in patients with severe fever with thrombocytopenia syndrome at the early stage-A multicenter study in China. PLoS Negl Trop Dis 2019; 13:e0007829. [PMID: 31765414 PMCID: PMC6934327 DOI: 10.1371/journal.pntd.0007829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/27/2019] [Accepted: 10/04/2019] [Indexed: 12/26/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus is an emerging infectious disease that was first identified in the rural areas of China in 2011. Severe cases often result in death due to multiple organ failure. To date, there are still numerous problems remain unresolved in SFTS, including unclear pathogenesis, lack of specific treatment, and no effective vaccines available. Aim To analyze the clinical information of patients with early-stage SFTS and to establish a nomogram for the mortality risk. Methods Between April 2011 and December 2018, data on consecutive patients who were diagnosed with SFTS were prospectively collected from five medical centers distributed in central and northeastern China. Multivariable Cox analyses were used to identify the factors independently associated with mortality. A nomogram for mortality was established using those factors. Results During the study period, 429 consecutive patients were diagnosed with SFTS at the early stage of the disease (within 7 days of fever), among whom 69 (16.1%) died within 28 days. The multivariable Cox proportional hazard regression analysis showed that low lymphocyte percentage, early-stage encephalopathy, and elevated concentration of serum LDH and BUN were independent risk factors for fatal outcomes. Received-operating characteristic curves for 7-, 14-, and 28-days survival had AUCs of 0.944 (95% CI: 0.920–0.968), 0.924 (95% CI: 0.896–0.953), and 0.924 (95% CI: 0.895–0.952), respectively. Among low-risk patients, 6 patients died (2.2%). Among moderate-risk patients, 25 patients died (24.0%, hazard ratio (HR) = 11.957). Among high-risk patients, the mortality rate was 69.1% (HR = 57.768). Conclusion We established a simple and practical clinical scoring system, through which we can identify critically ill patients and provide intensive medical intervention for patients as soon as possible to reduce mortality. We established a SFTS nomogram scoring system, which is the first nomogram for this disease. According to this nomogram, patients were divided into three levels of mortality risk: low, moderate, and high. This scoring system is helpful to identify critically ill patients, allowing for early intervention and intensive care, which may contribute to reducing the mortality of SFTS.
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Affiliation(s)
- Lin Wang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Statistics Room, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhenghua Zhao
- Department of Infectious Disease, Taian City Central Hospital, Taian, China
| | - Ling Lin
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Wei Zhang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rui Song
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Tian
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jing Wen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Xiaoli Yu
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Li Liu
- Department of Infectious Disease, Taian City Central Hospital, Taian, China
| | - Yang Feng
- Department of Infectious Disease, Taian City Central Hospital, Taian, China
| | - Yuanni Liu
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Chunqian Qiang
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Jianping Duan
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yanli Ma
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Ying Liu
- Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanan Liu
- Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chong Chen
- Graduate School of Capital Medical University, Beijing, China
| | - Ziruo Ge
- Graduate School of Capital Medical University, Beijing, China
| | - Xingwang Li
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhihai Chen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tianli Fan
- Department of Infectious Disease, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Wei Li
- Interventional Therapy Oncology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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23
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Endo T, Yamamoto N, Inoue S, Yoshikane T, Fujisawa N, Imada T, Hattori S. Severe fever with thrombocytopenia syndrome complicated with subdural hematoma: A rare case and literature review. J Gen Fam Med 2019; 20:251-254. [PMID: 31788403 PMCID: PMC6875529 DOI: 10.1002/jgf2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022] Open
Abstract
A 79-year-old woman presented with fever and general malaise. Examination revealed hepatic injury, thrombocytopenia, skin lesions, and regional lymphadenopathy; severe fever with thrombocytopenia syndrome (SFTS) was diagnosed using polymerase chain reaction. The patient developed impaired consciousness that worsened after 4 days. Magnetic resonance imaging of the head revealed a subdural hematoma in the occipital region with an uncertain onset time. As SFTS rarely causes intracranial hemorrhage, the associated risk factors are unknown. Clinicians may overlook potential intracranial hemorrhage in stuporous SFTS patients.
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Affiliation(s)
- Takeshi Endo
- Department of Internal MedicineUnnan City HospitalUnnan‐CityJapan
| | - Norio Yamamoto
- Department of OrthopedicsUnnan City HospitalUnnan‐CityJapan
| | - Shinichiro Inoue
- Department of NeuropsychiatryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceOkayama-CityJapan
| | - Tsutomu Yoshikane
- Department of NeurosurgeryShimane University Faculty of MedicineIzumo-CityJapan
| | - Naoki Fujisawa
- Division of VirologyShimane Prefectural Institute of Public Health and Environmental ScienceMatsue‐CityJapan
| | - Toshihiro Imada
- Department of General MedicineShimane Prefectural Central HospitalIzumo‐cityJapan
| | - Shuzo Hattori
- Department of Internal MedicineUnnan City HospitalUnnan‐CityJapan
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24
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Severe Fever with Thrombocytopenia Syndrome Phlebovirus causes lethal viral hemorrhagic fever in cats. Sci Rep 2019; 9:11990. [PMID: 31427690 PMCID: PMC6700174 DOI: 10.1038/s41598-019-48317-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/02/2019] [Indexed: 11/28/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever caused by the SFTS phlebovirus (SFTSV). SFTS patients were first reported in China, followed by Japan and South Korea. In 2017, cats were diagnosed with SFTS for the first time, suggesting that these animals are susceptible to SFTSV. To confirm whether or not cats were indeed susceptible to SFTSV, animal subjects were experimentally infected with SFTSV. Four of the six cats infected with the SPL010 strain of SFTSV died, all showing similar or more severe symptoms than human SFTS patients, such as a fever, leukocytopenia, thrombocytopenia, weight loss, anorexia, jaundice and depression. High levels of SFTSV RNA loads were detected in the serum, eye swab, saliva, rectal swab and urine, indicating a risk of direct human infection from SFTS-infected animals. Histopathologically, acute necrotizing lymphadenitis and hemophagocytosis were prominent in the lymph nodes and spleen. Severe hemorrhaging was observed throughout the gastrointestinal tract. B cell lineage cells with MUM-1 and CD20, but not Pax-5 in the lesions were predominantly infected with SFTSV. The present study demonstrated that cats were highly susceptible to SFTSV. The risk of direct infection from SFTS-infected cats to humans should therefore be considered.
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25
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Hevey MA, O'Halloran JA, Jagger BW, Staples JE, Lambert AJ, Panella AJ, Kosoy OI, Turabelidze G, Raymer DS, Ewald GA, Kwon JH. Heartland virus infection in a heart transplant recipient from the Heartland. Transpl Infect Dis 2019; 21:e13098. [PMID: 31009160 DOI: 10.1111/tid.13098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/07/2019] [Accepted: 04/14/2019] [Indexed: 11/27/2022]
Abstract
Tick-borne infections represent a significant health risk each year in the United States. Immunocompromised patients are typically at risk of more severe disease manifestations than their immunocompetent counterparts. Here we report a case of a newly emerging phlebovirus, Heartland virus, in a heart transplant recipient.
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Affiliation(s)
- Matthew A Hevey
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Jane A O'Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Brett W Jagger
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer E Staples
- National Center for Emerging and Zoonotic Infectious diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Amy J Lambert
- National Center for Emerging and Zoonotic Infectious diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Amanda J Panella
- National Center for Emerging and Zoonotic Infectious diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Olga I Kosoy
- National Center for Emerging and Zoonotic Infectious diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - George Turabelidze
- Missouri Department of Health and Senior Services, Jefferson City, Missouri
| | - David S Raymer
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Gregory A Ewald
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Jennie H Kwon
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
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26
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Wang G, Chang H, Jia B, Liu Y, Huang R, Wu W, Hao Y, Yan X, Xia J, Chen Y, Wu C. Nucleocapsid protein-specific IgM antibody responses in the disease progression of severe fever with thrombocytopenia syndrome. Ticks Tick Borne Dis 2019; 10:639-646. [PMID: 30824322 DOI: 10.1016/j.ttbdis.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/23/2018] [Accepted: 02/06/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is caused by the SFTS virus (SFTSV) and has a high fatality rate. SFTSV-specific antibody profiles among patients with different clinical outcomes are yet to be described. The nucleocapsid protein (NP) is the most immunogenic viral antigen of the SFTSV. This study, therefore, sought to determine NP-specific antibody responses among SFTS patients with different disease progressions. METHODS In the present study, 43 patients with confirmed SFTS were enrolled in our cohort, and 9 of them deceased. The clinical presentations and key laboratory parameters associated with SFTS fatality were also recorded. Serum samples from each patient were collected every 2 days during their hospitalization. NP-specific IgM and IgG responses as well as Gn or Gc-specific IgM responses were examined by enzyme-linked immunosorbent assay (ELISA), whereas, the dynamic viral loads of SFTSV RNA were quantified via real-time reverse transcription polymerase chain reaction (RT-PCR). RESULTS First, 77% of patients generated positive NP-specific IgM antibody responses within two weeks since illness onset, defined as 'N-specific IgM-positive patients', while the rest of the patients were termed as 'N-specific IgM-delayed patients'. Only 17% of the patients generated NP-specific IgG responses. The absence of NP-specific humoral responses was strongly associated with a high risk of fatality and severity of SFTS. IgM-positive patients had significantly lower levels of viral loads, less disturbed coagulopathy, and hepatic and cardiac damage compared to IgM-delayed patients. Moreover, compared to severe or fatal SFTS patients, mild SFTS patients had significantly higher magnitudes of NP-specific IgM responses, but not NP-specific IgG, Gn-specific IgM, or Gc-specific IgM responses. The abundance of NP-specific IgM responses negatively correlated with viral loads, coagulation disturbances, and hepatic injuries among SFTS patients. CONCLUSIONS Our data highlight distinct humoral profiles of NP-specific IgM responses among SFTS patients with different disease progressions and clinical outcomes.
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Affiliation(s)
- Gai Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Haiyan Chang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bei Jia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yong Liu
- Department of Experimental Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weihua Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yingying Hao
- Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Juan Xia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
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27
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Jia B, Wu W, Huang R, Wang G, Song P, Li Y, Liu Y, Xiong Y, Yan X, Hao Y, Xia J, Zhang Z, Chen Y, Wu C. Characterization of clinical features and outcome for human-to-human transmitted severe fever with thrombocytopenia syndrome. Infect Dis (Lond) 2018. [PMID: 29542384 DOI: 10.1080/23744235.2018.1449962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening infectious disease identified in 2009. SFTS is mainly transmitted by contact with ticks or animals; however, sporadic reports suggested that SFTS could be transmitted among humans. OBJECTIVES We aimed to comprehensively characterize clinical features and disease progression of SFTS acquired by human-to-human transmission. STUDY DESIGN A retrospective study of 90 SFTS patients was performed in a tertiary hospital of Nanjing, China, from October 2010 to October 2016. Seven cases of secondary SFTS were identified based on their epidemic timeline. Their clinical presentations, dynamic laboratory results and clinical outcome were analyzed. RESULTS First, 20 out of 83 primary SFTS patients were deceased, leading to a case-fatality ratio of 24.1%, while all secondary patients survived, suggesting a superior clinical outcome for secondary infection. Moreover, clinical symptoms and laboratory tests in primary and secondary SFTS patients were analyzed, respectively. Secondary SFTS patients developed milder clinical manifestation in the absence of neurological disorder and multiple organ failure. Further, clinical laboratory tests revealed that secondary patients had less disturbed key laboratory parameters, compared to those in primary SFTS patients. During day 7-13 post illness onset, most of the clinical laboratory results of secondary patients went back to normal range. They also had significantly lower level of viral load than primary patients. CONCLUSIONS Secondary SFTS acquired through human-to-human transmission leads to milder clinical representations and superior prognoses compared to primary SFTS, suggesting that the transmission route makes a difference in disease progression and clinical outcome of SFTS disease.
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Affiliation(s)
- Bei Jia
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Weihua Wu
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Rui Huang
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Guiyang Wang
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Peixin Song
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Yang Li
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Yong Liu
- b Department of Laboratory Medicine , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Yali Xiong
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Xiaomin Yan
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Yingying Hao
- c Department of Intensive Care Units , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Juan Xia
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Zhaoping Zhang
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Yuxin Chen
- b Department of Laboratory Medicine , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
| | - Chao Wu
- a Department of Infectious Diseases , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , Jiangsu , China
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