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Hashimoto T, Yahiro T, Ono K, Takenaka R, Demetria C, Khan S, Kimitsuki K, Abe R, Hiramatsu K, Nishizono A. Rapid Detection of Severe Fever with Thrombocytopenia Syndrome Virus in the Acute Phase of Infection by Direct Real-Time Reverse Transcription without RNA Extraction. Am J Trop Med Hyg 2024; 111:429-432. [PMID: 38889707 PMCID: PMC11310631 DOI: 10.4269/ajtmh.23-0541] [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: 08/14/2023] [Accepted: 03/23/2024] [Indexed: 06/20/2024] Open
Abstract
No specific treatment has been developed for severe fever with thrombocytopenia syndrome (SFTS). However, the prognosis can improve with early plasma exchange. Therefore, rapid and accurate detection of SFTS virus is important for diagnosis and prognosis. Direct real-time reverse transcription polymerase chain reaction (RT-PCR) testing is easier and more time-efficient than conventional real-time RT-PCR. Our study compared direct real-time RT-PCR efficiency without the RNA extraction and purification of conventional real-time RT-PCR. Samples were collected from 18 patients with SFTS and five without SFTS. A strong correlation (r = 0.774, 95% CI: 0.652-0.857, P <0.01) was found between conventional and direct real-time RT-PCR assays. Direct real-time RT-PCR showed 84.4% sensitivity and 92.0% specificity for viral detection. Direct real-time RT-PCR is an effective diagnostic tool for patients with acute phase SFTS, but further optimization is required for viral detection.
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Affiliation(s)
- Takehiro Hashimoto
- Infection Control Center, Oita University Hospital, Oita, Japan
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Takaaki Yahiro
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
- Department of Advanced Medical Sciences, Oita University Faculty of Medicine, Oita, Japan
- Research Center for Global and Local Infectious Diseases, Oita, Japan
| | - Kazuma Ono
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Ryuichi Takenaka
- Department of Emergency Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Catalino Demetria
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Sakirul Khan
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazunori Kimitsuki
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Ryuzo Abe
- Department of Emergency Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Kazufumi Hiramatsu
- Infection Control Center, Oita University Hospital, Oita, Japan
- Research Center for Global and Local Infectious Diseases, Oita, Japan
| | - Akira Nishizono
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
- Research Center for Global and Local Infectious Diseases, Oita, Japan
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Liu Z, Xue X, Geng S, Jiang Z, Ge Z, Zhao C, Xu Y, Wang X, Zhang W, Lin L, Chen Z. The differences in cytokine signatures between severe fever with thrombocytopenia syndrome (SFTS) and hemorrhagic fever with renal syndrome (HFRS). J Virol 2024; 98:e0078624. [PMID: 38916398 PMCID: PMC11265425 DOI: 10.1128/jvi.00786-24] [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: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) virus and hantavirus are categorized under the Bunyavirales order. The severe disease progression in both SFTS and hemorrhagic fever with renal syndrome (HFRS) is associated with cytokine storms. This study aimed to explore the differences in cytokine profiles and immune responses between the two diseases. A cross-sectional, single-center study involved 100 participants, comprising 46 SFTS patients, 48 HFRS patients, and 6 healthy controls. The study employed the Luminex cytokine detection platform to measure 48 cytokines. The differences in cytokine profiles and immune characteristics between the two diseases were further analyzed using multiple linear regression, principal component analysis, and random forest method. Among the 48 cytokines tested, 30 showed elevated levels in SFTS and/or HFRS compared to the healthy control group. Furthermore, there were 19 cytokines that exhibited significant differences between SFTS and HFRS. Random forest analysis suggested that TRAIL and CTACK were predictive of SFTS, while IL2Ralpha, MIG, IL-8, IFNalpha2, HGF, SCF, MCP-3, and PDGFBB were more common with HFRS. It was further verified by the receiver operating characteristic with area under the curve >0.8 and P-values <0.05, except for TRAIL. Significant differences were observed in the cytokine profiles of SFTS and HFRS, with TRAIL, IL2Ralpha, MIG, and IL-8 being the top 4 cytokines that most clearly distinguished the two diseases. IMPORTANCE SFTS and HFRS differ in terms of cytokine immune characteristics. TRAIL, IL-2Ralpha, MIG, and IL-8 were the top 4 that differed markedly between SFTS and HFRS.
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Affiliation(s)
- Zishuai Liu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Xue
- Department of Infectious Disease, Beijing Ditan Hospital, Peking University, Beijing, China
| | - Shuying Geng
- Department of Infectious Diseases, Yantai Qishan Hospital, Yantai, China
| | - Zhouling Jiang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ziruo Ge
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chenxi Zhao
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanli Xu
- Department of Infectious Diseases, Yantai Qishan Hospital, Yantai, China
| | - Xiaolei Wang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ling Lin
- Department of Infectious Diseases, Yantai Qishan Hospital, Yantai, China
| | - Zhihai Chen
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Infectious Disease, Beijing Ditan Hospital, Peking University, Beijing, China
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Qi Y, Wang J, Lu N, Qi X, Yang C, Liu B, Lu Y, Gu Y, Tan W, Zhu C, Ai L, Rao J, Mao Y, Yi H, Li Y, Yue M. Potential novel Colpodella spp. (phylum Apicomplexa) and high prevalence of Colpodella spp. in goat-attached Haemaphysalis longicornis ticks in Shandong province, China. Ticks Tick Borne Dis 2024; 15:102328. [PMID: 38432073 DOI: 10.1016/j.ttbdis.2024.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Tick-borne Apicomplexan parasites pose a significant threat to both public health and animal husbandry. Identifying potential pathogenic parasites and gathering their epidemiological data are essential for prospectively preventing and controlling infections. In the present study, genomic DNA of ticks collected from two goat flocks (Goatflock1 and Goatflock2) and one dog group (Doggroup) were extracted and the 18S rRNA gene of Babesia/Theileria/Colpodella spp. was amplified by PCR and sequenced. Phylogenetic analysis was conducted based on the obtained sequences. The differences in pathogen positive rates between ticks of different groups were statistically analyzed using the Chi-square or continuity-adjusted Chi-square test. As a result, two pathogenic Theileria (T.) luwenshuni genotypes, one novel pathogenic Colpodella sp. HLJ genotype, and two potential novel Colpodella spp. (referred to as Colpodella sp. struthionis and Colpodella sp. yiyuansis in this study) were identified in the Haemaphysalis (H.) longicornis ticks. Ticks of Goatflock2 had a significantly higher positive rate of Colpodella spp. than those from Goatflock1 (χ2=92.10; P = 8.2 × 10-22) and Doggroup (χ2=42.34; P = 7.7 × 10-11), and a significantly higher positive rate of T. luwenshuni than Doggroup (χ2=5.38; P = 0.02). However, the positive rates of T. luwenshuni between Goatflock1 and Goatflock2 were not significantly different (χ2=2.02; P = 0.16), and so as the positive rates of both pathogens between Goatflock1 and Doggroup groups (P > 0.05). For either Colpodella spp. or T. luwenshuni, no significant difference was found in prevalence between male and female ticks. These findings underscore the potential importance of Colpodella spp. in domestic animal-attached ticks, as our study revealed two novel Colpodella spp. and identified Colpodella spp. in H. longicornis for the first time. The study also sheds light on goats' potential roles in the transmission of Colpodella spp. to ticks and provides crucial epidemiological data of pathogenic Theileria and Colpodella. These data may help physicians, veterinarians, and public health officers prepare suitable detection and treatment methods and develop prevention and control strategies.
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Affiliation(s)
- Yong Qi
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Junhu Wang
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Nianhong Lu
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Xin Qi
- The Second People's Hospital of Yiyuan County, 256100, Zibo, Shandong, China
| | - Chaoyue Yang
- Army Medical University, 400038, Chongqing, China
| | - Bing Liu
- Department of Disease Control and Prevention, Rocket Force Characteristic Medical Center, 100088, 16 Xinjiekouwai street, Xicheng District, Beijing, China
| | - Yongfeng Lu
- Administration for Drug and Instrument Supervision and Inspection of PLAJLSF, 100071, Beijing, China
| | - Yuan Gu
- The Ninth Outpatient Department, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu province, 210002, China
| | - Weilong Tan
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Changqiang Zhu
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Lele Ai
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Jixian Rao
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Yingqing Mao
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Haiming Yi
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Yuexi Li
- Huadong Research Institute for Medicine and Biotechniques, 210002, #293 Zhongshandonglu, Nanjing, Jiangsu, China
| | - Ming Yue
- Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Wu Y, Zhou Q, Mao M, Chen H, Qi R. Diversity of species and geographic distribution of tick-borne viruses in China. Front Microbiol 2024; 15:1309698. [PMID: 38476950 PMCID: PMC10929907 DOI: 10.3389/fmicb.2024.1309698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Tick-borne pathogens especially viruses are continuously appearing worldwide, which have caused severe public health threats. Understanding the species, distribution and epidemiological trends of tick-borne viruses (TBVs) is essential for disease surveillance and control. Methods In this study, the data on TBVs and the distribution of ticks in China were collected from databases and literature. The geographic distribution of TBVs in China was mapped based on geographic locations of viruses where they were prevalent or they were detected in vector ticks. TBVs sequences were collected from The National Center for Biotechnology Information and used to structure the phylogenetic tree. Results Eighteen TBVs from eight genera of five families were prevalent in China. Five genera of ticks played an important role in the transmission of TBVs in China. According to phylogenetic analysis, some new viral genotypes, such as the Dabieshan tick virus (DTV) strain detected in Liaoning Province and the JMTV strain detected in Heilongjiang Province existed in China. Discussion TBVs were widely distributed but the specific ranges of viruses from different families still varied in China. Seven TBVs belonging to the genus Orthonairovirus of the family Nairoviridae such as Nairobi sheep disease virus (NSDV) clustered in the Xinjiang Uygur Autonomous Region (XUAR) and northeastern areas of China. All viruses of the family Phenuiviridae except Severe fever with thrombocytopenia syndrome virus (SFTSV) were novel viruses that appeared in the last few years, such as Guertu virus (GTV) and Tacheng tick virus 2 (TcTV-2). They were mainly distributed in the central plains of China. Jingmen tick virus (JMTV) was distributed in at least fourteen provinces and had been detected in more than ten species of tick such as Rhipicephalus microplus and Haemaphysalis longicornis, which had the widest distribution and the largest number of vector ticks among all TBVs. Parainfluenza virus 5 (PIV5) and Lymphatic choriomeningitis virus (LCMV) were two potential TBVs in Northeast China that could cause serious diseases in humans or animals. Ixodes persulcatus carried the highest number of TBVs, followed by Dermacentor nuttalli and H. longicornis. They could carry as many as ten TBVs. Three strains of Tick-borne encephalitis (TBEV) from Inner Mongolia Province clustered with ones from Russia, Japan and Heilongjiang Province, respectively. Several SFTSV strains from Zhejiang Province clustered with strains from Korea and Japan. Specific surveillance of dominant TBVs should be established in different areas in China.
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Affiliation(s)
| | | | | | | | - Rui Qi
- Institute of Microbiome Frontiers and One Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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Zhang Z, Hu X, Jiang Q, Jiao F, Du Q, Liu J, Luo M, Li A, Deng L, Xiong Y. Systemic inflammatory response syndrome in patients with severe fever with thrombocytopenia syndrome: prevalence, characteristics, and impact on prognosis. BMC Infect Dis 2024; 24:149. [PMID: 38291390 PMCID: PMC10829256 DOI: 10.1186/s12879-024-09026-4] [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: 11/02/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis with a high fatality rate in China. Previous studies have reported that dysregulated inflammatory response is associated with disease pathogenesis and mortality in patients with SFTS. This investigation aimed to evaluate the prevalence and characteristics of systemic inflammatory response syndrome (SIRS), and its impact on prognosis. METHODS Data on demographic characteristics, comorbid conditions, clinical manifestations, laboratory parameters, and survival time of patients with SFTS were collected. Patients were divided into the non-SIRS and SIRS groups according to the presence of SIRS, then their clinical data were compared. RESULTS A total of 290 patients diagnosed with SFTS were retrospectively enrolled, including 126(43.4%) patients with SIRS. Patients in the non-survivor group had more prevalence of SIRS than patients in the survivor group (P < 0.001), and SIRS (adjusted OR 2.885, 95% CI 1.226-6.786; P = 0.005) was shown as an independent risk factor for prognosis of patients with SFTS. Compared with patients without SIRS, patients with SIRS had lower WBC and neutrophils counts, and fibrinogen levels, but higher AST, LDH, amylase, lipase, CK, CK-MB, troponin I, APTT, thrombin time, D-dimer, CRP, IL-6, SAA levels, and viral load. The cumulative survival rate of patients with SIRS was significantly lower than that of patients without SIRS. Patients with SIRS also showed a higher incidence of bacterial or fungal infections than patients without SIRS. CONCLUSIONS SIRS is highly frequent in patients with SFTS, and it is associated with high mortality.
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Affiliation(s)
- Zhongwei Zhang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue Hu
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Huazhong University of Science and Technology, Wuhan, China
| | - Qunqun Jiang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fangzhou Jiao
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qian Du
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Liu
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mingqi Luo
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Anling Li
- Department of Clinical Laboratory, Center for Gene Diagnosis, and Program of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Liping Deng
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Yong Xiong
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Zhang Z, Hu X, Jiang Q, Hu W, Li A, Deng L, Xiong Y. Clinical characteristics and outcomes of acute kidney injury in patients with severe fever with thrombocytopenia syndrome. Front Microbiol 2023; 14:1236091. [PMID: 37779695 PMCID: PMC10533938 DOI: 10.3389/fmicb.2023.1236091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, the SFTS related acute kidney injury (AKI) was largely unexplored. This study aimed to investigate the clinical characteristics and outcomes of AKI in patients with SFTS. Methods The non-AKI and AKI groups were compared in terms of general characteristics, clinical features, laboratory parameters and cumulative survival rate. The independent risk factors for in-hospital mortality in patients with SFTS were analyzed by multivariate logistic regression to identify the population with poor prognosis. Results A total of 208 consecutive patients diagnosed with SFTS were enrolled, including 153 (73.6%) patients in the non-AKI group and 55 (26.4%) patients in the AKI group. Compared with patients without AKI, patients with AKI were older and had a higher frequency of diabetes. Among these laboratory parameters, platelet count, albumin and fibrinogen levels of patients with AKI were identified to be significantly lower than those of patients without AKI, while ALT, AST, ALP, triglyceride, LDH, BUN, uric acid, creatine, Cys-C, β2-MG, potassium, AMY, lipase, CK-MB, TnI, BNP, APTT, thrombin time, D-dimer, CRP, IL-6, PCT and ESR levels were significantly higher in patients with AKI. A higher SFTS viral load was also detected in the AKI patients than in the non-AKI patients. The cumulative survival rates of patients at AKI stage 2 or 3 were significantly lower than those of patients without AKI or at AKI stage 1. However, there was no significant difference in the cumulative survival rates between patients without AKI and those with stage 1 AKI. Univariate and multivariate binary logistic regression analyses demonstrated that stage 2 or 3 AKI was an independent risk factor for in-hospital mortality in patients with SFTS. Conclusion AKI is associated with poor outcomes in patients with SFTS, especially patients at AKI stage 2 or 3, who generally have high mortality. Our findings support the importance of early identification and timely treatment of AKI in patients with SFTS.
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Affiliation(s)
- Zhongwei Zhang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue Hu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qunqun Jiang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wenjia Hu
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Anling Li
- Department of Clinical Laboratory, Center for Gene Diagnosis, and Program of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liping Deng
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
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Matsuu A, Hatai H, Hifumi T, Hamakubo E, Take M, Tanaka T, Momoi Y, Endo Y, Koyoshi A, Kamikubo Y, Kamatsuki R, Kurusu N, Tabata H, Matsuyama H, Yanaidani M, Kawabata M, Kawabata T. Clinical and Pathological Findings in Fatal Cases of Severe Fever With Thrombocytopenia Syndrome With High Viremia in Cats. Top Companion Anim Med 2023; 52:100756. [PMID: 36586577 DOI: 10.1016/j.tcam.2022.100756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/09/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonotic disease caused by the SFTS virus (SFTSV). SFTSV causes severe symptoms both in humans and cats. In this study, we report the clinical and pathological findings of 4 fatal cases of cats with high SFTS viremia levels. These cats showed an acute onset of fever, leukopenia, thrombocytopenia, and increased serum amyloid A and pro-inflammatory cytokine levels. A high viral copy number was detected in the blood, oral swabs, rectal swabs, conjunctiva swabs, and urine. Histopathologically, necrotizing lymphadenitis, splenitis with lymphoblastoid cell proliferation, and hemophagocytosis were observed in all 4 cats. Immunohistochemistry revealed the presence of SFTSV antigen on lymphoblastoid B cells. SFTSV-RNA was detected in systemic tissues, including the brain. The present findings provide useful information for understanding the features of fatal SFTS in cats. To elucidate the mechanisms of severe progress of SFTS cats, as well as its role as a source of human infection, further research is needed.
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Affiliation(s)
- Aya Matsuu
- Transboundary Animal Diseases Research Center, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan.
| | - Hitoshi Hatai
- Laboratory of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Tatsuro Hifumi
- Transboundary Animal Diseases Research Center, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan; Laboratory of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Emu Hamakubo
- Transboundary Animal Diseases Research Center, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Maho Take
- Transboundary Animal Diseases Research Center, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Tetsuya Tanaka
- Laboratory of Infectious Diseases, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Yasuyuki Momoi
- Laboratory of Veterinary Diagnostic Imaging, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan; Department of Veterinary Clinical Pathology, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Endo
- Laboratory of Veterinary Internal Medicine, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Ai Koyoshi
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
| | - Yuka Kamikubo
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
| | - Raye Kamatsuki
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
| | - Natsuki Kurusu
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
| | - Haruna Tabata
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
| | | | - Mei Yanaidani
- Kawabata animal medical center, Kirishima, Kagoshima, Japan
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Subcellular localization of nucleocapsid protein of SFTSV and its assembly into the ribonucleoprotein complex with L protein and viral RNA. Sci Rep 2021; 11:22977. [PMID: 34836987 PMCID: PMC8626419 DOI: 10.1038/s41598-021-01985-x] [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: 02/02/2021] [Accepted: 10/29/2021] [Indexed: 11/08/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is an emerging bunyavirus that causes novel zoonotic diseases in Asian countries including China, Japan, South Korea, and Vietnam. In phleboviruses, viral proteins play a critical role in viral particle formation inside the host cells. Viral glycoproteins (GPs) and RNA-dependent RNA polymerase (RdRp) are colocalized in the Golgi apparatus and endoplasmic reticulum-Golgi intermediate compartment (ERGIC). The nucleocapsid (N) protein was widely expressed in the cytoplasm, even in cells coexpressing GP. However, the role of SFTSV N protein remains unclear. The subcellular localization of SFTSV structural proteins was investigated using a confocal microscope. Subsequently, minigenome and immunoprecipitation assays were carried out. The N protein interacts with viral RNA (vRNA) and further shows translational activity with RdRp which is L protein and localized in the ERGIC and Golgi apparatus when co-expressed with GP. On the other hand, mutant N protein did not interact with vRNA either localized in the ERGIC or Golgi apparatus. The interaction between the N protein of SFTSV and vRNA is important for the localization of viral proteins and viral assembly. This study provides useful insights into the life cycle of SFTSV, which will lead to the detection of antiviral targets.
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Yoo IY, Kim JY, Yoon YK, Huh HJ, Lee NY. Comparison Between the SFTS-QS Kit and the PowerChek SFTSV Real-time PCR Kit for the Detection of Severe Fever With Thrombocytopenia Syndrome Virus. Ann Lab Med 2020; 40:317-320. [PMID: 32067431 PMCID: PMC7054697 DOI: 10.3343/alm.2020.40.4.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/17/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022] Open
Abstract
The recent increase in severe fever with thrombocytopenia syndrome (SFTS) cases has led to the development of the SFTS-QS kit (MiCoBioMed, Seongnam, Korea) for detecting the SFTS virus (SFTSV, now renamed Huaiyangshan banyangvirus). SFTS-QS is a qualitative real-time reverse transcription PCR assay based on lab-on-a-chip technology. We evaluated the performance of the SFTS-QS kit and compared it with that of the PowerChek SFTSV Real-time PCR kit (PowerChek; Kogene Biotech, Seoul, Korea). A total of 117 serum samples were simultaneously assayed using the SFTS-QS and PowerChek kits. Sanger sequencing targeting the S and M segments of SFTSV was performed as the reference method. The total turnaround time of the two kits was compared. The SFTS-QS results agreed with those of PowerChek with a kappa value of 0.92. The diagnostic sensitivity and specificity of the SFTS-QS kit were both 100% (14/14 and 103/103, respectively), whereas those of the PowerChek kit were 100% (14/14) and 98.1% (101/103), respectively. The results of SFTS-QS and PowerChek were comparable; however, the SFTS-QS kit required a shorter total turnaround time. The SFTS-QS kit produced accurate and fast results and thus could serve as a useful tool for detecting SFTSV.
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Affiliation(s)
- In Young Yoo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Youn Kim
- Center for Clinical Medicine, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Institute of Emerging Infectious Diseases, Korea University College of Medicine, Seoul, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Huang XY, He ZQ, Wang BH, Hu K, Li Y, Guo WS. Severe fever with thrombocytopenia syndrome virus: a systematic review and meta-analysis of transmission mode. Epidemiol Infect 2020; 148:e239. [PMID: 32993819 PMCID: PMC7584033 DOI: 10.1017/s0950268820002290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a disease with a high case-fatality rate that is caused by infection with the SFTS virus (SFTSV). Five electronic databases were systematically searched to identify relevant articles published from 1 January 2011 to 1 December 2019. The pooled rates with 95% confidence interval (CI) were calculated by a fixed-effect or random-effect model analysis. The results showed that 92 articles were included in this meta-analysis. For the confirmed SFTS cases, the case-fatality rate was 0.15 (95% CI 0.11, 0.18). Two hundred and ninety-six of 1384 SFTS patients indicated that they had been bitten by ticks and the biting rate was 0.21 (95% CI 0.16, 0.26). The overall pooled seroprevalence of SFTSV antibodies among the healthy population was 0.04 (95% CI 0.03, 0.05). For the overall seroprevalence of SFTSV in animals, the seroprevalence of SFTSV was 0.25 (95% CI 0.20, 0.29). The infection rate of SFTSV in ticks was 0.08 (95% CI 0.05, 0.11). In conclusion, ticks can serve as transmitting vectors of SFTSVs and reservoir hosts. Animals can be infected by tick bites, and as a reservoir host, SFTSV circulates continuously between animals and ticks in nature. Humans are infected by tick bites and direct contact with patient secretions.
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Affiliation(s)
- X. Y. Huang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Z. Q. He
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - B. H. Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - K. Hu
- Henan Academy of Medical Sciences, Zhengzhou, China
| | - Y. Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - W. S. Guo
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
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11
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Gong L, Wang J, Zhang Y, Zhang L, Lyu Y, Ma W, Gao W, Chen W, Zhou Y, Wu J, Su B. Socioeconomic burden of severe fever with thrombocytopenia syndrome in endemic areas of Anhui Province, eastern China. Zoonoses Public Health 2019; 66:879-885. [PMID: 31334609 DOI: 10.1111/zph.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 01/30/2023]
Abstract
Understanding the socioeconomic burden of severe fever with thrombocytopenia syndrome (SFTS) is important for making decisions on health resources allocation. This study aimed to assess the economic burden of patients with this syndrome in endemic areas of the Anhui Province in 2018. A total of 114 patients were recruited, and the median age was 63.5 years, 62 (54.4%) were female, 97 (85.1%) were farmers, 108 (94.7%) were survival patients, and 71 (62.3%) had a family monthly income less than $453.3. The median times of hospital visits and hospitalizations of patients were three times, and the median lost work days of these patients, caregivers and visitors were 14.5 days, 14.5 days and 7.5 days, respectively. The median direct costs of the patient were $3,761.6, and the median indirect costs were $508.3. Taking direct and indirect costs into consideration, the median total economic costs of patients were $4,323.9, and the total annual cost of 2018 was $1,396,913.6. Although 113 (99.1%) patients had medical insurance, only 25.8% of costs were covered by reimbursement, and the total cost paid for by the patients and their families was $1,041,073.6 in 2018. Our findings revealed that the patients and their families had a significant economic burden, and preventive measures should be strengthened in endemic areas. The findings also provided baseline data for assessing the cost-effectiveness of the vaccines or anti-viral drugs in the near future in China.
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Affiliation(s)
- Lei Gong
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jinsheng Wang
- Anqing Municipal Center for Disease Control and Prevention, Anqing, China
| | - Yong Zhang
- Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Lei Zhang
- Hefei Municipal Center for Disease Control and Prevention, Hefei, China
| | - Yong Lyu
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Wanwan Ma
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Weilin Gao
- Anqing Municipal Center for Disease Control and Prevention, Anqing, China
| | - Weiguo Chen
- Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Yu Zhou
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Jiabing Wu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Bin Su
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
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12
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Qi R, Qin XR, Wang L, Han HJ, Cui F, Yu H, Liu JW, Yu XJ. Severe fever with thrombocytopenia syndrome can masquerade as hemorrhagic fever with renal syndrome. PLoS Negl Trop Dis 2019; 13:e0007308. [PMID: 30925154 PMCID: PMC6457554 DOI: 10.1371/journal.pntd.0007308] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/10/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever with a high fatality rate and high frequency of person-to-person transmission and is caused by SFTSV, a tick-borne Phlebovirus. Because SFTS has similar clinical manifestations and epidemic characters (such as spatial and temporal distributions) with hemorrhagic fever with renal syndrome (HFRS) in China, we reason that SFTS patients might be misdiagnosed as HFRS. Methodology/principal findings Acute-phase sera of 128 clinically diagnosed HFRS patients were retrospectively analyzed for Hantavirus IgM antibodies with ELISA. Hantavirus-negative patients’ sera were further analyzed for SFTSV IgM antibodies with ELISA. ELISA showed that 73 of 128 (57.0%) of clinically diagnosed HFRS patients were IgM antibody positive to Hantaviruses. Among the 55 Hantavirus-IgM negative patients, four (7.3%) were IgM antibody positive to SFTSV. The results indicated that the four SFTS patients were misdiagnosed as HFRS. The misdiagnosed SFTS patients had clinical manifestations common to HFRS and were unable to be differentiated from HFRS clinically. Conclusions Our study showed that SFTS patients could be clinically misdiagnosed as HFRS. The misdiagnosis of SFTS as HFRS causes particular concern because it may increase the risk of death of SFTS patients and person-to-person transmission of SFTSV without proper care for and isolation of SFTS patients. SFTS were clinically misdiagnosed as HFRS. It could cause particular concern in China. Physicians could not rely heavily on the exposure history. Both SFTS and HFRS patients are treated based on the clinical diagnosis in China. Laboratory confirmation of both diseases is not performed in clinical hospitals and the patients’ blood was usually submitted to a local or provincial center for disease control and prevention. In most cases the confirmation diagnosis is to provide retrospective information rather than to guide clinical therapy. Therefore, physicians need to carefully differentiate SFTS and HFRS patients because the fatality of SFTS is much higher than HFRS and SFTS is easily spread from person to person by contacting infected blood or even through aerosol.
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Affiliation(s)
- Rui Qi
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Xiang-rong Qin
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Ling Wang
- Zibo Center for Disease Control and Prevention, Zibo City, China
| | - Hui-ju Han
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Feng Cui
- Zibo Center for Disease Control and Prevention, Zibo City, China
| | - Hao Yu
- Fudan University School of Medicine, Shanghai, China
| | - Jian-wei Liu
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Xue-jie Yu
- Wuhan University School of Health Sciences, Wuhan, China
- State Key Laboratory of Virology, Wuhan University, Wuhan, China
- * E-mail: ,
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13
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Li D, Shao L, Bi Y, Niu G. Neutralizing antibodies to Severe Fever with Thrombocytopenia Syndrome Virus in general population, Shandong Province, China. Sci Rep 2018; 8:15401. [PMID: 30337627 PMCID: PMC6193936 DOI: 10.1038/s41598-018-33884-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV) in East Asia. The research on seroprevalence of SFTSV in healthy people and risk factors had been detailed. However, the levels of neutralizing antibodies against SFTSV in general population were currently unclear. In the present study, we tested 1375 healthy persons from Penglai County, eastern China, for SFTSV neutralizing antibodies; 0.58% (8/1,375) was positive and the positive rates were not significantly different among people at different age groups, occupations and genders. Besides, a follow-up study was conducted and the titer of neutralizing antibodies decreased over time in all eight people but one, and the neutralizing antibodies of five lasted for the entire study period of seven years. Our results suggesting that subclinical infection or a relatively mild form of SFTS illness is occurring in this population, but a small percentage of sera have neutralizing capacity to SFTSV. Hence, most people are just susceptible to SFTSV infection.
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Affiliation(s)
- Dexin Li
- School of Public Health and management, WeiFang Medical University, Weifang, 261053, China.,Laboratory Institute for Viral Disease Control and Prevention, China CDC, 155 Chang Bai Road, Chang Ping District, Beijing, 102206, China
| | - Lijun Shao
- School of Public Health and management, WeiFang Medical University, Weifang, 261053, China
| | - Yu Bi
- School of Public Health and management, WeiFang Medical University, Weifang, 261053, China
| | - Guoyu Niu
- School of Public Health and management, WeiFang Medical University, Weifang, 261053, China. .,Laboratory Institute for Viral Disease Control and Prevention, China CDC, 155 Chang Bai Road, Chang Ping District, Beijing, 102206, China.
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14
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Sun Y, Liu MM, Lei XY, Yu XJ. SFTS phlebovirus promotes LC3-II accumulation and nonstructural protein of SFTS phlebovirus co-localizes with autophagy proteins. Sci Rep 2018; 8:5287. [PMID: 29588492 PMCID: PMC5869591 DOI: 10.1038/s41598-018-23610-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/16/2018] [Indexed: 01/27/2023] Open
Abstract
Autophagy is essential for eukaryotic cell homeostasis and can perform both anti-viral and pro-viral roles depending on the kinds of viruses, cell types and cell environment. Severe fever with thrombocytopenia syndrome phlebovirus (SFTSV) is a newly discovered tick-borne virus in the Phenuiviridae family that causes a severe hemorrhagic fever disease in East Asia. In this study we determined interactions between SFTSV and autophagy. Our results showed that LC3-II (microtubule associated protein 1 light chain 3-II) protein accumulated from 4 h to 24 h after SFTSV infection compared to mock-infected Vero cells, and the use of E64d and pepstatin A did not affect the expression of LC3-II protein, which indicated that the increased LC3-II may be the result of inhibition of autophagic degradation caused by SFTSV infection. However, knockdown of LC3B promotes SFTSV replication, which indicated a negative role of LC3B protein in SFTSV replication. We also detected co-localization of SFTSV non-structure (NSs) protein with LC3B, p62 and Lamp2b respectively in SFTSV infected Vero cells, which indicated the possibility of selective autophagy or chaperone-mediated autophagy involving in SFTSV infection. Our results indicated that SFTSV infection promotes LC3 accumulation and several proteins of the autophagy pathway co-localize with NSs protein during SFTSV infection.
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Affiliation(s)
- Yue Sun
- School of Public Health, Shandong University, Jinan City, Shandong Province, China
| | - Miao-Miao Liu
- School of Public Health, Jining Medical University, Jinan City, Shandong Province, China
| | - Xiao-Ying Lei
- School of Public Health, Shandong University, Jinan City, Shandong Province, China.
| | - Xue-Jie Yu
- School of Health Sciences, Wuhan University, Wuhan City, Hubei Province, China.
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15
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Huang X, Wang S, Wang X, Lyu Y, Jiang M, Chen D, Li K, Liu J, Xie S, Lyu T, Sun J, Xu P, Cao M, Liang M, Li D. Estimation of the incidence of severe fever with thrombocytopenia syndrome in high endemic areas in China: an inpatient-based retrospective study. BMC Infect Dis 2018; 18:66. [PMID: 29402229 PMCID: PMC5800001 DOI: 10.1186/s12879-018-2970-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China. METHODS This study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level. RESULTS In total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients' IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces. CONCLUSIONS The actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - "SFTS clinical diagnosis cases" or using serological detection methods during acute phase should be considered to avoid missed diagnoses.
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Affiliation(s)
- Xiaoxia Huang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Shiwen Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province People’s Republic of China
| | - Yong Lyu
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Mei Jiang
- Yantai Center for Disease Control and Prevention, Yantai, Shandong Province People’s Republic of China
| | - Deying Chen
- Weihai Center for Disease Control and Prevention, Weihai, Shandong Province People’s Republic of China
| | - Kaichun Li
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Jingyu Liu
- Yantai Center for Disease Control and Prevention, Yantai, Shandong Province People’s Republic of China
| | - Shaoyu Xie
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Tao Lyu
- Weihai Center for Disease Control and Prevention, Weihai, Shandong Province People’s Republic of China
| | - Jie Sun
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Pengpeng Xu
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Minghua Cao
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province People’s Republic of China
| | - Mifang Liang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Dexin Li
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
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16
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Kwon JS, Kim MC, Kim JY, Jeon NY, Ryu BH, Hong J, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Kinetics of viral load and cytokines in severe fever with thrombocytopenia syndrome. J Clin Virol 2018; 101:57-62. [PMID: 29427908 PMCID: PMC7106421 DOI: 10.1016/j.jcv.2018.01.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 12/16/2022]
Abstract
SFTS viremia persists until week 3 from the day of symptom onset. The concentrations of inflammatory cytokines are elevated in SFTS patients. IFN-α, IL-10, and IP-10 are associated with the initial cytokine storm.
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in China, Japan, and Korea, which is characterized by high fever, thrombocytopenia, and high mortality. It is hypothesized that a cytokine storm plays an important role in the pathophysiology of SFTS. However, limited data have been published on the detailed kinetics of the viral load and cytokine profiles throughout the course of this disease. Objectives We investigated the patterns of changes in cytokines and viral load in SFTS patients. Study design During the admission period of patients, RNA was extracted from plasma and quantified by reverse transcription polymerase chain reaction. In addition, cytokine bead arrays were performed for the 18 cytokines and chemokines selected for testing. Results The median time from admission to the negative conversion of SFTS viremia was 17.0 days. When censored patients were found to be negative for viral load at discharge, the median duration of viral shedding was 13.0 days (95% CI, 5.4–20.6). Interferon (IFN)-α, interleukin (IL)-10, and IFN-γ-induced protein (IP)-10 concentrations significantly increased in the early course of disease and then decreased during the hospital stay. However, the concentrations of tumor necrosis factor-α, IL-1β, IL-12p40, IL-13, IL-17A, Regulated on Activation and Normally T-cell Expressed and Secreted (RANTES), and vascular endothelial growth factor (VEGF) increased during the late course of disease. Initial IP-10 levels during hospital days 1–4 were the most significantly correlated with initial viral load (r = 0.88, P < .01). Conclusion SFTS viremia persisted until weeks 2–3 and was highly correlated with initial plasma IP-10 levels. In addition, IFN-α, IL-10, and IP-10 were associated with the initial cytokine storm in SFTS.
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Affiliation(s)
- Ji-Soo Kwon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Chul Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Ji Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Na-Young Jeon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung-Han Ryu
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeongmin Hong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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17
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Matsumoto C, Shinohara N, Furuta RA, Tanishige N, Shimojima M, Matsubayashi K, Nagai T, Tsubaki K, Satake M. Investigation of antibody to severe fever with thrombocytopenia syndrome virus (SFTSV) in blood samples donated in a SFTS-endemic area in Japan. Vox Sang 2018; 113:297-299. [PMID: 29359332 DOI: 10.1111/vox.12629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
The risk of transfusion-transmitted infection (TTI) for severe fever with thrombocytopenia syndrome virus (SFTSV) is a concern because person-to-person transmission resulting from contact with SFTSV-contaminated blood has been reported. To obtain information regarding the risk of TTI-SFTSV, antibody testing was performed for blood samples donated in an severe fever with thrombocytopenia syndrome-endemic area in Japan. No antibody-positive samples were detected among 3990 samples. This finding suggested that there were few cases of SFTSV infection among donors and that the risk of TTI-SFTSV was also estimated low in Japan.
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Affiliation(s)
- C Matsumoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - N Shinohara
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - R A Furuta
- Kinki Block Blood Center, Japanese Red Cross Society, Osaka, Japan
| | - N Tanishige
- Chu-Shikoku Block Blood Center, Japanese Red Cross Society, Hiroshima, Japan
| | - M Shimojima
- Special Pathogens Laboratory, Department of Virology I, National Institute of Infectious Disease, Tokyo, Japan
| | - K Matsubayashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - T Nagai
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - K Tsubaki
- Chu-Shikoku Block Blood Center, Japanese Red Cross Society, Hiroshima, Japan
| | - M Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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18
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Huang YT, Zhao L, Wen HL, Yang Y, Yu H, Yu XJ. Neutralizing Antibodies to Severe Fever with Thrombocytopenia Syndrome Virus 4 Years after Hospitalization, China. Emerg Infect Dis 2018; 22:1985-1987. [PMID: 27767907 PMCID: PMC5088025 DOI: 10.3201/eid2211.160414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome is an emerging hemorrhagic fever disease in eastern Asia, caused by a tickborne bunyavirus. Of 25 patients hospitalized with this disease in China, 100% produced and maintained neutralizing antibodies to severe fever with thrombocytopenia syndrome virus for the study period of 4 years.
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19
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Replication capacity and adaptability of a severe fever with thrombocytopenia syndrome virus at different temperatures. PLoS One 2017; 12:e0188462. [PMID: 29190712 PMCID: PMC5708652 DOI: 10.1371/journal.pone.0188462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (SFTSV). Although fever and thrombocytopenia are the typical manifestations of SFTS, a specific SFTS case with no fever was observed in Zhejiang, China. In this report, we aimed to explore the probable reason for the absence of fever by analyzing the genetic characteristics and temperature sensitivity (ts) of the SFTSV strain ZJ2013-06, which was isolated from the specific case. Phylogenetically, different clusters of SFTSV strains circulated in Zhejiang. ZJ2013-06 was farthest from ZJ2014-02, an isolate belonging to a Chinese dominant cluster, and nearest to the coastal strain NB24/CHN/2013. Ts tests, performed on Vero cells at 37°C and 39°C, indicated that ZJ2013-06 had restricted replication at 39°C. Its viral loads were substantially reduced at 39°C compared with that at 37°C (approximately 100-fold reduction) and were significantly lower than that of ZJ2014-02 at 39°C (P < 0.01). By adaptive culture at 39°C, the induced strain ZJ2013-06-P7 was obtained. Owing to a reverse mutation (S1616), ZJ2013-06-P7 lost the ts of the original strain, displaying similar replication processes with NB24/CHN/2013. The results indicated that the amino acid residue 1616 was related to the ts characteristics of ZJ2013-06. Our study revealed that ZJ2013-06 was temperature-sensitive and may be related to the absence of fever in our case.
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Two confirmed cases of severe fever with thrombocytopenia syndrome with pneumonia: implication for a family cluster in East China. BMC Infect Dis 2017; 17:537. [PMID: 28774267 PMCID: PMC5541732 DOI: 10.1186/s12879-017-2645-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) was first reported in China in 2011. Human-to-human transmission of the virus occurred occasionally in family clusters. However, pneumonia as an onset syndrome was not common in most SFTS cases. Our aim is to report a family cluster of SFTS with clinical manifestation of pneumonia in Shanghai. Methods Epidemiologic investigations were conducted when a family cluster of severe fever with thrombocytopenia syndrome virus (SFTSV) infection was identified in Shanghai in June 2016. Samples were collected from two secondary cases and two close contacts with fever. SFTSV was detected by Real-Time reverse transcription polymerase chain reaction (RT-PCR). Results There were two confirmed STFS cases and one potential index case. The potential index case became ill on 21 May and died on 31 May. Case A had onset from 4 to 23 June and case B from 8 June to 25 June. All the three cases experienced pneumonia at the early stage of SFTSV infection. Three (3) out of thirty two (32) close contacts had symptoms of fever or cough but were detected STFSV negative by real-time RT-PCR. According to epidemiologic investigations, the potential index case had outdoor activities on a nearby hill. A tick bite could have been the reason for the SFTSV infection in the potential index case as ticks were found both in grassland or shrubs on the hill and also found on mice caught in her house. Both cases A and B had provided bedside care for the potential index case without any protection and had contacted with blood and other body fluids. Conclusion It was a family cluster of SFTSV infection imported from Jiangsu province located in the east of China. We suggested to become alert to atypical SFTSV infected cases.
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Sun Y, Liu MM, Luo LM, Zhao L, Wen HL, Zhang ZT, Liu JW, Xue ZF, Ma DQ, Ding SJ, Lei XY, Yu XJ. Seroprevalence of Severe Fever with Thrombocytopenia Syndrome Virus in Hedgehog from China. Vector Borne Zoonotic Dis 2017; 17:347-350. [DOI: 10.1089/vbz.2016.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yue Sun
- School of Public Health, Shandong University, Jinan, China
| | - Miao-miao Liu
- School of Public Health, Shandong University, Jinan, China
| | - Li-mei Luo
- School of Public Health, Shandong University, Jinan, China
| | - Li Zhao
- School of Public Health, Shandong University, Jinan, China
| | - Hong-Ling Wen
- School of Public Health, Shandong University, Jinan, China
| | - Zhen-Tang Zhang
- Huangdao District Center for Disease Control and Prevention, Qingdao City, China
| | - Jian-Wei Liu
- School of Public Health, Shandong University, Jinan, China
| | - Zai-Feng Xue
- Huangdao District Center for Disease Control and Prevention, Qingdao City, China
| | - Dong-Qiang Ma
- Huangdao District Center for Disease Control and Prevention, Qingdao City, China
| | - Shu-Jun Ding
- Shandong Province Center for Disease Control and Prevention, Jinan, China
| | - Xiao-Ying Lei
- School of Public Health, Shandong University, Jinan, China
| | - Xue-jie Yu
- School of Health Sciences, Wuhan University, Wuhan, China
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Zhan J, Cheng J, Hu B, Li J, Pan R, Yang Z, Zou W, Zhan F, Guo D. Pathogens and epidemiologic feature of severe fever with thrombocytopenia syndrome in Hubei province, China. Virus Res 2017; 232:63-68. [PMID: 28089865 PMCID: PMC7114523 DOI: 10.1016/j.virusres.2017.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 11/05/2022]
Abstract
To evaluate the aetiological agents and epidemiologic features of severe fever with thrombocytopenia syndrome (SFTS) in Hubei province, China, sera from patients were collected from January to December 2011. All cases occurred from April to December, and the epidemic peaked from May to August. The ages of patients ranged from 10 to 86 years (median=55years), and the incidence of SFTS increased with age. The female:male ratio of cases was 1.008:1, and 54.6% (77/141) and 1.4% (2/141) of the cases were confirmed by qPCR to be SFTSV and Hantavirus (HV) infection, respectively. No case of simultaneous infection with two or more pathogens was found. The research in this paper showed that some suspected SFTS cases are confused with HV infection due to similar symptoms. The analysis showed that the distribution of SFTSV has a marked regional aggregation in Hubei province.
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Affiliation(s)
- Jianbo Zhan
- Institute of Medical Virology, Wuhan University School of Basic Medical Sciences, Wuhan, 430072, China; Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Jing Cheng
- College of Medicine, Wuhan university of Science and Technology, Wuhan, 430081, China
| | - Bing Hu
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Jing Li
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Ruangang Pan
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Zhaohui Yang
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Wenjing Zou
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Faxian Zhan
- Division for Viral Disease Detection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
| | - Deyin Guo
- Institute of Medical Virology, Wuhan University School of Basic Medical Sciences, Wuhan, 430072, China.
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Zhan J, Wang Q, Cheng J, Hu B, Li J, Zhan F, Song Y, Guo D. Current status of severe fever with thrombocytopenia syndrome in China. Virol Sin 2017; 32:51-62. [PMID: 28251515 PMCID: PMC6598917 DOI: 10.1007/s12250-016-3931-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/20/2017] [Indexed: 12/13/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV). SFTSV is associated with a high mortality rate and has been reported in China, South Korea and Japan. SFTSV undergoes rapid changes owing to evolution, gene mutations, and reassortment between different strains of SFTSV. In this review, we summarize the recent cases and general properties of SFTS, focusing on the epidemiology, genetic diversity, clinical features, and diagnostics of SFTSV in China. From 2010 to October 2016, SFTS cases were reported in 23 provinces of China, with increased numbers yearly. Infection and death cases are mainly found in central China, where the Haemaphysalis longicornis ticks are spread. The national average mortality rate of SFTS infection was 5.3%, with higher risk to elder people. The main epidemic period was from May to July, with a peak in May. Thus, SFTS reminds a significant public health problem, and development of prophylactic vaccines and effective antiviral drugs will be highly needed.
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Affiliation(s)
- Jianbo Zhan
- Wuhan University School of Basic Medical Sciences, Wuhan, 430072, China
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Qin Wang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Jing Cheng
- Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Bing Hu
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Jing Li
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Faxian Zhan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
| | - Yi Song
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
| | - Deyin Guo
- Wuhan University School of Basic Medical Sciences, Wuhan, 430072, China.
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Zeng P, Yang Z, Bakkour S, Wang B, Qing S, Wang J, Chen L, Busch M, Shan H, Liu J, Lee TH. Development and validation of a real-time reverse transcriptase PCR assay for sensitive detection of SFTSV. J Med Virol 2016; 89:1131-1138. [PMID: 28036115 DOI: 10.1002/jmv.24760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/16/2016] [Accepted: 12/16/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome bunyavirus (sftsv) is an emerging tick-borne rna virus recently identified as the pathogen that causes severe fever with thrombocytopenia syndrome (sfts) in china. the existing commercial nucleic acid testing (comnat) assay with a relatively high claimed limit of quantitative detection (loqd) is not capable of sensitive detection and quantitation of sftsv. Thus, a new real-time reverse transcriptase (rt)-pcr assay with improved sensitivity is needed for clinical diagnosis; it could also be used to screen blood donors if necessary. MATERIALS AND METHODS We developed a new sftsv rt-pcr nat assay (newnat). About 129 plasma samples from 93 suspected sfts patients with typical clinical symptoms were tested using an anti-sftsv total antibody elisa and both comnat and newnat. The test performance of the two nat assays was evaluated and compared. RESULTS The newnat had a lower limit for quantitative testing compared to comnat. Twelve samples were comnat negative but newnat positive. Out of 35 suspected sfts patients who were comnat negative and anti-sftsv total antibody negative, four tested positive by the newnat assay and one of these four seroconverted within 2-4 days after testing newnat positive. A high correlation was observed between the cts of the newnat and comnat assays. CONCLUSION The newnat assay was sensitive for quantitative detection of sftsv and may be applicable to clinical diagnosis and studies of the need for blood donor screening.
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Affiliation(s)
- Peibin Zeng
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | | | - Sonia Bakkour
- Blood Systems Research Institute, San Francisco, California
| | | | - Shuli Qing
- Xinyang 154 Military Hospital, Xinyang, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Limin Chen
- Xinyang 154 Military Hospital, Xinyang, China
| | - Michael Busch
- Blood Systems Research Institute, San Francisco, California
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California
| | - Jing Liu
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Tzong-Hae Lee
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
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Liu MM, Lei XY, Yu XJ. Meta-analysis of the clinical and laboratory parameters of SFTS patients in China. Virol J 2016; 13:198. [PMID: 27899121 PMCID: PMC5129669 DOI: 10.1186/s12985-016-0661-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/25/2016] [Indexed: 04/09/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever in East Asia, which is caused by a novel bunyavirus-SFTSV. Many studies have reported the clinical characters of SFTS patients, but the reports were not consistent and a systematic summary of clinical manifestations and laboratory parameters are not available. Method A comprehensive literature research of Web of Science, PubMed, Wan Fang Data, and Chinese National Knowledge Infrastructure databases was conducted on articles which have described the clinical characters of SFTS patients. Data from selected studies were pooled by using STATA VERSION 12.0 software. Result Nine articles comprising 844 laboratory-confirmed SFTSV cases were included in this meta-analysis. The pooled case fatality rate was 16% (95% CI: 0.13–0.19). The major clinical characters of patients with SFTSV infection were fever, thrombocytopenia, leucopenia, gastrointestinal symptoms, and central nervous system manifestations. The risk factors for severe disease included bleeding tendency, central nervous system manifestations, elevated serum enzymes, and high viral load. Although there is no specific antiviral therapy for SFTSV infection, symptomatic treatment and supportive therapy including intensive monitoring is the most essential part of case management. Conclusion The major clinical characters of patients with SFTSV infection were fever, thrombocytopenia, leucopenia and gastrointestinal symptoms, and central nervous system manifestations. The risk factors for severity and fatality among SFTS patients included: old age, CNS manifestations, bleeding tendency, elevated serum enzymes, and high vial load.
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Affiliation(s)
- Miao-Miao Liu
- School of Public Health, Shandong University, 250012, Jinan, China
| | - Xiao-Ying Lei
- School of Public Health, Shandong University, 250012, Jinan, China
| | - Xue-Jie Yu
- School of Public Health, Shandong University, 250012, Jinan, China. .,Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, TX, 77555-0609, USA.
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Luo LM, Zhao L, Wen HL, Zhang ZT, Liu JW, Fang LZ, Xue ZF, Ma DQ, Zhang XS, Ding SJ, Lei XY, Yu XJ. Haemaphysalis longicornis Ticks as Reservoir and Vector of Severe Fever with Thrombocytopenia Syndrome Virus in China. Emerg Infect Dis 2016; 21:1770-6. [PMID: 26402039 PMCID: PMC4593435 DOI: 10.3201/eid2110.150126] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [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
Transstadial and transovarial virus transmission occur among ticks, and transmission to mice can occur through a tick bite. Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever in East Asia caused by SFTS virus (SFTSV), a newly discovered phlebovirus. The Haemaphysalis longicornis tick has been suspected to be the vector of SFTSV. To determine whether SFTSV can be transmitted among ticks, from ticks to animals, and from animals to ticks, we conducted transmission studies between developmental stages of H. longicornis ticks and between ticks and mice. Using reverse transcription PCR, we also analyzed the prevalence of SFTSV infection among H. longicornis ticks collected from vegetation in Shandong Province, China. Our results showed a low prevalence of SFTSV among collected ticks (0.2%, 8/3,300 ticks), and we showed that ticks fed on SFTSV-infected mice could acquire the virus and transstadially and transovarially transmit it to other developmental stages of ticks. Furthermore, SFTSV-infected ticks could transmit the virus to mice during feeding. Our findings indicate ticks could serve as a vector and reservoir of SFTSV.
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Zhang L, Sun J, Yan J, Lv H, Chai C, Sun Y, Shao B, Jiang J, Chen Z, Kortekaas J, Zhang Y. Antibodies against severe fever with thrombocytopenia syndrome virus in healthy persons, China, 2013. Emerg Infect Dis 2016; 20:1355-7. [PMID: 25061813 PMCID: PMC4111193 DOI: 10.3201/eid2008.131796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In June 2013, a subclinical infection with severe fever with thrombocytopenia syndrome virus (SFTSV) was detected in Zhejiang Province, China, prompting seroprevalence studies in 6 districts within the province. Of 986 healthy persons tested, 71 had IgG antibodies against SFTSV. This finding suggests that most natural infections with SFTSV are mild or subclinical.
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28
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Liu JW, Zhao L, Luo LM, Liu MM, Sun Y, Su X, Yu XJ. Molecular Evolution and Spatial Transmission of Severe Fever with Thrombocytopenia Syndrome Virus Based on Complete Genome Sequences. PLoS One 2016; 11:e0151677. [PMID: 26999664 PMCID: PMC4801363 DOI: 10.1371/journal.pone.0151677] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) was a novel tick-borne bunyavirus that caused hemorrhagic fever with a high fatality rate in East Asia. In this study we analyzed the complete genome sequences of 122 SFTSV strains to determine the phylogeny, evolution and reassortment of the virus. We revealed that the evolutionary rate of three genome segments were different, with highest in the S segment and lowest in the L segment. The SFTSV strains were phylogenetically classified into 5 lineages (A, B, C, D and E) with each genome segment. SFTSV strains from China were classified in all 5 lineages, strains from South Korea were classified into 3 lineages (A, D, and E), and all strains from Japan were classified in only linage E. Using the average evolutionary rate of the three genome segments, we found that the extant SFTSV originated 20–87 years ago in the Dabie Mountain area in central China. The viruses were then transmitted to other areas of China, Japan and South Korea. We also found that six SFTSV strains were reassortants. Selection pressure analysis suggested that SFTSV was under purifying selection according to the four genes (RNA-dependent RNA polymerase, glycoprotein, nucleocapsid protein, non-structural protein), and two sites (37, 1033) of glycoproteins were identified as being under strong positive selection. We concluded that SFTSV originated in central China and spread to other places recently and the virus was under purifying selection with high frequency of reassortment.
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Affiliation(s)
- Jian-Wei Liu
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Li Zhao
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Li-Mei Luo
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Miao-Miao Liu
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Yue Sun
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Xiang Su
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Xue-jie Yu
- School of Public Health, Shandong University, Jinan, Shandong Province, China
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Yang ZD, Hu JG, Lu QB, Guo CT, Cui N, Peng W, Wang LY, Qin SL, Wang HY, Zhang PH, Zhang XA, Liu W, Cao WC. The prospective evaluation of viral loads in patients with severe fever with thrombocytopenia syndrome. J Clin Virol 2016; 78:123-8. [PMID: 27062673 DOI: 10.1016/j.jcv.2016.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS), caused by novel bunyavirus (SFTSV) is a potentially fatal disease that was first identified in China. Person to person transmission through contact with blood or body fluids was considered as an important infection route. OBJECTIVES The study is designed to investigate the longitudinal viral loads following SFTSV infection and to identify factors affecting viral shedding in SFTS patients. METHODS A prospective, observational study was performed on 208 laboratory-confirmed SFTSV infected patients in Xinyang, Henan Province. Sequential serum samples were collected on admission and during the hospitalization for quantification of SFTSV RNA by real-time RT-PCR. RESULTS The viral RNA was undetectable in 55.6% of the patients on admission into the hospital, becoming detectable in most cases until three days and attained maximum level on six days after disease onset. This was followed by an obvious decrease thereafter, but maintained detectable for over 20 days. Viral load was independently predictable of severe disease outcome throughout the hospitalization. Viral load of >10(7)copies/mL was predictable of fatal outcome. The serum levels of PLT, WBC, LDH, AST and CK were significantly associated with viral loads level. CONCLUSIONS The diagnosis of SFTSV infection based on PCR test should be performed at least three days after disease onset. Peaking viral loads were attained around six days after disease, posing a highest risk of human-to-human transmission.
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Affiliation(s)
- Zhen-Dong Yang
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Jian-Gong Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Qing-Bin Lu
- School of Public Health, Peking University, Beijing 100191, PR China.
| | - Chen-Tao Guo
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Ning Cui
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Wei Peng
- The Shangcheng County People's Hospital, Shangcheng, PR China
| | - Li-Yuan Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Shu-Li Qin
- The 154 Hospital, Peoples Liberation Army, Xinyang 464000, PR China
| | - Hong-Yu Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
| | - Wu-Chun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
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Severe fever with thrombocytopenia syndrome: a newly discovered emerging infectious disease. Clin Microbiol Infect 2015; 21:614-20. [PMID: 25769426 DOI: 10.1016/j.cmi.2015.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a newly discovered emerging infectious disease that has recently become epidemic in Asia. The causative agent of SFTS is a novel phlebovirus in the family Bunyaviridae, designated SFTS virus (SFTSV). SFTS clinically presents with high fever, thrombocytopenia, leukocytopenia, gastrointestinal disorders, and multi-organ dysfunction, with a high viral load and a high case-fatality rate. In human infection, SFTSV targets microphages, replicates in the spleen of infected mice, and causes thrombocytopenia and a cytokine storm. The tick disseminates virus to humans and animals, forming a special transmission model in nature. Person-to-person transmission though direct contact with patient blood has been frequently reported. Measurements of viral RNA and antibodies have been established for diagnosis, but vaccines and specific therapeutics are not available so far.
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31
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Hu C, Guo C, Yang Z, Wang L, Hu J, Qin S, Cui N, Peng W, Liu K, Liu W, Cao W. The severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) antibody in a highly endemic region from 2011 to 2013: a comparative serological study. Am J Trop Med Hyg 2015; 92:479-81. [PMID: 25624404 DOI: 10.4269/ajtmh.14-0447] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A seropositive rate of 6.59% was determined in the highly endemic region for severe fever with thrombocytopenia syndrome. A significant correlation was observed between case incidence and seroprevalence on temporal and geographic levels. Seroprevalence was comparable in the last 3 years, indicating a stable and ongoing circulation of the infection.
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Affiliation(s)
- Chunyan Hu
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Chentao Guo
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Zhendong Yang
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Liyuan Wang
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Jiangong Hu
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Shuli Qin
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Ning Cui
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Wei Peng
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Kun Liu
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Wei Liu
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
| | - Wuchun Cao
- Graduate School of Anhui Medical University, Hefei, Anhui, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The 154 Hospital, Xinyang, Henan, China; The Shangcheng People's Hospital, Xinyang, Henan, China
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Zeng P, Ma L, Gao Z, Wang J, Liu J, Huang X, Yang Q, Cao R, Wen X, Zhu L, Ma H, Yang Z, Lee TH, Brambilla D, Yuan M, Glynn S, Ness P, Kleinman S, Busch M, Shan H. A study of seroprevalence and rates of asymptomatic viremia of severe fever with thrombocytopenia syndrome virus among Chinese blood donors. Transfusion 2014; 55:965-71. [PMID: 25496479 DOI: 10.1111/trf.12953] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome virus (SFTSV), an emerging tick-borne pathogen that can cause fatal severe fever with thrombocytopenia syndrome, was first identified in China in 2009. Limited evidence suggests that SFTSV can be transmitted between humans via blood contact, raising concerns over transfusion safety. A study of donor samples from three Chinese blood centers was conducted to investigate the seroprevalence and rate of SFTSV viremia among Chinese blood donors. STUDY DESIGN AND METHODS From April 16 to October 31, 2012, a total of 17,208 plasma samples were collected from donors at Xinyang (located in an SFTSV-endemic area), Mianyang, and Luoyang Blood Centers. Assessment of anti-SFTSV total antibody was performed on all samples using enzyme-linked immunosorbent assay. Repeat-reactive samples were tested for SFTSV RNA using reverse transcription (RT)-real-time polymerase chain reaction (PCR) assay with Taqman probes. In addition, 9960 of the Xinyang samples were tested in pools of 4 by the same PCR method and each of the samples in a reactive pool was tested individually. RESULTS Donor seroreactivity rates were as follows: Xinyang, 0.54% (80/14,752); Mianyang, 0.27% (3/1130); and Luoyang, 0.28% (3/1326). All seroreactive samples were negative on RT-PCR single-sample testing. Two RT-PCR-reactive donor samples were identified, both with estimated viral load of less than 20 plaque-forming units/mL. The RNA prevalence rate for SFTSV among donors in Xinyang was 0.02%. CONCLUSION This was the first multiregion study of SFTSV sero- and viral prevalence among Chinese blood donors. Viral prevalence was low and no seroreactive sample was viremic, suggesting a limited impact of SFTSV on blood safety in China.
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Affiliation(s)
- Peibin Zeng
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Lili Ma
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Zhan Gao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jing Liu
- Department of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | - Ruan Cao
- Mianyang Blood Center, Mianyang, China
| | | | - Lili Zhu
- Luoyang Blood Center, Luoyang, China
| | - Hongli Ma
- Luoyang Blood Center, Luoyang, China
| | | | - Tzong-Hae Lee
- Blood System Research Institute, San Francisco, California
| | | | | | | | - Paul Ness
- Department of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steve Kleinman
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hua Shan
- Department of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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Mild clinical course of severe Fever with thrombocytopenia syndrome virus infection in an elderly Japanese patient. Case Rep Infect Dis 2014; 2014:918135. [PMID: 25574405 PMCID: PMC4275604 DOI: 10.1155/2014/918135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 01/14/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious and hemorrhagic disease recently described in China and western Japan. A 71-year-old healthy Japanese woman noticed a tick biting her after harvesting in an orchard and removed it herself. She developed diarrhea, anorexia, and chills eight days later. Because these symptoms continued, she visited a primary care physician 6 days after the onset. Laboratory data revealed thrombocytopenia, leukocytopenia, and elevated liver enzymes. She was then referred to our hospital. Although not completely fulfilling the diagnostic criteria used in a retrospective study in Japan, SFTS was suspected, and we detected SFTS virus in the patient's blood using RT-PCR. However, she recovered without intensive treatment and severe complications 13 days after the onset. In this report, we present a mild clinical course of SFTS virus infection in Japan in detail.
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Age is a critical risk factor for severe fever with thrombocytopenia syndrome. PLoS One 2014; 9:e111736. [PMID: 25369237 PMCID: PMC4219771 DOI: 10.1371/journal.pone.0111736] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease in East Asia. SFTS is a tick borne hemorrhagic fever caused by SFTSV, a new bunyavirus named after the syndrome. We investigated the epidemiology of SFTS in Laizhou County, Shandong Province, China. Methods We collected serum specimens of all patients who were clinically diagnosed as suspected SFTS cases in 2010 and 2011 in Laizhou County. The patients' serum specimens were tested for SFTSV by real time fluorescence quantitative PCR (RT-qPCR). We collected 1,060 serum specimens from healthy human volunteers by random sampling in Laizhou County in 2011. Healthy persons' serum specimens were tested for specific SFTSV IgG antibody by ELISA. Results 71 SFTS cases were diagnosed in Laizhou County in 2010 and 2011, which resulted in the incidence rate of 4.1/100,000 annually. The patients ranged from 15 years old to 87 years old and the median age of the patients were 59 years old. The incidence rate of SFTS was significantly higher in patients over 40 years old and fatal cases only occurred in patients over 50 years old. 3.3% (35/1,060) of healthy people were positive to SFTSV IgG antibody. The SFTSV antibody positive rate was not significantly different among people at different age groups. Conclusion Our results revealed that seroprevalence of SFTSV in healthy people in Laizhou County was not significantly different among age groups, but SFTS patients were mainly elderly people, suggesting that age is the critical risk factor or determinant for SFTS morbidity and mortality.
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Discrimination of novel bunyavirus infection using routine laboratory test. Clin Microbiol Infect 2014; 21:204.e1-7. [PMID: 25658566 DOI: 10.1016/j.cmi.2014.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/25/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
The wide epidemic and high case fatality rate have made severe fever with thrombocytopenia syndrome (SFTS) a significant public health problem. The diagnosis and discrimination of SFTS virus (SFTSV) infection at an early stage of the disease is important for treatment choice. A prospective study was performed in an SFTS reference hospital during 2011-2013. Suspected SFTS patients were recruited and prospectively observed. Comparison between SFTSV-positive and -negative patients was made to identify the parameters that were related to positive detection by discriminant and classification tree analysis. A total of 538 SFTSV-positive and 396 negative patients were recruited and observed. Multiple logistic regression models demonstrated the significant parameters associated with positive detection, including decreased platelet counts and elevated aspartate aminotransferase (AST) level during the first stage (1∼4 days), decreased white blood cell and platelet counts, elevated creatine kinase (CK) and AST levels during the second stage (5∼7 days), and older age, decreased consciousness and elevated CK and AST during the third stage (8-11 days). The classification trees disclosed that the significant predictors for positive SFTSV detection were AST >50.6 U/L and AST/alanine transaminase (ALT) >1.3 at the first stage, CK >257 U/L or 57.7 U/L < CK ≤98.5 U/L with AST/ALT >1.6 at the second stage, as well as CK >630.7 U/L or 114.3 U/L < CK ≤630.7 U/L with decreased consciousness at the third stage. In making the clinically probable diagnosis of SFTS, the supplementation of AST and CK evaluations might remarkably improve the diagnostic capacity of routine laboratory tests, while the leukopenia is of limited use.
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