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Shan D, Chen W, Liu G, Zhang H, Chai S, Zhang Y. Severe fever with thrombocytopenia syndrome with central nervous system symptom onset: a case report and literature review. BMC Neurol 2024; 24:158. [PMID: 38730325 PMCID: PMC11084135 DOI: 10.1186/s12883-024-03664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a natural focal disease transmitted mainly by tick bites, and the causative agent is SFTS virus (SFTSV). SFTS can rapidly progress to severe disease, with multiple-organ failure (MOF) manifestations such as shock, respiratory failure, disseminated intravascular coagulation (DIC) and death, but cases of SFTS patients with central nervous system (CNS) symptoms onset and marked persistent involuntary shaking of the perioral area and limbs have rarely been reported. CASE PRESENTATION A 69-year-old woman with fever and persistent involuntary shaking of the perioral area and limbs was diagnosed with SFTS with CNS symptom onset after metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and peripheral blood identified SFTSV. The patient developed a cytokine storm and MOF during the course of the disease, and after aggressive antiviral, glucocorticoid, and gamma globulin treatments, her clinical symptoms improved, her laboratory indices returned to normal, and she had a good prognosis. CONCLUSION This case gives us great insight that when patients with CNS symptoms similar to those of viral encephalitis combined with thrombocytopenia and leukopenia are encountered in the clinic, it is necessary to consider the possibility of SFTS involving the CNS. Testing for SFTSV nucleic acid in CSF and blood (mNGS or polymerase chain reaction (PCR)) should be carried out, especially in critically ill patients, and treatment should be given accordingly.
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Affiliation(s)
- Dawei Shan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Gang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Huimin Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Shuting Chai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Zhou W, Dong Y, Si H, Yang C, Zhao J, Chen X, Ye Z. Visual analysis of global hemorrhagic fever with renal syndrome research from 1980 to 2022: Based on CiteSpace and VOSviewer. Medicine (Baltimore) 2024; 103:e37586. [PMID: 38552094 PMCID: PMC10977534 DOI: 10.1097/md.0000000000037586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The development and current state of hemorrhagic fever with renal syndrome (HFRS) over the past 40 years are analyzed in this study, along with explored and discovered the hotspots and frontiers in the field, which serve as the foundation for future investigation. METHODS CiteSpace and VOSviewer analysis software were used to visually analyze the literature data on HFRS from 1980 to 2022, including the annual number of publications, countries and research institutions, authors, co-cited literature and keywords. RESULTS The number of pertinent papers published in the field of HFRS displayed an overall upward trend from 1980 to 2022. The United States, China, Germany, Sweden, and France are the top 5 countries in terms of publishing volume, with high intermediate centrality mainly concentrated in Europe and the United States. The top 10 co-occurring keywords were hemorrhagic fever, renal syndrome, infection, virus, epidemic, nephropathia epidemical, disease, hantavirus, outbreak, and transmission. According to keyword cluster analysis, there were 4 main research fields. In the HFRS-related study, there were mainly 21 notable keywords and "Korean hemorrhagic fever" had the highest hemorrhagic value (28.87). CONCLUSION The United States, China, Germany, Sweden and other countries attached great importance to the HFRS-related research. Moreover, the collaboration between authors and institutions in various collaborator clusters should be strengthened. In recent decades, investigations have focused on the study of viral infection and the clinical symptoms and pathophysiology of HFRS. Future research may concentrate on factors affecting host population distribution and density, such as vaccine development and meteorological factors pertaining to virus transmission.
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Affiliation(s)
- Wenfang Zhou
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Yonghai Dong
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Hongyu Si
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Cheng Yang
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Jun Zhao
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Xiaona Chen
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhenzhen Ye
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
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Kim D, Lai CJ, Cha I, Jung JU. Current Progress of Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV) Vaccine Development. Viruses 2024; 16:128. [PMID: 38257828 PMCID: PMC10818334 DOI: 10.3390/v16010128] [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: 11/20/2023] [Revised: 01/03/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
SFTSV is an emerging tick-borne virus causing hemorrhagic fever with a case fatality rate (CFR) that can reach up to 27%. With endemic infection in East Asia and the recent spread of the vector tick to more than 20 states in the United States, the SFTSV outbreak is a globally growing public health concern. However, there is currently no targeted antiviral therapy or licensed vaccine against SFTSV. Considering the age-dependent SFTS pathogenesis and disease outcome, a sophisticated vaccine development approach is required to safeguard the elderly population from lethal SFTSV infection. Given the recent emergence of SFTSV, the establishment of animal models to study immunogenicity and protection from SFTS symptoms has only occurred recently. The latest research efforts have applied diverse vaccine development approaches-including live-attenuated vaccine, DNA vaccine, whole inactivated virus vaccine, viral vector vaccine, protein subunit vaccine, and mRNA vaccine-in the quest to develop a safe and effective vaccine against SFTSV. This review aims to outline the current progress in SFTSV vaccine development and suggest future directions to enhance the safety and efficacy of these vaccines, ensuring their suitability for clinical application.
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Affiliation(s)
- Dokyun Kim
- Cancer Biology Department, Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.K.); (C.-J.L.); (I.C.)
- Global Center for Pathogen and Human Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Chih-Jen Lai
- Cancer Biology Department, Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.K.); (C.-J.L.); (I.C.)
- Global Center for Pathogen and Human Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Inho Cha
- Cancer Biology Department, Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.K.); (C.-J.L.); (I.C.)
- Global Center for Pathogen and Human Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Jae U. Jung
- Cancer Biology Department, Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.K.); (C.-J.L.); (I.C.)
- Global Center for Pathogen and Human Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
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Zhang SS, Du J, Cui N, Yang X, Zhang L, Zhang WX, Yue M, Wu YX, Yang T, Zhang XA, Yang ZD, Lv HD, Lu QB, Liu W. Clinical efficacy of immunoglobulin on the treatment of severe fever with thrombocytopenia syndrome: a retrospective cohort study. EBioMedicine 2023; 96:104807. [PMID: 37738834 PMCID: PMC10520313 DOI: 10.1016/j.ebiom.2023.104807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Optimal treatment strategy for severe fever with thrombocytopenia syndrome (SFTS) remained unknown. We aimed to evaluate the efficacy of intravenous immunoglobulin (IVIG) on SFTS. METHODS A retrospective cohort study was conducted based on medical records of the laboratory-confirmed SFTS patients hospitalized during 2010-2020 in the 154th hospital, China. A 1:1 propensity score matching with age, sex, the interval from symptom onset to admission, presence of chronic viral hepatitis, diabetes and disease severity was performed between Non-IVIG group (supportive therapy) and IVIG group (IVIG plus supportive therapy). The matching variables were adjusted to compare the case fatality rates (CFRs), viral load and laboratory parameters between the two groups. Risk ratio (RR) and 95% confidence interval (CI) were reported. FINDINGS Totally 2219 SFTS patients were recruited. CFRs were significantly higher in 1051 patients in IVIG group than 1168 patients in Non-IVIG group (19.0% vs. 4.6%, RR = 4.30, 95% CI 3.12-5.93). The difference remained significant after matching (17.2% vs. 5.1%, RR = 4.02, 95% CI 2.71-5.97). The CFR of IVIG group was significantly higher in all age groups, two IVIG therapy delay groups and two therapy duration groups compared to that of Non-IVIG group (all P < 0.05). IVIG therapy was related to higher viral loads and reduced counts of lymphocytes, T cells, CD4+ T cells and natural killer cells in the blood (all P < 0.05). INTERPRETATION No obvious efficacy of IVIG in saving life or improving outcome of SFTS was observed. Caution is needed for clinical physicians to continue prescribing IVIG for SFTS patients. FUNDING Natural Science Foundation of China.
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Affiliation(s)
- Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Juan Du
- Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ning Cui
- The 154th Hospital, Xinyang, China
| | - Xin Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | | | - Wan-Xue Zhang
- Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ming Yue
- Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yong-Xiang Wu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Tong Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | | | | | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health, Anhui Medical University, Hefei, China.
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Wei X, Tu L, Qiu L, Chen M, Wang Y, Du M, Kan H, Dong Q, Xu X, Yuan H, Zhao L, Wen H. A Scoring Model for Predicting the Occurrence of Severe Illness in Hospitalized Patients with SFTS. Jpn J Infect Dis 2022; 75:382-387. [DOI: 10.7883/yoken.jjid.2021.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Xuemin Wei
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Lirui Tu
- Department of Infection, Shandong Provincial Public Health Clinical Center, China
| | - Ling Qiu
- Department of Infection, Shandong Provincial Public Health Clinical Center, China
| | - Mengting Chen
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Yao Wang
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Mengyu Du
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Haopeng Kan
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Qing Dong
- Department of Infection, Shandong Provincial Public Health Clinical Center, China
| | - Xiaoying Xu
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Haowen Yuan
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Li Zhao
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
| | - Hongling Wen
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five Year”, Shandong University), China
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Gong L, Zhang L, Wu J, Lu S, Lyu Y, Zhu M, Liu B, Zhu Y, Song D, Su B, Liu Z. Clinical Progress and Risk Factors for Death from Severe Fever with Thrombocytopenia Syndrome: A Multihospital Retrospective Investigation in Anhui, China. Am J Trop Med Hyg 2021; 104:1425-1431. [PMID: 33591933 DOI: 10.4269/ajtmh.20-0270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/31/2020] [Indexed: 11/07/2022] Open
Abstract
Knowledge of the clinical progress of severe fever with thrombocytopenia syndrome (SFTS) and the associated predictors of mortality is important for providing appropriate treatment in severe cases. A multihospital retrospective study was conducted in three SFTS-endemic cities, in 2018. Of the 208 SFTS-confirmed cases, there were 189 survivors and 19 deaths. The median age was 64 years; 104 (50.0%) patients were men, and 188 (90.4%) were farmers. Furthermore, 203 (97.6%) patients reported fever and 70 (33.7%) reported fatigue. Most fatal cases had complications including multiple-organ failure, central nervous syndrome (CNS) abnormalities, and disseminated intravascular coagulation. During the fever phase, alanine transaminase, aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatinine, D-dimer, glucose, hydroxybutyrate dehydrogenase, lactate dehydrogenase (LDH), procalcitonin, prothrombin time, and uric acid levels were higher in fatal than in nonfatal cases (P < 0.05). Creatine kinase (CK), CK-MB (CKMB), AST, and LDH levels were significantly lower in nonfatal than in fatal cases (P < 0.05). Central nervous syndrome abnormalities (odds ratio [OR] = 20.9, 95% CI: 4.3, 100), body temperature ≥ 38.5°C (OR = 23.2, 95% CI: 3.4, 158), BUN levels ≥ 6.4 mmol/L (OR = 9.9, 95% CI: 2.2, 44), CKMB levels ≥ 100 U/L (OR = 33.2, 95% CI: 5.8, 192), and LDH levels ≥ 1,000 U/L (OR = 8.3, 95% CI: 1.9, 37) were predictors of mortality. Our findings reveal that the presence of specific complications and laboratory parameters may serve as predictors of mortality and aid in early identification of severe SFTS cases in clinical practice.
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Affiliation(s)
- Lei Gong
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lei Zhang
- 2Hefei Municipal Center for Disease Control and Prevention, Hefei, China
| | - Jiabing Wu
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Siqi Lu
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yong Lyu
- 3Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Meng Zhu
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Boxi Liu
- 4Inner Mongolia Autonomous Regional Center for Disease Control and Prevention, Hohhot, China
| | - Yuliang Zhu
- 5Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Dandan Song
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Bin Su
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Zhirong Liu
- 1Anhui Provincial Center for Disease Control and Prevention, Hefei, China
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Ra SH, Kim MJ, Kim MC, Park SY, Park SY, Chong YP, Lee SO, Choi SH, Kim YS, Lee KH, Kim SH, Kee SH. Kinetics of Serological Response in Patients with Severe Fever with Thrombocytopenia Syndrome. Viruses 2020; 13:v13010006. [PMID: 33375753 PMCID: PMC7823500 DOI: 10.3390/v13010006] [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: 11/12/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is caused by SFTS virus (SFTSV). We investigated the detailed kinetics of serologic response in patients with SFTS. Twenty-eight patients aged ≥18 years were enrolled between July 2015 and October 2018. SFTS was confirmed by detecting SFTSV RNA in their plasma using reverse transcription polymerase chain reaction. SFTSV-specific IgG and IgM were measured using immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA). We found that SFTSV-specific IgG was detected at days 5–9 after symptom onset, and its titer was rising during the course of disease. SFTSV-specific IgM titer peaked at around week 2–3 from symptom onset. The SFTSV-specific seropositive rates for days 5–9, 10–14, 15–19, and 20–24 from symptom onset using IFA and ELISA were 63%, 76%, 90%, and 100%, and 58%, 86%, 100%, and 100%, respectively, for IgG, whereas they were 32%, 62%, 80%, and 100%, and 53%, 62%, 70%, and 100%, respectively, for IgM. The delayed IgM response could be attributed to the low sensitivity of SFTSV-specific IgM IFA or ELISA and/or impaired immune responses. The IgM test using IFA or ELISA that we used in this study is, therefore, insufficient for the early diagnosis of SFTS.
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Affiliation(s)
- Sang Hyun Ra
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Min-Chul Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Dongjak-gu, Seoul 06973, Korea;
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Yongsan-gu, Seoul 04401, Korea;
| | - Seong Yeon Park
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Ilsandong-gu, Goyang-si 10326, Korea;
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
| | - Keun Hwa Lee
- Department of Microbiology, Hanyang University College of Medicine, Seongdong-gu, Seoul 04763, Korea
- Correspondence: (K.H.L.); (S.-H.K.)
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Korea; (S.H.R.); (M.J.K.); (Y.P.C.); (S.-O.L.); (S.-H.C.); (Y.S.K.)
- Correspondence: (K.H.L.); (S.-H.K.)
| | - Sun-Ho Kee
- Department of Microbiology, Korea University College of Medicine, Seongbuk-gu, Seoul 02841, Korea;
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Lu QB, Li H, Jiang FC, Mao LL, Liu XS, Wang N, Zhou YY, Dai K, Yang ZD, Dong LY, Cui N, Zhang XA, Zhang SF, Zhang PH, Fang LQ, Liu W. The Differential Characteristics Between Severe Fever With Thrombocytopenia Syndrome and Hemorrhagic Fever With Renal Syndrome in the Endemic Regions. Open Forum Infect Dis 2020; 6:ofz477. [PMID: 32128325 PMCID: PMC7047964 DOI: 10.1093/ofid/ofz477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/01/2019] [Indexed: 11/21/2022] Open
Abstract
An effective differentiation between severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome was attained by a model considering patients’ age, mouse/tick contact, presence of blush, low back pain, diarrhea, enlarged lymph nodes, and white blood cell count.
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Affiliation(s)
- Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Fa-Chun Jiang
- Division of Infectious Disease, Qingdao Center for Disease Control and Prevention, Qingdao, People's Republic of China
| | - Ling-Ling Mao
- Liaoning Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Xue-Sheng Liu
- Liaoning Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Ning Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.,Department of Microbiology, Graduate School of Mudanjiang Normal University, Mudanjiang, People's Republic of China
| | - Yong-Yun Zhou
- China National Accreditation Service for Conformity Assessment, Beijing, People's Republic of China
| | - Ke Dai
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Zhen-Dong Yang
- The 990 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Xinyang, People's Republic of China
| | - Li-Yan Dong
- Division of Infectious Disease, Qingdao Center for Disease Control and Prevention, Qingdao, People's Republic of China
| | - Ning Cui
- The 990 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Xinyang, People's Republic of China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Shao-Fei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
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Endy TP. Viral Febrile Illnesses and Emerging Pathogens. HUNTER'S TROPICAL MEDICINE AND EMERGING INFECTIOUS DISEASES 2020. [PMCID: PMC7151808 DOI: 10.1016/b978-0-323-55512-8.00036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging or emerged diseases and viral pathogens are responsible historically and currently for large epidemics, global pandemics, and significant morbidity and mortality. Our civilization will continue to face the emergence of new pathogens and viruses: viruses will continue to evolve and adapt to new environments at a high rate; our population continues to grow through birth rate, land development, and migration; climate change will continue to increase the vector burden and spread and change the migratory pattern of animals; and our societal mobility will continue to increase through rapid transportation. The clinical evaluation of the febrile patient with a potential emerging viral pathogen involves documenting the likelihood for an infection by a detailed travel history, calculation of an incubation time by exposure, and an understanding of the disease progression though the clinical illness, which drives the differential diagnosis and the type of diagnostics ordered. Ultimately, the proper identification and diagnosis of a patient with a viral febrile illness due to an emerging pathogen will elicit the appropriate precautions to protect health care providers and communities, deliver appropriate therapeutic interventions, and initiate a targeted public health response. The majority of emerging diseases are caused by viruses, with many that are transmitted by insect vectors or are zoonotic. RNA viruses in particular have high mutation rates and can evolve rapidly in new and changing environments. This, in combination with societal factors, climate change, and rapid travel, has increased the number of epidemics from emerging pathogens in the last several decades. Understanding the travel history, incubation time of potential viruses, and the clinical presentation by illness day is essential in making the right diagnosis and identifying the infecting virus.
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Kim MC, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Differentiation of Severe Fever With Thrombocytopenia Syndrome From Scrub Typhus. Clin Infect Dis 2019; 66:1621-1624. [PMID: 29293899 DOI: 10.1093/cid/cix1119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
We developed a scoring system to differentiate severe fever with thrombocytopenia syndrome (SFTS) in 21 patients with SFTS and 91 with scrub typhus; it provided 100% sensitivity and 97% specificity (score > 1). Criteria included altered mental status, leukopenia, prolonged activated partial thromboplastin time, and normal C-reactive protein (1-point each).
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Affiliation(s)
- Min-Chul Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan.,Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
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11
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Calcium channel blockers reduce severe fever with thrombocytopenia syndrome virus (SFTSV) related fatality. Cell Res 2019; 29:739-753. [PMID: 31444469 DOI: 10.1038/s41422-019-0214-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/23/2019] [Indexed: 11/09/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS), an emerging tick-borne infectious disease caused by a novel phlebovirus (SFTS virus, SFTSV), was listed among the top 10 priority infectious diseases by the World Health Organization due to its high fatality of 12%-50% and possibility of pandemic transmission. Currently, effective anti-SFTSV intervention remains unavailable. Here, by screening a library of FDA-approved drugs, we found that benidipine hydrochloride, a calcium channel blocker (CCB), inhibited SFTSV replication in vitro. Benidipine hydrochloride was revealed to inhibit virus infection through impairing virus internalization and genome replication. Further experiments showed that a broad panel of CCBs, including nifedipine, inhibited SFTSV infection. The anti-SFTSV effect of these two CCBs was further analyzed in a humanized mouse model in which CCB treatment resulted in reduced viral load and decreased fatality rate. Importantly, by performing a retrospective clinical investigation on a large cohort of 2087 SFTS patients, we revealed that nifedipine administration enhanced virus clearance, improved clinical recovery, and remarkably reduced the case fatality rate by >5-fold. These findings are highly valuable for developing potential host-oriented therapeutics for SFTS and other lethal acute viral infections known to be inhibited by CCBs in vitro.
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12
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Yoo JR, Kim SH, Kim YR, Lee KH, Oh WS, Heo ST. Application of therapeutic plasma exchange in patients having severe fever with thrombocytopenia syndrome. Korean J Intern Med 2019; 34:902-909. [PMID: 29117665 PMCID: PMC6610197 DOI: 10.3904/kjim.2016.194] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 05/02/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. METHODS TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. RESULTS Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. CONCLUSION SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.
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Affiliation(s)
- Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Hyung Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Young Ree Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Keun Hwa Lee
- Department of Microbiology and Immunology, Jeju National University School of Medicine, Jeju, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Correspondence to Sang Taek Heo, M.D. Division of Infectious Diseases, Department of Internal Medicine, Jeju National University School of Medicine, 15 Aran 13- gil, Jeju 63241, Korea Tel: +82-64-754-8151 Fax: +82-64-717-1131 E-mail:
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13
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Park SW, Lee CS, Kim JH, Bae IG, Moon C, Kwak YG, Kim BN, Lee JH, Ryu SY, Jang HC, Hur J, Jun JB, Jung Y, Chang HH, Kim YK, Hwang JH, Kim YS, Jeong HW, Song KH, Park WB, Kim ES, Oh MD. Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction. BMC Infect Dis 2019; 19:174. [PMID: 30782137 PMCID: PMC6381645 DOI: 10.1186/s12879-019-3773-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/01/2019] [Indexed: 01/21/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm3; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm3; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9–96.4%) and a specificity of 96.1% (95% CI, 93.8–97.6%) for SFTS. Conclusion This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.
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Affiliation(s)
- Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.,Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jeong-Han Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Chisook Moon
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Younghee Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.
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14
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Choi S, Kim MC, Kwon JS, Kim JY, Lee KH, Kim SH. Case Report: Use of Plasma Exchange Followed by Convalescent Plasma Therapy in a Critically Ill Patient with Severe Fever and Thrombocytopenia Syndrome-Associated Encephalopathy: Cytokine/Chemokine Concentrations, Viral Loads, and Antibody Responses. Am J Trop Med Hyg 2018; 99:1466-1468. [PMID: 30277197 DOI: 10.4269/ajtmh.17-0766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We describe the case of a patient with severe fever with thrombocytopenia syndrome (SFTS) complicated by SFTS-associated encephalopathy who was successfully treated with 4-day plasma exchange followed by two-time convalescent plasma therapy. During plasma exchange, the plasma cytokines interferon-α and inducible protein-10 gradually decreased without change of plasma viral load. However, plasma viral load gradually decreased after convalescent plasma therapy. This case provides important insights for understanding the mechanisms of experimental therapy in severely affected SFTS patients.
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Affiliation(s)
- Sungim Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Chul Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea.,Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kwon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Keun Hwa Lee
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Kim UJ, Kim DM, Kim SE, Kang SJ, Jang HC, Park KH, Jung SI. Case report: detection of the identical virus in a patient presenting with severe fever with thrombocytopenia syndrome encephalopathy and the tick that bit her. BMC Infect Dis 2018; 18:181. [PMID: 29665796 PMCID: PMC5905174 DOI: 10.1186/s12879-018-3092-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. Haemophysalis longicornis ticks have been considered the vector of severe fever with thrombocytopenia syndrome virus (SFTSV). However, clear data on the transmission of SFTS from ticks to humans are limited. Case presentation We report an 84-year-old woman who presented with fever and altered mentality, which was confirmed as SFTS with encephalopathy by reverse-transcription polymerase chain reaction in blood and cerebrospinal fluid. The SFTSV was also identified in the tick that bit her, H. longicornis. Phylogenetic analyses indicated that the SFTSV from the patient and the tick was identical. The patient gradually recovered with treatments of corticosteroids and immunoglobulin. Conclusion These findings provide further evidence of SFTS viral transmission from H. longicornis to human.
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Affiliation(s)
- Uh Jin Kim
- Chonnam National University Medical School, Gwang-ju, Republic of Korea
| | - Dong-Min Kim
- Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Seong Eun Kim
- Chonnam National University Medical School, Gwang-ju, Republic of Korea
| | - Seung Ji Kang
- Chonnam National University Medical School, Gwang-ju, Republic of Korea
| | - Hee-Chang Jang
- Chonnam National University Medical School, Gwang-ju, Republic of Korea
| | - Kyung-Hwa Park
- Chonnam National University Medical School, Gwang-ju, Republic of Korea
| | - Sook In Jung
- Chonnam National University Medical School, Gwang-ju, Republic of Korea.
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16
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Ryu BH, Kim JY, Kim T, Kim MC, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Extensive severe fever with thrombocytopenia syndrome virus contamination in surrounding environment in patient rooms. Clin Microbiol Infect 2018; 24:911.e1-911.e4. [PMID: 29355730 DOI: 10.1016/j.cmi.2018.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease in Korea and China. Although there is previous evidence of person-to-person transmission via direct contact with body fluids, the role of environmental contamination by SFTS virus (SFTSV) in healthcare settings has not been established. We therefore investigated the contamination of the healthcare environment by SFTSV. METHODS We investigated the possible contamination of hospital air and surfaces with SFTSV transmission by collecting air and swabbing environmental surface samples in two hospitals treating six SFTS patients between March and September 2017. The samples were tested using real-time RT-PCR for SFTS M and S segments. RESULTS Of the six SFTS patients, four received mechanical ventilation and three died. Five rooms were occupied by those using mechanical ventilation or total plasma exchange therapy in isolation rooms without negative pressure and one room was occupied by a patient bedridden due to SFTS. SFTSV was detected in 14 (21%) of 67 swab samples. Five of 24 swab samples were obtained from fomites including stethoscopes, and 9 of 43 were obtained from fixed structures including doorknobs and bed guardrails. Some samples from fixed structures such as television monitors and sink tables were obtained in areas remote from the patients. SFTSV RNA was not detected in five air samples from three patients' rooms. CONCLUSIONS Our data suggest that SFTSV contamination was extensive in surrounding environments in SFTS patients' rooms. Therefore, more strict isolation methods and disinfecting procedures should be considered when managing SFTS patients.
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Affiliation(s)
- B-H Ryu
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Y Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T Kim
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - M-C Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - M J Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y-P Chong
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Woo
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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17
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Park SY, Kwon JS, Kim JY, Kim SM, Jang YR, Kim MC, Cho OH, Kim T, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis. Clin Microbiol Infect 2017; 24:432.e1-432.e4. [PMID: 28899841 DOI: 10.1016/j.cmi.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Severe fever with thrombocytopenia syndrome (SFTS) virus has a variety of central nervous system (CNS) manifestations. However, there are limited data regarding SFTS-associated encephalopathy/encephalitis (SFTSAE) and its mechanism. METHODS All patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to suspected acute encephalopathy were enrolled in three referral hospitals between January 2013 and October 2016. Real-time RT-PCR for SFTS virus and chemokine/cytokines levels from blood and CSF were analysed. RESULTS Of 41 patients with confirmed SFTS by RT-PCR for SFTS virus using blood samples, 14 (34%) underwent CSF examination due to suspected SFTSAE. All 14 patients with SFTSE revealed normal protein and glucose levels in CSF, and CSF pleocytosis was uncommon (29%, 4/14). Of the eight patients whose CSF was available for further analysis, six (75%) yielded positive results for SFTS virus. Monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) level in CSF were significantly higher than those in serum (geometric mean 1889 pg/mL in CSF versus 264 pg/mL in serum for MCP-1, p = 0.01, and geometric mean 340 pg/mL in CSF versus 71 pg/mL in serum for IL-8, p = 0.004). CONCLUSIONS The CNS manifestation of SFTS as acute encephalopathy/encephalitis is a common complication of SFTS. Although meningeal inflammation was infrequent in patients with SFTSAE, SFTS virus was frequently detected in CSF with elevated MCP-1 and IL-8. These findings indicate that possible direct invasion of the CNS by SFTS virus with the associated elevated cytokine levels in CSF may play an important role in the pathogenesis of SFTSAE.
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Affiliation(s)
- S Y Park
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - J-S Kwon
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Y Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-M Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y R Jang
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - M-C Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - O-H Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Y P Chong
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Woo
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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18
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Silvas JA, Aguilar PV. The Emergence of Severe Fever with Thrombocytopenia Syndrome Virus. Am J Trop Med Hyg 2017; 97:992-996. [PMID: 28820686 DOI: 10.4269/ajtmh.16-0967] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a newly recognized hemorrhagic fever disease found throughout Asia with a case fatality rate between 12% and 30%. Since 2009, SFTS has been reported in China throughout 14 Chinese Provinces. In addition, SFTS has been recognized in South Korea and Japan with the first confirmed cases reported in 2012. A similar disease, caused by the closely related Heartland virus, was also reported in the United States in 2009. SFTS is caused by SFTS virus, a novel tick-borne virus in the family Bunyaviridae, genus Phlebovirus. Unlike other mosquito- and sandfly-borne bunyaviruses, SFTS virus has not been extensively studied due to its recent emergence and many unknowns regarding its pathogenesis, life cycle, transmission, and options for therapeutics remains. In this review, we report the most current findings in SFTS virus research.
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Affiliation(s)
- Jesus A Silvas
- Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, Texas.,Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Patricia V Aguilar
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas.,Department of Pathology, University of Texas Medical Branch, Galveston, Texas.,Institute for Human Infection and Immunity, University of Texas Medical Branch, Galveston, Texas
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19
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Oh WS, Yoo JR, Kwon KT, Kim HI, Lee SJ, Jun JB, Ryu SY, Kim HA, Hur J, Wi YM, Lim MH, Heo ST. Effect of Early Plasma Exchange on Survival in Patients with Severe Fever with Thrombocytopenia Syndrome: A Multicenter Study. Yonsei Med J 2017; 58:867-871. [PMID: 28541003 PMCID: PMC5447121 DOI: 10.3349/ymj.2017.58.4.867] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/01/2017] [Accepted: 04/12/2017] [Indexed: 01/07/2023] Open
Abstract
Despite a high mortality rate, no specific treatment for severe fever with thrombocytopenia syndrome (SFTS) has been established. This study compared the clinical outcomes of SFTS patients treated with plasma exchange (PE group) with those who were not treated (non-PE group) at nine Korean hospitals between May 2013 and August 2015. A total of 53 SFTS patients were included: 24 (45.3%) PE cases and 29 (54.7%) non-PE cases. The overall in-hospital mortality rate was 32.1% (17/53). The in-hospital mortality rate of the PE group did not differ from that of the non-PE group (29.3% vs. 34.5%, p=0.680). Of the 24 PE cases, 16 (66.7%) were treated with PE within 7 days of symptom onset (early PE group). The early PE group survived longer than the non-PE group (mean 28.4 days vs. 22.6 days, p=0.044). Multivariate analysis showed an inverse association between early PE implementation and 30-day mortality (adjusted hazard ratio 0.052, 95% confidence interval 0.004-0.678, p=0.024). The results of this study suggest that early PE implementation may have a beneficial effect on the clinical outcome of SFTS patients.
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Affiliation(s)
- Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, Daegu Fatima Hospital, Deagu, Korea
| | - Hye In Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Deagu, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Yu Mi Wi
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min Hee Lim
- Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
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Choi SJ, Park SW, Bae IG, Kim SH, Ryu SY, Kim HA, Jang HC, Hur J, Jun JB, Jung Y, Chang HH, Kim YK, Yi J, Kim KH, Hwang JH, Kim YS, Jeong HW, Song KH, Park WB, Kim ES, Oh MD. Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015. PLoS Negl Trop Dis 2016; 10:e0005264. [PMID: 28033338 PMCID: PMC5226827 DOI: 10.1371/journal.pntd.0005264] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/11/2017] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was recently identified in China, South Korea and Japan. The objective of the study was to evaluate the epidemiologic and clinical characteristics of SFTS in South Korea. METHODS/PRINCIPAL FINDINGS SFTS is a reportable disease in South Korea. We included all SFTS cases reported to the Korea Centers for Disease Control and Prevention (KCDC) from January 2013 to December 2015. Clinical information was gathered by reviewing medical records, and epidemiologic characteristics were analyzed using both KCDC surveillance data and patient medical records. Risk factors for mortality in patients with SFTS were assessed. A total of 172 SFTS cases were reported during the study period. SFTS occurred throughout the country, except in urban areas. Hilly areas in the eastern and southeastern regions and Jeju island (incidence, 1.26 cases /105 person-years) were the main endemic areas. The yearly incidence increased from 36 cases in 2013 to 81 cases in 2015. Most cases occurred from May to October. The overall case fatality ratio was 32.6%. The clinical progression was similar to the 3 phases reported in China: fever, multi-organ dysfunction, and convalescence. Confusion, elevated C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS. Two outbreaks of nosocomial SFTS transmission were observed. CONCLUSIONS SFTS is an endemic disease in South Korea, with a nationwide distribution and a high case-fatality ratio. Confusion, elevated levels of C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS.
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Affiliation(s)
- Seong Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Younghee Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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