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Oh B, Park SC, Yang MS, Yang D, Ham G, Tark D, You MJ, Oh SI, Kim B. Difference in Intraspecies Transmissibility of Severe Fever with Thrombocytopenia Syndrome Virus Depending on Abrogating Type 1 Interferon Signaling in Mice. Viruses 2024; 16:401. [PMID: 38543766 PMCID: PMC10974630 DOI: 10.3390/v16030401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne zoonotic disease, is caused by infection with SFTS virus (SFTSV). A previous study reported that human-to-human direct transmission of SFTSV can occur. However, potential animal-to-animal transmission of SFTSV without ticks has not been fully clarified. Thus, the objective of this study was to investigate potential mice-to-mice transmission of SFTSV by co-housing three groups of mice [i.e., wild-type mice (WT), mice injected with an anti-type I interferon-α receptor-blocking antibody (IFNAR Ab), and mice with knockout of type I interferon-α receptor (IFNAR KO)] as spreaders or recipients with different immune competence. As a result, co-housed IFNAR Ab and IFNAR KO mice showed body weight loss with SFTS viral antigens detected in their sera, extracorporeal secretions, and various organs. Based on histopathology, white pulp atrophy in the spleen was observed in all co-housed mice except WT mice. These results obviously show that IFNAR Ab and IFNAR KO mice, as spreaders, exhibited higher transmissibility to co-housed mice than WT mice. Moreover, IFNAR KO mice, as recipients, were more susceptible to SFTSV infection than WT mice. These findings suggest that type I interferon signaling is a pivotal factor in mice intraspecies transmissibility of SFTSV in the absence of vectors such as ticks.
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Affiliation(s)
- Byungkwan Oh
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Seok-Chan Park
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Myeon-Sik Yang
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Daram Yang
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Gaeul Ham
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Dongseob Tark
- Laboratory for Infectious Disease Prevention, Korea Zoonosis Research Institute, Jeonbuk National University, 820-120, Hana-ro, Iksan 54531, Republic of Korea;
| | - Myung Jo You
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Sang-Ik Oh
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
| | - Bumseok Kim
- Biosafety Research Institute, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Republic of Korea; (B.O.); (S.-C.P.); (M.-S.Y.); (D.Y.); (G.H.); (M.J.Y.); (S.-I.O.)
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Liu T, Zhang N, Li H, Hou S, Liu X. Analysis of severe fever with thrombocytopenia syndrome cluster in east China. Virol J 2023; 20:199. [PMID: 37658435 PMCID: PMC10474674 DOI: 10.1186/s12985-023-02155-3] [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: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a common tick-borne, natural focal disease. SFTS virus (SFTSV) transmission can occur between family members through close contact with an infected patient. In this study, we explored the possible transmission route of an outbreak cluster in east China. METHOD A case-control study was carried out to analyze the potential risk factors for person-to-person transmission. Bunia virus was detected by IgM antibody, enzyme-linked immunosorbent assay, and reverse transcription polymerase chain reaction. Chi-square, univariate, and multivariate analyses were performed to calculate the association of possible risk factors for SFTSV transmission. RESULTS Two patients had a clear history of blood and aerosols contact, and one may be exposed to aerosols in a closed environment. Five close contacts of the Index patient were IgM-positive and three were IgM and SFTSV RNA positive. Exposure to a poorly ventilated space where the corpse was stored (χ2 = 5.49, P = 0.019) and contact with the Index patient's contaminated items (χ2 = 15.77, P < 0.001) significantly associated with SFTSV infection. CONCLUSION We suspect that the cluster outbreak was possibly a person-to-person transmission of SFTSV, which may have been transmitted by directly contacting with blood of SFTS patient. The propagation of aerosols in closed environments is also an undeniable transmission.
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Affiliation(s)
- Tao Liu
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China
| | - Nannan Zhang
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China
| | - Haiwen Li
- Department of Infectious Disease Control, Zhaoyuan Center for Disease Control and Prevention, Yantai, Shandong Province, P. R. China
| | - Shuting Hou
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China.
| | - Xiuwei Liu
- Department of Infectious Disease Control, Yantai Center for Disease Control and Prevention, 17 Fuhou Rd, Laishan District, Yantai, Shandong Province, P. R. China.
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Williams HM, Thorkelsson SR, Vogel D, Milewski M, Busch C, Cusack S, Grünewald K, Quemin EJ, Rosenthal M. Structural insights into viral genome replication by the severe fever with thrombocytopenia syndrome virus L protein. Nucleic Acids Res 2023; 51:1424-1442. [PMID: 36651274 PMCID: PMC9943659 DOI: 10.1093/nar/gkac1249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is a phenuivirus that has rapidly become endemic in several East Asian countries. The large (L) protein of SFTSV, which includes the RNA-dependent RNA polymerase (RdRp), is responsible for catalysing viral genome replication and transcription. Here, we present 5 cryo-electron microscopy (cryo-EM) structures of the L protein in several states of the genome replication process, from pre-initiation to late-stage elongation, at a resolution of up to 2.6 Å. We identify how the L protein binds the 5' viral RNA in a hook-like conformation and show how the distal 5' and 3' RNA ends form a duplex positioning the 3' RNA terminus in the RdRp active site ready for initiation. We also observe the L protein stalled in the early and late stages of elongation with the RdRp core accommodating a 10-bp product-template duplex. This duplex ultimately splits with the template binding to a designated 3' secondary binding site. The structural data and observations are complemented by in vitro biochemical and cell-based mini-replicon assays. Altogether, our data provide novel key insights into the mechanism of viral genome replication by the SFTSV L protein and will aid drug development against segmented negative-strand RNA viruses.
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Affiliation(s)
| | | | - Dominik Vogel
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Morlin Milewski
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Carola Busch
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | | | - Kay Grünewald
- Centre for Structural Systems Biology, Leibniz Institute of Virology, Hamburg, Germany,University of Hamburg, Hamburg, Germany
| | - Emmanuelle R J Quemin
- Centre for Structural Systems Biology, Leibniz Institute of Virology, Hamburg, Germany
| | - Maria Rosenthal
- To whom correspondence should be addressed. Tel: +49 40 285380 930;
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Liu Z, Zhang R, Liu Y, Ma R, Zhang L, Zhao Z, Ge Z, Ren X, Zhang W, Lin L, Chen Z. Eosinophils and basophils in severe fever with thrombocytopenia syndrome patients: Risk factors for predicting the prognosis on admission. PLoS Negl Trop Dis 2022; 16:e0010967. [PMID: 36542604 PMCID: PMC9770358 DOI: 10.1371/journal.pntd.0010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) virus (SFTSV) is an emerging tick-borne phlebovirus with a high fatality rate. Previous studies have demonstrated the poor prognostic role of eosinophils (EOS) and basophils (BAS) in predicting multiple viral infections. This study aimed to explore the role of EOS and BAS in predicting prognosis of patients with SFTS. METHODOLOGY A total of 194 patients with SFTS who were admitted to Yantai City Hospital from November 2019 to November 2021 were included. Patients' demographic and clinical data were collected. According to the clinical prognosis, they were divided into survival and non-survival groups. Independent risk factors were determined by univariate and multivariate logistic regression analyses. FINDINGS There were 171 (88.14%) patients in the survived group and 23 (11.86%) patients in the non-survived group. Patients' mean age was 62.39 ± 11.85 years old, and the proportion of males was 52.1%. Older age, neurological manifestations, hemorrhage, chemosis, and increased levels of laboratory variables, such as EOS% and BAS% on admission, were found in the non-survival group compared with the survival group. EOS%, BAS%, aspartate aminotransferase (AST), direct bilirubin (DBIL), and older age on admission were noted as independent risk factors for poor prognosis of SFTS patients. The combination of the EOS% and BAS% had an area under the curve (AUC) of (0.82; 95% CI: 0.725, 0.932, P = 0.000), which showed an excellent performance in predicting prognosis of patients with SFTS compared with neutrophil-to-lymphocyte ratio (NLR), and both exhibited a satisfactory performance in predicting poor prognosis compared with De-Ritis ratio (AST/alanine aminotransferase (ALT) ratio). EOS% and BAS% were positively correlated with various biomarkers of tissue damage and the incidence of neurological complications in SFTS patients. CONCLUSION EOS% and BAS% are effective predictors of poor prognosis of patients with early-stage SFTS. The combination of EOS% and BAS% was found as the most effective approach.
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Affiliation(s)
- Zishuai Liu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rongling Zhang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanni Liu
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Ruize Ma
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ligang Zhang
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Zhe Zhao
- 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
| | - Xingxiang Ren
- 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 City Hospital for Infectious Disease, Yantai, China,* E-mail: (LL); (ZC)
| | - Zhihai Chen
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China,* E-mail: (LL); (ZC)
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Dai ZN, Peng XF, Li JC, Zhao J, Wu YX, Yang X, Yang T, Zhang SF, Dai K, Guan XG, Yuan C, Yang ZD, Cui N, Lu QB, Huang Y, Fan H, Zhang XA, Xiao GF, Peng K, Zhang LK, Liu W, Li H. Effect of genomic variations in severe fever with thrombocytopenia syndrome virus on the disease lethality. Emerg Microbes Infect 2022; 11:1672-1682. [PMID: 35603493 PMCID: PMC9225783 DOI: 10.1080/22221751.2022.2081617] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV), an emerging tick-borne bunyavirus, causes mild-to-moderate infection to critical illness or even death in human patients. The effect of virus variations on virulence and related clinical significance is unclear. We prospectively recruited SFTSV-infected patients in a hotspot region of SFTS endemic in China from 2011 to 2020, sequenced whole genome of SFTSV, and assessed the association of virus genomic variants with clinical data, viremia, and inflammatory response. We identified seven viral clades (I-VII) based on phylogenetic characterization of 805 SFTSV genome sequences. A significantly increased case fatality rate (32.9%) was revealed in one unique clade (IV) that possesses a specific co-mutation pattern, compared to other three common clades (I, 16.7%; II, 13.8%; and III, 11.8%). The phenotype-genotype association (hazard ratios ranged 1.327-2.916) was confirmed by multivariate regression adjusting age, sex, and hospitalization delay. We revealed a pronounced inflammation response featured by more production of CXCL9, IL-10, IL-6, IP-10, M-CSF, and IL-1β, in clade IV, which was also related to severe complications. We observed enhanced cytokine expression from clade IV inoculated PBMCs and infected mice. Moreover, the neutralization activity of convalescent serum from patients infected with one specified clade was remarkably reduced to other viral clades. Together, our findings revealed a significant association between one specific viral clade and SFTS fatality, highlighting the need for molecular surveillance for highly lethal strains in endemic regions and unravelled the importance of evaluating cross-clade effect in development of vaccines and therapeutics.
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Affiliation(s)
- Zi-Niu Dai
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.,College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, People's Republic of China
| | - Xue-Fang Peng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Jia-Chen Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Jing Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Yong-Xiang Wu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Xin Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Tong Yang
- 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
| | - Ke Dai
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Xiu-Gang Guan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Chun Yuan
- The People's Liberation Army 990 Hospital, Xinyang, People's Republic of China
| | - Zhen-Dong Yang
- The People's Liberation Army 990 Hospital, Xinyang, People's Republic of China
| | - Ning Cui
- The People's Liberation Army 990 Hospital, Xinyang, People's Republic of China
| | - Qing-Bin Lu
- School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yong Huang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Hang Fan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 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
| | - Geng-Fu Xiao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Ke Peng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Lei-Ke Zhang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 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.,College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, 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
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de Albuquerque BHDR, de Oliveira MTFC, Aderaldo JF, de Medeiros Garcia Torres M, Lanza DCF. Human seminal virome: a panel based on recent literature. Basic Clin Androl 2022; 32:16. [PMID: 36064315 PMCID: PMC9444275 DOI: 10.1186/s12610-022-00165-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background The seminal virome and its implications for fertility remain poorly understood. To date, there are no defined panels for the detection of viruses of clinical interest in seminal samples. Results In this study, we characterized the human seminal virome based on more than 1,000 studies published over the last five years. Conclusions The number of studies investigating viruses that occur in human semen has increased, and to date, these studies have been mostly prospective or related to specific clinical findings. Through the joint analysis of all these studies, we have listed the viruses related to the worsening of seminal parameters and propose a new panel with the main viruses already described that possibly affect male fertility and health. This panel can assist in evaluating semen quality and serve as a tool for investigation in cases of infertility.
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Chen R, Li Q, Chen H, Yang H, Wei X, Chen M, Wen H. Severe fever with thrombocytopenia syndrome virus replicates in brain tissues and damages neurons in newborn mice. BMC Microbiol 2022; 22:204. [PMID: 35987890 PMCID: PMC9392058 DOI: 10.1186/s12866-022-02609-8] [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: 12/06/2021] [Accepted: 07/27/2022] [Indexed: 11/14/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) virus (SFTSV) is an emerging tick-borne phlebovirus with a high fatality rate of 12–30%, which has an expanding endemic and caused thousands of infections every year. Central nervous system (CNS) manifestations are an important risk factor of SFTS outcome death. Further understanding of the process of how SFTSV invades the brain is critical for developing effective anti-SFTS encephalitis therapeutics. We obeserved changes of viral load in the brain at different time points after intraperitoneal infection of SFTSV in newborn C57/BL6 mice. The virus invaded the brain at 3 h post-infection (hpi). Notably, the viral load increased exponentially after 24 hpi. In addition, it was found that in addition to macrophages, SFTSV infected neurons and replicated in the brain. These findings provide insights into the CNS manifestations of severe SFTS, which may lead to drug development and encephalitis therapeutics.
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Nakada N, Yamamoto K, Tanaka M, Ashizawa H, Yoshida M, Umemura A, Fukuda Y, Katoh S, Sumiyoshi M, Mihara S, Kobayashi T, Ito Y, Ashizawa N, Takeda K, Ide S, Iwanaga N, Takazono T, Tashiro M, Tanaka T, Nakamichi S, Morimoto K, Ariyoshi K, Morita K, Kurihara S, Yanagihara K, Furumoto A, Izumikawa K, Mukae H. Clinical Differentiation of Severe Fever with Thrombocytopenia Syndrome from Japanese Spotted Fever. Viruses 2022; 14:v14081807. [PMID: 36016429 PMCID: PMC9415593 DOI: 10.3390/v14081807] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) and Japanese spotted fever (JSF; a spotted fever group rickettsiosis) are tick-borne zoonoses that are becoming a significant public health threat in Japan and East Asia. Strategies for treatment and infection control differ between the two; therefore, initial differential diagnosis is important. We aimed to compare the clinical characteristics of SFTS and JSF based on symptomology, physical examination, laboratory data, and radiography findings at admission. This retrospective study included patients with SFTS and JSF treated at five hospitals in Nagasaki Prefecture, western Japan, between 2013 and 2020. Data from 23 patients with SFTS and 38 patients with JSF were examined for differentiating factors and were divided by 7:3 into a training cohort and a validation cohort. Decision tree analysis revealed leukopenia (white blood cell [WBC] < 4000/μL) and altered mental status as the best differentiating factors (AUC 1.000) with 100% sensitivity and 100% specificity. Using only physical examination factors, absence of skin rash and altered mental status resulted in the best differentiating factors with AUC 0.871, 71.4% sensitivity, and 90.0% specificity. When treating patients with suspected tick-borne infection, WBC < 4000/µL, absence of skin rash, and altered mental status are very useful to differentiate SFTS from JSF.
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Affiliation(s)
- Nana Nakada
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
- Health Center, Nagasaki University, Nagasaki 852-8521, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
- Correspondence:
| | - Moe Tanaka
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Hiroki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan
| | - Asuka Umemura
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan
| | - Yuichi Fukuda
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan
| | - Shungo Katoh
- Department of General Internal Medicine, Nagasaki Rosai Hospital, Sasebo 857-0134, Japan
| | - Makoto Sumiyoshi
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan
| | - Satoshi Mihara
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan
| | - Tsutomu Kobayashi
- Department of Respiratory Medicine, Sasebo Chuo Hospital, Sasebo 857-1195, Japan
| | - Yuya Ito
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Sasebo Chuo Hospital, Sasebo 857-1195, Japan
- Infectious Disease Experts Training Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Naoki Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Masato Tashiro
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Takeshi Tanaka
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Seiko Nakamichi
- Health Center, Nagasaki University, Nagasaki 852-8521, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Shintaro Kurihara
- Department of Medical Safety, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Akitsugu Furumoto
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan
- Infectious Disease Experts Training Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Koichi Izumikawa
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan
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Li JC, Zhao J, Li H, Fang LQ, Liu W. Epidemiology, clinical characteristics, and treatment of severe fever with thrombocytopenia syndrome. INFECTIOUS MEDICINE 2022; 1:40-49. [PMID: 38074982 PMCID: PMC10699716 DOI: 10.1016/j.imj.2021.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 02/23/2024]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by a novel phlebovirus (SFTS virus, SFTSV) in the family Phenuiviridae of the order Bunyavirales. The disease causes a wide spectrum of clinical signs and symptoms, ranging from mild febrile disease accompanied by thrombocytopenia and/or leukocytopenia to hemorrhagic fever, encephalitis, multiple organ failure, and death. SFTS was first identified in China and was subsequently reported in South Korea and Japan. The case-fatality rate ranges from 2.7% to 45.7%. Older age has been consistently shown to be the most important predictor of adverse disease outcomes. Older age exacerbates disease mainly through dysregulation of host immune cells and uncontrolled inflammatory responses. Tick-to-human transmission is the primary route of human infection with SFTSV, and Haemaphysalis longicornis is the primary tick vector of SFTSV. Despite its high case-fatality rate, vaccines and antiviral therapies for SFTS are not currently available. The therapeutic efficacies of several antiviral agents against SFTSV are currently being evaluated. Ribavirin was initially identified as a potential antiviral therapy for SFTS but was subsequently found to inefficiently improve disease outcomes, especially among patients with high viral loads. Favipiravir (T705) decreased both time to clinical improvement and mortality when administered early in patients with low viral loads. Anti-inflammatory agents including corticosteroids have been proposed to play therapeutic roles. However, the efficacy of other therapeutic modalities, such as convalescent plasma, is not yet clear.
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Affiliation(s)
| | | | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
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Wang L, Xu Y, Zhang S, Bibi A, Xu Y, Li T. The AST/ALT Ratio (De Ritis Ratio) Represents an Unfavorable Prognosis in Patients in Early-Stage SFTS: An Observational Cohort Study. Front Cell Infect Microbiol 2022; 12:725642. [PMID: 35211422 PMCID: PMC8861437 DOI: 10.3389/fcimb.2022.725642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS), a widely prevalent infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV) that carries with it a high mortality rate, has emerged to be a public health concern. This study aimed to investigate the epidemiological and clinical characteristics of patients infected with SFTSV, seeking novel prognostic risk factors for SFTS. Methods In this retrospective and cross-sectional study, confirmed SFTS patients from the First Affiliated Hospital of Anhui Medical University were enrolled from September 1, 2019, to December 12, 2020. Cases were analyzed for epidemiological, demographic, clinical, and laboratory data. Logistic regression models were used to assess the association between predictors and outcome variables. A generalized additive mixed model (GAMM) was conducted to analyze the trending shift of aspartate aminotransferase/alanine transaminase-ratio (AST/ALT-ratio) and platelet (PLT) in SFTS patients treated with ribavirin. p values ≤ 0.05 were considered statistically significant. Results Clinical and laboratory results of 107 hospitalized patients with SFTSV infection were retrospectively described. The mean age at onset of disease was 60.38 ± 11.29 years old and the ratio between male and female was 1:1.2. Fever and thrombocytopenia are hallmark features of SFTS. Furthermore, multiple cases also experienced neurological complications, gastrointestinal/skeletal muscle symptoms together with other non-specific clinical manifestations; laboratory dataset outcomes reported dysregulated levels for routine blood biomarkers, coagulation function, and biochemistry. Overall, 107 patients were segregated into two groups according to patient condition at the clinical endpoint (survivors/non-survivors). SFTS survivors had a higher level of PLT- counts, total protein (TP), and estimated glomerular filtration rate (eGFR), while levels of activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer (D-D), fibrinogen degradation products (FDP), ALT, AST, AST/ALT-ratio, creatinine (Cr), creatine phosphokinase (CK) and procalcitonin (PCT) was higher in non-survivors. Results from univariate Cox regression revealed that elevated levels of FDP, TT, AST/ALT-ratio, PCT, as well as decreased eGFR level and presence of central nervous system symptoms (CNS), were significant predictors for SFTS prognostic, results from multivariate logistic regression analysis in three adjusted models showed AST/ALT-ratio and PCT were independent risk factors for the prognosis of SFTS patients. Kaplan–Meier survival analysis showed that SFTS patients with AST/ALT-ratio >2.683 were associated with a shorter futime (means survival time), therefore indicating an unfavorable prognosis. Treatment with ribavirin could increase PLT count while decreasing AST/ALT-ratio within SFTS patients. Conclusion SFTS is an emerging infectious disease, possibly leading to multiple-organ injury; AST/ALT-ratio was an independent risk factor for the prognosis of SFTS patients. Further investigation should be performed in order to gain more knowledge on this disease and guide clinical management.
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Affiliation(s)
| | | | | | | | | | - Tao Li
- *Correspondence: Tao Li, ; Yuanhong Xu,
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11
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Ashizawa H, Yamamoto K, Ashizawa N, Takeda K, Iwanaga N, Takazono T, Sakamoto N, Sumiyoshi M, Ide S, Umemura A, Yoshida M, Fukuda Y, Kobayashi T, Tashiro M, Tanaka T, Katoh S, Morimoto K, Ariyoshi K, Morimoto S, Tun MMN, Inoue S, Morita K, Kurihara S, Izumikawa K, Yanagihara K, Mukae H. Associations between Chest CT Abnormalities and Clinical Features in Patients with the Severe Fever with Thrombocytopenia Syndrome. Viruses 2022; 14:v14020279. [PMID: 35215872 PMCID: PMC8877260 DOI: 10.3390/v14020279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus. It involves multiple organ systems, including the lungs. However, the significance of the lung involvement in SFTS remains unclear. In the present study, we aimed to investigate the relationship between the clinical findings and abnormalities noted in the chest computed tomography (CT) of patients with SFTS. The medical records of 22 confirmed SFTS patients hospitalized in five hospitals in Nagasaki, Japan, between April 2013 and September 2019, were reviewed retrospectively. Interstitial septal thickening and ground-glass opacity (GGO) were the most common findings in 15 (68.1%) and 12 (54.5%) patients, respectively, and lung GGOs were associated with fatalities. The SFTS patients with a GGO pattern were elderly, had a disturbance of the conscious and tachycardia, and had higher c-reactive protein levels at admission (p = 0.009, 0.006, 0.002, and 0.038, respectively). These results suggested that the GGO pattern in patients with SFTS displayed disseminated inflammation in multiple organs and that cardiac stress was linked to higher mortality. Chest CT evaluations may be useful for hospitalized patients with SFTS to predict their severity and as early triage for the need of intensive care.
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Affiliation(s)
- Hiroki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8102, Japan; (H.A.); (H.M.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
- Correspondence:
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (M.T.); (T.T.); (K.I.)
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
| | - Naoki Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (M.T.); (T.T.); (K.I.)
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
| | - Makoto Sumiyoshi
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan; (M.S.); (S.I.)
| | - Shotaro Ide
- Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan; (M.S.); (S.I.)
| | - Asuka Umemura
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan; (A.U.); (M.Y.); (Y.F.)
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan; (A.U.); (M.Y.); (Y.F.)
| | - Yuichi Fukuda
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan; (A.U.); (M.Y.); (Y.F.)
| | - Tsutomu Kobayashi
- Department of Respiratory Medicine, Sasebo Chuo Hospital, Sasebo 857-1195, Japan;
| | - Masato Tashiro
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (M.T.); (T.T.); (K.I.)
| | - Takeshi Tanaka
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (M.T.); (T.T.); (K.I.)
| | - Shungo Katoh
- Department of General Internal Medicine, Nagasaki Rosai Hospital, Nagasaki 857-0134, Japan;
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (K.M.); (K.A.)
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (K.M.); (K.A.)
| | - Shimpei Morimoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan;
| | - Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (S.I.); (K.M.)
| | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (S.I.); (K.M.)
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan; (M.M.N.T.); (S.I.); (K.M.)
| | - Shintaro Kurihara
- Department of Medical Safety, Nagasaki University Hospital, Nagasaki 852-8102, Japan;
| | - Koichi Izumikawa
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (M.T.); (T.T.); (K.I.)
| | - Katzunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan;
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8102, Japan; (H.A.); (H.M.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan; (N.A.); (K.T.); (N.I.); (T.T.); (N.S.)
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12
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Single-cell landscape of peripheral immune responses to fatal SFTS. Cell Rep 2021; 37:110039. [PMID: 34818556 DOI: 10.1016/j.celrep.2021.110039] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/19/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high fatality. Poor prognosis of SFTS has been associated with dysregulated host immunity; however, the immune patterns associated with pathophysiology involving SFTS exacerbation remain unclear. Here, we show that the single-cell landscape of peripheral immune responses is reprogrammed in SFTS and characterized by monocyte shift to an intermediate type along with complement activation, perturbation of plasmablast composition, and highly exhausted T cells, all correlated with lethal consequences. We identify the overexpression of interferon (IFN)-stimulated genes across most immune cell types after SFTSV infection, which are simultaneously related to older age, high viremia, and a hyperinflammatory response. A retrospective clinical study reveals no efficiency of IFN-α in treating SFTS. These data collectively support the intermediate monocytes and IFN-I-inducible plasmablasts to be major targets for SFTS virus infection, and they indicate the pivotal role of the IFN-I response in exacerbating hyperinflammation and lethal SFTS.
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13
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Clinical Update of Severe Fever with Thrombocytopenia Syndrome. Viruses 2021; 13:v13071213. [PMID: 34201811 PMCID: PMC8310018 DOI: 10.3390/v13071213] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile illness characterized by fever, leukopenia, thrombocytopenia, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting resulting from infection with the SFTS virus (SFTSV). The SFTSV is transmitted to humans by tick bites, primarily from Haemaphysalis longicornis, Amblyomma testudinarium, Ixodes nipponensis, and Rhipicephalus microplus. Human-to-human transmission has also been reported. Since the first report of an SFTS patient in China, the number of patients has also been increasing. The mortality rate of patients with SFTS remains high because the disease can quickly lead to death through multiple organ failure. In particular, an average fatality rate of approximately 20% has been reported for SFTS patients, and no treatment strategy has been established. Therefore, effective antiviral agents and vaccines are required. Here, we aim to review the epidemiology, clinical manifestations, laboratory diagnosis, and various specific treatments (i.e., antiviral agents, steroids, intravenous immunoglobulin, and plasma exchange) that have been tested to help to cope with the disease.
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14
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Li H, Jiang XM, Cui N, Yuan C, Zhang SF, Lu QB, Yang ZD, Xin QL, Song YB, Zhang XA, Liu HZ, Du J, Fan XJ, Yuan L, Yuan YM, Wang Z, Wang J, Zhang L, Zhang DN, Wang ZB, Dai K, Bai JY, Hao ZN, Fan H, Fang LQ, Xiao G, Yang Y, Peng K, Wang HQ, Li JX, Zhang LK, Liu W. Clinical effect and antiviral mechanism of T-705 in treating severe fever with thrombocytopenia syndrome. Signal Transduct Target Ther 2021; 6:145. [PMID: 33859168 PMCID: PMC8050330 DOI: 10.1038/s41392-021-00541-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/24/2021] [Accepted: 02/27/2021] [Indexed: 11/08/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) virus (SFTSV) is an emerging tick-borne virus with high fatality and an expanding endemic. Currently, effective anti-SFTSV intervention remains unavailable. Favipiravir (T-705) was recently reported to show in vitro and in animal model antiviral efficacy against SFTSV. Here, we conducted a single-blind, randomized controlled trial to assess the efficacy and safety of T-705 in treating SFTS (Chinese Clinical Trial Registry website, number ChiCTR1900023350). From May to August 2018, laboratory-confirmed SFTS patients were recruited from a designated hospital and randomly assigned to receive oral T-705 in combination with supportive care or supportive care only. Fatal outcome occurred in 9.5% (7/74) of T-705 treated patients and 18.3% (13/71) of controls (odds ratio, 0.466, 95% CI, 0.174-1.247). Cox regression showed a significant reduction in case fatality rate (CFR) with an adjusted hazard ratio of 0.366 (95% CI, 0.142-0.944). Among the low-viral load subgroup (RT-PCR cycle threshold ≥26), T-705 treatment significantly reduced CFR from 11.5 to 1.6% (P = 0.029), while no between-arm difference was observed in the high-viral load subgroup (RT-PCR cycle threshold <26). The T-705-treated group showed shorter viral clearance, lower incidence of hemorrhagic signs, and faster recovery of laboratory abnormities compared with the controls. The in vitro and animal experiments demonstrated that the antiviral efficacies of T-705 were proportionally induced by SFTSV mutation rates, particularly from two transition mutation types. The mutation analyses on T-705-treated serum samples disclosed a partially consistent mutagenesis pattern as those of the in vitro or animal experiments in reducing the SFTSV viral loads, further supporting the anti-SFTSV effect of T-705, especially for the low-viral loads.
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Affiliation(s)
- Hao Li
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Xia-Ming Jiang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China
| | - Ning Cui
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Chun Yuan
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Shao-Fei Zhang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Qing-Bin Lu
- School of Public Health, Peking University, Beijing, P. R. China
| | - Zhen-Dong Yang
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Qin-Lin Xin
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China
| | - Ya-Bin Song
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Xiao-Ai Zhang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Hai-Zhou Liu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China
| | - Juan Du
- School of Public Health, Peking University, Beijing, P. R. China
| | - Xue-Juan Fan
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Lan Yuan
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Yi-Mei Yuan
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Zhen Wang
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Juan Wang
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Lan Zhang
- The 154 Hospital, People's Liberation Army, Xinyang, Henan, P. R. China
| | - Dong-Na Zhang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Zhi-Bo Wang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Ke Dai
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Jie-Ying Bai
- Institute of Molecular Medicine, Peking University, Beijing, P. R. China
| | - Zhao-Nian Hao
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hang Fan
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Li-Qun Fang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Gengfu Xiao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China
| | - Yang Yang
- Department of Biostatistics and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Ke Peng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China
| | - Hong-Quan Wang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China
| | - Jian-Xiong Li
- Department of Cancer, People's Liberation Army General Hospital, Beijing, P. R. China.
| | - Lei-Ke Zhang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, P. R. China.
| | - Wei Liu
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P. R. China.
- Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing, P. R. China.
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Residual and Late Onset Symptoms Appeared in a Patient with Severe Fever with Thrombocytopenia in a Convalescence Stage. Viruses 2021; 13:v13040657. [PMID: 33920248 PMCID: PMC8069184 DOI: 10.3390/v13040657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by Dabie bandavirus (formerly SFTS virus, SFTSV). Its manifestations during the convalescent phase have not been widely described. We report a patient presenting with hematospermia, fatigue, myalgia, alopecia, insomnia, and depression during the recovery phase of SFTS. Since these symptoms are widely observed in patients with viral hemorrhagic fevers, there might be common mechanisms between SFTS and other viral hemorrhagic fevers. Close monitoring may be required during the recovery phase of SFTS.
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Wang X, Lin L, Zhao Z, Zhou W, Ge Z, Shen Y, Wang L, Zhang W, Song R, Tian D, Wen J, Cui S, Yu X, Feng Y, Liu Y, Qiang C, Duan J, Ma Y, Li X, Fan T, Zhao Y, Chen Z. The predictive effect of the platelet-to-lymphocyte ratio (PLR) and the neutrophil-to-lymphocyte ratio (NLR) on the risk of death in patients with severe fever with thrombocytopenia syndrome (SFTS): a multi-center study in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:208. [PMID: 33708835 PMCID: PMC7940944 DOI: 10.21037/atm-20-4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Severe fever with thrombocytopenia syndrome is caused by infection with the severe fever with thrombocytopenia syndrome virus. Methods Between April 2011 and December 2019, data on consecutive patients who were diagnosed with severe fever with thrombocytopenia syndrome were prospectively collected from five medical centers in China. The score of the death risk model was correlated with the platelet-to-lymphocyte ratio and the neutrophil-to-lymphocyte ratio. Multivariable Cox analyses were used to identify the independent factors associated with mortality. Results During the study period, 763 patients were diagnosed with severe fever with thrombocytopenia syndrome; 415 of these patients were enrolled in our study. We found that the neutrophil-to-lymphocyte ratio of the group that died was significantly higher on admission (P=0.007) than that of the group that survived, and the neutrophil-to-lymphocyte ratio showed a positive correlation with the score of the death risk model. Multivariate Cox regression suggested that a neutrophil-to-lymphocyte ratio greater than 5.4 was an independent risk factor for survival time (HR=6.767, P=0.011). Platelet-to-lymphocyte ratio did not show a special role in this study. Conclusions A neutrophil-to-lymphocyte ratio greater than 5.4 can increase the risk of death and decrease the survival time of patients. In summary, the neutrophil-to-lymphocyte ratio provides a supplementary means for effectively managing severe fever with thrombocytopenia syndrome (SFTS).
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Affiliation(s)
- Xiankun Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Ling Lin
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Zhenghua Zhao
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Wei Zhou
- Department of Infectious Diseases, Dalian sixth people's hospital, Dalian, China
| | - Zirou Ge
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Lin Wang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Wei Zhang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Rui Song
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Di Tian
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Jing Wen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Shuping Cui
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Xiaoli Yu
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Yang Feng
- Department of Infectious Diseases, Taian City Central Hospital, Taian, China
| | - Yuanni Liu
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Chunqian Qiang
- Department of Infectious Diseases, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Jianping Duan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yanli Ma
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Xingwang Li
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
| | - Tianli Fan
- Department of Infectious Diseases, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhihai Chen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University. Beijing, China
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Sun JM, Wu HX, Lu L, Liu Y, Mao ZY, Ren JP, Yao WW, Qu HH, Liu QY. Factors associated with spatial distribution of severe fever with thrombocytopenia syndrome. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 750:141522. [PMID: 32846249 DOI: 10.1016/j.scitotenv.2020.141522] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) was firstly identified in mainland China in 2009 and the geographic distribution has expanded in recent years. In this study, we constructed ecological niche models (ENM) of SFTS with meteorological factors, environmental factor, and density of domestic animals using MaxEnt. We found four significant associated factors including altitude, yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity which accounted for 94.1% percent contribution. SFTS occurrence probability was high when altitude was between -100 m and 100 m, and the probability was nearly 0 when altitude was beyond 3000 m. Response curves of SFTS to the yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity were all reversed V-shape. SFTS occurrence probability was high where the yearly average temperature, yearly accumulated precipitation, and yearly relative humidity were 12.5-17.5 °C, 700-2250 mm and 63-82%, respectively. ENMs predicted that the potential high-risk areas were mainly distributed in eastern areas and central areas of China. But there were some predicted potential high-risk areas where no SFTS case was reported up to date. More researches should be done to make clear whether SFTS case had occurred in these areas.
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Affiliation(s)
- Ji-Min Sun
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Hai-Xia Wu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Liang Lu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Ying Liu
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, China
| | | | - Jiang-Ping Ren
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Wen-Wu Yao
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Hong-Hua Qu
- Qilu Hospital of Shandong University, China.
| | - Qi-Yong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, China.
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18
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Li J, Li S, Yang L, Cao P, Lu J. Severe fever with thrombocytopenia syndrome virus: a highly lethal bunyavirus. Crit Rev Microbiol 2020; 47:112-125. [PMID: 33245676 DOI: 10.1080/1040841x.2020.1847037] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel bunyavirus. Since 2007, SFTS disease has been reported in China with high fatality rate up to 30%, which drew high attention from Centre for Disease Control and Prevention and government. SFTSV is endemic in the centra l and eastern China, Korea and Japan. There also have been similar cases reported in Vietnam. The number of SFTSV infection cases has a steady growth in these years. As SFTSV could transmitted from person to person, it will expose the public to infectious risk. In 2018 annual review of the Blueprint list of priority diseases, World Health Organisation has listed SFTSV infection as prioritised diseases for research and development in emergency contexts. However, the pathogenesis of SFTSV remains largely unclear. Currently, there are no specific therapeutics or vaccines to combat infections of SFTSV. This review discusses recent findings of epidemiology, transmission pathway, pathogenesis and treatments of SFTS disease.
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Affiliation(s)
- Jing Li
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Shen Li
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Li Yang
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Pengfei Cao
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Jianhong Lu
- NHC Key Laboratory of Carcinogenesis, Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.,Department of Microbiology, School of Basic Medical Sciences, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
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19
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Crump A, Tanimoto T. Severe Fever with Thrombocytopenia Syndrome: Japan under Threat from Life-threatening Emerging Tick-borne Disease. JMA J 2020; 3:295-302. [PMID: 33225100 PMCID: PMC7676996 DOI: 10.31662/jmaj.2019-0073] [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: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
Japan, like many other parts of the world, is under threat from newly emerging, potentially fatal diseases. Severe fever with thrombocytopenia syndrome (SFTS), first clinically identified in 2009, is an emerging tick-borne hemorrhagic viral disease, currently limited in distribution to East Asia. Relatively little is known about the disease with an initial Case Fatality Rate ranging from 5% to 40%. It primarily affects the elderly living in rural areas, which is particularly troublesome given Japan’s rapidly aging population. Control efforts are severely hampered by lack of specific knowledge of the disease and its means of transmission, coupled with the absence of both a vaccine and an effective treatment regime, although some antiviral drugs and blood transfusions are successful in treating the disease. Despite both the causative virus and vector ticks being commonly found throughout Japan, the disease shows a very specific, limited geographical distribution for as yet unknown reasons.
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20
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Blitvich BJ, Magalhaes T, Laredo-Tiscareño SV, Foy BD. Sexual Transmission of Arboviruses: A Systematic Review. Viruses 2020; 12:v12090933. [PMID: 32854298 PMCID: PMC7552039 DOI: 10.3390/v12090933] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022] Open
Abstract
Arthropod-borne viruses (arboviruses) are primarily maintained in nature in transmission cycles between hematophagous arthropods and vertebrate hosts, but an increasing number of arboviruses have been isolated from or indirectly detected in the urogenital tract and sexual secretions of their vertebrate hosts, indicating that further investigation on the possibility of sexual transmission of these viruses is warranted. The most widely recognized sexually-transmitted arbovirus is Zika virus but other arboviruses, including Crimean-Congo hemorrhagic fever virus and dengue virus, might also be transmitted, albeit occasionally, by this route. This review summarizes our current understanding on the ability of arboviruses to be sexually transmitted. We discuss the sexual transmission of arboviruses between humans and between vertebrate animals, but not arthropod vectors. Every taxonomic group known to contain arboviruses (Asfarviridae, Bunyavirales, Flaviviridae, Orthomyxoviridae, Reoviridae, Rhabdoviridae and Togaviridae) is covered.
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Affiliation(s)
- Bradley J. Blitvich
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA;
- Correspondence: ; Tel.: +1-515-294-9861; Fax: +1-515-294-8500
| | - Tereza Magalhaes
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.M.); (B.D.F.)
| | - S. Viridiana Laredo-Tiscareño
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA;
| | - Brian D. Foy
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.M.); (B.D.F.)
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Akagi K, Miyazaki T, Oshima K, Umemura A, Shimada S, Morita K, Senju H, Tashiro M, Takazono T, Saijo T, Kurihara S, Sekino M, Yamamoto K, Imamura Y, Izumikawa K, Yanagihara K, Uda A, Morikawa S, Yoshikawa T, Kurosu T, Shimojima M, Saijo M, Mukae H. Detection of viral RNA in diverse body fluids in an SFTS patient with encephalopathy, gastrointestinal bleeding and pneumonia: a case report and literature review. BMC Infect Dis 2020; 20:281. [PMID: 32295538 PMCID: PMC7160946 DOI: 10.1186/s12879-020-05012-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that commonly has a lethal course caused by the tick-borne Huaiyangshan banyang virus [former SFTS virus (SFTSV)]. The viral load in various body fluids in SFTS patients and the best infection control measure for SFTS patients have not been fully established. CASE PRESENTATION A 79-year-old man was bitten by a tick while working in the bamboo grove in Nagasaki Prefecture in the southwest part of Japan. Due to the occurrence of impaired consciousness, he was referred to Nagasaki University Hospital for treatment. The serum sample tested positive for SFTSV-RNA in the genome amplification assay, and he was diagnosed with SFTS. Furthermore, SFTSV-RNA was detected from the tick that had bitten the patient. He was treated with multimodal therapy, including platelet transfusion, antimicrobials, antifungals, steroids, and continuous hemodiafiltration. His respiration was assisted with mechanical ventilation. On day 5, taking the day on which he was hospitalized as day 0, serum SFTSV-RNA levels reached a peak and then decreased. However, the cerebrospinal fluid collected on day 13 was positive for SFTSV-RNA. In addition, although serum SFTSV-RNA levels decreased below the detectable level on day 16, he was diagnosed with pneumonia with computed tomography. SFTSV-RNA was detected in the bronchoalveolar lavage fluid on day 21. By day 31, he recovered consciousness completely. The pneumonia improved by day 51, but SFTSV-RNA in the sputum remained positive for approximately 4 months after disease onset. Strict countermeasures against droplet/contact infection were continuously conducted. CONCLUSIONS Even when SFTSV genome levels become undetectable in the serum of SFTS patients in the convalescent phase, the virus genome remains in body fluids and tissues. It may be possible that body fluids such as respiratory excretions become a source of infection to others; thus, careful infection control management is needed.
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Affiliation(s)
- Kazumasa Akagi
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Respiratory Medicine, Nagasaki Prefecture Shimabara Hospital, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. .,Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kazuhiro Oshima
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Internal Medicine, Goto Central Hospital, Nagasaki, Japan
| | - Asuka Umemura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Present Address: Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo, Japan
| | - Satoshi Shimada
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomomi Saijo
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Shintaro Kurihara
- Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Uda
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigeru Morikawa
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takeshi Kurosu
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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