Epidemiological investigation and genomic characterization of the first case of fever with thrombocytopenia syndrome in Puyang / 中华微生物学和免疫学杂志

Objective:To report the first case of sever fever with thrombocytopenia syndrome caused by severe fever with thrombocytopenia syndrome virus (SFTSV) in Puyang city, and to study the epidemiological and molecular characteristics of S, M, L fragments of the SFTSV isolate.Methods:The epidemiological characteristics of this case was analyzed with epidemiological methods. SFTSV was isolated from the patient′s serum sample. Nucleic acid of SFTSV was extracted and detected by fluorescent RT-PCR. A multiplex PCR method was constructed to amplify the nucleic acid sequence of the virus. whole-genome sequencing was performed on the next-generation sequencing platform. MEGA11 and DNAStar was used for homology analysis and a phylogenetic tree was constructed.Results:Epidemiological investigation showed that the patient and his close contacts had no history of travel or tick bite within 14 d, but had a history of fieldwork. The patient′s serum sample was positive for SFTSV nucleic acid. Genetic analysis showed that the S, M, L gene fragments of the first SFTSV isolate in Puyang belonged to genotype E. This isolate shared 94.8%-99.6%, 94.0%-99.8% and 95.7%-99.7% nucleotide sequence homology with the representative strains acquired from GeneBank in S, M, L gene fragments, respectively.Conclusions:This case was the first case of SFTSV-caused severe fever with thrombocytopenia syndrome in Puyang. The SFTSV isolate shared a close homology with domestic isolates, but its genotype was significantly different from the SFTSV strains isolated in Henan in recent years, indicating that it might an imported case from other places in Henan Province or Hubei Province. Disease monitoring and professional training for medical personnel should be strengthened and more attention should be paid to the evolution and mutation of SFTSV.

Vector biological monitoring and strategy to prevent and control severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) in Daishan Country Zhoushan Islands 2011-2018 / 上海预防医学

Objective To study the severe fever with thrombocytopenia syndrome bunyavirus (SFTSV)-related vector biological monitoring in Daishan County, Zhoushan Island of Zhejiang Province, and to explore the prevention and control strategies. Methods The monitoring was conducted as follows:squirrel-cage method was used for rodents from 2012 to 2014;the Buqi method for free tick density in villages and towns with confirmed cases in Daishan County from 2015 to 2018;and body surface comb method for parasitic ticks.RT-PCR method was used to detect SFTSV in ticks and rat specimens.Epidemiological survey followed by extensive health education was conducted from 2011 to 2015.Comprehensive health prevention and control measures, such as precision health education and chemical elimination of vectors were taken from 2016 to 2018. Results A total of 327 rodents were captured, including 172 stinking shrews, accounting for 52.60%, and 92 yellow mice, accounting for 28.13%.The main species of ticks was Haematopsus longicortus, accounting for 94.20%.Among them, there were 135 parasitic ticks in three species:Haematopsus longicorum, S.scallopus, and T.nigra. There were 382 free ticks in 6 species, including Haematopsichum longicorum, Sickle fan tick, Hemophilus fannicus, Ixodes ovaliformis, Ixodes granulata, and Ixodes sinensis.From May to October in 2015, the density of field ticks was ≥50 per cloth flag.From May 2016 to 2018, after the elimination application of chemical agents for elimination, the density of ticks was ≤50 per cloth flag.All ticks and rodent specimens tested by RT-PCR were negative for SFTSV.Since precision education in 2016, the awareness rate of SFTS in rural areas has increased from 32.05% to 83.33%.Approximately 70 early warning notices for the epidemic situation were issued in advance.Since 2017, the number of SFTS has been declining year by year, and only 8 cases occurred in 2018. Conclusion In the field environment, chlorothalonil is the dominant mouse species and long horn blood ticks are the dominant ticks.The government leadership, cooperation among departments, technical service provided by professional organization, health education, reduction of tick density in residential environment, timely risk early warning notice, and other comprehensive prevention and control hand strategy all contribute to the achieved result of prevention and control.

Analysis of three family clusters of severe fever with thrombocytopenia syndrome by exposure risk matrix / 预防医学

Objective@#To analyze three events of severe fever with thrombocytopenia syndrome （SFTS） among family members by exposure risk matrix, so as to provide reference for SFTS prevention and control.@*Methods @#The field investigation and clinical data of seven confirmed cases with SFTS reported in Linhai from 2014 to 2016 were collected. Exposure risk matrix was used to list the risk of exposure two weeks before the onset, such as the environment, duration of activity and protection, and evaluate the possible routes of transmission. @*Results@#The first event involved three sisters. Two of them had plucked tea together on a hill, and the possibility of infection through tick bites were 60% and 75%, respectively. Another sister was more likely to be infected by ticks in her residence after visiting her sister （no physical contact with the sick sister）, with a possibility of 74%. The second event involved two cases （mother and son）. They were more likely to be infected by ticks in the current residential area, and the possibility were 100% and 80%, respectively. The third event involved two cases （husband and wife）. The wife had 60% possibility of being infected by the ticks on the hill she picked arbutus, and 40% by the ticks in her residence. The husband was most likely to be infected through contacting with body fluids or blood of his wife （44%）, then through the ticks on the hill he picked arbutus （33%）. @*Conclusion@#Among seven cases with SFTS reported in Linhai from 2014 to 2016, six cases have more than 50% possibility of being infected by tick bites; one case has higher possibility of being infected by contacting with body fluids or blood of a patient, but tick bites could not be ruled out.

Congenital abnormalities and arthrogryposis in newly born lambs in Al Muthanna province Iraq. Suspicion of Akabane virus infection / Anormalidades congênitas e artrogripose em cordeiros recém-nascidos na província de Al Muthanna, Iraque. Suspeita de infecção pelo vírus Akabane

Akabane virus, a member of the Orthobunyavirus genus in the family Bunyaviridae, causes congenital abnormalities and arthrogryposis with hydrocephalus or hydroencephaly in ruminants. This study intends to describe the clinical signs, gross and histopathological features seen in 25 affected lambs in an outbreak of congenital arthrogryposis with hydrocephalus or hydranencephaly in Al-Muthanna governorate, Iraq after a large number of stillbirths and musculoskeletal deformities from October 2017 to May 2018. Skeletal muscle hypoplasia was seen in the limbs of the affected lambs accompanied with severe arthrogryposis and gross visible brain malformations. In addition, fetal mummifications, stillbirths, and dead lambs were also seen. The most histopathological features in muscle fibers were degenerative lesions and absences of cross-striation accompanied with mild infiltration of neutrophils and mononuclear cells in severely affected lambs. The meninges of affected lambs revealed fused membranes with focal areas of fibrous thickenings and necrotic debris. In conclusion, according to clinical signs, gross and histopathological investigations, Akabane virus, a member of the Orthobunyavirus genus in the family Bunyaviridae, causes congenital abnormalities and arthrogryposis with hydrocephalus or hydroencephaly in ruminants and could be the cause of this outbreak, although future studies must be performed to confirm the etiology of this outbreak. Moreover, other causes of hydrocephalus or cerebellar malformation, such as Schmallenberg virus, bluetongue virus and border disease virus and teratogenic plants that lead to arthrogryposis, have to be investigated. Also, the authorities should take prevention and control measurements to stop the replication of arthropod vectors.(AU)

O presente trabalho descreve os sinais clínicos, as lesões macroscópicas e os aspectos histológicos observados em 25 cordeiros acometidos em um surto de artrogripose congênita com hidrocéfalo ou hidrocefalia registrado no Iraque, governadoria Al-Muthama após a ocorrência de nascimentos prematuros e deformidades músculo-esqueléticas no período compreendido entre outubro de 2017 e maio de 2018. A hipoplasia músculo-esquelética foi observada nos membros dos cordeiros afetados, acompanhada de severa artrogripose e malformações cerebrais, grosseiras visíveis, além de mumificações fetais, nascimentos prematuros e morte de cordeiros. Os principais aspectos histopatológicos nas fibras musculares foram lesões degenerativas e ausências da estriação cruzada acompanhada de leve infiltração de neutrófilos e células mononucleares dos cordeiros severamente afetados. As meninges dos cordeiros afetados apresentaram fusão de membranas com áreas focais de espessamento fibroso e debris necróticos. O vírus Akabane, um membro do gênero Orthobunyavirus, da família Bunyaviridae, causa anormalidades congênitas e artrogripose com hidrocéfalo e hidrocefalia em ruminantes e poderá vir a ser a causa do presente surto. Os autores recomendam a realização de novos estudos com investigações epidemiológicas e isolamento do agente causal. Contudo, outras causas de hidrocéfalo ou malformações cerebrais como as determinadas pelo vírus Schmallenberg, vírus da língua azul e vírus da doença de border, bem como de plantas teratogênicas que determinam a artrogripose, também deverão ser investigadas. As autoridades sanitárias deverão tomar medidas de prevenção e controle para bloquear a replicação do vírus em artrópodes vetores.(AU)

Analysis on the epidemiology and etiologic characteristics of first imported severe fever with thrombocytopenia syndrome case in Shenzhen / 中华实验和临床病毒学杂志

Objective@#To study the epidemiology and the etiology characteristics of first imported severe fever with thrombocytopenia syndrome (SFTS) case reported in Shenzhen city in 2017.@*Methods@#Data on descriptive epidemiology was collected to study the characteristics to the epidemic. The serum sample collected from the suspect SFTS case was detected for IgM, IgG by ELISA and severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) nucleic acid by real-time RT-PCR. The samples were further inoculated in Vero cell for virus isolation. The partial fragements of L and S gene were amplified by RT-PCR and sequenced to construct homology comparison and phylogenetic tree with the strains isolated from other areas.@*Results@#The case was laboratory confirmed imported SFTS case in Shenzhen on May 2017. IgM antibody and RNA of SFTSV were detected in the serum sample. SFTSV named GDSZ01/2017/China was successfully isolated from the serum sample. The high nucleotide homology of L and S genome segments were found at 95.3%-98.2% and 93.8%-98.8% with other representative strains from the popular provinces, respectively. The phylogenetic tree indicated that GDSZ01 was most close to SDTA_3 strain, next to strains in Hubei procince. The isolated SFTSV belonged to genotype C3 with HB29, HB154.@*Conclusions@#The virological, serological and molecular features showed that the imported case of SFTS in 2017 was caused by SFTSV C3 genotype.

Differences of clinical manifestations and organ damage between patients with severe fever with thrombocytopenia syndrome and patients with tsutsugamushi disease / 中华传染病杂志

Objective To analyze the differences of clinical manifestations and organ damage between patients with severe fever with thrombocytopenia syndrome(SFTS)and patients with tsutsugamushi disease,and to investigate the prognostic factors of SFTS.Methods The research was performed on 49 patients with SFTS and 16 patients with tsutsugamushi disease who visited the First Affiliated Hospital of Anhui Medical University from October 2014 to June 2017.The general information of patients including region,age,gender and clinical manifestations were evaluated.Blood routine,liver and kidney function,myocardial enzyme levels,lipase,amylase,electrolytes,C-reactive protein,procalcitonin,prothrombin time(PT)and activated partial thromboplastin time(APTT)were continuously monitored during the course of disease.T test was used for continuous variables of normal distribution,and non-parametric test was used for variables of non-normal distribution.Chi-square test was used for categorical variables.Results The mean age of SFTS patients was 62.1±15.5(ranging from 17 to 87 years)and the mean age of tsutsugamushi patients was 56.1±9.2(ranging from 47 to 73 years).There was no significant difference between the two groups(t=1.47,P=0.147).There were 25 males(51%)in SFTS patients and 8 males(50%)in tsutsugamushi disease patients.There was no significant difference between the two groups(x2=0.005,P=0.943).The incidences of headache,vomiting,superficial lymphadenectasis,disturbance of consciousness,proteinuria,hematuria,pulmonary infection,multiple organ dysfunction and acute pancreatitis in SFTS patients were all significantly higher than those in tsutsugamushi disease patients(x2=8.82,4.38,8.71,11.17,7.88,5.56,4.35,9.43,and 8.13,respectively,P <0.05 or 0.01).The counts of leukocytes(Z=2.73),neutrophils(Z=2.46),lymphocytes(Z=3.15),platelets(Z=4.25),albumin(Z=2.65)and sodium ion(t=2.10)in SFTS patients were all significantly lower than those in patients with tsutsugamushi disease(P <0.05 or 0.01).The levels of aspartate aminotransferase(Z=2.94),lactate dehydrogenase(Z=3.42),creatine kinase(CK)(Z=2.88),amylase(Z=2.11),lipase(Z=2.82),creatinine(Z=2.07)and urea nitrogen(Z=2.50)in fatal SFTS patients were all significantly higher than those in patients with tsutsugamushi disease(P <0.05 or 0.01).Among 49 SFTS patients,16 patients died and 33 patients recovered finally.The age(t=3.33),platelet count(Z=2.55),alanine aminotransferase(ALT)(Z=2.10),aspartate aminotransferase(AST)(Z=2.22),lactate dehydrogenase(Z=2.26),CK(Z=3.50),CK-MB(Z=3.10),creatinine(Z=2.17),urea nitrogen(Z=2.36),and sodium(t=2.65)between the two subgroups had significant differences(P <0.05 or 0.01).Conclusions SFTS is more severe and has high mortality,while tsutsugamushi disease has a better prognosis.Early differential diagnosis and early rational treatment are important to reduce the mortality of patients with SFTS.

Risk factors for mortality in patients with severe fever with thrombocytopenia syndrome / 中华传染病杂志

Objective To analyze the clinical features and risk factors for mortality of patients with severe fever with thrombocytopenia syndrome (SFTS) in Zhoushan, the eastern coastal of China with high incidence of severe fever with thrambocytopenia syndrome bunyavirus infection, to provide reference for reducing the mortality rate of SFTS.Methods Clinical data of 107 cases of SFTS from Zhoushan Hospital during June 2011 to June 2016 were retrospectively analyzed.According to the prognosis, patients were divided into survival group and death group.The clinical features and the laboratory results were analyzed with a case-control method to analyze the prognostic factors.Normal distribution data were compared with the independent t test.Kolmogorov-Smirnov Z test were used in data with skewness distribution.Categorical data were analyze by chi-square test.The related risk factors were analyzed with the receiver-operating characteristic (ROC) curve and multivariate unconditioned logistics regression analysis.Results Seventeen cases among 107 STFs patients died, yielding the mortality rate of 15.9%.The proportion of patients suffering from two or more underlying diseases, with disorders of consciousness, activated partial thromboplastin time (APTT), the level of creatine kinase (CK), lactate dehydrogenase (LDH) as well as sepsis-related or sequential organ failure assessment (SOFA) score in death group were all significantly higher than those in the survival group (all P73.45 s, SOFA scores >9 were the independent risk factors for mortality of SFTS (OR=6.947, 8.459 and 11.770, respectively, all P<0.05).Conclusion Ca2+, APTT and SOFA score are the independent risk factors for prognosis of SFTS, which provide reference for prognostic evaluation of SFTS.

An investigation on the serum epidemiology of the new-Bunyavirus among the blood-donors in Guiyang city / 国际检验医学杂志

Objective To investigate the potential infectious of the new-Bunyavirus among the blood-donors in Guiyang area.Methods A total of 1 187 blood samples and the basic data were collected from the blood center of Guizhou.The new-Bunyavirus total antibody in serum was tested by enzyme-linked immunosorbent assay(ELISA).The samples were tested repeatedly by ELSIA,and general statistics description of the samples′ data was did by Excel2007,and the age,gender,occupation and collecting time of the samples were analyzed by SPSS19.0.Results The positive rate of new-Bunyavirus total antibody among blood-donors in Guiyang was 5.31%,and the new-Bunyavirus total antibody titers was 1∶20-1∶64.The positive were tested by PCR for identifying,PCR results of all positive samples were negative.The positive rates between different genders,ages,occupations,and nationalities were not statistically significant(P>0.05),but the difference of positive rates between epidemic period and later stages of the epidemic was statistically significant(χ2=4.623,P=0.032).Conclusion There are new-Bunyavirus total antibody positive samples in blood-donors,noticing that there is a possibility of potential infection among Guiyang blood-donors and even healthy people.

Laboratory investigation of reactive plasmacytosis in patients with severe fever with throbocytopenia syndrome / 中华传染病杂志

Objective To investigate the immunological characteristics and clinical significance of reactive plasmacytosis in patients with severe fever with throbocytopenia syndrome (SFTS).Methods Bunyavirus-infected patients who were diagnosed with SFTS were collected from March 2015 to October 2015 in Taizhou Hospital.Morphology analysis of bone marrow and peripheral blood (PB) smear, as well as flow cytometry analysis of plasma cell immune phenotype from peripheral blood were conducted.Serum immunoglobulin levels and helper T hymphocytes (Th)1/Th2 cytokine expressions were detected.Mann-Whitney U test was used.Results PB plasma cells from all of the SFTS patients increased in varying degrees, and the phenotype of the plasma cells was CD19+CD38++CD45+CD138+, which indicated normal mature plasma cells.The ratio of PB plasma cells was >0.030 in 10/16 patients, and >0.300 in 2/16 patients.The ratios of PB plasma cells in the patients with severe and critical groups were significantly higher than that in the mild group (0.052 vs 0.016, P0.05).The serum IgG, IgA and IgM levels did not increase in acute stage, with the median of 11.6 g/L, 2.56 g/L and 1.60 g/L (reference value 0.46 to 3.04 g/L), respectively.Conclusion The patients with SFTS show excessive humoral and cellular immunity, and the severity of disease is positively correlated with the ratio of peripheral plasma cells and the levels of cytokines IL-6 and IL-10.

The analysis of clinical features and prognosis factors in patients with severe fever with thrombocytopenia syndrome / 中华传染病杂志

Objective To explore the influence of clinical indicators in patients with thrombocytopenia syndrome (SFTS) with severe fever on disease development and prognosis.Methods The SFTS patients who were admitted to the Department of Infection Diseases of Wuhan Union Hospital between April 1, 2015 and October 30, 2015 were included.Among 164 patients with SFTS, there were 136 cases recovered and 28 cases died.Clinical date including clinical manifestations and laboratory test index were collected and retrospectively analyzed.The correlation between the prognosis and clinical indicators were analyzed with the Spearman correlation analysis, the discriminatory power of clinical dates were tested with the area under the receiver-operating characteristic curve.Results The average age of died patients in the study was (64.5±9.1), which increased significantly(t=-3.609,P<0.01) compared with recovered patients with (56.9±10.2).Laboratory results suggest all patients had a drop in white blood cell and platelet count;almost all patients had a drop in serum calcium levels, and a rise in aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase (CK), activated partial thromboplastin time (APTT), D-dimmer levels.The nucleic acid quantification of SFTSV suggests death patients (5.83±0.98) lg TCID50/mL was significantly higher than the recovered patients (3.96±1.08) lg TCID50/mL, with statistical difference (t=-8.49, P<0.01).Conclusions Age, the nucleic acid quantification of SFTSV, CK and APTT are factors can be used to predict prognosis of SFTS.

Spontaneous Acute Subdural Hemorrhage in a Patient with a Tick Borne Bunyavirus-Induced Severe Fever with Thrombocytopenia Syndrome / 대한신경손상학회지

We report the first case of severe fever with thrombocytopenia syndrome (SFTS) and a spontaneous acute subdural hematoma (SDH) in Korea. A 79-year-old male presented with fever and thrombocytopenia. On the third day of hospitalization, his mental changed from drowsy to semi-coma. Brain computed tomography indicated an acute subdural hemorrhage on the right convexity. He was given early decompressive craniectomy, but did not survive. Real-time reverse transcription polymerase chain reaction analysis of a blood sample indicated the presence of SFTS virus (SFTSV). This is the first reported case with intracranial hemorrhage and SFTS. This case report describes our treatment of a patient with acute SDH and an infection from a tick-borne species of Bunyaviridae.

Clinical analysis of patients with severe fever with thrombocytopenia syndrome bunyavirus infection and hemorrhagic fever with renal syndrome / 中华传染病杂志

Objective To compare the differences of epidemiology, clinical characteristics, laboratory results and prognosis between patients with severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) infection and those with hemorrhagic fever with renal syndrome (HFRS).Methods Medical records of 16 hospitalized cases with SFTSV infection and 28 hospitalized HFRS cases from January 2012 to June 2016 were reviewed in affiliated Yijishan Hospital of Wannan Medical College.In details, the comparative analysis of patients between the two groups were conducted in sex, age, occupation, onset season, contact history, underlying diseases, fever duration, oliguria, bleeding (including petechiae, ecchymoses, gum bleeding, bloody stool and hematuria), secondary infection, consciousness disturbance, dialysis treatment, length of hospital stay, laboratory results and prognosis.Continuous variables of normal, non-normal distribution data were compared using two-sample t test and rank sum test, respectively.Categorical variables were showed in rate and compared using chi-square test.Results The differences between the two groups in age (t=2.585), occupation (χ2=4.914), onset season (χ2=4.325) and contact history (χ2=9.617) were all statistically significant (all P<0.05).In SFTSV infection group, the mean fever duration was (8.81±3.17) d.There were 2 cases of oliguria, 10 cases of bleeding, 7 cases of secondary infection, 5 cases of consciousness disturbance.No patient received dialysis.The average length of hospital stay was (13.44±7.91) d.In HFRS group, the mean fever duration was (5.96±2.20) d.In addition, there were 24 cases of oliguria, 25 cases of bleeding, 9 cases of secondary infection, 3 cases of consciousness disorder.Twelve cases received dialysis treatment in this group.The average length of hospital stay was (18.04±15.75) d.Furthermore, there were significant differences between the two groups in fever duration (t=3.511), oliguria (χ2=22.578), bleeding (χ2=4.490) and dialysis (χ2=7.392) (all P<0.05).The significant differences were also found in white blood cell count, blood urea nitrogen, serum creatinine, albumin, amylase, lipase, creatine kinase, serum sodium, chloride, calcium, carbon dioxide combining power and blood glucose between the SFTSV infection group and HFRS group (all P<0.05).However, there was no significant difference in prognosis between the two groups (Z=1.574, P=0.115).Conclusions There are differences in epidemiological history, clinical manifestations and laboratory findings between the SFTSV infection group and HFRS group, which may help differential diagnosis and treatment of these two diseases.

Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated with SFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompanied with multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis for the treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them with ribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospital with a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experienced persistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reverse transcription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasma exchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admitted to the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empirical antibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administered orally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSV result from a real-time RT-PCR. The patient had a successful recovery.

A Pediatric Case of Severe Fever with Thrombocytopenia Syndrome in Korea

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease and elderly people living in rural areas have the greatest risk of infection. We report the first pediatric case of SFTS in Korea and the clinical characteristics and disease progression in children. A 10-year-old child from Chonnam province visited the hospital with myalgia and a history of fever over the previous 8 days. Her father noticed a tick on her head and removed it before fever developed. Because the symptoms continued, her father consulted the community health center and SFTS virus was detected both from the tick (Haemaphysalis longicornis) and the patient's blood. On hospitalization, fever and severe myalgia were improved and no gastrointestinal and hemorrhagic symptoms were observed. The patient was successfully treated with a combination of steroids, IVIG, and ribavirin. In this report, a pediatric case of SFTS presents a mild clinical course but close attention must be paid to the screening of children with mild symptoms consisting of SFTS.

A review on the epidemiologic features of severe fever with thrombocytopenia syndrome / 中华流行病学杂志

Severe fever with Thrombocytopenia Syndrome (SFTS) is an emerging hemorrhagic fever disease in the rural areas of east-central China,which is caused by SFTSV-a newly discovered bunyavirus.SFTSV is most likely transmitted by tick bites but can also be transmitted within human beings.The onset of SFTS is sudden and with rapid progress,with main clinical manifestations as fever,thrombocytopenia,leucopenia and gastrointestinal and hepatorenal dysfunctions.Some patients may die from multiple organ failure,and the case fatality rate is approximately 10％.In this paper,we use the method of literature review to summarize the recent research progress of SFTS which includes the epidemic distribution characteristics,medium of transmission,host animals,transmission routes and susceptibility in the general population.

A review on the epidemiologic features of severe fever with thrombocytopenia syndrome / 中华流行病学杂志

Severe fever with Thrombocytopenia Syndrome (SFTS) is an emerging hemorrhagic fever disease in the rural areas of east-central China,which is caused by SFTSV-a newly discovered bunyavirus.SFTSV is most likely transmitted by tick bites but can also be transmitted within human beings.The onset of SFTS is sudden and with rapid progress,with main clinical manifestations as fever,thrombocytopenia,leucopenia and gastrointestinal and hepatorenal dysfunctions.Some patients may die from multiple organ failure,and the case fatality rate is approximately 10％.In this paper,we use the method of literature review to summarize the recent research progress of SFTS which includes the epidemic distribution characteristics,medium of transmission,host animals,transmission routes and susceptibility in the general population.

Clinical characteristics and risk factors for mortality of patients with severe fever with thrombocytopenia syndrome / 中华传染病杂志

Objective To summarize the clinical and laboratory characteristics of patients with severe fever with thrombocytopenia syndrome (SFTS ) and to identify the related risk factors for mortality .Methods Clinical features and laboratory parameters were collected from 40 SFTS patients (7 deaths and 33 survivors) .Dynamic changes of laboratory data were compared between the two groups , including white blood cell count (WBC ) , platelet count (PLT ) , alanine aminotransferase (ALT ) , aspartate aminotransferase (AST) ,creatine kinase (CK) ,lactate dehydrogenase (LDH) ,prothrombin time (PT) ,activated partial thromboplastin time (APTT) and thrombin time (TT) .Continuous variables with normal distribution were compared with t test ,and those with non‐normal distribution were compared with nonparametric test ;categorical variables were compared with χ2 test .Univariate Logistic regression was used to evaluate the risk factors associated with death .Results For the deceased patients and the survivors ,the APTT were 56 .40 s and 44 .45 s ,respectively (Z=5 .419 ,P=0 .04) at day 1—7 .Those were 66 .25 s and 36 .85 s ,respectively (Z=10 .112 ,P=0 .009) at day 8—10 ,and (125 .06 ± 11 .88) s and (33 .44 ± 6 .50) s ,respectively (t=45 .760 ,P 15 s (OR= 24 .00 ,95% CI:1 .99—289 .60) ,APTT>70 s (OR= 42 .67 ,95% CI:3 .54—514 .85) and TT > 120 s (OR= 0 .14 ,95% CI:0 .02—0 .88) were risk factors for the death of SFTS patients (all P< 0 .05) .Conclusion Prolonged APT T ,T T and PT at early stage and progressively increasing during the disease course suggest poor prognosis of SFTS .

Severe Fever with Thrombocytopenia Syndrome Presenting with Hemophagocytic Lymphohistiocytosis

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease caused by the newly discovered SFTS Bunyavirus, and there have been no case reports of SFTS patients presenting with hemophagocytic lymphohistiocytosis (HLH) in the English literature. We report a case of SFTS presenting with HLH in a 73-year-old immunocompetent male farmer. Although the patient had poor prognostic factors for SFTS, such as old age and central nervous system symptoms, he recovered fully with supportive care.

Bone Marrow Suppression and Hemophagocytic Histiocytes Are Common Findings in Korean Severe Fever with Thrombocytopenia Syndrome Patients

The causes of cytopenia in patients with severe fever with thrombocytopenia syndrome (SFTS) are not fully understood until now. We reviewed the bone marrow (BM) findings of patients with SFTS to unravel the cause of the cytopenia. Three Korean SFTS were enrolled in this study. Thrombocytopenia, neutropenia, and anemia were detected in all three patients. Severe hypocellular marrow (overall cellularity <5%) and a decreased number of megakaryocytes were noted in one patient, and hypo-/normocellular marrow and an increased number of hemophagocytic histiocytes were observed in two patients. Megakaryocytes were relatively preserved in two patients. Although a limited number of cases are available, our observations suggest that both BM suppression and peripheral destruction or sequestration are causes of cytopenia of patients with SFTS. To the best of our knowledge, this is the first well documented pathologic evaluation of Korean SFTS.

The bone marrow morphology characteristics and the clinical significance of six patients with severe fever with thrombocytopenia syndrome / 中华传染病杂志

Objective To investigate the bone marrow morphology characteristics in patients with severe fever with thrombocytopenia syndrome (SFTS)and to evaluate the clinical value of bone marrow morphology examination in the diagnosis of SFTS.Methods The bone marrow morphology and clinical data of six newly diagnosed SFTS patients with positive test of novel bunyavirus infection admitted to Taizhou Hospital from July 2011 to November 2014 were retrospectively analyzed.Results The increased ratio of lymphoid and monocytoid histiocytes (0.02 - 0.23 )and hemophagocytic phenomenon were observed in all of the six patients′ bone marrow smears.Two of the six cases were diagnosed with hemophagocytic lymphohistiocytosis (HLH)according to the clinical diagnosis criteria and the remaining four cases were defined as highly suspected HLH.Conclusions The progression of SFTS disease might be closely related with HLH induced by novel bunyavirus infection.Morphology examination of bone marrow smear is beneficial for the early differential diagnosis of SFTS.