ABSTRACT
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease caused by the SFTS virus (SFTSV). Clinical symptoms of SFTS often involve encephalopathy and other central neurological symptoms, particularly in seriously ill patients; however, pathogenesis of encephalopathy by SFTSV is largely unknown. Herein, we present case reports of three patients with SFTS, complicated by encephalopathy, admitted to Tokushima University hospital: one patient was a 63-year-old man, while the other two were 83- and 86-year-old women. All of them developed disturbance of consciousness around the 7th day post onset of fever. After methylprednisolone pulse therapy of 500 mg/day, all of them recovered without any neurological sequelae. SFTSV genome was not detected in the cerebrospinal fluid of 2 out of the 3 patients that were available for examination. In these patients, disturbance of consciousness seemed to be an indirect effect of the cytokine storm triggered by SFTSV infection. We propose that short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy during early phase of SFTSV infection.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Brain Diseases/drug therapy , Bunyaviridae Infections/drug therapy , Fever/drug therapy , Methylprednisolone/administration & dosage , Phlebovirus/isolation & purification , Thrombocytopenia/drug therapy , Tick-Borne Diseases/drug therapy , Aged, 80 and over , Anti-Inflammatory Agents/therapeutic use , Brain Diseases/cerebrospinal fluid , Brain Diseases/etiology , Brain Diseases/virology , Bunyaviridae Infections/cerebrospinal fluid , Bunyaviridae Infections/complications , Bunyaviridae Infections/virology , Female , Fever/cerebrospinal fluid , Fever/etiology , Fever/virology , Hospitals, University , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged , Phlebovirus/drug effects , Phlebovirus/genetics , Pulse Therapy, Drug , Syndrome , Thrombocytopenia/cerebrospinal fluid , Thrombocytopenia/virology , Tick-Borne Diseases/cerebrospinal fluid , Tick-Borne Diseases/virologyABSTRACT
45 infants and children with thrombocytopenia and septicemia were studied. Many parameters of blood coagulation, the platelet diameters and the megakaryocytes of the bone marrow (Feulgen stained cytophotometry and maturity of the megakaryocytes) were examined. 15 patients had a consumption coagulopathy and 30 were classified as having an isolated septic thrombocytopenia. In both groups the number of the megakaryocytes of the bone marrow smears were normal. 81% of the megakaryocytes were mature. The patient group with isolated septic thrombocytopenia had significantly greater ploidy values of the megakaryocytes than a control group. In both groups the diameters of the platelets were also significantly greater than in an age matched control group of children with a normal platelet count. These results allow the conclusion that the thrombocytopenia in pediatric patients with septicemia is not caused by a diminished production of platelets.
