An emerging infectious disease was identified as severe fever with thrombocytopenia syndrome (SFTS) in central China since late March 2009. We found the patients with SFTS had severe clinical symptoms, and progressed rapidly to multiple organ dysfunction syndrome (MODS) with high fatality rate of 25%-30%. The aim of this study was to assess the significance of risk factors predicting the development of MODS and death in SFTS patients. Consecutive SFTS admissions between May 2009 and September 2011 were analyzed for parameters of organ function during hospitalization using Marshall scoring system for MODS, and platelet counts were recorded on admission and at 24, 48, 72 h and one week after admission. We investigated the kinetics of organ failures and analyzed the association between age, platelet count and development of MODS or death. A total of 92 SFTS patients were enrolled in this study. Among them, 32 patients with dysfunction of over 4 organs were identified, 45% of them died within 72 h, 72% died within 5 days, and 76% died within 7 days after admission. We also found cumulative Marshall score was significantly higher in death patients (11.76±2.05) than in survival patients (4.22±1.98) (P<0.001). In addition, SFTS patients had older age and lower platelet counts in MODS and death groups. Furthermore, we also observed that there was a close correlation between platelet count on admission and Marshall score (P<0.001). High Marshall score, advanced age and lower platelet counts were the main risk factors for the development of MODS, and those factors could predict mortality in SFTS patients, suggesting prompt treatment and close monitoring of severe complications, especially MODS, are of great importance in saving patients' lives.
We demonstrated that SFTSV infection resulted in a robust circulating Treg response in patients with SFTS. Our investigation suggested that the proportions of CD4+/total lymphocytes and CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in circulating blood could serve as sensitive indices to evaluate the changes in Tregs in SFTS and predict the progression of SFTS.
Objective Microvesicles (MV) released from blood cells play an important role in the progress of diseases. The purpose of this study is to detect circulating MV level of patients suffering from severe fever with thrombocytopenia syndrome (SFTS).
Methods The plasma samples of SFTS patients and healthy controls were collected. And MV from samples were isolated and MV levels were detected quantitatively.
Results The results showed that the level of the circulating MV in SFTS patients was obviously higher than that of the healthy control, with statistically significant difference. Further analysis revealed that MV level was relevant to the severity of SFTS patients, namely the higher the concentration of MV, the more severity of the disease. Linear correlation analysis showed that the circulating MV level in SFTS was correlated positively with leukocyte count (r = 0.243, P < 0.05), but no correlation with the platelet count (r = 0.193, P >0.05).
Conclusions We demonstrated that there existed high level of circulating MV in SFTS patients, and the level of circulating MV had a close relationship with the severity of the disease and leukocyte count. Therefore, monitoring the level of circulating MV may provide a new indicator for predicting the prognosis of SFTS patients.
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