Associations between Chest CT Abnormalities and Clinical Features in Patients with the Severe Fever with Thrombocytopenia Syndrome

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.

Clinical Differentiation of Severe Fever with Thrombocytopenia Syndrome from Japanese Spotted Fever

“…The present study revealed that SFTS and JSF did not differ in patients' underlying conditions; however, many symptoms, such as altered mental status and diarrhea were more frequently found in patients with SFTS. These symptoms may be associated with viremia in SFTS [30,31]. Skin rash and tick bite were frequently found in patients with JFS.…”

“…All definitions used in the study were established before the data analyses. An episode of SFTS was defined as SFTSV, in which viral RNA was confirmed by real-time PCR analysis of a serum sample, as previously described [31]. The diagnosis of JSF was defined as either a 4-fold increase in immunoglobulin G (IgG) in the serum sample with immunofluorescence assay, PCR analysis of a blood sample, or tissue biopsy (eschar) [32].…”

“…Two Japanese Respiratory Society (JRS) board-certified pulmonologists each with 15 years of experience reviewed all chest radiographs and CT examinations independently and arrived at a consensus. Cardiomegaly was defined as a cardiothoracic (CTR) ratio > 0.50, based on posterior-anterior (PA) chest radiographs, or a CTR ratio > 0.55 on anteriorposterior (AP) chest radiographs [31]. Abnormalities on chest CT were characterized by consolidation, ground-glass opacity (GGO), centrilobular nodules, interstitial septal thickening, and bronchial wall thickening.…”

“…Abnormalities on chest CT were characterized by consolidation, ground-glass opacity (GGO), centrilobular nodules, interstitial septal thickening, and bronchial wall thickening. The presence of mediastinal lymph node enlargement (>10 mm along the short axis), pleural effusion, pericardial effusion (pericardial thickness of 4 mm or more [31]), hepatomegaly (diameter of >16.0 cm at craniocaudal line [31]), splenomegaly (width measurement of >10.5 cm [31]), and additional lung findings were also recorded.…”

Viral shedding pattern of severe fever with thrombocytopenia syndrome virus in severely ill patients:A Prospective, Multicenter Study

“…SFTSV infection can elicit damage to multiple organ systems including lung. It was reported that lung imaging abnormalities was present in 29 to 68.1% of SFTS patients [41]. Pulmonary infection was associated with fatality or increased disease course in SFTS patients [42].…”