Bone marrow findings in severe fever with thrombocytopenia syndrome: prominent haemophagocytosis and its implication in haemophagocytic lymphohistiocytosis

Kim, Namhee; Kim, Kye-Hyung; Lee, Su Jin; Park, Sanghyuk; Kim, In-Suk; Lee, Eun Yup; Yi, Jongyoun

doi:10.1136/jclinpath-2015-203417

Cited by 22 publications

(11 citation statements)

References 16 publications

(24 reference statements)

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“…These findings were not uncommon in our data (S3 & S4 Tables). Although we did not observe bone marrow findings, hemophagocytosis in the bone marrow of SFTS patients has been reported as one of the key findings [36–38]. As a cause of secondary HLH, SFTS needs to be considered in endemic areas.…”

Section: Discussionmentioning

confidence: 55%

Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015

et al. 2016

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BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was recently identified in China, South Korea and Japan. The objective of the study was to evaluate the epidemiologic and clinical characteristics of SFTS in South Korea.Methods/Principal FindingsSFTS is a reportable disease in South Korea. We included all SFTS cases reported to the Korea Centers for Disease Control and Prevention (KCDC) from January 2013 to December 2015. Clinical information was gathered by reviewing medical records, and epidemiologic characteristics were analyzed using both KCDC surveillance data and patient medical records. Risk factors for mortality in patients with SFTS were assessed. A total of 172 SFTS cases were reported during the study period. SFTS occurred throughout the country, except in urban areas. Hilly areas in the eastern and southeastern regions and Jeju island (incidence, 1.26 cases /105 person-years) were the main endemic areas. The yearly incidence increased from 36 cases in 2013 to 81 cases in 2015. Most cases occurred from May to October. The overall case fatality ratio was 32.6%. The clinical progression was similar to the 3 phases reported in China: fever, multi-organ dysfunction, and convalescence. Confusion, elevated C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS. Two outbreaks of nosocomial SFTS transmission were observed.ConclusionsSFTS is an endemic disease in South Korea, with a nationwide distribution and a high case-fatality ratio. Confusion, elevated levels of C-reactive protein, and prolonged activated partial thromboplastin times were associated with mortality in patients with SFTS.

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Section: Discussionmentioning

confidence: 55%

Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015

et al. 2016

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“…34 The most common pathogen is Epstein-Barr virus, but zoonotic diseases including many rickettsial diseases and severe fever with thrombocytopenia syndrome, a tick-borne viral disease emerging in East Asia, are important causes of HLH. 35,36 The etiologic agent in a secondary HLH case may be difficult to identify in a timely manner, because many diagnostic tests are not available in every hospital and need to be referred to reference laboratories.…”

Section: Discussionmentioning

confidence: 99%

Human Granulocytic Anaplasmosis as a Cause of Febrile Illness in Korea Since at Least 2006

Yi¹,

Kim²,

Ko³

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Human granulocytic anaplasmosis (HGA) is a tick-borne rickettsial zoonosis with fever, thrombocytopenia, and leukopenia. HGA has been reported in Korea in 2013 but it is uncertain how long it has existed. A retrospective study was conducted on patients who underwent bone marrow examination due to fever and cytopenia, with no clear hematologic or microbiologic causes, from 2003 through 2012. Laboratory diagnosis was made by detecting 16S rRNA genes of Anaplasma phagocytophilum from the stored blood samples. Among the 70 patients, five (7.1%) HGA cases were found, and the earliest case dated back to 2006. Two cases met the diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH) and were fatal. Although HGA has been prevalent in Korea since at least 2006, it is not always diagnosed and has posed a possible lethal health risk to the people in Korea. HGA should be considered as a cause of fever with cytopenia or HLH.

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“…In addition, elucidation of the cell and tissue tropism associated with mortality can explain viral lethality (33). Results from histopathological studies have shown that necrotizing lymphadenitis and prominent hemophagocytosis are the pathological characteristics of fatal SFTS, and large atypical immunoblastic cells are major infected cells in the lymph nodes, spleen, and bone marrow (6,18,(34)(35)(36)(37). However, detailed characterization of the viral target cells and tissues is required to understand the pathogenic mechanisms of lethal SFTSV infection.…”

Section: Introductionmentioning

confidence: 99%

Severe fever with thrombocytopenia syndrome virus targets B cells in lethal human infections

Suzuki

Sato

Sano

et al. 2020

Journal of Clinical Investigation

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jp (HS). in vitro experiments using PBMCs and cell lines. MK conducted EM analysis and acquired EM images. SM, SF, TY, M. Shimojima, and M. Saijo provided reagents for histopathological and virological assays. TS wrote the original draft of the manuscript. All authors contributed to reviewing and editing the manuscript. SM and M. Saijo supervised the study and supported analyses. TS and HH supervised the study.

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Bone marrow findings in severe fever with thrombocytopenia syndrome: prominent haemophagocytosis and its implication in haemophagocytic lymphohistiocytosis

Abstract: Haemophagocytosis in the bone marrow of SFTS patients may be common. In SFTS endemic areas, SFTS should be one of the differential diagnoses of fever of unknown origin with haemophagocytosis in the bone marrow.

Cited by 22 publications

References 16 publications

Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015

Severe Fever with Thrombocytopenia Syndrome in South Korea, 2013-2015

Human Granulocytic Anaplasmosis as a Cause of Febrile Illness in Korea Since at Least 2006

Severe fever with thrombocytopenia syndrome virus targets B cells in lethal human infections

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