Case-Fatality Ratio and Effectiveness of Ribavirin Therapy Among Hospitalized Patients in China Who Had Severe Fever With Thrombocytopenia Syndrome

Liu, Wei; Lü, Qing; Cui, Ning; Li, Hao; Wang, Li Yuan; Liu, Kun; Yang, Zhen; Wang, Bing Jun; Wang, Hong Yu; Zhang, Yao Yun; Zhang, Lu; Hu, Chun Yan; Yuan, Chun; Fan, Xue Juan; Wang, Zhen; Zhang, Lan; Zhang, Xiao Ai; Walker, David H.; Cao, Wu Chun

doi:10.1093/cid/cit530

Cited by 185 publications

(169 citation statements)

References 15 publications

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“…It is therefore unlikely that ribavirin would be effective in the treatment of patients who are already showing symptoms of SFTS. This corresponds with a report by Liu et al, which noted that neither fatality ratios nor blood laboratory test results of SFTS patients improved with ribavirin therapy (32). However, in hepatitis C, combination therapies that include ribavirin (along with interferon and/or specific antiviral drugs) have been shown to be very effective, while the usage of ribavirin alone is less profound (13,33).…”

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confidence: 87%

Effects of Ribavirin on Severe Fever with Thrombocytopenia Syndrome Virus In Vitro

et al. 2014

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SUMMARY:Severe fever with thrombocytopenia syndrome (SFTS) is a disease with a high case fatality rate that is caused by infection with the recently identified tick-borne SFTS virus (SFTSV), for which there are no specific countermeasures. We examined the effects of ribavirin and mizoribine, which are nucleoside analogue drugs with broad antiviral activities, on SFTSV proliferation in vitro. When 3 cell lines were treated with these drugs before and during infection with a Chinese SFTSV strain, the 99z effective concentrations (EC 99 ) of ribavirin were 19-64 mg/ml (78-262 mM); in contrast, the EC 99 of mizoribine was ＞500 mg/ml (1,929 mM). Similar levels of inhibitory effects of ribavirin were observed with 4 Japanese SFTSV strains. However, when Vero cells were treated with ribavirin 3 days after inoculation, the inhibitory effect was dramatically decreased, indicating that ribavirin did not effectively reduce virus production in pre-infected cells. These results suggest that ribavirin could be used as postexposure prophylaxis for the prevention of SFTS.

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confidence: 87%

Effects of Ribavirin on Severe Fever with Thrombocytopenia Syndrome Virus In Vitro

et al. 2014

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“…A high viral load in the serum is characteristic of fatal SFTS infection (19,20), and the main pathological finding of SFTSV infection are necrotizing lymphadenitis with both numerous apoptotic cells and nuclear debris (16). However, the present case had typical necrotizing lymphadenitis strongly positive for the SFTSV-NP antigen only in a solitary paraaortic lymph node.…”

Section: Discussionmentioning

confidence: 49%

Fatal Severe Fever with Thrombocytopenia Syndrome: An Autopsy Case Report

et al. 2016

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As of June 2014, among six patients who had severe fever with thrombocytopenia syndrome (SFTS) at our hospital, an 83-year-old man died despite receiving appropriate critical care. An autopsy revealed extensive ischemic damage of the intra-abdominal organs, including the liver, spleen, stomach and gut, due to severe celiac atherosclerotic stenosis and superior mesenteric arterial thrombosis. Many SFTS virus nucleoprotein antigen-immunoreactive cells were detected in a paraaortic node, where necrotizing lymphadenitis was seen, and in the spleen. Fewer such cells were seen in the liver, bone marrow and adrenals. Conclusion: Atherosclerosis, in addition to hemophagocytic lymphohistiocytosis syndrome, can be lethal in elderly SFTS patients.

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“…Ribavirin, which is used as an antiviral agent to treat hepatitis C, has been reported as an antiviral activity against SFTS in vitro [6]. However, it is not clinically valid when the drug is used as the sole regimen against SFTS infection [7]. On the other hand, combination therapy with ribavirin and other therapeutic agents such as plasma exchange, antibiotics, interferon, and steroids is effective, although evidence for this has only been obtained from a small number of cases [8].…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Fever With Thrombocytopenia Syndrome Accompanied by Self-Limiting Severe Proteinuria That Inversely Correlated With the Platelet Count

et al. 2016

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We herein present a case of a 68-year-old man who was referred to our hospital for a tick bite accompanied by fever and general malaise. He exhibited typical clinical symptoms such as abdominal pain, diarrhea, and vomiting during hospitalization. A laboratory examination showed progressive thrombocytopenia and leukopenia during the early part of hospitalization. A definite diagnosis of severe fever with thrombocytopenia syndrome (SFTS) was made by a reverse transcription polymerase chain reaction (RT-PCR) from his blood sample in the Tokushima Prefectural Public Health Institute. Proteinuria is generally detected in more than half of patients with SFTS. In the present case, the clinical course showed a clear inverse correlation between self-limiting severe proteinuria and the platelet count during hospitalization. Although it is not currently clear how immunological interactions among the virus, platelets, and immunoglobulins affect the glomerulus or cause proteinuria, our results may contribute to elucidating the pathogenic mechanism of SFTS-associated glomerulonephritis. To the best of our knowledge, this case report is the first to show an inverse correlation between proteinuria and the platelet count in a patient with SFTS.

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Case-Fatality Ratio and Effectiveness of Ribavirin Therapy Among Hospitalized Patients in China Who Had Severe Fever With Thrombocytopenia Syndrome

Abstract: These findings can improve knowledge about the characteristics of patients with fatal outcomes and the use of antiviral drug for SFTS.

Cited by 185 publications

References 15 publications

Effects of Ribavirin on Severe Fever with Thrombocytopenia Syndrome Virus In Vitro

Effects of Ribavirin on Severe Fever with Thrombocytopenia Syndrome Virus In Vitro

Fatal Severe Fever with Thrombocytopenia Syndrome: An Autopsy Case Report

A Case of Severe Fever With Thrombocytopenia Syndrome Accompanied by Self-Limiting Severe Proteinuria That Inversely Correlated With the Platelet Count

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