Detection of viral RNA in diverse body fluids in an SFTS patient with encephalopathy, gastrointestinal bleeding and pneumonia: a case report and literature review

Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that commonly has a lethal course caused by the tick-borne Huaiyangshan banyang virus [former SFTS virus (SFTSV)]. The viral load in various body fluids in SFTS patients and the best infection control measure for SFTS patients have not been fully established. Case presentation: A 79-year-old man was bitten by a tick while working in the bamboo grove in Nagasaki Prefecture in the southwest part of Japan. Due to the occurrence of impaired consciousness, he was referred to Nagasaki University Hospital for treatment. The serum sample tested positive for SFTSV-RNA in the genome amplification assay, and he was diagnosed with SFTS. Furthermore, SFTSV-RNA was detected from the tick that had bitten the patient. He was treated with multimodal therapy, including platelet transfusion, antimicrobials, antifungals, steroids, and continuous hemodiafiltration. His respiration was assisted with mechanical ventilation. On day 5, taking the day on which he was hospitalized as day 0, serum SFTSV-RNA levels reached a peak and then decreased. However, the cerebrospinal fluid collected on day 13 was positive for SFTSV-RNA. In addition, although serum SFTSV-RNA levels decreased below the detectable level on day 16, he was diagnosed with pneumonia with computed tomography. SFTSV-RNA was detected in the bronchoalveolar lavage fluid on day 21. By day 31, he recovered consciousness completely. The pneumonia improved by day 51, but SFTSV-RNA in the sputum remained

Single-cell landscape of peripheral immune responses to fatal SFTS

“…Tick bite has been recognized as the main infection route, and Haemaphysalis longicornis has been identified as the predominant tick vector (Hu et al, 2020;Luo et al, 2015). It is suggested that the toll and potential threat of SFTS have been underappreciated, given the wide distribution and dispersal of the predominant tick vector (Miao et al, 2020;Rainey et al, 2018), and another transmission potential via contact with patient's blood and/or human body fluid (Akagi et al, 2020;Koga et al, 2019;Tang et al, 2013). Despite the clear public health significance, approved vaccines or specific therapeutics against SFTS are still unavailable.…”

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

“…The SFTSV viral titer was not correlated significantly with GGO abnormalities in our study; however, a quantitative RT-PCR was performed partially (72.7%) in two hospitals, and serial SFTSV follow-up measurement was performed in only 40.9% of all patients with SFTS; therefore, it was difficult to make a conclusion regarding this connection. Viral dissemination in the pulmonary alveoli was confirmed using bronchoalveolar lavage in one of our patients who presented with GGO in the lung [11], suggesting that the GGO pattern may be generated by viral dissemination and accelerated inflammation in the lung. Pleural effusion, pericardial effusion, and mediastinal lymph node enlargement in the present study (22.7%, 18.1%, and 13.6%, respectively) were similar to those in a previous study (38%, 24%, and 14%, respectively) [12].…”

“…SFTS involves multiple organs, including the liver, muscles, central nervous system, kidney, genital organs, and lungs [9][10][11]. It was reported that ∼9.6% to 28.7% of patients with SFTS experience respiratory symptoms, including cough, sputum, and dyspnea, with radiographic abnormalities being present in 29 to 45% of patients with SFTS [12].…”

Highly adaptive Phenuiviridae with biomedical importance in multiple fields

“…Symptoms and epidemiological information are useful for the preliminary diagnosis of some phenuivirid diseases. However, confirmation of phenuivirid diseases should be based on symptoms, epidemiological information, and correct detection of the nucleic acids, proteins, and/or antibodies specific to relevant phenuiviruses [28,[151][152][153].…”