Application of therapeutic plasma exchange in patients having severe fever with thrombocytopenia syndrome

Abstract

Background/Aims Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. Methods TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. Results Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. Conclusions SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.

Alterations of Gut Microbiome in the Patients With Severe Fever With Thrombocytopenia Syndrome

“…And a previous research had reported that the majority of SFTS (86%) are detected in subjects 50 years of age or older ( Liu et al, 2015 ), which is same with our finding. Previous studies had pay attention to the ecology and transmission cycle ( Wang et al, 2015 ; Li et al, 2016 ), pathogenesis ( Wu et al, 2014 ; Ning et al, 2015 ; Silvas et al, 2015 ) and treatment ( Kim et al, 2016 ; Yoo et al, 2017 ) of SFTS, but no one has pointed to the alteration of gut microbiota for SFTS patients, this study aim to find some differences of gut microbiome between SFTS patients and health people.…”

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

“…Despite the high awareness within the medical community in SFTS-endemic areas, and the use of antiviral therapy such as ribavirin, the case fatality rate of SFTS is still as high as 15%, which is the same as other severe viral diseases including viral hemorrhagic fevers (15). In SFTS, inflammatory cytokine storms (11,(16)(17)(18)(19) as well as impairment of immune responses including innate immunity (14,(20)(21)(22)(23)(24)(25), antiviral T cell function (26), and antiviral humoral responses (27) have important roles in the pathogenic progress of lethal infections. Immune impairment and high viral loads are also characteristics of several other viral hemorrhagic fevers (28), but these diseases differ in terms of pathology and pathogenesis, about which little is known for SFTS.…”

Antiviral Drugs Against Severe Fever With Thrombocytopenia Syndrome Virus Infection

“…The development of specific treatment for SFTS is crucial because SFTSV infection is relatively rare and the affected patients are mainly elderly. Some proposed treatments for SFTS include steroid pulse therapy (Nakamura et al, 2018), plasma exchange (Oh et al, 2014;Yoo et al, 2019), and antiviral drugs (Saijo, 2018); however, their effectiveness remains unclear.…”