Associated microbiota and treatment of severe fever with thrombocytopenia syndrome complicated with infections

Abstract

The purpose of this study is to assess the incidence and management of coinfections in hospitalized severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) patients. We retrospectively evaluated the microbiological database records of the SFTS patients in the first affiliated hospital of Anhui Medical University from January 1, 2018, to December 1, 2021. According to the obtained results, coinfections including pulmonary infection, bloodstream infection, biliary tract infection, urinary tract infection, and abdominal infection were observed in SFTS patients. The incidence rate of fungal infections was found to be high in SFTS patients. Furthermore, we suggest that old age people should be evaluated for the risk of fungal infection. In comparison to the non-infection group, patients in the coinfection group were more likely to get mechanical ventilation, antibacterial treatment, antifungal treatment, and blood product therapy (p < 0.001), with a significantly longer length of stay (p < 0.05). In SFTS patients, the most prevalent strains were Aspergillus fumigatus, Aspergillus flavus, Candida, Klebsiella pneumonia, and Escherichia coli. In this investigation, 66.2% (106/160) of patients were given antibiotics, most often Piperacillin/tazobactam or minocycline. 15.6% (25/160) of patients were treated with antifungal drugs: 13.1% (21/160) with voriconazole.Patients with SFTS Associated Pulmonary Aspergillosis (SAPA) received active antifungal treatment, but the mortality rate was still 23.5% (8/34). Only 6 of the 11 patients with SFTS Associated Candidiasis were treated with antifungal drugs with no mortality. Due to the high frequency of fungal pulmonary infection in SFTS patients, more standardized fungal detection program should be strengthened.

Pulmonary infection in patients with severe fever with thrombocytopenia syndrome: A multicentre observational study

“…Recent studies have reported the significantly high incidence of co‐infections in SFTS, and these studies suggested consistently that respiratory infections were predominant and should be of sufficient concern 6,7 . SFTSV can cause cytokine storm and immunosuppression in severe cases.…”

“…5 Recent studies have reported the significantly high incidence of co-infections in SFTS, and these studies suggested consistently that respiratory infections were predominant and should be of sufficient concern. 6,7 SFTSV can cause cytokine storm and immunosuppression in severe cases. It has been demonstrated that fatal patients were more biased towards negative immune modulation, including significantly increased Th17 and decreased CD4 + T lymphocytes.…”

High CRP/PNI levels predict an unfavorable prognosis in severe fever with thrombocytopenia syndrome: A propensity score matching study

“…To our knowledge, our sample size is the largest among previously published reports. A study on SFTS from the First Affiliated Hospital of Anhui Medical University included 160 patients with SFTS 28 . Another multicenter cohort study from 13 university hospitals in Korea included 142 patients with SFTS 27 .…”

“…A study on SFTS from the First Affiliated Hospital of Anhui Medical University included 160 patients with SFTS. 28 Another multicenter cohort study from 13 university hospitals in Korea included 142 patients with SFTS. 27 In addition, a study on SFTS conducted in Nanjing included 256 patients.…”

The dose–response relationship between smoking and the risk factor for invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome

“…Invasive pulmonary aspergillosis (IPA), which is thought to be one of the most frequent infections in SFTS patients, widely develops in immuno-compromised people and has been found to increase the mortality of SFTS according to several studies (Sakaguchi et al, 2019;Iwao et al, 2021;Ge et al, 2022). The incidence of IPA in SFTS is ∼20%, while the mortality of these cases is between 20 and over 50% (Bae et al, 2020;Hu et al, 2021;Xu et al, 2021;Zhang et al, 2022). A study from China reported that patients who received early antifungal treatment tended to have improved survival rates, which indicated the necessity of early diagnosis and timely treatment (Hu et al, 2021).…”