Serial analysis of cytokine and chemokine profiles and viral load in severe fever with thrombocytopenia syndrome

Abstract

Rationale:Severe fever with thrombocytopenia syndrome (SFTS) is a recently recognized fatal infectious disease caused by the SFTS virus, and severe cases are complicated by the presence of hemophagocytic lymphohistiocytosis (HLH) associated with a cytokine storm. Herein, we report on serial changes of serum cytokine levels and viral load in a severe case of SFTS.Patient concerns:A 63-year-old Japanese woman presented with high-grade fever, abdominal pain, diarrhea, impaired consciousness, leukocytopenia, and thrombocytopenia.Diagnosis:SFTS was diagnosed based on a positive serum test for SFTS virus RNA and electroencephalogram (EEG) findings of encephalopathy.Interventions:The patient was treated with supportive therapy, including steroid pulse therapy (intravenous methylprednisolone 1 g/d for 3 days) for HLH and intravenous recombinant thrombomodulin 19200 U/d for 7 days for disseminated intravascular coagulation.Outcomes:Treatment for 7 days improved both symptoms and abnormal EEG findings, and SFTS virus RNA disappeared from the serum at day 10 from the onset of symptoms. The serum cytokines and chemokines analysis during the clinical course revealed 2 distinct phases: the acute phase and the recovery phase. The cytokines and chemokines elevated in the acute phase included interleukin (IL)-6, IL-10, interferon (IFN)-α2, IFN-γ, tumor necrosis factor-α, interferon-γ-induced protein-10, and fractalkine, while the IL-1β, IL-12p40, IL-17, and vascular endothelial growth factor levels were higher in the recovery phase.Conclusion:These observations suggest that the cytokines and chemokines elevated in the acute phase may reflect the disease severity resulted in a cytokine storm, while those in the recovery phase may be attributed to T-cell activation and differentiation.

The Diagnosis of Severe Fever with Thrombocytopenia Syndrome Using Metagenomic Next-Generation Sequencing: Case Report and Literature Review

“…Previously, a 63-yearold Japanese woman was diagnosed with SFTS based on a positive serum test for SFTSV RNA and the changes of electroencephalogram (EEG). 14 Another 62-year-old previously healthy woman diagnosed as having SFTS by realtime reverse transcription polymerase chain reaction. 15 Here, we report for the first time a case of serologically negative SFTS diagnosed via mNGS.…”

Ineffective communication equals no communication: a case report of splenic hyperfunction combined with pseudothrombocytopenia

“…This study aimed to report a case of a 68-year-old woman with splenic hyperfunction and thrombocytopenia in The Lianshui County People's Hospital, China. Thrombocytopenia was mostly reported by a single factor in previous study (1,2). In this case, thrombocytopenia was caused by both the hypersplenism of organic lesions and the hidden false reduction influenced by EDTA, which was rare in clinical treatment.…”

Residual and Late Onset Symptoms Appeared in a Patient with Severe Fever with Thrombocytopenia in a Convalescence Stage

“…Although some of these complications are commonly found in various critical illness other than viral hemorrhagic fevers [ 13 , 14 ], SFTS is an infectious disease that is included in the viral hemorrhagic fevers, and there might be common pathophysiological mechanisms behind the complications in the recovery phase among viral hemorrhagic fevers. One hypothesis is that chemokines and cytokines such as interleukin (IL)-1β, IL-12p40, IL-17, and vascular endothelial growth factor, which have been found to be elevated during the recovery phase of SFTS [ 15 ], cause the convalescent phase symptoms. In the present case, we did not measure these cytokines; thus, the actual relationship between the symptoms of the present case and cytokines is unclear.…”