Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in China and case-fatality rate of SFTS is very high (approximately 10%). However, genetic susceptibility for SFTS virus (SFTSV) infection and fatal outcome of SFTSV infection in humans are unclear. In this study, we investigated the clinical, laboratory and epidemiological features of SFTS in a cluster of three sisters who died of SFTSV infection between late April and mid-May 2014. Before disease onset, two of the sisters (Case A and case B) had common exposure history for ticks by working together in a field to pick tea leaves from April 8 to April 12. The third sister (Case C) did not live or work together with case A and B, but had ticks in her living environment. SFTSV RNA sequences were amplified from three cases were not identical, suggesting that the three sisters were most likely infected with SFTSV through tick bite rather than through person-to-person transmission of SFTSV. The sequence of SFTSV from case C was identical to SFTSV sequences from 3 groups of ticks collected around the residential area of case C. Seroprevalence of SFTSV IgG antibody among healthy population in the area where the patients resided was 4.05% (3/74). The majority of SFTSV infections were mild cases and all three sisters died of SFTSV infection suggested that they were highly susceptible to SFTSV. Our findings indicated that genetic susceptibility was a risk factor for SFTSV infection and fatal outcome.
Highlights
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever that was reported recently in rural areas of China
The cluster of SFTS virus (SFTSV) infection occurred in Linhai County, Zhejiang Province which locates in southeastern China
We reported a cluster of SFTSV infection in southeastern China
Summary
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever that was reported recently in rural areas of China. Liu W et al reported that older age, decreased level of consciousness, and elevated levels of lactate dehydrogenase and creatine kinase were significantly associated with fatal outcome of SFTSV infection [4]. Similarity, Gai ZT et al reported that a period of 7–13 days after the onset of illness was the critical stage and the key risk factors that contributed to patient death were elevated serum aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase fraction, the appearance of CNS (central nervous system) symptoms, hemorrhagic manifestation, disseminated intravascular coagulation, and multi-organ failure [5]. Between late April and mid-May 2014, a cluster of SFTSV infection occurred in southeastern China and three sisters contracted SFTSV infection and all of them deceased This cluster informed us that death of SFTS patient may be probably related to genetic susceptibility
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