Abstract
Severe fever with thrombocytopenia syndrome (SFTS) as an emerging infection disease results in high morbidity and mortality in China. In this study, the circulating levels of 36 inflammatory mediators in 33 SFTS patients on days 3–7, 8–12 and 13–20 post-illness were measured by a multiplex Luminex® system dynamically. Among the patients, 15 severe patients recovered, 11 severe patients died within three weeks. We found IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, eotaxin, IL-8, IP-10, MCP-1, MIP-1α, MIP-1β and fractalkine were significantly upregulated in SFTS patients. Elevated IL-15 and eotaxin in SFTS patients were reported firstly. The highest levels of pro-inflammatory and anti-inflammatory cytokines coexisted in fatal patients during the first week. Inflammatory mediators remained high levels when death occurred in fatal patients, they were recovered within three weeks in nonfatal patients. Our results showed the occurrence of inflammatory storm in SFTS patients were associated with the severity of SFTS. RANTES and PDGF were down regulated and remained significantly lower levels in fatal patients throughout the course of disease, the concentrations of RANTES and PDGF were remarkably positively correlated with the platelet count. Our results demonstrated that dysregulated inflammatory response was associated with disease pathogenesis and mortality in SFTS patients.
Highlights
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus which is referred to as SFTS virus (SFTSV)1
Contribution of the inflammatory response to disease severity and seek experimental evidence to guide future therapeutic strategies, we continuously measured the production of 36 important inflammatory mediators and the virus load in blood samples collected from SFTS patients with different prognoses
In the first week post-illness, 1 patients died with complications of pulmonary infection, acute pancreatitis and multiple organ dysfunction syndrome (MODS), 1 patients died with complications of hemorrhage of digestive tract and MODS; on day 8–12, 2 patients died with complications of pulmonary infection and 2 patients died with complications of MODS; on days 13–20 of disease, 2 patients died with complications of MODS and diffuse intravascular coagulation (DIC), 2 patients died with complications of MODS and pulmonary infection
Summary
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus which is referred to as SFTS virus (SFTSV). SFTS is an acute-onset disease in most patients with major clinical symptoms, including acute fever, thrombocytopenia, leukocytopenia, gastrointestinal symptoms, neural disorders, elevated lactate dehydrogenase (LDH), and creatine kinase (CK), the illness can quickly progress to multiple organ dysfunction syndrome (MODS), death usually occurs within 2 weeks of the onset of SFTS5. The dynamic changes of inflammatory factors and virus load with the disease progression in SFTS patients are less clear, which is important for clinicians to evaluate the disease prognosis. Contribution of the inflammatory response to disease severity and seek experimental evidence to guide future therapeutic strategies, we continuously measured the production of 36 important inflammatory mediators and the virus load in blood samples collected from SFTS patients with different prognoses
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