Nakamura Shingen, Azuma Momoyo, Maruhashi Tomoko, Sogabe Kimiko, Sumitani Ryohei, Uemura Munenori, Iwasa Masami, Fujii Shiro, Miki Hirokazu, Kagawa Kumiko, Hiraga Takashi, Kondo Noriyasu, Fujita Hiromi, Mahara Fumihiko, Abe Masahiro
Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Division of Infection Control, Tokushima University Hospital, Tokushima, Japan.
J Infect Chemother. 2018 May;24(5):389-392. doi: 10.1016/j.jiac.2017.11.004. Epub 2018 Feb 7.
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease caused by the SFTS virus (SFTSV). Clinical symptoms of SFTS often involve encephalopathy and other central neurological symptoms, particularly in seriously ill patients; however, pathogenesis of encephalopathy by SFTSV is largely unknown. Herein, we present case reports of three patients with SFTS, complicated by encephalopathy, admitted to Tokushima University hospital: one patient was a 63-year-old man, while the other two were 83- and 86-year-old women. All of them developed disturbance of consciousness around the 7th day post onset of fever. After methylprednisolone pulse therapy of 500 mg/day, all of them recovered without any neurological sequelae. SFTSV genome was not detected in the cerebrospinal fluid of 2 out of the 3 patients that were available for examination. In these patients, disturbance of consciousness seemed to be an indirect effect of the cytokine storm triggered by SFTSV infection. We propose that short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy during early phase of SFTSV infection.
发热伴血小板减少综合征（SFTS）是一种由SFTS病毒（SFTSV）引起的蜱传感染性疾病。SFTS的临床症状常涉及脑病和其他中枢神经系统症状，尤其是在重症患者中；然而，SFTSV导致脑病的发病机制在很大程度上尚不清楚。在此，我们报告了3例因脑病并发SFTS并入住德岛大学医院的患者：1例为63岁男性，另外2例分别为83岁和86岁女性。他们均在发热起病后第7天左右出现意识障碍。在接受500毫克/天的甲泼尼龙冲击治疗后，他们均康复且无任何神经后遗症。在3例可供检查的患者中，有2例患者的脑脊液中未检测到SFTSV基因组。在这些患者中，意识障碍似乎是SFTSV感染引发的细胞因子风暴的间接效应。我们提出，短期糖皮质激素治疗可能对SFTSV感染早期的脑病治疗有益。
