Zuo Yan, Wang Heming, Huang Jiaxiang, Zhang Fang, Lv Dongmei, Meng Tao, Bibi Asma, Shen Jilong, Wang Lianzi, Wang Zhongxin, Xu Yuanhong
Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Pathogen Biology and Provincial Laboratories of Pathogen Biology and Zoonoses, Anhui Medical University, Hefei, Anhui, China.
J Med Virol. 2023 Apr;95(4):e28712. doi: 10.1002/jmv.28712.
Co-infection in patients with severe fever with thrombocytopenia syndrome (SFTS) has been reported, posing a serious threat to survival and treatment. We aimed to systematically investigate the SFTS associated pulmonary infection, particularly invasive pulmonary fungal infection (IPFI). During April 2019 to October 2021, we conducted a multicentre observational study on adult hospitalized patients confirmed with SFTS from three tertiary hospital in central China. Demographic, clinical and laboratory data of patients were collected and re-assessed. A total of 443 patients (51.7% were male sex) were included for analysis with median age of 65-year-old. Among them, 190 (42.9%) patients met the criteria for pulmonary infection. Pulmonary infection was associated with shorter survival time (p < 0.0001 by log-rank test), and adjusted hazard ratio was 1.729 [95% confidence interval, 1.076-2.780] (p = 0.024). Age (odds ratio (OR) 1.040 [1.019-1.062], p < 0.001), time from onset to admission (OR 1.163 [1.070-1.264], p < 0.001), having severe status (OR 3.166 [2.020-4.962], p < 0.001) and symptoms of skin change (OR 2.361 [1.049-5.316], p < 0.001) at admission and receiving intravenous immunoglobin (OR 2.185 [1.337-3.569], p = 0.002) were independent risk factors for the occurrence of pulmonary infection. A total of 70 (15.8%) patients were defined as IPFI. Multivariate analysis showed that time from onset to admission (OR 1.117 [1.016-1.229], p = 0.022), severe status (OR 5.737 [3.054-10.779], p < 0.001), having smoking history (OR 3.178 [1.251-8.070], p = 0.015) and autoimmunity disease (OR 7.855 [1.632-37.796], p = 0.010), receiving intravenous immunoglobin (OR 3.270 [1.424-7.508], p = 0.005) were independent risk factors for the occurrence of IPFI. In SFTS patients with pulmonary infection, white blood count <2.09 × 10 per L (OR 11.064 [3.708-33.012], p < 0.001) and CD3 CD4 T cell count <104.0 per μL (OR 10.429 [3.395-32.038], p < 0.001) could independently predict IPFI. This study showed the high prevalence and poor outcomes of pulmonary infection and IPFI in patients with SFTS. These findings highlighted the need for active surveillance of fungal pathogens and early antifungal treatment in patients with SFTS.
发热伴血小板减少综合征（SFTS）患者合并感染的情况已有报道，这对患者的生存和治疗构成了严重威胁。我们旨在系统地调查与SFTS相关的肺部感染，尤其是侵袭性肺部真菌感染（IPFI）。在2019年4月至2021年10月期间，我们对来自中国中部三家三级医院确诊为SFTS的成年住院患者进行了一项多中心观察性研究。收集并重新评估了患者的人口统计学、临床和实验室数据。共有443例患者（51.7%为男性）纳入分析，中位年龄为65岁。其中，190例（42.9%）患者符合肺部感染标准。肺部感染与较短的生存时间相关（对数秩检验p<0.0001），调整后的风险比为1.729[95%置信区间，1.076 - 2.780]（p = 0.024）。年龄（优势比（OR）1.040[1.019 - 1.062]，p<0.001）、发病至入院时间（OR 1.163[1.070 - 1.264]，p<0.001）、病情严重（OR 3.166[2.020 - 4.962]，p<0.001）、入院时皮肤改变症状（OR 2.361[1.049 - 5.316]，p<0.001）以及接受静脉注射免疫球蛋白（OR 2.185[1.337 - 3.569]，p = 0.002）是肺部感染发生的独立危险因素。共有70例（15.8%）患者被定义为IPFI。多因素分析显示，发病至入院时间（OR 1.117[1.016 - 1.229]，p = 0.022）、病情严重（OR 5.737[3.054 - 10.779]，p<0.001）、有吸烟史（OR 3.178[1.251 - 8.070]，p = 0.015）、自身免疫性疾病（OR 7.855[1.632 - 37.796]，p = 0.010）以及接受静脉注射免疫球蛋白（OR 3.270[1.424 - 7.508]，p = 0.005）是IPFI发生的独立危险因素。在合并肺部感染的SFTS患者中，白细胞计数<2.09×10⁹/L（OR 11.064[3.708 - 33.012]，p<0.001）和CD3⁺CD4⁺T细胞计数<104.0/μL（OR 10.429[3.395 - 32.038]，p<0.001）可独立预测IPFI。本研究表明SFTS患者肺部感染和IPFI的患病率高且预后差。这些发现强调了对SFTS患者进行真菌病原体主动监测和早期抗真菌治疗的必要性。
