Seo Jun-Won, Lee You Mi, Tamanna Sadia, Bang Mi-Seon, Kim Choon-Mee, Kim Da Young, Yun Na Ra, Kim Jieun, Jung Sook In, Kim Uh Jin, Kim Seong Eun, Kim Hyun Ah, Kim Eu Suk, Hur Jian, Kim Young Keun, Jeong Hye Won, Heo Jung Yeon, Jung Dong Sik, Lee Hyungdon, Park Sun Hee, Kwak Yee Gyung, Lee Sujin, Lim Seungjin, Kim Dong-Min
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea.
Premedical Science, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea.
Viruses. 2024 Dec 11;16(12):1906. doi: 10.3390/v16121906.
Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile illness caused by the SFTS virus (SFTSV). We conducted this study to propose a scientific evidence-based treatment that can improve prognosis through changes in viral load and inflammatory cytokines according to the specific treatment of SFTS patients. This prospective and observational study was conducted at 14 tertiary referral hospitals, which are located in SFTS endemic areas in Korea, from 1 May 2018 to 31 October 2020. Patients of any age were eligible for inclusion if they were polymerase chain reaction positive against SFTSV, or showed a four-fold or higher increase in IgG antibody titers between two serum samples collected during the acute and convalescent phases. On the other hand, patients with other tick-borne infections were excluded. In total, 79 patients were included in the study. The viral load of the group treated with steroids was 3.39, 3.21, and 1.36 log RNA copies/reaction at each week since the onset of symptoms, and the viral load in patients treated with plasma exchange was 4.47, 2.60, and 2.00 log RNA copies/reaction at each week after symptom onset. The inflammatory cytokines were not reduced effectively by any specific treatment except IVIG for the entire treatment period. Secondary infections according to pathogens revealed four bacterial (26.7%) and one fungal (6.7%) infection in the steroid group. The viral load of SFTSV and inflammatory cytokines cannot be decreased by steroid and plasma exchange treatments. Secondary bacterial infections can occur when steroids are administered for the treatment of SFTS. Therefore, caution should be exercised when choosing treatment strategies for SFTS.
发热伴血小板减少综合征（SFTS）是一种由SFTS病毒（SFTSV）引起的急性发热性疾病。我们开展这项研究是为了提出一种基于科学证据的治疗方法，该方法可根据SFTS患者的具体治疗情况，通过病毒载量和炎性细胞因子的变化来改善预后。这项前瞻性观察性研究于2018年5月1日至2020年10月31日在韩国SFTS流行地区的14家三级转诊医院进行。任何年龄的患者，只要其针对SFTSV的聚合酶链反应呈阳性，或在急性期和恢复期采集的两份血清样本之间IgG抗体滴度升高四倍或更高，均符合纳入标准。另一方面，排除患有其他蜱传感染的患者。该研究共纳入79例患者。症状出现后每周，接受类固醇治疗组的病毒载量分别为3.39、3.21和1.36 log RNA拷贝/反应，接受血浆置换治疗的患者症状出现后每周的病毒载量分别为4.47、2.60和2.00 log RNA拷贝/反应。在整个治疗期间，除静脉注射免疫球蛋白外，任何特定治疗均未有效降低炎性细胞因子水平。根据病原体分类的继发感染显示，类固醇治疗组有4例细菌感染（26.7%）和1例真菌感染（6.7%）。类固醇和血浆置换治疗无法降低SFTSV的病毒载量和炎性细胞因子水平。使用类固醇治疗SFTS时可能会发生继发细菌感染。因此，在为SFTS选择治疗策略时应谨慎。
