4 years ago

Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis

Severe fever with thrombocytopenia syndrome (SFTS) virus has various spectrums of central nervous system (CNS) manifestations. However, there are limited data regarding SFTS-associated encephalopathy/encephalitis (SFTSAE) and the mechanism of SFTSAE. Methods All patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to suspected acute encephalopathy were enrolled in three referral hospitals between Jan 2013 and October 2016. Real-time reverse-transcriptase polymerase chain reaction for SFTS virus and chemokine/cytokines levels from blood and CSF were analysed. Results Of 41 patients with confirmed SFTS by RT-PCR for SFTS virus using blood samples, 14 (34%) patients underwent CSF examination due to suspected SFTSAE. All 14 patients with SFTSE revealed normal protein and glucose levels in CSF, and CSF pleocytosis was uncommon (29%, 4/14). Of the 8 patients whose CSF was available for further analysis, 6 (75%) yielded positive results for SFTS virus. MCP-1 and IL-8 level in CSF were significantly higher than those in serum (geometric mean 1,889 pg/ml in CSF vs. 264 pg/ml in serum for MCP-1, P=.01, and geometric mean 340 pg/ml in CSF vs. 71 pg/ml in serum for IL-8, P=.004). Conclusions The CNS manifestation of SFTS as acute encephalopathy/encephalitis is a common complication of SFTS. Although meningeal inflammation was infrequent in patients with SFTSAE, SFTS virus was frequently detected in CSF with elevated MCP-1 and IL-8. These findings indicate that possible direct invasion of the CNS by SFTS virus with the associated elevated cytokine levels in CSF may play an important role in the pathogenesis of SFTSAE.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17305001

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