Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange
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Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated withSFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompaniedwith multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis forthe treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them withribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospitalwith a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experiencedpersistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reversetranscription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loadingdose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasmaexchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admittedto the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empiricalantibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administeredorally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSVresult from a real-time RT-PCR. The patient had a successful recovery.
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated withSFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompaniedwith multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis forthe treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them withribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospitalwith a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experiencedpersistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reversetranscription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loadingdose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasmaexchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admittedto the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empiricalantibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administeredorally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSVresult from a real-time RT-PCR. The patient had a successful recovery.
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