Higher Fatality for Severe Fever with Thrombocytopenia Syndrome Complicated by Hemophagocytic Lymphohistiocytosis
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초록
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious zoonosis caused by the SFTS virus. Hemophagocyticlymphohistiocytosis (HLH) is a life-threatening syndrome associated with excessive immune activation. Cytokine stormsare often seen in both SFTS and HLH, resulting in rapid disease progression and poor prognosis. The aim of this study was toidentify whether SFTS cases complicated by HLH are related to higher rates of mortality. Descriptive analysis of the frequency ofclinical and laboratory data, complications, treatment outcomes, and HLH-2004 criteria was performed. Cases presenting withfive or more clinical or laboratory findings corresponding to the HLH-2004 diagnostic criteria were defined as SFTS cases complicatedby HLH. Eighteen cases of SFTS were identified during a 2-year study period, with a case-fatality proportion of 22.2% (4among 18 cases, 95% confidence interval 9%–45.2%). SFTS cases complicated by HLH were identified in 33.3% (6 among 18 cases). A mortality rate of 75% (3 among 4 cases) was recorded among SFTS cases complicated by HLH. Although there were no statisticallysignificant differences in outcomes, fatal cases exhibited more frequent correlation with HLH-2004 criteria than non-fatalcases [3/14 (21.4%) vs. 3/4 (75%), p=0.083]. In conclusion, the present study suggests the possibility that SFTS casescomplicated by HLH are at higher risk of poor prognosis.
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious zoonosis caused by the SFTS virus. Hemophagocyticlymphohistiocytosis (HLH) is a life-threatening syndrome associated with excessive immune activation. Cytokine stormsare often seen in both SFTS and HLH, resulting in rapid disease progression and poor prognosis. The aim of this study was toidentify whether SFTS cases complicated by HLH are related to higher rates of mortality. Descriptive analysis of the frequency ofclinical and laboratory data, complications, treatment outcomes, and HLH-2004 criteria was performed. Cases presenting withfive or more clinical or laboratory findings corresponding to the HLH-2004 diagnostic criteria were defined as SFTS cases complicatedby HLH. Eighteen cases of SFTS were identified during a 2-year study period, with a case-fatality proportion of 22.2% (4among 18 cases, 95% confidence interval 9%–45.2%). SFTS cases complicated by HLH were identified in 33.3% (6 among 18 cases). A mortality rate of 75% (3 among 4 cases) was recorded among SFTS cases complicated by HLH. Although there were no statisticallysignificant differences in outcomes, fatal cases exhibited more frequent correlation with HLH-2004 criteria than non-fatalcases [3/14 (21.4%) vs. 3/4 (75%), p=0.083]. In conclusion, the present study suggests the possibility that SFTS casescomplicated by HLH are at higher risk of poor prognosis.
참고문헌 (17)
- "Taxonomy"[URL]
- Liu Q, "Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis", Lancet Infect Dis, 14, pp.763~772 (2014)
- Li H, "Epidemiological and clinical features of laboratory-diagnosed severe fever with thrombocytopenia syndrome in China, 2011-17 : a prospective observational study", Lancet Infect Dis, 18, pp.1127~1137 (2018)
- Kaneko M, "A fatal case of severe fever with thrombocytopenia syndrome complicated by hemophagocytic lymphohistiocytosis", Kansenshogaku zasshi, 89, pp.592~596 (2015)
- Oh HS, "Hemophagocytic lymphohistiocytosis associated with SFTS virus infection: a case report with literature review", Medicine (Baltimore), 95, pp.e4476~ (2016)
- Kim UJ, "Hyperferritinemia as a diagnostic marker for severe fever with thrombocytopenia syndrome", Dis Markers, 2017, pp.6727184~ (2017)
- Cohen LA, "Serum ferritin is derived primarily from macrophages through a nonclassical secretory pathway", Blood, 116, pp.1574~1584 (2010)
- Gai ZT, "Clinical progress and risk factors for death in severe fever with thrombocytopenia syndrome patients", J Infect Dis, 206, pp.1095~1102 (2012)
- Nakano A, "Hemophagocytic lymphohistiocytosis in a fatal case of severe fever with thrombocytopenia syndrome", Intern Med, 56, pp.1597~1602 (2017)
- Kim N, "Bone marrow findings in severe fever with thrombocytopenia syndrome:prominent haemophagocytosis and its implication in haemophagocytic lymphohistiocytosis", J Clin Pathol, 69, pp.537~541 (2016)
- Jordan MB, "How I treat hemophagocytic lymphohistiocytosis", Blood, 118, pp.4041~4052 (2011)
- Stone NJ, "2013 ACC", AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology, J Am Coll Cardiol, pp.2014, 63(25 Pt B)[DOI]
- Levey AS, "Definition and classification of chronic kidney disease : a position statement from Kidney Disease : Improving Global Outcomes(KDIGO)", Kidney Int, 67, pp.2089~2100 (2005)
- Choi SJ, "Severe fever with thrombocytopenia syndrome in South Korea, 2013-2015", PLoS Negl Trop Dis, 10, pp.e0005264~ (2016)
- 오원섭, "Effect of Early Plasma Exchange on Survival in Patients with Severe Fever with Thrombocytopenia Syndrome: A Multicenter Study", Yonsei Medical Journal, 58(4), pp.867~871 (2017), 연세대학교의과대학[DOI]
- Kato H, "Epidemiological and clinical features of severe fever with thrombocytopenia syndrome in Japan, 2013-2014", PLoS One, 11, pp.e0165207~ (2016)
- 신상용, "Bone Marrow Suppression and Hemophagocytic Histiocytes Are Common Findings in Korean Severe Fever with Thrombocytopenia Syndrome Patients", Yonsei Medical Journal, 57(5), pp.1286~1289 (2016), 연세대학교의과대학[DOI]