Application of therapeutic plasma exchange in patients having severe fever with thrombocytopenia syndrome
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Background/Aims: Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. Methods: TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. Results: Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. Conclusions: SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.
Abstract
Background/Aims: Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. Methods: TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. Results: Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. Conclusions: SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.
참고문헌 (26)
- Yu XJ, "Fever with thrombocytopenia associated with a novel bunyavirus in China", N Engl J Med, 364, pp.1523~1532 (2011)
- Liu Q, "Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis", Lancet Infect Dis, 14, pp.763~772 (2014)
- Gai ZT, "Clinical progress and risk factors for death in severe fever with thrombocytopenia syndrome patients", J Infect Dis, 206, pp.1095~1102 (2012)
- Tang X, "Human-to-human transmission of severe fever with thrombocytopenia syndrome bunyavirus through contact with infectious blood", J Infect Dis, 207, pp.736~739 (2013)
- Kim WY, "Nosocomial transmission of severe fever with thrombocytopenia syndrome in Korea", Clin Infect Dis, 60, pp.1681~1683 (2015)
- Gong Z, "Probable aerosol transmission of severe fever with thrombocytopenia syndrome virus in southeastern China", Clin Microbiol Infect, 21, pp.1115~1120 (2015)
- Jeong EJ, "Viral shedding from diverse body fluids in a patient with severe fever with thrombocytopenia syndrome", J Clin Virol, 80, pp.33~35 (2016)
- Liu S, "Systematic review of severe fever with thrombocytopenia syndrome : virology, epidemiology, and clinical characteristics", Rev Med Virol, 24, pp.90~102 (2014)
- Deng B, "Clinical features and factors associated with severity and fatality among patients with severe fever with thrombocytopenia syndrome Bunyavirus infection in Northeast China", PLoS One, 8, pp.e80802~ (2013)
- "Severe fever with thrombocytopenia syndrome (SFTS), and statistical system of notifiable disease surveillance system (2013-2015)" (2017)[URL]
- Oh WS, "Plasma exchange and ribavirin for rapidly progressive severe fever with thrombocytopenia syndrome", Int J Infect Dis, 18, pp.84~86 (2014)
- Liu W, "Case-fatality ratio and effectiveness of ribavirin therapy among hospitalized patients in china who had severe fever with thrombocytopenia syndrome", Clin Infect Dis, 57, pp.1292~1299 (2013)
- Marshall JC, "Multiple organ dysfunction score : a reliable descriptor of a complex clinical outcome", Crit Care Med, 23, pp.1638~1652 (1995)
- Heid CA, "Real time quantitative PCR", Genome Res, 6, pp.986~994 (1996)
- Zhang YZ, "Hemorrhagic fever caused by a novel Bunyavirus in China : pathogenesis and correlates of fatal outcome", Clin Infect Dis, 54, pp.527~533 (2012)
- Park SY, "Use of plasma therapy for severe fever with thrombocytopenia syndrome encephalopathy", Emerg Infect Dis, 22, pp.1306~1308 (2016)
- Shimojima M, "Effects of ribavirin on severe fever with thrombocytopenia syndrome virus in vitro", Jpn J Infect Dis, 67, pp.423~427 (2014)
- Kim UJ, "Successful treatment of rapidly progressing severe fever with thrombocytopenia syndrome with neurological complications using intravenous immunoglobulin and corticosteroid", Antivir Ther, 21, pp.637~640 (2016)
- Deng B, "Cytokine and chemokine levels in patients with severe fever with thrombocytopenia syndrome virus", PLoS One, 7, pp.e41365~ (2012)
- Schwartz J, "Guidelines on the use of therapeutic apheresis in clinical practiceevidence-based approach from the Writing Committee of the American Society for Apheresis : the sixth special issue", J Clin Apher, 28, pp.145~284 (2013)
- Patel P, "Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A : an associated respiratory failure and hemodynamic shock", Pediatr Crit Care Med, 12, pp.e87~e89 (2011)
- Kurnaz F, "A case of Crimean-Congo haemorrhagic fever successfully treated with therapeutic plasma exchange and ribavirin", Trop Doct, 41, pp.181~182 (2011)
- Meco BC, "Double filtration plasmapheresis for a case of Crimean-Congo hemorrhagic fever", Transfus Apher Sci, 48, pp.331~334 (2013)
- Pearl RG, "Metabolic alkalosis due to plasmapheresis", Am J Med, 79, pp.391~393 (1985)
- Mokrzycki MH, "Therapeutic plasma exchange : complications and management", Am J Kidney Dis, 23, pp.817~827 (1994)
- Cui N, "Clinical progression and predictors of death in patients with severe fever with thrombocytopenia syndrome in China", J Clin Virol, 59, pp.12~17 (2014)