[HTML][HTML] Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis

SY Park, JS Kwon, JY Kim, SM Kim, YR Jang… - Clinical Microbiology …, 2018 - Elsevier
SY Park, JS Kwon, JY Kim, SM Kim, YR Jang, MC Kim, OH Cho, T Kim, YP Chong, SO Lee…
Clinical Microbiology and Infection, 2018Elsevier
Objectives Severe fever with thrombocytopenia syndrome (SFTS) virus has a variety of
central nervous system (CNS) manifestations. However, there are limited data regarding
SFTS-associated encephalopathy/encephalitis (SFTSAE) and its mechanism. Methods All
patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to
suspected acute encephalopathy were enrolled in three referral hospitals between January
2013 and October 2016. Real-time RT-PCR for SFTS virus and chemokine/cytokines levels …
Objectives
Severe fever with thrombocytopenia syndrome (SFTS) virus has a variety of central nervous system (CNS) manifestations. However, there are limited data regarding SFTS-associated encephalopathy/encephalitis (SFTSAE) and its mechanism.
Methods
All patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to suspected acute encephalopathy were enrolled in three referral hospitals between January 2013 and October 2016. Real-time RT-PCR 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%) 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 eight patients whose CSF was available for further analysis, six (75%) yielded positive results for SFTS virus. Monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) level in CSF were significantly higher than those in serum (geometric mean 1889 pg/mL in CSF versus 264 pg/mL in serum for MCP-1, p = 0.01, and geometric mean 340 pg/mL in CSF versus 71 pg/mL in serum for IL-8, p = 0.004).
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.
Elsevier