FTLS or SFTS Fever Thrombocytopenia and Leukopenia Syndrome

FTLS or SFTS • • • Fever, Thrombocytopenia and Leukopenia Syndrome Severe Fever with Thrombocytopenia Syndrome First reported in China in 2007 First thought as Anaplasma or Tsutsugamushi? Later turned out to be viral illness. • • (1) acute onset with fever (2) low white blood cell and platelet counts (3) high AST/ALT (4) positive urine protein CFR 12. 7%. 95 cases in 2007. CFR >30% in 2009 Xu B et al. PLo. S Pathog [Internet]. 2011 Nov [cited 2013 Feb 14]; 7(11). Available from: http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3219706/ Yu X-J et al. New England Journal of Medicine. 2011; 364(16): 1523– 32.

Bunyaviridae • a family of negative-stranded, enveloped RNA viruses. • Mainly infected through arthropods. • Hantavirus • Rift Valley fever virus • Crimean-Congo hemorrhagic fever virus

• Most phleboviruses (1 of 5 Bunyaviridae) are associated with sandflies • • The nonpathogenic Uukuniemi virus is a tickborne phlebovirus. Rift Valley fever is transmitted mainly by aedes species mosquitoes. Crimean-Congo hemorrhagic fever virus by tick bite Hantavirus by rat bite, feces, urines etc, , ,

Geographic Distribution of SFTS in Mainland China. Yu X et al. N Engl J Med 2011; 364: 1523 -1532.

Xu B et al. PLo. S Pathog [Internet]. 2011 Nov [cited 2013 Feb 14]; 7(11). Available from: http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3219706/

Clinical Symptoms of Hospitalized Patients with Laboratory-Confirmed SFTS. Yu X et al. N Engl J Med 2011; 364: 1523 -1532.

Xu B et al. PLo. S Pathog [Internet]. 2011 Nov [cited 2013 Feb 14]; 7(11). Available from: http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3219706/

Laboratory Findings in Patients with SFTS. Yu X et al. N Engl J Med 2011; 364: 1523 -1532.

Xu B et al. PLo. S Pathog [Internet]. 2011 Nov [cited 2013 Feb 14]; 7(11). Available from: http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3219706/

Morphologic Features of SFTS Bunyavirus. Yu X et al. N Engl J Med 2011; 364: 1523 -1532.

Phylogenetic Analysis of SFTS Bunyavirus and Other Phleboviruses. Yu X et al. N Engl J Med 2011; 364: 1523 -1532.

DDxs • • Leptospirosis Hantavirus infection HUS TTP Anaplasma Tsutsugamushi disease Hemorrhagic fever syndromes of other types

ダニは、、、 • • • 10 of 186 ticks (5. 4%) of the species Haemaphysalis longicornis that were collected from domestic animals in the areas where the patients lived contained SFTSV RNA. Regular hosts of H. longicornis include most mammals, including goats, cattle, sheep, yak, donkeys, pigs, deer, cats, rats, mice, hedgehogs, weasels, brushtail possums, and humans, along with some birds. H. longicornis ticks were dominant in regions of endemicity, while Rhipicephalus microplus is more abundant in regions of nonendemicity. H. longicornis is widely distributed in the Asia–Pacific region, including China, Korea, Japan, Australia, the Pacific Islands, and New Zealand. ライム、アナプラズマなども媒介

Ixodidae マダニ目マダニ科 Amblyomma – 130 species (includes some of Aponomma) • Anomalohimalaya – 3 species • Bothriocroton – 7 species • Cosmiomma – 1 species • Cornupalpatum – 1 species • Compluriscutula – 1 species • Dermacentor – 34 species (includes Anocentor) • Haemaphysalis – 166 species • Hyalomma – 27 species • Ixodes – 243 species • Margaropus – 3 species • Nosomma – 2 species • Rhipicentor – 2 species http: //en. wikipedia. org/wiki/Ixodidae#cite_note-list-2 • Rhipicephalus – 82 species (includes Boophilus)

Zhang Y-Z et al. J. Virol. 2012 Mar; 86(5): 2864– 8.

Engorged female New Zealand cattle tick, Haemaphysalis longicornis フタトゲチマダニ Journal of the New Zealand Medical Association, 29 -July-2011, Vol 124 No 1339

Wikipediaより。オウシマダニ（Rhipicephalus microplus ）

http: //www. yakuji. co. jp/entry 30059. html

Li. Bio. Science Trends. 2012 Jan 11; 5(6): 273– 6.

リバビリンとは、、 • • guanosine analog an unusually wide spectrum of antiviral activity in vitro against both DNA and RNA viruses first described in 1972 approved by FDA in 1986 for aerosol treatment of children with severe RSV infection, although the efficacy remains controversial (American Academy of Pediatrics, 2006 Oral ribavirin was approved by the US FDA in 1998 for treatment of chronic HCV infection in combination with interferon. 1 -β-d-ribofuranosyl-1, 2, 4 -triazole-3 -carboxamide 日本では経口薬のみ（HCV用） Grayson, M. Lindsay. Kucers' The Use of Antibiotics, 6 th Edition. Hodder Arnold, 10/2010. <vbk: 9781444120431#outline(252. 1)>.

Grayson, M. Lindsay. Kucers' The Use of Antibiotics, 6 th Edition. Hodder Arnold, 10/2010. <vbk: 9781444120431#outline(252. 1)>.

ヒト−ヒト感染？ Tang X et al. J Infect Dis. 2013 Mar 1; 207(5): 736– 9.

Tang X et al. J Infect Dis. 2013 Mar 1; 207(5): 736– 9.

Epidemic curve shows progression of the family cluster and timeline of key events during the index patient’s illness as well as pertinent exposure histories of secondary patients. a. Exposure during period of providing bedside care may not have occurred continuously during the exposure period. Bao C et al. Clin Infect Dis. 2011; 53: 1208 -1214 © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup. com.