title: Fever with thrombocytopenia associated with a novel bunyavirus in China.
abstract: BACKGROUND
  Heightened surveillance of acute febrile illness in China since 2009 has led to the identification of a severe fever with thrombocytopenia syndrome (SFTS) with an unknown cause. Infection with Anaplasma phagocytophilum has been suggested as a cause, but the pathogen has not been detected in most patients on laboratory testing.
  
  
  METHODS
  We obtained blood samples from patients with the case definition of SFTS in six provinces in China. The blood samples were used to isolate the causal pathogen by inoculation of cell culture and for detection of viral RNA on polymerase-chain-reaction assay. The pathogen was characterized on electron microscopy and nucleic acid sequencing. We used enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and neutralization testing to analyze the level of virus-specific antibody in patients' serum samples.
  
  
  RESULTS
  We isolated a novel virus, designated SFTS bunyavirus, from patients who presented with fever, thrombocytopenia, leukocytopenia, and multiorgan dysfunction. RNA sequence analysis revealed that the virus was a newly identified member of the genus phlebovirus in the Bunyaviridae family. Electron-microscopical examination revealed virions with the morphologic characteristics of a bunyavirus. The presence of the virus was confirmed in 171 patients with SFTS from six provinces by detection of viral RNA, specific antibodies to the virus in blood, or both. Serologic assays showed a virus-specific immune response in all 35 pairs of serum samples collected from patients during the acute and convalescent phases of the illness.
  
  
  CONCLUSIONS
  A novel phlebovirus was identified in patients with a life-threatening illness associated with fever and thrombocytopenia in China. (Funded by the China Mega-Project for Infectious Diseases and others.).
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xue-Jie
authors.initials: XJ
authors.lastname: Yu
authors.forename: Mi-Fang
authors.initials: MF
authors.lastname: Liang
authors.forename: Shou-Yin
authors.initials: SY
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Jian-Dong
authors.initials: JD
authors.lastname: Li
authors.forename: Yu-Lan
authors.initials: YL
authors.lastname: Sun
authors.forename: Lihong
authors.initials: L
authors.lastname: Zhang
authors.forename: Quan-Fu
authors.initials: QF
authors.lastname: Zhang
authors.forename: Vsevolod L
authors.initials: VL
authors.lastname: Popov
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Qu
authors.forename: Qun
authors.initials: Q
authors.lastname: Li
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Zhang
authors.forename: Rong
authors.initials: R
authors.lastname: Hai
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Fa-Xian
authors.initials: FX
authors.lastname: Zhan
authors.forename: Xian-Jun
authors.initials: XJ
authors.lastname: Wang
authors.forename: Biao
authors.initials: B
authors.lastname: Kan
authors.forename: Shi-Wen
authors.initials: SW
authors.lastname: Wang
authors.forename: Kang-Lin
authors.initials: KL
authors.lastname: Wan
authors.forename: Huai-Qi
authors.initials: HQ
authors.lastname: Jing
authors.forename: Jin-Xin
authors.initials: JX
authors.lastname: Lu
authors.forename: Wen-Wu
authors.initials: WW
authors.lastname: Yin
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.forename: Xu-Hua
authors.initials: XH
authors.lastname: Guan
authors.forename: Jia-Fa
authors.initials: JF
authors.lastname: Liu
authors.forename: Zhen-Qiang
authors.initials: ZQ
authors.lastname: Bi
authors.forename: Guo-Hua
authors.initials: GH
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Ren
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Zhao
authors.forename: Jing-Dong
authors.initials: JD
authors.lastname: Song
authors.forename: Jin-Rong
authors.initials: JR
authors.lastname: He
authors.forename: Tao
authors.initials: T
authors.lastname: Wan
authors.forename: Jing-Shan
authors.initials: JS
authors.lastname: Zhang
authors.forename: Xiu-Ping
authors.initials: XP
authors.lastname: Fu
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Sun
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Dong
authors.forename: Zi-Jian
authors.initials: ZJ
authors.lastname: Feng
authors.forename: Wei-Zhong
authors.initials: WZ
authors.lastname: Yang
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: David H
authors.initials: DH
authors.lastname: Walker
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: De-Xin
authors.initials: DX
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D002044:Bunyaviridae Infections / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D002681:China / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000821:virology*; D005260:Female; D005334:Fever / Q000821:virology; D016679:Genome, Viral; D006801:Humans; D026863:Ixodidae / Q000821:virology; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D016851:Orthobunyavirus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D010802:Phylogeny; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013921:Thrombocytopenia / Q000821:virology*
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral