title: Hemorrhagic fever caused by a novel Bunyavirus in China: pathogenesis and correlates of fatal outcome.
abstract: BACKGROUND
  Hemorrhagic fever-like illness caused by a novel Bunyavirus, Huaiyangshan virus (HYSV, also known as Severe Fever with Thrombocytopenia virus [SFTSV] and Fever, Thrombocytopenia and Leukopenia Syndrome [FTLS]), has recently been described in China.
  
  
  METHODS
  Patients with laboratory-confirmed HYSV infection who were admitted to Union Hospital or Zhongnan Hospital between April 2010 and October 2010 were included in this study. Clinical and routine laboratory data were collected and blood, throat swab, urine, or feces were obtained when possible. Viral RNA was quantified by real-time reverse-transcriptase polymerase chain reaction. Blood levels of a range of cytokines, chemokines, and acute phase proteins were assayed.
  
  
  RESULTS
  A total of 49 patients with hemorrhagic fever caused by HYSV were included; 8 (16.3%) patients died. A fatal outcome was associated with high viral RNA load in blood at admission, as well as higher serum liver transaminase levels, more pronounced coagulation disturbances (activated partial thromboplastin time, thrombin time), and higher levels of acute phase proteins (phospholipase A, fibrinogen, hepcidin), cytokines (interleukin [IL]-6, IL-10, interferon-γ), and chemokines (IL-8, monocyte chemotactic protein 1, macrophage inflammatory protein 1b). The levels of these host parameters correlated with viral RNA levels. Blood viral RNA levels gradually declined over 3-4 weeks after illness onset, accompanied by resolution of symptoms and laboratory abnormalities. Viral RNA was also detectable in throat, urine, and fecal specimens of a substantial proportion of patients, including all fatal cases assayed. CONCLUSIONS. Viral replication and host immune responses play an important role in determining the severity and clinical outcome in patients with infection by HYSV.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
authors.forename: Yong-Zhen
authors.initials: YZ
authors.lastname: Zhang
authors.forename: Yong-Wen
authors.initials: YW
authors.lastname: He
authors.forename: Yong-An
authors.initials: YA
authors.lastname: Dai
authors.forename: Yanwen
authors.initials: Y
authors.lastname: Xiong
authors.forename: Han
authors.initials: H
authors.lastname: Zheng
authors.forename: Dun-Jin
authors.initials: DJ
authors.lastname: Zhou
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Qiangzheng
authors.initials: Q
authors.lastname: Sun
authors.forename: Xue-Lian
authors.initials: XL
authors.lastname: Luo
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Cheng
authors.forename: Xin-Cheng
authors.initials: XC
authors.lastname: Qin
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Tian
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Chen
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.forename: Dong
authors.initials: D
authors.lastname: Jin
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Guo
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.forename: Jin-Song
authors.initials: JS
authors.lastname: Peng
authors.forename: Guo-Bin
authors.initials: GB
authors.lastname: Zhang
authors.forename: Shaomin
authors.initials: S
authors.lastname: Zhang
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Chen
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Li
authors.forename: Zhenjun
authors.initials: Z
authors.lastname: Li
authors.forename: Shan
authors.initials: S
authors.lastname: Lu
authors.forename: Changyun
authors.initials: C
authors.lastname: Ye
authors.forename: Menno D
authors.initials: MD
authors.lastname: de Jong
authors.forename: Jianguo
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D001769:Blood / Q000821:virology; D002044:Bunyaviridae Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D002681:China / Q000453:epidemiology; D005243:Feces / Q000821:virology; D005260:Female; D006482:Hemorrhagic Fevers, Viral / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016851:Orthobunyavirus / Q000145:classification* / Q000302:isolation & purification*; D010614:Pharynx / Q000821:virology; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D016019:Survival Analysis; D014556:Urine / Q000821:virology; D019562:Viral Load
chemical_list: D012367:RNA, Viral