title: Severe fever with thrombocytopenia syndrome bunyavirus-related human encephalitis.
abstract: BACKGROUND
  Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus. Until recently, SFTSV-associated encephalitis remained largely uninvestigated.
  
  
  METHODS
  We made clinical investigation on SFTS patients who experienced encephalitis in one reference hospital in Henan Province from 2011 to 2013 to identify the risk factors for encephalitis occurrence and their fatal outcome development.
  
  
  RESULTS
  Altogether 538 SFTS patients were included and 19.1% of them developed encephalitis. Fatal outcome occurred in 44.7% of the encephalitis patients. The risk factors associated with encephalitis occurrence and death included older age, longer delay between disease onset and hospital admission, pre-existing diabetes and myalgias, as well as the laboratory evaluations of higher virus load on admission, decreased WBC, PLT count, lymphocyte percentage and ALB, elevated neutrophils percentage, AST, ALT, LDH, CK, ALP, GGT, BUN and CREA. These parameters could be used as potential predictors referring to severe SFTS cases. One SFTSV strain was isolated from cerebrospinal fluid sample. Cytokine/chemokine assay revealed that blood EOTAXIN, IFN-γ, IL-15, IL-6, IP-10, TNF-α were remarkably elevated before clinical deterioration in the confirmed encephalitis patient.
  
  
  CONCLUSIONS
  SFTSV is capable of infecting the central nervous system and screening for SFTSV in encephalitis of unknown reason should be performed in SFTS endemic regions. The encephalitis occurrence and fatal outcome could be potentially predicted by clinical and laboratory evaluations.
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Ning
authors.initials: N
authors.lastname: Cui
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Rong
authors.initials: R
authors.lastname: Liu
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China.
authors.forename: Qing-Bin
authors.initials: QB
authors.lastname: Lu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei 230032, PR China.
authors.forename: Li-Yuan
authors.initials: LY
authors.lastname: Wang
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Qin
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhuang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Xiao-Ai
authors.initials: XA
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Jian-Gong
authors.initials: JG
authors.lastname: Hu
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China.
authors.forename: Jing-Yu
authors.initials: JY
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China. Electronic address: lwbime@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China. Electronic address: caowc@bmi.ac.cn.
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002043:Bunyaviridae; D002555:Cerebrospinal Fluid / Q000821:virology; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D021821:Communicable Diseases, Emerging / Q000821:virology; D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010217:Phlebotomus Fever / Q000097:blood / Q000150:complications / Q000821:virology*; D016856:Phlebovirus / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D019562:Viral Load
chemical_list: D016207:Cytokines
keywords: Cerebrospinal fluid; Neurologic syndromes; Risk factors; Severe fever with thrombocytopenia syndrome virus; Viral encephalitis