title: The world first two cases of severe fever with thrombocytopenia syndrome: An epidemiological study in Nagasaki, Japan.
abstract: Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus (SFTSV), a novel phlebovirus belonging to the family Bunyaviridae, was reported in China for the first time in 2009. We observed two cases where the SFTSV was isolated for the first time in Nagasaki, Japan, in 2005. Two males in their 60s, a farmer and a hunter, respectively, living in Nagasaki developed SFTS during the same period. The patients developed similar clinical symptoms and signs, such as fever, loss of consciousness, and multiple organ dysfunction. The farmer died and the hunter survived. A retrospective diagnosis of SFTS was made in 2013, and genetic analysis revealed that the patients were infected with different SFTSV strains. Retrospective analysis of cytokine production in non-fatal case revealed interleukin (IL)-6, IL-8 and interferon-γ level of acute phase was low and could be potential prognostic factors. As there are no epidemiological studies of positive rate of SFTSV antibody in people living in endemic areas in Japan, a field study was performed. Volunteers at high risk for tick bites, such as hunters, farmers, and soldiers, were recruited in 6 regions, including the areas where the SFTS cases occurred. Three hundred and twenty six volunteers in Nagasaki prefecture were examined and none of these tested positive for the SFTSV antibody. Our data indicates that the risk for SFTSV infection is not high in Nagasaki prefecture. Further collection of blood samples from endemic areas is warranted for the prevention of SFTSV infection.
authors.affiliation: Infection Control and Education Center, Nagasaki University Hospital, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kurihara
authors.affiliation: Department of Neurology, Nagasaki Kita Hospital, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Satoh
authors.affiliation: Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan.
authors.forename: Fuxun
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hayasaka
authors.affiliation: Department of Virology 1, National Institute of Infectious Diseases, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimojima
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Tashiro
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Saijo
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takazono
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Misuzu
authors.initials: M
authors.lastname: Tsukamoto
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mukae
authors.affiliation: Department of Virology 1, National Institute of Infectious Diseases, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Saijo
authors.affiliation: Department of Virology, Institute of Tropical Medicine, Nagasaki University, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Morita
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.affiliation: Infection Control and Education Center, Nagasaki University Hospital, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan. Electronic address: koizumik@nagasaki-u.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002044:Bunyaviridae Infections / Q000453:epidemiology* / Q000821:virology; D002648:Child; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016856:Phlebovirus; D013577:Syndrome; D013921:Thrombocytopenia / Q000453:epidemiology / Q000821:virology*; D055815:Young Adult
keywords: Antibody; Epidemiology; First cases; Severe fever with thrombocytopenia syndrome