title: Decreased myeloid dendritic cells indicate a poor prognosis in patients with severe fever with thrombocytopenia syndrome.
abstract: OBJECTIVE
  Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease caused by a novel bunyavirus in which host immune system suppression is thought to be crucial in the development of disease. This study was designed to study the frequencies and activation status of dendritic cells (DCs) at different stages of SFTS and their association with disease severity.
  
  
  METHODS
  All confirmed SFTS patients (N=115) were recruited from the Wuhan Union Hospital in 2015; routine laboratory parameters were collected. The frequencies, phenotypes, and subsets of circulating DCs, including myeloid and plasmacytoid dendritic cells (mDCs and pDCs), were analyzed by flow cytometry. Serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-α) were detected by ELISA. The laboratory parameters and other clinical events related to mortality were assessed by multivariate logistic regression analysis and receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The frequency of circulating mDCs, especially from day 9 after disease onset, could serve as a valuable prognostic biomarker for the outcome in SFTS patients (area under the curve=0.929, p<0.0001). In addition, persistent down-regulation of the co-stimulatory molecules CD80/CD86 on the mDCs was observed during the disease process. Moreover, levels of mDCs were inversely correlated with the production of IL-6, IL-10, and TNF-α and with viral load at admission.
  
  
  CONCLUSIONS
  The present results indicate that DCs might be functionally impaired in SFTS. A decreased level of circulating mDCs was closely correlated with the severity of SFTS.
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Shue
authors.initials: S
authors.lastname: Xiong
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Mingyue
authors.initials: M
authors.lastname: Li
authors.affiliation: Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Mengji
authors.initials: M
authors.lastname: Lu
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China. Electronic address: Drpengcheng@hust.edu.cn.
authors.forename: Cheng
authors.initials: C
authors.lastname: Peng
authors.affiliation: Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China. Electronic address: xin11@hotmail.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003713:Dendritic Cells / Q000166:cytology*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D005434:Flow Cytometry; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D016856:Phlebovirus / Q000502:physiology; D011379:Prognosis; D012372:ROC Curve; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10
keywords: Acute phase; Dendritic cell; Mortality; Prognosis; Severe fever with thrombocytopenia syndrome