Analysis Of Clinical Features And Death Factors Of Fever With Thrombocytopenia Syndrome

ObjectiveSevere fever with thrombocytopenia syndrome(SFTS),It is a newly emerging infectious disease caused by Severe fever with thrombocytopenia syndrome virus(SFTSV).The main clinical manifestations includes fever,thrombocytopenia,and multiple organ damage,which are reported in China,South Korea and Japan with high mortality.This study reviewed the clinical features、the risk factors of death,and the clinical characteristics of patients with central nervous system infection of Severe fever with thrombocytopenia syndrome patients,summarized the clinical manifestations of Severe fever with thrombocytopenia syndrome,early identification of severe SFTS cases and high mortality risk cases,and then It provides a theoretical basis for clinical diagnosis,treatment and prognosis judgement.MethodInclusion criteria 70 patients with SFTS were collected in Nanjing Drum Tower Hospital during the period of 2012.03-2017.12,which was in line with the diagnostic criteria of the fever companion thrombocytopenia syndrome(2010 Edition).The results of patient epidemiology,clinical manifestation,laboratory examination and imaging were collected to analyze the clinical characteristics,death relatede factors of SFTS patients.Exclusion criteria patients in our hospital who were hospitalized for less than 72h included patients who died within 72 hours and discharged automatically.Result1.The clinical features ALL cases are acute onset.All the symptoms of fever and Na are all,and the changes of digestive system,urinary system,muscle system,blood system,central nervous system are accompanied by different degrees.Most of the respiratory diseases are secondary hospital acquired pneumonia,mainly bacterial infection,and some patients with sputum culture can be examined.Fungal infection was associated with widespread use of broad-spectrum antibiotics,bedding,ventilator use and immunodeficiency for a long time.The results of laboratory examination showed that the platelet count decreased,most of the patients had urine protein + or above and urinary occult blood(+),and some patients had abnormal liver function,renal function,coagulation function,cerebrospinal fluid examination and so on.The results of the laboratory examination were abnormal.Imaging examination mainly included pulmonary infection,peri pancreatic exudation and abnormal cortical signal.After symptomatic treatment,most patients had good prognosis,symptoms gradually disappeared,and laboratory results returned to normal.2.Clinical characteristics of patients with CNS infection When combined with CNS infection,the above clinical manifestations were excluded.Encephalopathy and epilepsy were the main manifestations.Brain diseases such as indifference,irritability,delirium,lethargy,disorder of orienteering,serious patients can appear coma,no movement and sensory disorders,physical examination can have stiff neck,no nervous system positioning,epilepsy can be a local limb convulsions,even large seizures.Cerebrospinal fluid examination showed that white blood cells were slightly increased,mainly lymphocytes,sugar and chloride were not changed,and cerebrospinal fluid protein was slightly increased.Abnormal changes in electroencephalogram(EEG)were observed.MRI revealed abnormal cortical signal.3.Clinical characteristics of death cases The clinical characteristics of death cases were more severe than those of surviving patients.Most of the dead patients were elderly patients with CNS symptoms,respiratory and circulatory failure,liver and renal failure,and coagulation dysfunction.ConclusionSevere fever with thrombocytopenia syndrome caused by SFTSV infection are different,involving multiple systems and multiple organs,which can lead to SIRS and MODS.Elderly,persistent MODS,ALT↑,AST↑,TT↑,APTT↑ and SCr↑ were associated with SFTS death.