PMID- 28899841 OWN - NLM STAT- MEDLINE DCOM- 20180824 LR - 20180824 IS - 1469-0691 (Electronic) IS - 1198-743X (Linking) VI - 24 IP - 4 DP - 2018 Apr TI - Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis. PG - 432.e1-432.e4 LID - S1198-743X(17)30500-1 [pii] LID - 10.1016/j.cmi.2017.09.002 [doi] AB - OBJECTIVES: Severe fever with thrombocytopenia syndrome (SFTS) virus has a variety of central nervous system (CNS) manifestations. However, there are limited data regarding SFTS-associated encephalopathy/encephalitis (SFTSAE) and its mechanism. METHODS: All patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to suspected acute encephalopathy were enrolled in three referral hospitals between January 2013 and October 2016. Real-time RT-PCR for SFTS virus and chemokine/cytokines levels from blood and CSF were analysed. RESULTS: Of 41 patients with confirmed SFTS by RT-PCR for SFTS virus using blood samples, 14 (34%) underwent CSF examination due to suspected SFTSAE. All 14 patients with SFTSE revealed normal protein and glucose levels in CSF, and CSF pleocytosis was uncommon (29%, 4/14). Of the eight patients whose CSF was available for further analysis, six (75%) yielded positive results for SFTS virus. Monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) level in CSF were significantly higher than those in serum (geometric mean 1889 pg/mL in CSF versus 264 pg/mL in serum for MCP-1, p = 0.01, and geometric mean 340 pg/mL in CSF versus 71 pg/mL in serum for IL-8, p = 0.004). CONCLUSIONS: The CNS manifestation of SFTS as acute encephalopathy/encephalitis is a common complication of SFTS. Although meningeal inflammation was infrequent in patients with SFTSAE, SFTS virus was frequently detected in CSF with elevated MCP-1 and IL-8. These findings indicate that possible direct invasion of the CNS by SFTS virus with the associated elevated cytokine levels in CSF may play an important role in the pathogenesis of SFTSAE. CI - Copyright (c) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. FAU - Park, S Y AU - Park SY AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea. FAU - Kwon, J-S AU - Kwon JS AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, J Y AU - Kim JY AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, S-M AU - Kim SM AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Jang, Y R AU - Jang YR AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea. FAU - Kim, M-C AU - Kim MC AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea. FAU - Cho, O-H AU - Cho OH AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. FAU - Kim, T AU - Kim T AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. FAU - Chong, Y P AU - Chong YP AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Lee, S-O AU - Lee SO AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Choi, S-H AU - Choi SH AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, Y S AU - Kim YS AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Woo, J H AU - Woo JH AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, S-H AU - Kim SH AD - Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: kimsunghanmd@hotmail.com. LA - eng PT - Journal Article DEP - 20170909 PL - England TA - Clin Microbiol Infect JT - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JID - 9516420 RN - 0 (Cytokines) RN - SFTS phlebovirus SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Diseases/*etiology/*pathology MH - Cerebrospinal Fluid/*virology MH - Cytokines/blood/cerebrospinal fluid MH - Encephalitis/*etiology/*pathology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Phlebotomus Fever/*complications MH - Phlebovirus/*isolation & purification MH - Real-Time Polymerase Chain Reaction MH - Retrospective Studies OTO - NOTNLM OT - Central nervous system OT - Chemokines OT - Cytokines OT - Encephalopathy OT - Severe fever with thrombocytopenia syndrome EDAT- 2017/09/14 06:00 MHDA- 2018/08/25 06:00 CRDT- 2017/09/14 06:00 PHST- 2017/05/18 00:00 [received] PHST- 2017/08/28 00:00 [revised] PHST- 2017/09/05 00:00 [accepted] PHST- 2017/09/14 06:00 [pubmed] PHST- 2018/08/25 06:00 [medline] PHST- 2017/09/14 06:00 [entrez] AID - S1198-743X(17)30500-1 [pii] AID - 10.1016/j.cmi.2017.09.002 [doi] PST - ppublish SO - Clin Microbiol Infect. 2018 Apr;24(4):432.e1-432.e4. doi: 10.1016/j.cmi.2017.09.002. Epub 2017 Sep 9.