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内容に関するご意見、お問い合わせは kiwata@med.kobe-u.ac.jp
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Fever, Thrombocytopenia and Leukopenia Syndrome
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Severe Fever with Thrombocytopenia Syndrome
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First reported in China in 2007
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First thought as Anaplasma or Tsutsugamushi? Later turned out to be viral illness.
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(1) acute onset with fever
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(2) low white blood cell and platelet counts
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(3) high AST/ALT
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(4) positive urine protein
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CFR 12.7%. 95 cases in 2007.
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CFR >30% in 2009
Xu B et al. PLoS Pathog [Internet]. 2011 Nov [cited 2013 Feb 14];7(11).
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219706/
Yu X-J et al. New England Journal of Medicine. 2011;364(16):1523–32.

• a family of negative-stranded, enveloped
RNA viruses.
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Mainly infected through arthropods.
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Hantavirus
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Rift Valley fever virus
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Crimean-Congo hemorrhagic fever virus

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Most phleboviruses (1 of 5 Bunyaviridae) are associated with sandflies
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The nonpathogenic Uukuniemi virus is a tickborne phlebovirus.
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Rift Valley fever is transmitted mainly by aedes species mosquitoes.
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Crimean-Congo hemorrhagic fever virus by tick bite
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Hantavirus by rat bite, feces, urines etc,,,

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国立感染症研究所 http://www.nih.go.jp/niid/ja/sfts/sfts-iasrs/3142-pr3963.html

Geographic Distribution of SFTS in Mainland China.
Yu X et al. N Engl J Med 2011;364:1523-1532.

Xu B et al. PLoS Pathog [Internet]. 2011 Nov [cited 2013 Feb 14];7(11). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219706/

Clinical Symptoms of Hospitalized Patients with Laboratory-Confirmed SFTS.
Yu X et al. N Engl J Med 2011;364:1523-1532.

Xu B et al. PLoS Pathog [Internet]. 2011 Nov [cited 2013 Feb 14];7(11).
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219706/

Laboratory Findings in Patients with SFTS.
Yu X et al. N Engl J Med 2011;364:1523-1532.

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2012 年秋、海外渡航歴のない成人患者
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発熱、嘔吐、下痢（黒色便）
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明らかなダニ咬傷なし
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白血球数（ 400/mm 3 ）と血小板数（ 8.9
× 10 4 /mm 3 ） が著明に低下
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AST 、 ALT 、 LDH 、 CK 高値
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血液凝固系の異常、フェリチンの著明な上昇
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血尿、 蛋白尿
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胸腹部単純 CT で右腋窩リンパ節腫大
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骨髄穿刺でマクロファージによる血球貪食像を伴う低形成髄の所見
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その後に四肢脱力および肉眼的血尿と多量の黒色便を認め、全身状態
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が不良となり死亡
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血液からウイルスが分離され、 SFTSV と同定
ELISA 、 IF 法による SFTSV に対する抗体検査 陰性
国立感染症研究所 http://www.nih.go.jp/niid/ja/sfts/sfts-iasrs/3142-pr3963.html

Xu B et al. PLoS Pathog [Internet]. 2011 Nov [cited 2013 Feb 14];7(11). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219706/

Morphologic Features of SFTS Bunyavirus.
Yu X et al. N Engl J Med 2011;364:1523-1532.

Phylogenetic Analysis of SFTS Bunyavirus and Other Phleboviruses.
Yu X et al. N Engl J Med 2011;364:1523-1532.

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Leptospirosis
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Hantavirus infection
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HUS
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TTP
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Anaplasma
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Tsutsugamushi disease
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Hemorrhagic fever syndromes of other types

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10 of 186 ticks (5.4%) of the species Haemaphysalis longicornis that were collected from domestic animals in the areas where the patients lived contained SFTSV RNA.
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Regular hosts of H. longicornis include most mammals, including goats, cattle, sheep, yak, donkeys, pigs, deer, cats, rats, mice, hedgehogs, weasels, brushtail possums, and humans, along with some birds.
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H. longicornis ticks were dominant in regions of endemicity, while
Rhipicephalus microplus is more abundant in regions of nonendemicity.
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H. longicornis is widely distributed in the Asia–Pacific region, including
China, Korea, Japan, Australia, the Pacific Islands, and New Zealand.
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ライム、アナプラズマなども媒介

Amblyomma – 130 species (includes some of Aponomma )
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Anomalohimalaya – 3 species
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Bothriocroton – 7 species
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Cosmiomma – 1 species
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Cornupalpatum – 1 species
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Compluriscutula – 1 species
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Dermacentor – 34 species (includes Anocentor )
Haemaphysalis – 166 species

Zhang Y-Z et al. J. Virol. 2012 Mar;86(5):2864–8.

Engorged female New Zealand cattle tick, Haemaphysalis longicornis フタトゲチマダニ
Journal of the New Zealand Medical Association, 29-July-2011, Vol 124 No 1339

Wikipedia より。オウシマダニ（ Rhipicephalus microplus ）

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血液などからの SFTSV の分離・同定
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RT-PCR による SFTSV 遺伝子検出
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ペア血清 IgG 抗体価
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国立感染症研究所ウイルス第一部で検査が可能である
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リバビリン使用の報告があるが、その有効性は確認さ
れていない
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有効なワクチンなし
国立感染症研究所 http://www.nih.go.jp/niid/ja/sfts/sfts-iasrs/3142-pr3963.html

http://www.yakuji.co.jp/entry30059.html

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Li. BioScience Trends. 2012 Jan 11;5(6):273–6.

Li. BioScience Trends. 2012 Jan 11;5(6):273–6.

• guanosine analog
• an unusually wide spectrum of antiviral activity in vitro
• against both DNA and RNA viruses
• first described in 1972
• approved by FDA in 1986 for aerosol treatment of children with severe
RSV infection, although the efficacy remains controversial (American
Academy of Pediatrics, 2006
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Oral ribavirin was approved by the US FDA in 1998 for treatment of chronic HCV infection in combination with interferon.
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1β-d-ribofuranosyl-1,2,4-triazole-3-carboxamide
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日本では経口薬のみ（ HCV 用）
Grayson, M. Lindsay. Kucers' The Use of Antibiotics, 6th Edition. Hodder Arnold, 10/2010. <vbk:9781444120431#outline(252.1)>.

Grayson, M. Lindsay. Kucers' The Use of Antibiotics, 6th Edition. Hodder Arnold, 10/2010. <vbk:9781444120431#outline(252.1)>.

Grayson, M. Lindsay. Kucers' The Use of Antibiotics, 6th Edition. Hodder Arnold, 10/2010. <vbk:9781444120431#outline(252.1)>.

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Gai Zet al.. Clin Infect Dis. 2012 Jan 15;54(2):249–52.

Tang X et al. J Infect Dis. 2013 Mar 1;207(5):736–9.

Tang X et al. J Infect Dis. 2013 Mar 1;207(5):736–9.

Gai Zet al.. Clin Infect Dis. 2012 Jan 15;54(2):249–52.

Epidemic curve shows progression of the family cluster and timeline of key events during the index patient’s illness as well as pertinent exposure histories of secondary patients. aExposure during period of providing bedside care may not have occurred continuously during the exposure period.
Bao C et al. Clin Infect Dis. 2011;53:1208-1214
© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of
America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.