Transcript H. longicornis

SFTS
Kentaro Iwata, MD MSc FACP FIDSA
Division of Infectiuos Diseases
Kobe University Hospital
Last Updated February 15, 2013
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FTLS or SFTS
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Fever, Thrombocytopenia and Leukopenia Syndrome
Severe Fever with Thrombocytopenia Syndrome
First reported in China in 2007
First thought as Anaplasma or Tsutsugamushi? Later turned out to be viral illness.
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(1) acute onset with fever
(2) low white blood cell and platelet counts
(3) high AST/ALT
(4) positive urine protein
CFR 12.7%. 95 cases in 2007.
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.
Bunyaviridae
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a family of negative-stranded, enveloped
RNA viruses.
Mainly infected through arthropods.
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Hantavirus
Rift Valley fever virus
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.
Rift Valley fever is transmitted mainly by aedes
species mosquitoes.
Crimean-Congo hemorrhagic fever virus by tick
bite
Hantavirus by rat bite, feces, urines etc,,,
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日本語では重症熱性血小板減少症候群
SFTSV. ブニヤウイルス科フレボウイルス
属
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.
国内発生例
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2012年秋、海外渡航歴のない成人患者
発熱、嘔吐、下痢（黒色便）
明らかなダニ咬傷なし
白血球数（400/mm3）と血小板数（8.9×104/mm3） が著明に低下
AST、ALT、LDH、CK高値
血液凝固系の異常、フェリチンの著明な上昇
血尿、 蛋白尿
胸腹部単純CTで右腋窩リンパ節腫大
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
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、全身状態が
不良となり死亡
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.
DDxs
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Leptospirosis
Hantavirus infection
HUS
TTP
Anaplasma
Tsutsugamushi disease
Hemorrhagic fever syndromes of other types
ダニは、、、
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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.
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.
H. longicornis ticks were dominant in regions of endemicity, while
Rhipicephalus microplus is more abundant in regions of nonendemicity.
H. longicornis is widely distributed in the Asia–Pacific region, including
China, Korea, Japan, Australia, the Pacific Islands, and New Zealand.
ライム、アナプラズマなども媒介
Ixodidae マダニ目マダニ科
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Amblyomma – 130 species (includes some of Aponomma)
Anomalohimalaya – 3 species
Bothriocroton – 7 species
Cosmiomma – 1 species
Cornupalpatum – 1 species
Compluriscutula – 1 species
Dermacentor – 34
species (includes Anocentor)
http://en.wikipedia.org/wiki/Ixodidae#cite_note-list-2
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 ）
診断・治療
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血液などからのSFTSVの分離・同定
RT-PCRによるSFTSV遺伝子検出
ペア血清IgG抗体価
国立感染症研究所ウイルス第一部で検査が可能である
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
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
リバビリン？
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７２歳女性に免疫グロブリン、抗菌薬ととも
に使用
元気になって退院
Li. BioScience Trends. 2012 Jan 11;5(6):273–6.
Li. BioScience Trends. 2012 Jan 11;5(6):273–6.
リバビリンとは、、
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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
Oral ribavirin was approved by the US FDA in 1998 for treatment of
chronic HCV infection in combination with interferon.
1-β-d-ribofuranosyl-1,2,4-triazole-3-carboxamide
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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ヒト−ヒト感染の可能性もあり
血液との曝露？
病院内感染も。ICU医やエンゼルケア後に
、、、
Gai Zet al.. Clin Infect Dis. 2012 Jan 15;54(2):249–52.
ヒト−ヒト感染？
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.
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: [email protected].