Pulmonary infection in patients with severe fever with thrombocytopenia syndrome: A multicentre observational study

Yan Zuo; Heming Wang; Jiaxiang Huang; Fang Zhang; Dongmei Lv; Tao Meng; Asma Bibi; Jilong Shen; Lianzi Wang; Zhongxin Wang; Yuanhong Xu

doi:10.1002/jmv.28712

Pulmonary infection in patients with severe fever with thrombocytopenia syndrome: A multicentre observational study

J Med Virol. 2023 Apr;95(4):e28712. doi: 10.1002/jmv.28712.

Authors

Yan Zuo^{1

2}, Heming Wang³, Jiaxiang Huang⁴, Fang Zhang⁵, Dongmei Lv^{1

2}, Tao Meng^{1

2}, Asma Bibi^{1

2}, Jilong Shen², Lianzi Wang^{1

2}, Zhongxin Wang¹, Yuanhong Xu^{1

2}

Affiliations

¹ Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
² Department of Pathogen Biology and Provincial Laboratories of Pathogen Biology and Zoonoses, Anhui Medical University, Hefei, Anhui, China.
³ Department of Clinical Laboratory, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
⁴ Department of Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
⁵ Department of Food Engineering, Anhui Science and Technology University, Chuzhou, Anhui, China.

PMID: 36991571
DOI: 10.1002/jmv.28712

Abstract

Co-infection in patients with severe fever with thrombocytopenia syndrome (SFTS) has been reported, posing a serious threat to survival and treatment. We aimed to systematically investigate the SFTS associated pulmonary infection, particularly invasive pulmonary fungal infection (IPFI). During April 2019 to October 2021, we conducted a multicentre observational study on adult hospitalized patients confirmed with SFTS from three tertiary hospital in central China. Demographic, clinical and laboratory data of patients were collected and re-assessed. A total of 443 patients (51.7% were male sex) were included for analysis with median age of 65-year-old. Among them, 190 (42.9%) patients met the criteria for pulmonary infection. Pulmonary infection was associated with shorter survival time (p < 0.0001 by log-rank test), and adjusted hazard ratio was 1.729 [95% confidence interval, 1.076-2.780] (p = 0.024). Age (odds ratio (OR) 1.040 [1.019-1.062], p < 0.001), time from onset to admission (OR 1.163 [1.070-1.264], p < 0.001), having severe status (OR 3.166 [2.020-4.962], p < 0.001) and symptoms of skin change (OR 2.361 [1.049-5.316], p < 0.001) at admission and receiving intravenous immunoglobin (OR 2.185 [1.337-3.569], p = 0.002) were independent risk factors for the occurrence of pulmonary infection. A total of 70 (15.8%) patients were defined as IPFI. Multivariate analysis showed that time from onset to admission (OR 1.117 [1.016-1.229], p = 0.022), severe status (OR 5.737 [3.054-10.779], p < 0.001), having smoking history (OR 3.178 [1.251-8.070], p = 0.015) and autoimmunity disease (OR 7.855 [1.632-37.796], p = 0.010), receiving intravenous immunoglobin (OR 3.270 [1.424-7.508], p = 0.005) were independent risk factors for the occurrence of IPFI. In SFTS patients with pulmonary infection, white blood count <2.09 × 10⁹ per L (OR 11.064 [3.708-33.012], p < 0.001) and CD3⁺ CD4⁺ T cell count <104.0 per μL (OR 10.429 [3.395-32.038], p < 0.001) could independently predict IPFI. This study showed the high prevalence and poor outcomes of pulmonary infection and IPFI in patients with SFTS. These findings highlighted the need for active surveillance of fungal pathogens and early antifungal treatment in patients with SFTS.

Keywords: SFTS; aspergillosis; invasive pulmonary fungal infection; pulmonary infection; risk factors.

Publication types

Observational Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Lung
Male
Phlebovirus*
Pneumonia* / complications
Severe Fever with Thrombocytopenia Syndrome*
Thrombocytopenia* / complications
Thrombocytopenia* / epidemiology