Infect Chemother.  2017 Mar;49(1):72-77. 10.3947/ic.2017.49.1.72.

Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange

Affiliations
  • 1Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea. cheonlang1@daum.net

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated with SFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompanied with multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis for the treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them with ribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospital with a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experienced persistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reverse transcription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasma exchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admitted to the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empirical antibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administered orally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSV result from a real-time RT-PCR. The patient had a successful recovery.

Keyword

Severe fever with thrombocytopenia syndrome; Bunyavirus; Ribavirin; Plasma exchange

MeSH Terms

Anti-Bacterial Agents
Central Nervous System
Chills
Diarrhea
Disease Progression
Fever*
Hemorrhage
Humans
Leukopenia
Male
Middle Aged
Mortality
Multiple Organ Failure
Myalgia
Nausea
Orthobunyavirus
Plasma Exchange*
Plasma*
Ribavirin*
Thrombocytopenia*
Tick-Borne Diseases
Vomiting
Anti-Bacterial Agents
Ribavirin

Figure

  • Figure 1 Laboratory findings and fever of two patients with severe fever with thrombocytopenia syndrome. CPK, creatinine phosphokinase; LDH, lactate dehydrogenase; HD, hospital day.


Cited by  1 articles

Effect of Early Plasma Exchange on Survival in Patients with Severe Fever with Thrombocytopenia Syndrome: A Multicenter Study
Won Sup Oh, Jeong Rae Yoo, Ki Tae Kwon, Hye In Kim, Su Jin Lee, Jae-Bum Jun, Seong Yeol Ryu, Hyun Ah Kim, Jian Hur, Yu Mi Wi, Min Hee Lim, Sang Taek Heo
Yonsei Med J. 2017;58(4):867-871.    doi: 10.3349/ymj.2017.58.4.867.


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