Diagnosis and treatment of severe fever with thrombocytopenia syndrome, Chinese expert consensus at a glance!

Fever with thrombocytopenia syndrome (SFTS) is an acute natural zoonotic disease
caused by fever with thrombocytopenia syndrome virus (SFTSV).
Clinically, fever with thrombocytopenia is the main feature, and a small number of patients are critically ill and rapidly progress to severe and critical disease (collectively referred to as severe disease), and eventually die
due to multiple organ failure.
The Expert Consensus on the Diagnosis and Treatment of Severe Fever with Thrombocytopenia Syndrome mainly provides guidance for the diagnosis and treatment of SFTS and improving the success rate of clinical treatment of severe SFTS
.

Recommendation 1 SFTSV can induce cytokine storms, severe inflammatory response syndromes, and coagulation abnormalities, leading to multiple organ failure, and the mortality rate in severe patients is high, and early recognition is particularly important
.

Recommendation 2 The high-risk factors of patients with severe SFTS include advanced age, underlying diseases and comorbidities, etc.
, the disease progresses rapidly, and the prognosis is very poor, and clinical attention should be paid to the disease progression
of severe patients.

Recommendation 3 Patients with severe SFTS may develop hemophagocytic lymphohistiocytosis (HLH), SFTS-associated viral myocarditis, SFTS-associated encephalitis, invasive pulmonary aspergillosis (IPA) and other complications that lead to exacerbation and complications, resulting in poor prognosis
.

Recommendation 4 Patients with severe disease should be closely monitored for peripheral blood/bone marrow cytology, blood biochemistry, coagulation function, inflammatory factors, and serum SFTSV load
.

Recommendation 5 SFTS
can be confirmed by epidemiological history, clinical features, and SFTSV nucleic acid testing.
Differentiation of infectious and noninfectious diseases with fever with thrombocytopenia, particularly tick-active areas, and other tick-borne infectious diseases
, is required.

Recommendation 6 Patients with severe SFTS should be placed in intensive care; At present, there are no specific antiviral drugs to support symptomatic treatment and strengthen nutrition; early detection and proactive management of complications; Use glucocorticoids with caution and blood purification therapy
when appropriate.

Recommendation 7 Secondary HLH can be detected and diagnosed early according to HLH diagnostic criteria; Treatment can be individualized according to the HLH-94 protocol, closely monitoring response to treatment and adjusting treatment in a timely manner
.

Recommendation 8 Patients with severe SFTS can be complicated by varying degrees of viral myocarditis, which can be treated according to the conventional treatment of viral myocarditis, and relevant indicators should be closely monitored and myocardial protective therapy
given.

Recommendation 9 Patients with SFTS with impaired consciousness should be placed in intensive care, with airway protection and ventilatory support, management of elevated intracranial pressure, and correction of electrolyte imbalances
as soon as possible.
Routine imaging and cerebrospinal fluid studies other than non-contrast head CT or MRI are not recommended
.

Recommendation 10 Patients with severe SFTS are prone to IPA and can occur in the absence of high-risk factors such as immunosuppressive therapy and broad-spectrum antimicrobial use, and clinical vigilance
is required.
Treatment includes intravenous and topical antifungal therapy and respiratory support
.

The above content is excerpted from: Chen Guang, Chen Tao, et al.
Expert consensus on the diagnosis and treatment of severe fever with thrombocytopenia syndrome[J].
Infectious Disease Information,2022,35(05):385-393.
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