(399,103 - 16 - 408)

重症熱性血小板減少症候群 −自験例を交えて 

Severe fever with thrombocytopenia syndrome

岩原 義人1) 成瀬 桂史2)  大串 文隆3)
いわはら よしひと Yoshihito Iwahara
  
独立行政法人国立病院機構高知病院 1)内科,2)病理,3)呼吸器科

Key words: 重症熱性血小板減少症候群(SFTS),マダニ,新興感染症,院内感染防
Key words: severe fever with thrombocytopenia syndrome (SFTS), tick bite,
emerging infectious disease, human-to-human transmission

要旨

 重症熱性血小板減少症候群(severe fever with thrombocytopenia syndrome:SFTS)はマダニが媒介すると考えられている中国で発見された新興感染症である。2013年1月,国内で初めての症例が確認され,その後国内で症例報告が相次いだ。
 SFTSの症状は発熱と消化器症状が中心で,その他全身倦怠,リンパ節腫脹,出血傾向,意識障害や痙攣などの神経症状などがみられる。また血小板や白血球の減少,凝固異常,血清酵素の上昇,腎機能障害,電解質異常,蛋白尿などを認める。
 現在のところ特異的な治療法はない。ヒトからヒトへの感染が報告されており,院内感染対策が重要である。
 自験例はSFTSとして典型的な臨床像を呈し,急激な経過をとり死亡された。今後,発症や重症化リスクを軽減させるワクチンの開発や転帰を改善させる治療の開発が望まれる。

Abstract: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease recently discovered in central and northeast China. The causative agent called severe fever with thrombocytopenia syndrome virus (SFTSV) was identified in 2011. Tick bite were presumed to be the mode of transmission. The first case in Japan was reported in January, 2013, and since then, so many patients, including cases in Kochi, have been evidently reported. SFTS has fatality rates ranging from 6% to as high as 12% recently, though the initial fatality rate was 30%. The ages of the patients ranged from 39 to 83 years, most (75%) were over 50 years of age.
The major clinical symptoms of SFTS are fever, fatigue, gastrointestinal symptoms (abdominal pain or tenderness, nausea, vomiting and diarrhea), thrombocytopenia, leucopenia, elevated serum enzyme levels, renal dysfunction, electrolyte imbalances, lymphadenopathy, and central nervous system manifestations (apathy, lethargy, coma and convulsion). Neither vaccines nor specific therapies have been developed so far, so treatment is only centered on symptomatic or supportive therapy. Human-to-human transmission within family and hospital has been reported, so medical staffs should carefully take protective precautions in the patient’s room. For the help of understanding of the clinical features, we present a typical case of SFTS with a rapidly fatal clinical course that we experienced. SFTS virus antigen and gene were detected from the autopsy specimens by using immunohistochemistry and PCR technique. He was proved to have had almost all risk factors associated with death such as CNS manifestations, DIC and MOF that were evaluated in China. Since such cases are of great concern, effective prevention and treatment strategies for SFTS are urged to be established.
このサイト内でのご意見・お問い合わせはこちらまでご連絡ください。
Copyright(C)2018 一般社団法人高知県医師会All Rights Reserved.