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Pulmonary infection in patients with severe fever with thrombocytopenia syndrome: A multicentre observational study
Yan Zuo1,2, Heming Wang3, Jiaxiang Huang4
1Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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.
Insights
Severe fever with thrombocytopenia syndrome (SFTS) patients often develop pulmonary infections, including invasive pulmonary fungal infections (IPFI). Early detection and antifungal treatment are crucial for improving outcomes in these high-risk patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Co-infections complicate severe fever with thrombocytopenia syndrome (SFTS) management, impacting patient survival.
- Pulmonary infections, especially invasive pulmonary fungal infections (IPFI), are significant concerns in SFTS patients.
Purpose of the Study:
- To systematically investigate the prevalence and risk factors of SFTS-associated pulmonary infections.
- To identify predictors for invasive pulmonary fungal infections (IPFI) in SFTS patients.
Main Methods:
- A multicenter observational study involving 443 hospitalized adult SFTS patients in central China (April 2019 - October 2021).
- Collection and analysis of demographic, clinical, and laboratory data.
- Multivariate analysis to determine independent risk factors and predictors for pulmonary infection and IPFI.
Main Results:
- 42.9% of SFTS patients developed pulmonary infections, associated with significantly shorter survival times.
- Independent risk factors for pulmonary infection included older age, delayed admission, severe status, skin changes, and IVIG use.
- IPFI occurred in 15.8% of patients; risk factors included delayed admission, severe status, smoking history, autoimmune disease, and IVIG use.
- Low white blood cell count (<2.09 × 10^9/L) and low CD3+CD4+ T cell count (<104.0/μL) independently predicted IPFI in SFTS patients with pulmonary infection.
Conclusions:
- Pulmonary infections and IPFI are highly prevalent in SFTS patients, leading to poor outcomes.
- Active surveillance for fungal pathogens and prompt antifungal therapy are essential for managing SFTS patients with pulmonary infections.
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