Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study.
<h4>Background</h4>Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease characterized by a high case fatality rate. Despite extensive research on acute-phase manifestations, the long-term clinical sequelae in survivors remain poorly characterize...
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Public Library of Science (PLoS)
2025-08-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0013276 |
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| author | Ning Cui Xin Yang Hong-Han Ge Xiao-Hong Yin Yi-Mei Yuan Chao Zhou Xi Wang Hai-Feng Pan Hao Li Xiao-Ai Zhang Li-Qun Fang Li-Fen Hu Peng-Tao Bao Wei Liu |
| author_facet | Ning Cui Xin Yang Hong-Han Ge Xiao-Hong Yin Yi-Mei Yuan Chao Zhou Xi Wang Hai-Feng Pan Hao Li Xiao-Ai Zhang Li-Qun Fang Li-Fen Hu Peng-Tao Bao Wei Liu |
| author_sort | Ning Cui |
| collection | DOAJ |
| description | <h4>Background</h4>Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease characterized by a high case fatality rate. Despite extensive research on acute-phase manifestations, the long-term clinical sequelae in survivors remain poorly characterized.<h4>Methods</h4>In this prospective cohort study from 2010 to 2024, 1,197 SFTS survivors and 188 age/sex-matched febrile controls without SFTS were enrolled from the highest endemic region in China. Participants underwent face-to-face interview, serial clinical evaluations and laboratory testing at 6, 12, 18 and 24 months post-discharge, with extended follow-up for a subset (n = 294) over 11 years. Propensity score matching and multivariate logistic regression were used to determine the factors associated with long-term sequelae risk.<h4>Results</h4>A total of 62.57% (749/1,197) of survivors developed persistent sequelae, significantly higher than controls (51.60%, 97/188; P < 0.05). Key manifestations included memory impairment (33.50%, 401/1,197), arthralgia (33.08%, 396/1,197), alopecia (32.25%, 386/1,197) and visual decline (31.08%, 372/1,197). Laboratory abnormalities persisted for ≥10 years in 0.33% of survivors, notably thrombocytopenia, elevated lactate dehydrogenase, and cystatin C. Compared to non-SFTS group, a significantly higher proportion of SFTS survivors had decreased white blood cell count, eosinophil percentage and mean corpuscular hemoglobin. The long-term sequelae risk exhibited distinct patterns across factors: encephalitis development was associated with significantly higher risks of memory impairment (adjusted OR = 2.39) and thrombocytopenia (adjusted OR = 3.36); corticosteroid usage during hospitalization showed increased risks of arthralgia (adjusted OR=2.17) and elevated BUN (adjusted OR=3.87); while high viral load (≥1 × 106 copies/mL) exhibited significantly higher incidences of most prevalent clinical manifestations and multiple laboratory abnormalities (all P < 0.05).<h4>Conclusion</h4>SFTS survivors exhibit multisystemic sequelae, with high viral load and acute-phase neurological involvement serving as critical prognostic indicators. These findings underscore the need for long-term monitoring and targeted therapeutic strategies for SFTS. |
| format | Article |
| id | doaj-art-c2ceb816b11e4a6f82dca3dc4f0fe0b4 |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-c2ceb816b11e4a6f82dca3dc4f0fe0b42025-08-23T05:33:10ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352025-08-01198e001327610.1371/journal.pntd.0013276Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study.Ning CuiXin YangHong-Han GeXiao-Hong YinYi-Mei YuanChao ZhouXi WangHai-Feng PanHao LiXiao-Ai ZhangLi-Qun FangLi-Fen HuPeng-Tao BaoWei Liu<h4>Background</h4>Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease characterized by a high case fatality rate. Despite extensive research on acute-phase manifestations, the long-term clinical sequelae in survivors remain poorly characterized.<h4>Methods</h4>In this prospective cohort study from 2010 to 2024, 1,197 SFTS survivors and 188 age/sex-matched febrile controls without SFTS were enrolled from the highest endemic region in China. Participants underwent face-to-face interview, serial clinical evaluations and laboratory testing at 6, 12, 18 and 24 months post-discharge, with extended follow-up for a subset (n = 294) over 11 years. Propensity score matching and multivariate logistic regression were used to determine the factors associated with long-term sequelae risk.<h4>Results</h4>A total of 62.57% (749/1,197) of survivors developed persistent sequelae, significantly higher than controls (51.60%, 97/188; P < 0.05). Key manifestations included memory impairment (33.50%, 401/1,197), arthralgia (33.08%, 396/1,197), alopecia (32.25%, 386/1,197) and visual decline (31.08%, 372/1,197). Laboratory abnormalities persisted for ≥10 years in 0.33% of survivors, notably thrombocytopenia, elevated lactate dehydrogenase, and cystatin C. Compared to non-SFTS group, a significantly higher proportion of SFTS survivors had decreased white blood cell count, eosinophil percentage and mean corpuscular hemoglobin. The long-term sequelae risk exhibited distinct patterns across factors: encephalitis development was associated with significantly higher risks of memory impairment (adjusted OR = 2.39) and thrombocytopenia (adjusted OR = 3.36); corticosteroid usage during hospitalization showed increased risks of arthralgia (adjusted OR=2.17) and elevated BUN (adjusted OR=3.87); while high viral load (≥1 × 106 copies/mL) exhibited significantly higher incidences of most prevalent clinical manifestations and multiple laboratory abnormalities (all P < 0.05).<h4>Conclusion</h4>SFTS survivors exhibit multisystemic sequelae, with high viral load and acute-phase neurological involvement serving as critical prognostic indicators. These findings underscore the need for long-term monitoring and targeted therapeutic strategies for SFTS.https://doi.org/10.1371/journal.pntd.0013276 |
| spellingShingle | Ning Cui Xin Yang Hong-Han Ge Xiao-Hong Yin Yi-Mei Yuan Chao Zhou Xi Wang Hai-Feng Pan Hao Li Xiao-Ai Zhang Li-Qun Fang Li-Fen Hu Peng-Tao Bao Wei Liu Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. PLoS Neglected Tropical Diseases |
| title | Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. |
| title_full | Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. |
| title_fullStr | Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. |
| title_full_unstemmed | Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. |
| title_short | Long-term clinical sequelae in severe fever with thrombocytopenia syndrome: A longitudinal cohort study. |
| title_sort | long term clinical sequelae in severe fever with thrombocytopenia syndrome a longitudinal cohort study |
| url | https://doi.org/10.1371/journal.pntd.0013276 |
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