The first identification and retrospective study of Severe Fever with Thrombocytopenia Syndrome in Japan

J Infect Dis. 2014 Mar;209(6):816-27. doi: 10.1093/infdis/jit603. Epub 2013 Nov 14.


Background: Severe fever with thrombocytopenia syndrome (SFTS) is caused by SFTS virus (SFTSV), a novel bunyavirus reported to be endemic in central and northeastern China. This article describes the first identified patient with SFTS and a retrospective study on SFTS in Japan.

Methods: Virologic and pathologic examinations were performed on the patient's samples. Laboratory diagnosis of SFTS was made by isolation/genome amplification and/or the detection of anti-SFTSV immunoglobulin G antibody in sera. Physicians were alerted to the initial diagnosis and asked whether they had previously treated patients with symptoms similar to those of SFTS.

Results: A female patient who died in 2012 received a diagnosis of SFTS. Ten additional patients with SFTS were then retrospectively identified. All patients were aged ≥50 years and lived in western Japan. Six cases were fatal. The ratio of males to females was 8:3. SFTSV was isolated from 8 patients. Phylogenetic analyses indicated that all of the Japanese SFTSV isolates formed a genotype independent to those from China. Most patients showed symptoms due to hemorrhage, possibly because of disseminated intravascular coagulation and/or hemophagocytosis.

Conclusions: SFTS has been endemic to Japan, and SFTSV has been circulating naturally within the country.

Keywords: Hemophagocytosis; SFTS; SFTS virus: Japan; Severe fever with thrombocytopenia syndrome; bunyavirus; tick borne virus infection.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bunyaviridae Infections / diagnosis*
  • Bunyaviridae Infections / virology
  • Chlorocebus aethiops
  • Female
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Phlebovirus / genetics
  • Phlebovirus / isolation & purification*
  • Phylogeny
  • Retrospective Studies
  • Vero Cells