Epidemiological data
The epidemiological data of 23 patients were shown in Table 1. The average age of all the patients was(58.9±12.1)years old(The range was 23-77 years old). There were 13 women(56.5%)and 10 men(43.5%), and the ratio of female to male was 1.3:1. Except for 19 farmers(82.6%), 1 unemployed person(4.3%), 2 retirees(8.7%) and 1 worker(4.3%),all had a history of going to mountainous or hilly areas before the onset of the disease. 21 cases(91.3%)occurred in spring and summer, mainly in May with 12 cases(52.2%)and in June with 6 cases(26.1%). There were 5 cases(21.7%) of tick bite history before onset. Two patients(8.7%)had participated in the nursing of one patient with fever and thrombocytopenia syndrome, who eventually died of disseminated intravascular coagulation and multiple organ failure. 17 patients(73.9%)came from the mountainous areas of southern Anhui Province, 2 patients(8.7%)came from the Dabie Mountains and 4 patients(17.4%)came from the hilly areas around the Yangtze River valley. There were 10 patients(43.5%) with chronic diseases, including 4 cases(17.4%) of type 2 diabetes, 2 cases(8.7%)of hypertension, 2 cases(8.7%)of cholelithiasis, 1 case(4.3%)of chronic bronchitis and 1 case of hypophysis.
Clinical symptoms
The related clinical data such as symptoms and signs were shown in Table 2. In all the patients, 23 cases(100%)had fever and the mean heat duration was (8.24 ± 3.6) days. 14 patients (60.9%) had clinical hemorrhage, including 4 cases(17.4%)of black stool, 4 cases(17.4%)of skin ecchymosis, 2 cases(8.7%)of gingival bleeding, 1 case(4.3%)of hemoptysis, 1 case(4.3%)of gross hematuria, 1 case(4.3%)of epistaxis and 1 case(4.3%)of abdominal hematoma. Secondary infection was found in 9 cases (39.1%), including 4 cases(17.4%)of pulmonary infection, 4 cases(17.4%)of abdominal infection and 1 case(4.3%)of urinary tract infection. All patients were not treated with dialysis and the average length of stay was (11.5 ± 4.1) days.
Laboratory results
Laboratory results were shown in Table 3. There were 23 cases(100%) of thrombocytopenia, 20 cases(87.0%)of leucocytopenia and 16 cases(69.6%)of low albumin. In addition, GPT, GOT, AMY, LIP, CK, CK-MB, LDH and D-dimer increased in some patients. Semi-quantitative urinary protein results showed 12 cases (52.2%) with +++, 5 cases (21.7%) with ++, 3 cases (13.0%) with +, 1 case (4.3%) with ± and 2 cases (8.7%) with -. Semi-quantitative urinary occult blood results showed 3 cases (13.0%) with +++, 4 cases (17.4%) with ++, 9 cases (40.1%) with + in, 3 cases (13.0%) with ± and 4 cases (17.4%) with -. Fecal occult blood results showed 4 cases (17.4%) with +, 4 cases (17.4%) with ± and 15 cases (65.2%) with -.
Prognosis
Five cases (21.7%) were cured, 14 cases (60.9%) were improved, 2 cases (8.7%) were unhealed and 2 cases (8.7%) died of multiple organ failure.
Case introduction
One patient, who was a 60-year-old female farmer with fever and general fatigue lasting 4 days from Guangde County, Anhui Province, was hospitalized on May 13, 2014. During the course of the disease, the patient had nausea, no vomiting and feeling of weakness and anorexia. On May 11, 2014, blood routine examination was conducted in local hospitals such as WBC of 5.0×109/L, haemoglobin(HGB)of 107g/L and PLT of 87.0×109/L. The infusion treatment was performed but the specific plan was unknown and the curative effect was not good. And tThen the patient was transferred to our hospital. The patient had a history of taken care ofing her sister, who was a patient with fever and thrombocytopenia syndrome and died of disseminated intravascular coagulation and multiple organ failure. in Zhejiang Province, 10 days before the onset of the disease. The patient was conscious with temperature of 38.7℃, a small amount of ecchymosis on the upper limb and purple ecchymosis on the upper abdomen. The conjunctiva was slightly edema. Her abdomen was soft and a mass about 3cm×4cm ×4cm without fluctuation sense and no tenderness at the left lower abdomen could be touched. Laboratory data were WBC of 1.9×109/L, HGB of 97g/L, PLT of 40.0×109/L, PT of 9.2s, international standardized ratio of 0.75, D-dimer of 9.94 ug/ml, urine occult blood of +, urinary protein of ++, fecal occult blood of -, albumin of 28.7g/L, GPT of 71U/L, GOT of 128U/L, BUN of 1.87mmol/L, CR of 71.7umol/L, CK of 216U/L, CK-MB of 24U/L,LDH of 586U/L, AMY of 152.0 U/L and LIP of 160.0 U/L. The patient’s abdominal CT (Fig. 1)showed that a mass was found at the left abdominal wall, which was considered the possibility of hematoma. The progressive decline of HGB was lowest to 57g/L. There were some treatment measurements such as ribavirin injection, recombinant human granulocyte colony stimulating factor, somatostatin, ordering fasting, liver protection, hemostasis, prevention and treatment of infection and symptomatic supporting treatment. At last, her temperature returned to normal and the left lower abdominal mass disappeared. WBC and PLT gradually returned to normal(Fig. 2 and Fig. 3), HGB increased significantly, liver function and myocardial enzymes returned to normal and pancreatic function improved. She was cured and discharged on June 13, 2014.