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Severe fever with thrombocytopenia syndrome — Clinical Guidelines

Overview

Severe Fever with Thrombocytopenia Syndrome (SFTS) is a tick-borne viral disease characterized by high fever, thrombocytopenia, and multi-organ dysfunction, often leading to significant morbidity and mortality 1 2.

Diagnosis

Clinical Criteria: High fever, thrombocytopenia, leukopenia, and gastrointestinal symptoms 1 6.

Laboratory Tests: Elevated IL-6 and IL-10 levels are predictive of poor outcomes 5.

Viral Detection: RT-PCR for SFTS virus RNA in blood and other tissues 7.

Organ Dysfunction Assessment: Multiple Organ Dysfunction Score (MODS) for evaluating organ dysfunction 1 12.

Management

Supportive Care: Intensive care support including fluid resuscitation, inotropic support, and mechanical ventilation for respiratory failure 1 4.

Antiviral Therapy: No specific antiviral treatment widely recommended; supportive care remains primary 3.

Management of Complications: Treatment of disseminated intravascular coagulation (DIC) and management of bleeding tendencies 4 10.

Monitoring: Close monitoring for development of MODS within initial 72 hours of hospitalization to predict mortality 1 12.

Special Populations

Pregnancy: Successful cesarean delivery reported in a patient with SFTS; careful monitoring of maternal and fetal status required 17.

Elderly: Higher risk of severe complications and mortality; tailored supportive care essential 4 10.

Key Recommendations

Assess MODS Early: Evaluate Multiple Organ Dysfunction Score within the first 72 hours of hospitalization to predict hospital mortality (Evidence: Moderate) 1 12.

Monitor Cytokine Levels: Regularly measure IL-6 and IL-10 levels to guide prognosis and management strategies (Evidence: Moderate) 5.

Supportive Care Focus: Prioritize intensive supportive care measures including organ support systems for patients developing MODS (Evidence: Strong) 1 4.

References

1 Yoo JR, Heo ST, Kim M, Kim M, Kang MJ, Kim S et al.. Multiple organ dysfunction score for assessing patients with severe fever with thrombocytopenia syndrome. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2026. link 2 Hao Y, Sun J, Wu Q, Sun Y, Pan Z, Wang X et al.. Precise staging of severe fever with thrombocytopenia syndrome: Integrating the extent of organ damage for prognostic and therapeutic applications. PLoS neglected tropical diseases 2025. link 3 Ding Y, Kong L. Clinical Management Strategies for Severe Fever with Thrombocytopenia Syndrome Induced by Tick Bites: A Case Report and Literature Review. The American journal of case reports 2025. link 4 Shan D, Chen W, Liu G, Zhang H, Chai S, Zhang Y. Severe fever with thrombocytopenia syndrome with central nervous system symptom onset: a case report and literature review. BMC neurology 2024. link 5 Yoo JR, Kim TJ, Heo ST, Hwang KA, Oh H, Ha T et al.. IL-6 and IL-10 Levels, Rather Than Viral Load and Neutralizing Antibody Titers, Determine the Fate of Patients With Severe Fever With Thrombocytopenia Syndrome Virus Infection in South Korea. Frontiers in immunology 2021. link 6 Liu J, Fu H, Sun D, Wu S, Wang L, Yao M et al.. Analysis of the laboratory indexes and risk factors in 189 cases of severe fever with thrombocytopenia syndrome. Medicine 2020. link 7 Tong Y, Wang Q, Fu Y, Li S, Zhang Z, Zhang Z et al.. Molecular identification of severe fever with thrombocytopenia syndrome viruses from tick and bitten patient in Southeast China. Virology journal 2020. link 8 Imataki O, Uemura M, Masugata H. Severe rhabdomyolysis associated with severe fever with thrombocytopenia syndrome in a married couple: a case report. BMC infectious diseases 2019. link 9 Li S, Li Y, Wang Q, Yu X, Liu M, Xie H et al.. Multiple organ involvement in severe fever with thrombocytopenia syndrome: an immunohistochemical finding in a fatal case. Virology journal 2018. link 10 Nakano A, Ogawa H, Nakanishi Y, Fujita H, Mahara F, Shiogama K et al.. Hemophagocytic Lymphohistiocytosis in a Fatal Case of Severe Fever with Thrombocytopenia Syndrome. Internal medicine (Tokyo, Japan) 2017. link 11 Kim N, Kim KH, Lee SJ, Park SH, Kim IS, Lee EY et al.. Bone marrow findings in severe fever with thrombocytopenia syndrome: prominent haemophagocytosis and its implication in haemophagocytic lymphohistiocytosis. Journal of clinical pathology 2016. link 12 Jie SH, Zhou Y, Sun LP, Liang KW, Yi XL, Li HY. Close correlation between development of MODS during the initial 72 h of hospitalization and hospital mortality in severe fever with thrombocytopenia syndrome. Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban 2013. link 13 Sekine I, Hagiwara T, Miyazaki H, Hirayama K, Dobashi H, Kogawa K et al.. Thrombocytopenia with absent radii syndrome: studies on serum thrombopoietin levels and megakaryopoiesis in vitro. Journal of pediatric hematology/oncology 1998. link 14 Ballmaier M, Schulze H, Strauss G, Cherkaoui K, Wittner N, Lynen S et al.. Thrombopoietin in patients with congenital thrombocytopenia and absent radii: elevated serum levels, normal receptor expression, but defective reactivity to thrombopoietin. Blood 1997. link 15 MacDonald MR, Schaefer GB, Olney AH, Patton DF. Hypoplasia of the cerebellar vermis and corpus callosum in thrombocytopenia with absent radius syndrome on MRI studies. American journal of medical genetics 1994. link 16 Homans AC, Cohen JL, Mazur EM. Defective megakaryocytopoiesis in the syndrome of thrombocytopenia with absent radii. British journal of haematology 1988. link 17 Turner RJ, Spencer RA, Miyazawa K. Successful cesarean section in a gravida with the thrombocytopenia with absent radius syndrome. A case report. The Journal of reproductive medicine 1986. link 18 Teufel M, Enders H, Dopfer R. Consanguinity in a Turkish family with thrombocytopenia with absent radii (TAR) syndrome. Human genetics 1983. link 19 Hall JG, Levin J, Kuhn JP, Ottenheimer EJ, van Berkum KA, McKusick VA. Thrombocytopenia with absent radius (TAR). Medicine 1969. link

Severe fever with thrombocytopenia syndrome