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A series of patients infected with the emerging tick-borne Yezo virus in China: an active surveillance and genomic analysis - 08/11/24

Doi : 10.1016/S1473-3099(24)00616-9 
Ming-Zhu Zhang, MD a, b, *, Cai Bian, MD c, *, Run-Ze Ye, MD d, *, Xiao-Ming Cui, PhD b, e, *, Nan-Nan Yao, MS c, *, Ji-Hu Yang, MS b, *, Yan-Li Chu, MD c, Xiao-Ling Su, BS b, Ya-Fei Wu, MS e, f, Jin-Ling Ye, BS c, Shun-Shuai Liu, MS b, Xiao-Yu Shi, BS b, Wenqiang Shi, PhD b, e, Na Jia, ProfMD b, e, Yu-Guo Chen, ProfMD d, Lin Zhao, ProfPhD a, Yuan-Chun Zheng, ProfMD c, Xiao-Min Zheng, ProfMD c, , Jia-Fu Jiang, ProfPhD b, e, , Wu-Chun Cao, ProfPhD a, b, e, ,
a Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China 
b State Key Laboratory of Pathogen and Biosecurity, Beijing, China 
c Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China 
d Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China 
e Research Unit of Discovery and Tracing of Natural Focus Diseases, Chinese Academy of Medical Sciences, Beijing, China 
f Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China 

* Correspondence to: Prof Wu-Chun Cao, State Key Laboratory of Pathogen and Biosecurity, Beijing 100071, China State Key Laboratory of Pathogen and Biosecurity Beijing 100071 China
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 08 November 2024

Summary

Background

Yezo virus (YEZV) is an emerging tick-borne pathogen, which was initially reported in Japan in 2021. Only one patient had been reported in China so far. We aimed to describe the epidemiological, clinical, and laboratory findings of a series of patients, and to characterise the viral genomes of YEZV.

Methods

In this active surveillance and genomic analysis, we conducted active surveillance at Mudanjiang Forestry Central Hospital, Heilongjiang Province of northeast China. Participants were eligible for inclusion if they sought medical care for a recent tick bite between May 1 and July 31, in 2022 and 2023, and between May 1 and July 10, in 2024. We collected sera from participants to detect YEZV infection by meta-transcriptomic sequencing, real-time RT-PCR, and indirect immunofluorescence assay. We isolated YEZV by cell culture and characterised the pathogen by morphological and phylogenetic analyses.

Findings

A series of 18 patients with YEZV infection (12 male and six female; median age 53 years, IQR 45–60) were identified among 988 participants. The patients presented with fever (18 patients, 100%), headache (ten patients, 56%), dizziness (nine patients, 50%), malaise (three patients, 17%), lumbago (three patients, 17%), and cough (three patients, 17%). Nine (50%) patients had rash around the tick bite site and four (22%) had lymphadenopathy. Nine (50%) patients had gastrointestinal symptoms, and five (28%) had neurological symptoms. We observed leukopenia in ten (63%) and thrombocytopenia in five (31%) of 16 assessed patients. Elevated hepatic transaminase concentrations were identified in 13 (72%) of all 18 patients, lactate dehydrogenase or α-hydroxybutyric dehydrogenase in nine (50%), serum amyloid protein A in 13 (72%), and hypersensitive C-reactive protein in ten (56%). Eight (7%) of 119 Ixodes persulcatus ticks removed from participants were positive for YEZV. Three YEZV strains were isolated from the sera of patients. Ten viral genomes were obtained from five patients, a blood-sucking I persulcatus removed from a participant, and four host-questing tick samples collected in the areas where patients were identified or in the adjacent region. Phylogenetic analyses revealed that YEZVs in either patients or ticks were divided into two clades, each with distinct mutations.

Interpretation

Awareness of YEZV infection is important and clinicians should consider the virus when diagnosing patients with suitable symptoms.

Funding

National Key Research and Development Program of China.

Translation

For the Chinese translation of the abstract see Supplementary Materials section.

Le texte complet de cet article est disponible en PDF.

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