The cat that bit her half a month ago suddenly died of poison! A Zhejiang woman panicked and went to the hospital for a checkup, and found that she was also infected with this terrible virus

After being bitten by a cat, I was actually infected with the new Bunyavirus? This happened in the emergency department of the Hubin Branch of Zhejiang Provincial Hospital of Traditional Chinese Medicine.

"Doctor, I want to do a toxicology test"

"Doctor, I want to do a toxicology test for my mother." Not long ago, a young girl came to the emergency room of the Hubin Branch of the Provincial Hospital of Traditional Chinese Medicine and asked this question as soon as she entered. The emergency doctor on duty that day, Jiang Qingyu, was curious and asked the reason. It turned out that the girl's mother (Auntie Sun) was bitten by the cat raised in her village half a month ago, and then the cat suddenly died.

"My mother got a rabies vaccine right after she was bitten by a cat, but she still vomited after eating, had a low-grade fever, was weak, and felt dizzy," the girl said anxiously. "My family believes that the cat died of poisoning. My mother may have also been poisoned after being bitten by the cat. We did some tests at the hospital in my hometown, but there were no clear results."

After listening to this story, Jiang Qingyu also read all the examination reports of Aunt Sun. The blood routine test showed a significant decrease in white blood cells and platelets, and the urine routine test showed proteinuria, occult blood, and renal insufficiency. Although the examination was not perfect, it had already indicated that the condition was not simple.

Jiang Qingyu immediately reported Aunt Sun's condition to Zhang Zhuoyi, director of the emergency medicine department. After another detailed inquiry into the medical history and physical examination, Zhang Zhuoyi determined that Aunt Sun had an infection, not drug poisoning, but the pathogen of the infection was unknown, and special infections such as cat's claw fever could not be ruled out. The condition could also progress to multiple organ failure.

Zhang Zhuoyi immediately suggested that Aunt Sun be hospitalized for emergency treatment, and immediately contacted Professor Jiang Ronglin from the Department of Critical Care Medicine for consultation. After the consultation, the two agreed: given a history of cat bites, infection with special pathogens could not be ruled out, and a second-generation gene sequencing test was recommended to confirm the diagnosis of the pathogen.

On the third day after hospitalization, the mystery was finally solved.

The next-generation sequencing of Aunt Sun's peripheral blood suggested infection with a new Bunyavirus , ruling out the possibility of cat's claw fever caused by Bartonella henselae.

What is the new Bunyavirus? The new Bunyavirus, also known as the fever with thrombocytopenia syndrome virus (SFTSV), is a new type of RNA virus first discovered and reported by Chinese scholars from ticks in 2009. It can cause a clinical syndrome with fever, thrombocytopenia and multiple organ dysfunction as the main manifestations, with a mortality rate of 6% to 30% and a poor prognosis.

The source and carrier of SFTSV are still unknown, but ticks are considered the most common vector of transmission. It can be transmitted among people through blood contact, but it is transmitted from person to person. The incubation period is shorter than that of tick bites, the symptoms are mild, and the prognosis is good with early diagnosis and treatment. The disease mainly occurs in forest areas, hilly areas, and more often in spring and summer. The incubation period may be 1 to 2 weeks.

After consulting relevant literature, this patient is the first case of cat bite-induced infection with the new Bunyavirus in China. There is also only one related report of cat bite-induced infection with the new Bunyavirus in the world: a Japanese woman died after being bitten by a cat. The autopsy revealed severe multiple organ failure caused by infection with the new Bunyavirus!

Therefore, it cannot be simply assumed that infection is only through tick bites in China. It is also possible that the cat was infected with SFTSV and transmitted it to the patient through saliva from the bite wound. The patient contracted SFTSV after being bitten by the sick cat. Although the cat was not clearly diagnosed with virological SFTSV infection, these data strongly support the hypothesis that the patient was directly infected with SFTSV from the sick cat.

Clinical manifestations of SFTSV infection The clinical manifestations of SFTSV infection are non-specific and difficult to distinguish from other diseases, such as human granulocytic anaplasmosis, leptospirosis, and epidemic hemorrhagic fever. Early clinical data suggest that the clinical manifestations of SFTSV are fever, gastrointestinal symptoms (including loss of appetite, nausea, vomiting, diarrhea), myalgia, oral bleeding, and local lymphadenopathy. Common symptoms also include proteinuria, hematuria, dizziness, headache, and chills. Laboratory test results often show elevated lactate dehydrogenase and transaminase, followed by decreased platelet count and lymphocyte count, and elevated alanine aminotransferase and creatine kinase.

How to treat and prevent? The treatment of SFTSV is mainly supportive care, and there is no specific antiviral treatment. Supportive care includes fluid replacement, maintenance of electrolyte balance, and transfusion of fresh frozen plasma and platelets, but the effect is limited. Antibiotics can prevent or treat secondary bacterial infections, especially in patients with a history of tick bites. Studies have shown that tigecycline or new quinolones can prevent bacterial infections transmitted by tick bites. In addition to their bactericidal or bacteriostatic effects, these antibiotics can also inhibit the body's inflammatory response.

There is currently no vaccine to prevent SFTSV infection. The main preventive measures are health education, preventing tick exposure or bites, and avoiding contact with the blood, secretions or excrement of SFTSV patients. Medical staff or contacts of confirmed patients need to take basic personal protection, including gloves, masks, and eye and skin protection; during the epidemic season, crowd protection includes spraying insecticides, wearing long-sleeved clothes, and avoiding entering epidemic areas as much as possible.

Regarding Aunt Sun’s treatment, the emergency physician team continued to provide symptomatic treatment such as anti-infection and protection of organ function, as well as isolation treatment. She was later transferred to the Infectious Disease Department of the Qiantang Campus of the Provincial Hospital of Traditional Chinese Medicine for further treatment. Her recovery is going well and she was discharged from the hospital on November 15.

Chengshi Interactive·Metropolitan Express reporter Yu Qianqian

Correspondents: Jiang Qingyu, Huang Sijia, Qi Ji