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BMJ 2011; 342 doi: (Published 21 March 2011) Cite this as: BMJ 2011;342:d1788

New human pathogen discovered in China

A brand new infectious disease has emerged from central and northeast China, after a surveillance operation identified a cluster of adults admitted to hospital with high fever, abdominal symptoms, thrombocytopenia, and leucocytopenia (severe fever with thrombocytopenia syndrome; SFTS). After initial searches for known pathogens drew a blank, investigators isolated an unknown virus from the blood of a 42 year old farmer who developed SFTS in June 2009. Another 170 cases of the same infection were later confirmed; 21 (12%) infected patients died.

The new pathogen turned out to be a phlebovirus in the Bunyaviridae family, a group that includes other human pathogens, such as the virus responsible for Rift Valley fever. Investigators suspected an insect vector and started molecular screening of mosquitoes and ticks. They found the new virus in a small number of Haemaphysalis longicornis ticks from affected provinces. H longicornis is widely distributed throughout the Asia Pacific region, and can be carried by a multitude of animals including large farm animals, cats, mice, hedgehogs, possums, weasels, yaks, and even humans.

Most of the adults infected by the new virus—designated SFTSV—were farmers who worked outdoors in wooded and hilly areas. Chinese investigators discovered cases in all six provinces they surveyed after the initial outbreak. They think that SFTSV is probably already prevalent in China and has been active but undetected for some time. There is no evidence that the new virus can spread from person to person.

Mixed results for early tracheotomy after cardiac surgery

Intensivists may have to curb their enthusiasm for early tracheotomy in patients likely to need prolonged ventilation. Trial after trial has failed to confirm earlier promises of faster weaning and reduced mortality rates, says an editorial (p 434). The latest comes from France. Adults given a tracheotomy four days after cardiac surgery had no more ventilator-free days than controls managed …

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