Mechanisms and clinical characteristics of organ injury in severe fever with thrombocytopenia syndrome: a comprehensive review

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonotic disease caused by Bandavirus dabieense (commonly referred to as SFTS virus, SFTSV), with a case-fatality rate as high as 30%. Although SFTSV is mainly found in East Asia (China, Japan, and South Korea), its recent expansion to Southeast Asia and Africa has broadened its geographic range, presenting a formidable threat to global public health. Mortality is predominantly associated with the progression of multiple organ failure, including hematological, hepatic, neurological, cardiac, pulmonary and kidney injuries, as well as increasingly recognized pancreatic and male reproductive tract injuries. To date, accumulating evidence has demonstrated that organ injury in SFTS results from both direct viral cytopathic effects and dysregulated host immune responses. However, the precise incidence and mortality risks of individual organ injuries remain insufficiently characterized, and the relative pathogenic contributions of direct viral cytopathy versus immune-mediated damage across distinct organ systems have not been fully elucidated. This review systematically summarizes the pathogenic mechanisms and clinical characteristics of organ injury in SFTS, with a particular focus on early predictive biomarkers for organ injury. We also highlight current knowledge gaps and propose potential directions for future research. A comprehensive understanding of these mechanisms and clinical features is crucial for improving early risk stratification and developing organ-protective therapeutic strategies to reduce the high mortality of SFTS.

The authors' abstract, as published at the source. Virology Journal, 2026 · DOI ↗