Clinical Usefulness of Nested Reverse-Transcription Polymerase Chain Reaction for the Diagnosis of Severe Fever with Thrombocytopenia Syndrome

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  • 1 Department of Internal Medicine, Chosun University, Gwangju, South Korea

Severe fever with thrombocytopenia syndrome (SFTS), caused by SFTS virus (SFTSV) is an emerging tick-borne infectious disease. Few studies have assessed the clinical usefulness of nested reverse-transcription polymerase chain reaction (RT-PCR) for diagnosing SFTS. We performed conventional RT-PCR targeting the M segment, nested RT-PCR targeting M and S segments, and real-time RT-PCR targeting the S segment of SFTSV for four patients with suspected SFTS. Although conventional RT-PCR results for the first two patients were negative at admission, nested RT-PCR using the S or M targets was positive for the same samples. Likewise, in the other two patients, initial samples were confirmed positive in all three tests, but follow-up testing demonstrated negative conventional RT-PCR and positive nested RT-PCR results. Thus, delayed testing using conventional RT-PCR or real-time RT-PCR in symptomatic patients with SFTS may result in missed diagnoses, and compared with these methods, nested RT-PCR may increase the window for obtaining positive SFTSV PCR results. Meanwhile, the indirect immunofluorescence assay showed seroconversion to SFTSV antibodies in all four patients. Nested RT-PCR for SFTSV M and S segments could help diagnose SFTS in patients testing negative by conventional RT-PCR.

Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, School of Medicine, Chosun University, 588 Seosuk-dong, Republic of Korea, Dong-gu, Gwangju 61453. E-mail:

Disclosure: This study was approved by the Ethics in Human Research Committee of Chosun University Hospital under IRB No.2017-10-012.

Authors’ addresses: Choon-Mee Kim, Dong-Min Kim, and Na-Ra Yun, Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, South Korea, E-mails:,, and