A Case of Severe Fever With Thrombocytopenia Syndrome Co-infected With Pseudomonas aeruginosa and Aspergillus fumigatus - Open Access Case Report

Sep 30, 2026

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Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infection with high mortality. Co-infections involving SFTS virus (SFTSV) and other pathogens can intensify disease and rapidly progress to multiple organ failure. This report describes an SFTS case complicated by Pseudomonas aeruginosa and Aspergillus fumigatus, in which intensive symptomatic supportive care, targeted anti-viral, anti-bacterial, and anti-fungal treatment could not prevent deterioration. The patient was discharged and died the same day; subsequent metagenomic next-generation sequencing detected SFTSV, P. aeruginosa, and A. fumigatus, supporting early pathogen screening and targeted therapy to improve prognosis.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Introduction

Case Presentation

Initial assessment and differential diagnosis

Hospital course and management

Review began 11/05/2025 Review ended 12/04/2025 Published 12/08/2025 © Copyright 2025 Zhao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98752 Open Access Case Report A Case of Severe Fever With Thrombocytopenia Syndrome Co-infected With Pseudomonas aeruginosa and Aspergillus fumigatus Jing Zhao 1, Yanjun Wang 1, Huan Zhang 1 , Jing Feng 1 1. Department of Infectious Diseases, Weifang People 's Hospital, Weifang City, CHN Corresponding author: Jing Feng, [fengjing201001@sina.com](fengjing201001@sina.com) Abstract Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease with a high mortality rate. Co-infections with SFTS virus (SFTSV) and other pathogens can exacerbate the condition, leading to rapidly progressive multiple organ failure. We reported a case of SFTS complicated by Pseudomonas aeruginosa and Aspergillus fumigatus. Despite active symptomatic supportive treatment (including anti-virus, anti-infection, anti-antifungal treatment, liver protection, and other advanced life supports), the patient 's condition deteriorated rapidly, leading to multiple organ failure. The patient was discharged home and died on the same day. The next day, her blood test results reported that SFTSV, Pseudomonas aeruginosa and Aspergillus fumigatus were detected through metagenomic next-generation sequencing (mNGS) . It suggests that early pathogen screening and targeted anti-infective treatment are crucial for improving the prognosis. Categories: Other, Internal Medicine, Infectious Disease Keywords: aspergillus fumigatus, metagenomic next-generation sequencing, mortality, pseudomonas aeruginosa, severe fever with thrombocytopenia syndrome Introduction Severe fever with thrombocytopenia syndrome (SFTS), an emerging tick-borne disease caused by the SFTS bunyavirus (SFTSV), has posed a significant public health threat in Asia since its identification in China in 2009 [1] . Characterized by fever, thrombocytopenia, and a high case-fatality rate (2 .7-45. 7%), SFTS can progress rapidly to multi-organ dysfunction syndrome (MODS) [2,3] . While invasive fungal infections, particularly aspergillosis, have been increasingly recognized as fatal complications in severe SFTS cases [4,5], concurrent bacterial and fungal co-infections remain sparsely reported. Such polymicrobial challenges could obscure the clinical picture, accelerate clinical decline, and demand a nuanced diagnostic approach. Here, we reported a fatal case of SFTS complicated by Pseudomonas aeruginosa and Aspergillus fumigatus. Case Presentation A 53-year-old woman from Shandong Province, with medical history of hypertension and type 2 diabetes, visited a local clinic on July 8th, 2023, with a complaint of fever for four days. Her body temperature was 38.3°C accompanied by chills, myalgia and fatigue, and nausea. Initial treatment with intravenous cefoxitinand oral nimesulide was ineffective. Later that same day, she developed acute neurological deterioration including agitation, delirium, and incoherent speech, prompting hospital admission. Initial assessment and differential diagnosis On admission to the local hospital, key findings included leukocytopenia (white blood cell (WBC) 1.07×10⁹/L), thrombocytopenia (platelet (PLT) 38×10⁹/L), mild liver injury (alanine aminotransferase (ALT) 57 U/L, aspartate aminotransferase (AST) 139U/L) and myocardial injury (lactate dehydrogenase (LDH) 1050U/L) . ECG showed a prolonged QT interval. Initial cranial and chest CT scans were unremarkable. The acute onset of fever, thrombocytopenia, leukopenia, and neurological symptoms in a rural resident during summer prompted a broad differential diagnosis. Primary considerations included: SFTS, other viral inf

FAQs

What was the patient’s primary diagnosis in this case report?

The patient was diagnosed with severe fever with thrombocytopenia syndrome (SFTS). The case was further complicated by co-infections with Pseudomonas aeruginosa and Aspergillus fumigatus.

How were the pathogens detected after the patient’s clinical decline?

Metagenomic next-generation sequencing (mNGS) detected SFTSV, Pseudomonas aeruginosa, and Aspergillus fumigatus in subsequent blood test results.

What treatment approaches were used, and what was the outcome?

Treatment included active symptomatic supportive care along with anti-viral, anti-infective, and anti-fungal therapies, plus advanced life support. Despite these measures, the patient’s condition deteriorated rapidly, leading to multiple organ failure, discharge on the same day, and death that day.

Sep 30, 2026

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