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KEY DIFFERENTIATING FEATURES BETWEEN SCRUB TYPHUS AND HEMORRHAGIC FEVER WITH RENAL SYNDROME IN NORTHERN CHINA

Both scrub typhus and hemorrhagic fever with renal syndrome (HFRS) are severely epidemic in northern China and often present with acute undifferentiated fever. To correctly distinguish the two diseases at an early stage, we collected and compared clinical and routine laboratory data of 46 patients with confirmed scrub typhus and 49 patients with confirmed HFRS presenting to the outpatient departments of three town hospitals in northern China. Most patients with HFRS but none of the patients with scrub typhus had hemorrhagic manifestations. Retro-orbital pain, lumbar back pain, flank tenderness, proteinuria, and occult blood in urine often occurred in patients with HFRS. However, skin eschar, regional lymphadenopathy, and maculopapular rash were more commonly found in patients with scrub typhus. In addition, platelet counts in patients with HFRS were significantly lower than in patients with scrub typhus. These findings will be useful for physicians to distinguish scrub typhus from HFRS.

Received September 4, 2006. Accepted for publication January 14, 2007.

Acknowledgments: The authors thank the physicians and staff of Wanggou town, Fangcheng town, and Shangye town hospitals in Feixian County, Shandong Province, for performing the ELISA tests and filling out questionnaires.

Financial support: This study was carried out with financial support from the National Natural Science Foundation of China (30590370 and 30371237), National Natural Science Foundation of Beijing (7021004 and 7061005), and the Commission of the European Community, as part of the project "Effective and Acceptable Strategies for the Control of SARS and New Emerging Infections in China and Europe" (Contract 003824).

^* Address correspondence to Wu-Chun Cao, Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, 20 Dong Da Jie Street, Fengtai District, Beijing 100071, People’s Republic of China. E-mail: caowc{at}nic.bmi.ac.cn or caowc2000{at}yahoo.com.cn

Authors’ addresses: Yun-Xi Liu, Dan Feng, Qian Zhang, Na Jia, Pan-He Zhang, Hong Yang, and Wu-Chun Cao, Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing 100071, People’s Republic of China. Zhong-Tang Zhao and Jian Li, School of Public Health, Shandong University, Jinan 250012, People’s Republic of China. Sake J. De Vlas, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Jing-Si Min, Wanggou Town Hospital of Feixian County, Shandong Province 273408, People’s Republic of China. Pei-Tian Feng, Shangye Town Hospital of Feixian County, Shandong Province 273401, People’s Republic of China. Shu-Bin Ma, Fangcheng Town Hospital of Feixian County, Shandong Province 273409, People’s Republic of China.

Reprint requests: Wu-Chun Cao, Beijing Institute of Microbiology and Epidemiology, State Key Lab of Pathogen and Biosecurity, 20 Dong-Da-Jie Street, Fengtai District, Beijing 100071, People’s Republic of China. E-mail: caowc{at}nic.bmi.ac.cn or caowc2000{at}yahoo.com.cn.