• 1

    Kawamura A, Tanaka H, Tamura A, 1995. Tsutsugamushi Disease. Tokyo: University of Tokyo Press.

  • 2

    Silpapojakul K, 1997. Scrub typhus in the Western Pacific region. Ann Acad Med Singapore 26 :794–800.

  • 3

    Brown GW, Robinson DM, Huxsoll DL, Ng TS, Lim KJ, Sannasey G, 1976. Scrub typhus: a common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg 70 :444– 448.

    • Search Google Scholar
    • Export Citation
  • 4

    Chen XR, 2001. Scrub Typhus and Orientia tsutsugamushi. Beijing: Military Medical Science Press.

  • 5

    Wu GH, 2000. The epidemiological characteristics and prevention and cure of scrub typhus in China. Chin J Public Health 16 :777–779.

  • 6

    Yang YF, Wang JL, Yao YC, Cheng ZR, Xu ZP, Wang M, 1987. Preliminary investigation of scrub typhus in Shandong Province. Chin J Epidemiol 8 :280.

    • Search Google Scholar
    • Export Citation
  • 7

    Liu YX, Yang ZQ, Wu QY, Sun HL, Meng XR, Peng ZL, Miao ZS, 2000. Epidemiological study of autumn_winter type scrub typhus in a new endemic focus of Fei County, Shandong Province, China. Syst Appl Acarol 5 :25–31.

    • Search Google Scholar
    • Export Citation
  • 8

    Chierakul W, de Fost M, Suputtamongkol Y, Limpaiboon R, Dondorp A, White NJ, van der Poll T, 2004. Differential expression of interferon-γ and interferon γ–inducing cytokines in Thai patients with scrub typhus or leptospirosis. Clin Immunol 113 :140–144.

    • Search Google Scholar
    • Export Citation
  • 9

    Watt G, Jongsakul K, Chouriyagune C, Paris R, 2003. Differentiating dengue virus infection from scrub typhus in Thai adult with fever. Am J Trop Med Hyg 68 :536–538.

    • Search Google Scholar
    • Export Citation
  • 10

    Ching WM, Rowland D, Zhang Z, Bourgeois AL, Kelly D, Dasch GA, Devine PL, 2001. Early diagnosis of scrub typhus with a rapid flow assay using recombinant major outer membrane protein antigen (r56) of Orientia tsutsugamushi.Clin Diagn Lab Immunol 8 :409–414.

    • Search Google Scholar
    • Export Citation
  • 11

    Luan FQ, Hou L, Liu YA, Wang WX, 1998. Differentiating hemorrhagic fever with renal syndrome from atypical scrub typhus. Trans Qingdao Med School 34 :20.

    • Search Google Scholar
    • Export Citation
  • 12

    Schmaljohn CS, Dalrymple JM, 1983. Analysis of Hantaan virus RNA: evidence for a new genus of Bunyaviridae.Virology 131 :482–491.

  • 13

    Lee HW, Lee PW, Baek LJ, Chu YK, 1990. Geographical distribution of hemorrhagic fever with renal syndrome and hantaviruses. Arch Virol 1 :5–18.

    • Search Google Scholar
    • Export Citation
  • 14

    Chen HX, Luo CW, 1996. The surveilence of haemorrhagic fever with renal syndrome in China, 1931–95. Chin J Vector Biol Control 7 :1–26.

    • Search Google Scholar
    • Export Citation
  • 15

    Song G, 1998. Manual for Prevention and Cure of Hemorrhagic Fever With Renal Syndrome. Beijing: People’s Health Press.

  • 16

    Chen HX, Luo CW, 2002. Surveillance of the hemorrhagic fever with renal syndrome patients in China. Chin J Epidemiol 23 :63–66.

  • 17

    Liu YX, Zhao ZT, Xu XQ, Li J, Gao Y, Jiang JF, Zhang JL, Yang ZQ, Cao WC, 2006. Detection and genotyping of Hantavirus in the sera of hemorrhagic fever patients with renal syndrome from Shandong Province based on nested RT-PCR integrated with RFLP and SSCP. Chin J Zoon 22 :624–628.

    • Search Google Scholar
    • Export Citation
  • 18

    Liu YX, Zhao ZT, Gao Y, Jia CQ, Zhang JL, Yang ZQ, Wang SM, Jiang BF, 2004. Characterization of Orientia tsutsugamushi strains isolated in Shandong province, China by immunofluorescence and restriction fragment length polymorphism (RFLP) analyses. Southeast Asian J Trop Med Public Health 35 :353–357.

    • Search Google Scholar
    • Export Citation
  • 19

    Liu YX, Cao WC, Gao Y, Zhang JL, Yang ZQ, Zhao ZT, Foley JE, 2006. Orientia tsutsugamushi in eschars from scrub typhus patients. Emerg Infect Dis 12 :1109–1112.

    • Search Google Scholar
    • Export Citation
  • 20

    Kim EC, Kim IS, Choi Y, Kim SG, Lee JS, 1994. Rapid differentiation between Hantaan and Seoul viruses by polymerase chain reaction and restriction enzyme analysis. J Med Virol 3 :245–248.

    • Search Google Scholar
    • Export Citation
  • 21

    McDonald JC, Maclean JD, McDade JE, 1988. Imported rickettsial disease: Clinical and epidemiologic features. Am J Med 85 :799–805.

  • 22

    Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam: a study of 87 cases. Ann Intern Med 79 :26–30.

  • 23

    Yu ES, 2000. Studies on Scrub Typhus in China. Hong Kong: Asia Medicine Press.

  • 24

    Chayakul P, Panich V, Silpapojakul K, 1988. Scrub typhus pneumonitis: an entity which is frequently missed. Q J Med 68 :595–602.

  • 25

    Yi BT, Zhang ZY, 2002. The epidemic situation and control of dengue fever in China. China Public Health 18 :1128–1130.

  • 26

    Shi MH, Jiang SG, 2000. Epidemiological progresses of leptospirosis in the last fifty years. Chin J Epidemiol 21 :228–230.

  • 27

    Han GD, Deng XL, Liu KY, 2004. Review of the research in diagnosis and surveillance of malaria in the last thirty years in Shandong Province. Chin Trop Med 4 :885–887.

    • Search Google Scholar
    • Export Citation
  • 28

    Wang ZQ, You XD, Wang YL, Wang XJ, Kang DM, Wang M, Li ZZ, 2003. Surveillance of rodent hosts with hemorrhagic fever with renal syndrome (HFRS) infections from 1998 to 2002 in Shandong Province. Lit Inf Prev Med 9 :693–694.

    • Search Google Scholar
    • Export Citation
  • 29

    Yang ZQ, Miao ZS, Liu YX, 2000. A study on the epidemiology and preventive measures of epidemic hemorrhagic fever in army barrack area in Shandong province. Chin J Epidemiol 21 :30–33.

    • Search Google Scholar
    • Export Citation
  • 30

    Huggins JW, Hsiang CM, Cosgriff TM, Guang MY, Smith JI, Wu ZO, LeDuc JW, Zheng ZM, Meegan JM, Wang QN, Oland DD, Gui XE, Gibbs PH, Yuan GH, Zhang TM, 1991. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis 164 :1119–1127.

    • Search Google Scholar
    • Export Citation
 
 
 
 

 

 
 
 

 

 

 

 

 

 

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

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  • 1 Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, People’s Republic of China; School of Public Health, Shandong University, Jinan, People’s Republic of China; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Wanggou Town Hospital of Feixian County, Shandong Province, People’s Republic of China; Shangye Town Hospital of Feixian County, Shandong Province, People’s Republic of China; Fangcheng Town Hospital of Feixian County, Shandong Province, People’s Republic of 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.

Author Notes

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@nic.bmi.ac.cn or caowc2000@yahoo.com.cn.
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