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

YUN-XI LIU 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

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DAN FENG 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

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QIAN ZHANG 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

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NA JIA 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

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ZHONG-TANG ZHAO 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

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SAKE J. DE VLAS 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

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JIAN LI 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

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PAN-HE ZHANG 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

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HONG YANG 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

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JING-SI MIN 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

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PEI-TIAN FENG 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

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SHU-BIN MA 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

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WU-CHUN CAO 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

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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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