Misdiagnosis of Scrub Typhus As Hemorrhagic Fever with Renal Syndrome and Potential Co-infection of Both Diseases in Patients in Shandong Province, China, 2013-2014

Overview

Journal PLoS Negl Trop Dis

Specialties Infectious Diseases
Tropical Medicine

Date 2021 Mar 30

PMID 33784301

Citations 4

Authors

Xiao-Lan Gu

Rui Qi

Wen-Qian Li

Yong-Jun Jiao

Hao Yu

Xue-Jie Yu

Affiliations

Soon will be listed here.

Abstract

Background: Scrub typhus, caused by Orientia tsutsugamushi, an obligate intracellular gram-negative bacterium, along with hemorrhagic fever with renal syndrome (HFRS), caused by hantaviruses, are natural-focus infectious diseases prevalent in Shandong Province, China. Both diseases have similar clinical manifestations in certain disease stages and similar epidemic seasons, which has caused difficulties for physicians in distinguishing them. The aim of this study was to investigate whether misdiagnosis of scrub typhus as HFRS occurred in patients in Shandong Province.

Methods: Serum samples (N = 112) of clinically suspected HFRS patients from 2013 to 2014 in Shandong Province were analyzed with enzyme-linked immunosorbent assay (ELISA) for antibodies to both hantavirus and Orientia tsutsugamushi.

Results: ELISA showed that 56.3% (63/112) and 8.0% (9/112) of clinically suspected HFRS patients were IgM antibody positive to hantavirus and O. tsutsugamushi, respectively. Among the hantavirus IgM antibody positive patients, 7.9% (5/63) were also IgM antibody positive to O. tsutsugamushi. Among the hantavirus IgM antibody negative sera, 8.2% (4/49) of sera were positive to O. tsutsugamushi.

Conclusions: We concluded that some scrub typhus patients were misdiagnosed as HFRS and co-infection of scrub typhus and HFRS might exist in China. Due to the different treatments for scrub typhus and HFRS, physicians should carefully differentiate between scrub typhus and HFRS and consider administering anti-rickettsia antibiotics if treatment for HFRS alone does not work.

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References

Zhao L, Zhai S, Wen H, Cui F, Chi Y, Wang L . Severe fever with thrombocytopenia syndrome virus, Shandong Province, China. Emerg Infect Dis. 2012; 18(6):963-5. PMC: 3358154. DOI: 10.3201/eid1806.111345. View

Weitzel T, Dittrich S, Lopez J, Phuklia W, Martinez-Valdebenito C, Velasquez K . Endemic Scrub Typhus in South America. N Engl J Med. 2016; 375(10):954-61. DOI: 10.1056/NEJMoa1603657. View

Kuhn J, Adkins S, Alioto D, Alkhovsky S, Amarasinghe G, Anthony S . 2020 taxonomic update for phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales. Arch Virol. 2020; 165(12):3023-3072. PMC: 7606449. DOI: 10.1007/s00705-020-04731-2. View

Wormser G, Dattwyler R, Shapiro E, Halperin J, Steere A, Klempner M . The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43(9):1089-134. DOI: 10.1086/508667. View

Giengkam S, Blakes A, Utsahajit P, Chaemchuen S, Atwal S, Blacksell S . Improved Quantification, Propagation, Purification and Storage of the Obligate Intracellular Human Pathogen Orientia tsutsugamushi. PLoS Negl Trop Dis. 2015; 9(8):e0004009. PMC: 4552649. DOI: 10.1371/journal.pntd.0004009. View

Sun Y, Wei Y, Yang Y, Ma Y, de Vlas S, Yao H . Rapid increase of scrub typhus incidence in Guangzhou, southern China, 2006-2014. BMC Infect Dis. 2017; 17(1):13. PMC: 5216553. DOI: 10.1186/s12879-016-2153-3. View

Zhang C, Fu X, Zhang Y, Nie C, Li L, Cao H . Epidemiological and time series analysis of haemorrhagic fever with renal syndrome from 2004 to 2017 in Shandong Province, China. Sci Rep. 2019; 9(1):14644. PMC: 6787217. DOI: 10.1038/s41598-019-50878-7. View

Zhang S, Song H, Liu Y, Li Q, Wang Y, Wu J . Scrub typhus in previously unrecognized areas of endemicity in China. J Clin Microbiol. 2010; 48(4):1241-4. PMC: 2849583. DOI: 10.1128/JCM.01784-09. View

Park S, Ha N, Ryu B, Bang J, Song H, Kim Y . Urbanization of scrub typhus disease in South Korea. PLoS Negl Trop Dis. 2015; 9(5):e0003814. PMC: 4441427. DOI: 10.1371/journal.pntd.0003814. View

10.

Fang L, Zhao L, Wen H, Zhang Z, Liu J, He S . Reservoir host expansion of hantavirus, China. Emerg Infect Dis. 2014; 21(1):170-1. PMC: 4285249. DOI: 10.3201/eid2101.140960. View

11.

Jiang F, Zhang Z, Dong L, Hao B, Xue Z, Ma D . Prevalence of hemorrhagic fever with renal syndrome in Qingdao City, China, 2010-2014. Sci Rep. 2016; 6():36081. PMC: 5081555. DOI: 10.1038/srep36081. View

12.

Lee H, Cho P, Moon S, Na B, Kang Y, Sohn Y . Current situation of scrub typhus in South Korea from 2001-2013. Parasit Vectors. 2015; 8:238. PMC: 4416255. DOI: 10.1186/s13071-015-0858-6. View

13.

Devamani C, Prakash J, Alexander N, Suzuki M, Schmidt W . Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study. PLoS Negl Trop Dis. 2019; 13(2):e0007160. PMC: 6405239. DOI: 10.1371/journal.pntd.0007160. View

14.

Liu Y, Feng D, Suo J, Xing Y, Liu G, Liu L . Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China. BMC Infect Dis. 2009; 9:82. PMC: 2703643. DOI: 10.1186/1471-2334-9-82. View

15.

Sando E, Suzuki M, Katoh S, Fujita H, Taira M, Yaegashi M . Distinguishing Japanese Spotted Fever and Scrub Typhus, Central Japan, 2004- 2015. Emerg Infect Dis. 2018; 24(9):1633-1641. PMC: 6106405. DOI: 10.3201/eid2409.171436. View

16.

Fang L, Zhao W, de Vlas S, Zhang W, Liang S, Looma C . Spatiotemporal dynamics of hemorrhagic fever with renal syndrome, Beijing, People's Republic of China. Emerg Infect Dis. 2009; 15(12):2043-5. PMC: 3044508. DOI: 10.3201/eid1512.081078. View

17.

Xiao H, Tong X, Gao L, Hu S, Tan H, Huang Z . Spatial heterogeneity of hemorrhagic fever with renal syndrome is driven by environmental factors and rodent community composition. PLoS Negl Trop Dis. 2018; 12(10):e0006881. PMC: 6218101. DOI: 10.1371/journal.pntd.0006881. View

18.

Wang L, Wang T, Cui F, Zhai S, Zhang L, Yang S . Hemorrhagic Fever with Renal Syndrome, Zibo City, China, 2006-2014. Emerg Infect Dis. 2016; 22(2):274-6. PMC: 4734509. DOI: 10.3201eid/2202.151516. View

19.

Peter J, Sudarsan T, Prakash J, M Varghese G . Severe scrub typhus infection: Clinical features, diagnostic challenges and management. World J Crit Care Med. 2015; 4(3):244-50. PMC: 4524821. DOI: 10.5492/wjccm.v4.i3.244. View

20.

Walker D . Scrub Typhus - Scientific Neglect, Ever-Widening Impact. N Engl J Med. 2016; 375(10):913-5. DOI: 10.1056/NEJMp1608499. View