Co-Circulation of Multiple Hemorrhagic Fever Diseases with Distinct Clinical Characteristics in Dandong, China

Abstract

Hemorrhagic fevers (HF) caused by viruses and bacteria are a major public health problem in China and characterized by variable clinical manifestations, such that it is often difficult to achieve accurate diagnosis and treatment. The causes of HF in 85 patients admitted to Dandong hospital, China, between 2011–2012 were determined by serological and PCR tests. Of these, 34 patients were diagnosed with Huaiyangshan hemorrhagic fever (HYSHF), 34 with Hemorrhagic Fever with Renal Syndrome (HFRS), one with murine typhus, and one with scrub typhus. Etiologic agents could not be determined in the 15 remaining patients. Phylogenetic analyses of recovered bacterial and viral sequences revealed that the causative infectious agents were closely related to those described in other geographical regions. As these diseases have no distinctive clinical features in their early stage, only 13 patients were initially accurately diagnosed. The distinctive clinical features of HFRS and HYSHF developed during disease progression. Enlarged lymph nodes, cough, sputum, and diarrhea were more common in HYSHF patients, while more HFRS cases presented with headache, sore throat, oliguria, percussion pain kidney area, and petechiae. Additionally, HYSHF patients displayed significantly lower levels of white blood cells (WBC), higher levels of creations kinase (CK) and alanine aminotransferase (ALT), while HFRS patients presented with an elevation of blood urea nitrogen (BUN) and creatinine (CREA). These clinical features will assist in the accurate diagnosis of both HYSHF and HFRS. Overall, our data reveal the complexity of pathogens causing HFs in a single Chinese hospital, and highlight the need for accurate early diagnosis and a better understanding of their distinctive clinical features.

Isolation and characterization of a novel arenavirus harbored by Rodents and Shrews in Zhejiang province, China

“…Although the human pathogenicity of Wenzhou virus is unclear, both vigilance and more research are clearly necessary as many arenavirus species are known to cause severe human diseases. Hemorrhagic fever diseases, which are caused by Hantavirus, Huaiyangshan virus, Rickesttsiales bacteria, are highly prevalent in China and a significant public health burden (Zhang et al, 2010;Zhang et al, 2012;Chen et al, 2014). Importantly, these diseases are often misdiagnosed due to a similarity in symptoms, and the etiologic agents are often unknown (Chen et al, 2014), although it is clear that some are likely to be rodentborne.…”

“…Hemorrhagic fever diseases, which are caused by Hantavirus, Huaiyangshan virus, Rickesttsiales bacteria, are highly prevalent in China and a significant public health burden (Zhang et al, 2010;Zhang et al, 2012;Chen et al, 2014). Importantly, these diseases are often misdiagnosed due to a similarity in symptoms, and the etiologic agents are often unknown (Chen et al, 2014), although it is clear that some are likely to be rodentborne. Because of the wide distribution of Rattus rats in China, determining whether the commonly carried WENV is pathogenic to humans is clearly of importance.…”

“…Several viral pathogens are known to cause hemorrhagic fevers in China (Gao et al, 2010;Zhang et al, 2010;Zhang et al, 2012;Chen et al, 2014). Indeed, China is one of the most important endemic areas for Hemorrhagic Fever with Renal Syndrome (HFRS), which is caused by hantaviruses and transmitted by rodents (Zhang et al, 2010).…”

Reemergence and Autochthonous Transmission of Dengue Virus, Eastern China, 2014

“…Although the remaining 4 serum samples were negative for dengue-specific IgM, we amplified DENV sequences from them, as described in the next section. Results of routine microbiologic examinations for bacteria by culture and antigen detection were negative in all cases, as were serologic and genetic tests for hantaviruses, phleboviruses, and Rickettsiales bacteria, performed as described ( 10 ).…”

Molecular detection of spotted fever group rickettsiae in hard ticks, northern China

“…Fever, headache, muscle pain, rash and eschar are the main syndromes of rickettsiosis caused by SFG rickettsiae (Fang, Blanton, & Walker, ; Santibáñez, Portillo, Santibáñez, Palomar, & Oteo, ). These atypical presentations are often misdiagnosed as other diseases caused by other pathogens, such as Hantavirus and severe fever with thrombocytopenia syndrome virus (Chen et al, ; Lu et al, ). Therefore, PCR plays a key role in the detection and accurate diagnose of SFG rickettsiae in ticks and vertebrate, including humans.…”