Co-circulation of multiple hemorrhagic fever diseases with distinct clinical characteristics in Dandong, China

PLoS One. 2014 Feb 27;9(2):e89896. doi: 10.1371/journal.pone.0089896. eCollection 2014.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Bacteria / classification
  • Bacteria / genetics
  • China / epidemiology
  • Ecchymosis / pathology
  • Female
  • Fever
  • Hemorrhagic Fever with Renal Syndrome
  • Hemorrhagic Fevers, Viral / diagnosis*
  • Hemorrhagic Fevers, Viral / epidemiology*
  • Hemorrhagic Fevers, Viral / etiology
  • Hemorrhagic Fevers, Viral / therapy
  • Humans
  • Leukocyte Count
  • Male
  • Middle Aged
  • Phylogeny
  • Platelet Count
  • RNA, Ribosomal, 16S
  • Treatment Outcome
  • Viruses / classification
  • Viruses / genetics

Substances

  • RNA, Ribosomal, 16S

Grants and funding

This study was supported by National Natural Science Foundation of China (Grants 81290343 and 81273014), and by the State Key Laboratory for Infectious Disease Prevention and Control (Grants 2011SKLID101 and 2012SKLID309). ECH is funded by an NHMRC Australia Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.