Abstract
Background: Scrub typhus caused by Orientia tsutsugamushi, an obligatory intracellular bacterium, and hemorrhagic fever with renal syndrome (HFRS) caused by hantavirus 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 caused difficulties for physicians to distinguish them correctly. The aim of this study was to investigate whether misdiagnosis or co-infection of scrub typhus and HFRS existed in Shandong Province. Methods: We analyzed 112 serum samples of clinically diagnosed HFRS patients from 2013 to 2014 in Shandong Province with enzyme-linked immunosorbent assay (ELISA). Findings: ELISA showed that 56·3% (63/112) and 8·0% (9/112) of clinically diagnosed HFRS patients were IgM antibody positive to hantavirus and O. tsutsugamushi, respectively, suggesting that these IgM antibody positive patients were infected with hantavirus or O. tsutsugamushi. Among the confirmed HFRS patients who were IgM antibody positive to hantavirus, 7·9% (5/63) were also IgM antibody positive to O. tsutsugamushi, suggesting that these patients were co-infected with hantavirus and O. tsutsugamushi. Among the hantavirus IgM antibody negative sera, 8·2% (4/49) of sera were positive to O. tsutsugamushi, suggesting these patients were infected with O. tsutsugamushi. We concluded that a large portion of HFRS patients were co-infected with scrub typhus and some scrub typhus patients were misdiagnosed as HFRS. Interpretations: Due to the different treatments for scrub typhus and HFRS, physicians should carefully differentiate between scrub typhus, HFRS, and co-infection of both diseases for better treatment of patients. Funding Statement: National Natural Science Funds (China). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval of this study was admitted by the ethics committees of Wuhan University.
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