Scrub typhus in previously unrecognized areas of endemicity in China.
Scrub typhus, caused by Orientia tsutsugamushi, has emerged recently in areas of northern China where the disease had not been known to exist. We analyzed epidemiological, clinical, and laboratory data for 104 patients who were admitted to a hospital in Fuyang City between 26 September and 1 November 2008. We showed that the major clinical manifestations of the patients were fever (100%), headache (82%), myalgias (77%), eschar (67%), rash (52%), and unusual facial flushing (62%). Among the 104 patients, the sera of 98% contained IgM antibodies to O. tsutsugamushi detected by indirect immunofluorescence assays (IFA), and DNA of the O. tsutsugamushi 56-kDa gene was amplified by PCR from the blood of 36 patients. We conclude that 104 patients were infected with scrub typhus in Fuyang City, Anhui Province. Our study indicates that physicians need to consider the diagnosis of scrub typhus for febrile patients living in northern China, where scrub typhus had not been considered to exist in the past.
Zhang
Shouyin
S
State Key Lab for Infectious Diseases Prevention and Control, National Institute for Communicable Diseases Prevention and Control, China Centers for Disease Control and Prevention, Beijing 102206, China.
Song
Hongbin
H
Liu
Yan
Y
Li
Qun
Q
Wang
Yong
Y
Wu
Jiabin
J
Wan
Junfeng
J
Li
Guolan
G
Yu
Changjun
C
Li
Xiuyong
X
Yin
Wenwu
W
Xu
Zhen
Z
Liu
Bo
B
Zhang
Qian
Q
Wan
Kanglin
K
Li
Guichang
G
Fu
Xiuping
X
Zhang
Jingshan
J
He
Jinrong
J
Hai
Rong
R
Yu
Dongzheng
D
Walker
David H
DH
Xu
Jianguo
J
Yu
Xue-Jie
XJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D002648:Child; D002681:China / Q000453:epidemiology; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D019353:Endemic Diseases; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D012285:Orientia tsutsugamushi / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012612:Scrub Typhus / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D017422:Sequence Analysis, DNA; D055815:Young Adult
D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D007075:Immunoglobulin M