title: 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.
authors.affiliation: Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xin-Cheng
authors.initials: XC
authors.lastname: Qin
authors.affiliation: Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Song
authors.affiliation: Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Chen
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China.
authors.forename: Yong-Xiang
authors.initials: YX
authors.lastname: Zhao
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jing-Shan
authors.initials: JS
authors.lastname: Zhang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jin-Rong
authors.initials: JR
authors.lastname: He
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China.
authors.forename: Xue-Hua
authors.initials: XH
authors.lastname: Zhao
authors.affiliation: Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China.
authors.forename: De-Wei
authors.initials: DW
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Kang
authors.initials: XK
authors.lastname: Fu
authors.affiliation: Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Di
authors.initials: D
authors.lastname: Tian
authors.affiliation: Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xing-Wang
authors.initials: XW
authors.lastname: Li
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Xu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China ; Department of Virology, Haartman Institute, University of Helsinki, Finland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Plyusnin
authors.affiliation: Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Holmes
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yong-Zhen
authors.initials: YZ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001419:Bacteria / Q000145:classification / Q000235:genetics; D002681:China / Q000453:epidemiology; D004438:Ecchymosis / Q000473:pathology; D005260:Female; D005334:Fever; D006480:Hemorrhagic Fever with Renal Syndrome; D006482:Hemorrhagic Fevers, Viral / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D010976:Platelet Count; D012336:RNA, Ribosomal, 16S; D016896:Treatment Outcome; D014780:Viruses / Q000145:classification / Q000235:genetics
chemical_list: D012336:RNA, Ribosomal, 16S