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Abstract：
BACKGROUND: The geographic spread of Japanese spotted fever (JSF) in China is gradually expanding, particularly in regions where severe fever with thrombocytopenia syndrome (SFTS) is highly prevalent, with both diseases sharing similarities in epidemiology and clinical presentation. The microbiological diagnosis of JSF is challenging, compounded by low awareness among healthcare professionals in newly affected areas. Moreover, primary healthcare facilities without polymerase chain reaction (PCR) testing capabilities for SFTS often misdiagnose JSF as SFTS.
METHODS: All 3 patients had a history of working in the fields, with cold like symptoms in the early fever stages, but the fever did not improve after a few days. The accompanying symptoms were also very different. Physical examination revealed enlarged lymph nodes, different forms of rash, with or without eschar. Laboratory tests showed thrombocytopenia, eosinophilia, elevated lactate dehydrogenase, and transaminase, with 1 patient experiencing renal damage. It is worth noting that these 3 patients reside in an area where SFTS is endemic, and there have been no prior reports of JSF. They exhibited clinical symptoms and laboratory test results closely resembling those of SFTS. Therefore, they were initially misdiagnosed with SFTS in their local hospitals.
METHODS: The 3 patients who arrived at our hospital 7 days after symptom onset and were subsequently diagnosed with JSF by metagenomic next-generation sequencing (mNGS).
METHODS: Doxycycline treatment for 1 week.
RESULTS: The patients\' symptoms quickly improved with no side effects, and the results of laboratory tests went back to normal.
CONCLUSIONS: By comparing the clinical characteristics of JSF patients and SFTS patients comprehensively, we found that APTT and procalcitonin levels may be valuable in assisting in the identification of SFTS and JSF. In all areas where tick-borne diseases are endemic, include SFTS-epidemic areas, we recommend using the Weil-Felix test to screen for potential rickettsiosis in patients presenting with fever and thrombocytopenia with or without rash in primary healthcare settings, as well as simultaneous testing for the SFTS virus and spotted fever group rickettsioses sequence. Additionally, mNGS sequencing should be used to confirm the diagnosis and provide information for epidemiological investigations in patients who are suspected of having spotted fever group rickettsiosis.
METHODS: All 3 patients had a history of working in the fields, with cold like symptoms in the early fever stages, but the fever did not improve after a few days. The accompanying symptoms were also very different. Physical examination revealed enlarged lymph nodes, different forms of rash, with or without eschar. Laboratory tests showed thrombocytopenia, eosinophilia, elevated lactate dehydrogenase, and transaminase, with 1 patient experiencing renal damage. It is worth noting that these 3 patients reside in an area where SFTS is endemic, and there have been no prior reports of JSF. They exhibited clinical symptoms and laboratory test results closely resembling those of SFTS. Therefore, they were initially misdiagnosed with SFTS in their local hospitals.
METHODS: The 3 patients who arrived at our hospital 7 days after symptom onset and were subsequently diagnosed with JSF by metagenomic next-generation sequencing (mNGS).
METHODS: Doxycycline treatment for 1 week.
RESULTS: The patients\' symptoms quickly improved with no side effects, and the results of laboratory tests went back to normal.
CONCLUSIONS: By comparing the clinical characteristics of JSF patients and SFTS patients comprehensively, we found that APTT and procalcitonin levels may be valuable in assisting in the identification of SFTS and JSF. In all areas where tick-borne diseases are endemic, include SFTS-epidemic areas, we recommend using the Weil-Felix test to screen for potential rickettsiosis in patients presenting with fever and thrombocytopenia with or without rash in primary healthcare settings, as well as simultaneous testing for the SFTS virus and spotted fever group rickettsioses sequence. Additionally, mNGS sequencing should be used to confirm the diagnosis and provide information for epidemiological investigations in patients who are suspected of having spotted fever group rickettsiosis.
摘要：
背景：日本斑点热（JSF）在中国的地理传播正在逐渐扩大，特别是在严重发热伴血小板减少综合征（SFTS）非常普遍的地区，两种疾病在流行病学和临床表现上具有相似性。JSF的微生物学诊断具有挑战性，再加上新受影响地区的医疗保健专业人员意识不足。此外，没有SFTS聚合酶链反应(PCR)检测能力的初级医疗机构经常将JSF误诊为SFTS.
方法：所有3名患者都有在田间工作的历史，在发烧早期有类似感冒的症状，但是几天后发烧没有改善。伴随的症状也非常不同。体格检查发现淋巴结肿大，不同形式的皮疹，有或没有焦痂。实验室检查显示血小板减少症,嗜酸性粒细胞增多,乳酸脱氢酶升高，和转氨酶，1例患者出现肾损害。值得注意的是，这3名患者居住在SFTS流行的地区，之前没有关于JSF的报道。他们表现出与SFTS非常相似的临床症状和实验室测试结果。因此,他们最初在当地医院被误诊为SFTS。
方法：3例患者在出现症状后7天到达我们医院，随后通过宏基因组下一代测序（mNGS）诊断为JSF。
方法：多西环素治疗1周。
结果：患者症状迅速改善，没有副作用，实验室检查的结果恢复正常。
结论：通过综合比较JSF患者和SFTS患者的临床特征，我们发现APTT和降钙素原水平可能有助于SFTS和JSF的鉴定.在所有蜱传疾病流行的地区，包括SFTS流行地区，我们建议使用Weil-Felix测试筛查在主要医疗机构中出现发热和血小板减少伴或不伴皮疹的患者的潜在立克次体病,以及同时检测SFTS病毒和斑点热组立克次体序列。此外,应使用mNGS测序来确认诊断，并为怀疑患有斑点热组立克次体病的患者的流行病学调查提供信息。
方法：所有3名患者都有在田间工作的历史，在发烧早期有类似感冒的症状，但是几天后发烧没有改善。伴随的症状也非常不同。体格检查发现淋巴结肿大，不同形式的皮疹，有或没有焦痂。实验室检查显示血小板减少症,嗜酸性粒细胞增多,乳酸脱氢酶升高，和转氨酶，1例患者出现肾损害。值得注意的是，这3名患者居住在SFTS流行的地区，之前没有关于JSF的报道。他们表现出与SFTS非常相似的临床症状和实验室测试结果。因此,他们最初在当地医院被误诊为SFTS。
方法：3例患者在出现症状后7天到达我们医院，随后通过宏基因组下一代测序（mNGS）诊断为JSF。
方法：多西环素治疗1周。
结果：患者症状迅速改善，没有副作用，实验室检查的结果恢复正常。
结论：通过综合比较JSF患者和SFTS患者的临床特征，我们发现APTT和降钙素原水平可能有助于SFTS和JSF的鉴定.在所有蜱传疾病流行的地区，包括SFTS流行地区，我们建议使用Weil-Felix测试筛查在主要医疗机构中出现发热和血小板减少伴或不伴皮疹的患者的潜在立克次体病,以及同时检测SFTS病毒和斑点热组立克次体序列。此外,应使用mNGS测序来确认诊断，并为怀疑患有斑点热组立克次体病的患者的流行病学调查提供信息。
