Wei Liu, MD (*); Hao Li, PhD (*); Qing-Bin Lu, MD (*); Ning Cui, BS (*); Zhen-Dong Yang, BS; Jian-Gong Hu, MS; Ya-Di Fan, MS; Chen-Tao Guo, MS; Xiao-Kun Li, MS; Ya-Wei Wang, MS; Kun Liu, PhD; Xiao-Ai Zhang, PhD; Lan Yuan, MS; Pu-Yu Zhao, BS; Shu-Li Qin, BS; Wu-Chun Cao, PhD
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Natural Science Foundation of China or the China Mega-Project for Infectious Diseases.
Grant Support: By the National Natural Science Foundation of China (grants 81222037, 81290344, and 81130086) and the China Mega-Project for Infectious Diseases (grant 2013ZX10004-202).
Disclosures: Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M15-2572.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and statistical code: Not available. Data set: Available from Drs. Cao (email@example.com) and W. Liu (firstname.lastname@example.org).
Requests for Single Reprints: Wu-Chun Cao, PhD, and Wei Liu, MD, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, People's Republic of China; e-mail, email@example.com and firstname.lastname@example.org.
Current Author Addresses: Drs. W. Liu, H. Li, K. Liu, Zhang, and Cao; and Mr. Hu, Ms. Fan, Mr. Guo, Mr. X.K. Li, and Mr. Wang: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, People's Republic of China.
Dr. Lu: School of Public Health, Peking University, 38 Xue-Yuan Road, Haidian District, Beijing 100191, People's Republic of China.
Mr. Cui, Mr. Yang, Ms. Yuan, Mr. Zhao, and Mr. Qin: The 154 Hospital, People's Liberation Army, 104 Nan-Hu Road, Shihe District, Xinyang 464000, People's Republic of China.
Author Contributions: Conception and design: W.C. Cao, H. Li, W. Liu.
Analysis and interpretation of the data: W.C. Cao, N. Cui, Y.D. Fan, J.G. Hu, H. Li, W. Liu, K. Liu, Q.B. Lu.
Drafting of the article: W.C. Cao, N. Cui, H. Li, W. Liu, Q.B. Lu.
Critical revision for important intellectual content: N. Cui, H. Li, W. Liu, Q.B. Lu, S.L. Qin.
Final approval of the article: W.C. Cao, N. Cui, Y.D. Fan, C.T. Guo, J.G. Hu, H. Li, X.K. Li, W. Liu, K. Liu, Q.B. Lu, S.L. Qin, Y.W. Wang, Z.D. Yang, L. Yuan, X.A. Zhang, P.Y. Zhao.
Provision of study materials or patients: N. Cui, Y.D. Fan, C.T. Guo, J.G. Hu, X.K. Li, H. Li, W. Liu, S.L. Qin, Y.W. Wang, Z.D. Yang, L. Yuan, P.Y. Zhao.
Statistical expertise: W. Liu, Q.B. Lu.
Obtaining of funding: W.C. Cao, W. Liu.
Administrative, technical, or logistic support : W.C. Cao, N. Cui, W. Liu, Z.D. Yang, X.A. Zhang, P.Y. Zhao.
Collection and assembly of data: N. Cui, Y.D. Fan, C.T. Guo, J.G. Hu, H. Li, W. Liu, K. Liu, Q.B. Lu, S.L. Qin, Z.D. Yang, L. Yuan, P.Y. Zhao.
Liu W, Li H, Lu Q, Cui N, Yang Z, Hu J, et al. Candidatus Rickettsia tarasevichiae Infection in Eastern Central China: A Case Series. Ann Intern Med. 2016;164:641-648. doi: 10.7326/M15-2572
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Published: Ann Intern Med. 2016;164(10):641-648.
Published at www.annals.org on 29 March 2016
Human infection with Candidatus Rickettsia tarasevichiae (CRT) was first reported in northeastern China in 2012.
To describe the clinical spectrum and laboratory findings of patients infected with CRT in eastern central China.
A sentinel hospital for severe fever with thrombocytopenia syndrome (SFTS) in eastern central China in 2014.
Hospitalized patients with SFTS-like illness.
Molecular and serologic tests were performed to diagnose CRT infection. Data about clinical manifestations and laboratory findings were retrieved from medical records.
56 of 733 assessed patients had CRT based on polymerase chain reaction and sequencing. All patients presented with nonspecific manifestations, including fever (96%), malaise (88%), myalgia (57%), cough (25%), and dizziness (14%). Only 2 patients had rash. Further, 16% had eschar, 29% had lymphadenopathy, 100% had gastrointestinal symptoms, 34% had neurologic symptoms, 43% had hemorrhagic manifestations, and 23% had signs of plasma leakage. Thrombocytopenia was observed in 70%, leukopenia in 59%; lymphopenia in 45%; and elevated levels of lactate dehydrogenase in 82%, aspartate aminotransferase in 70%, alanine aminotransferase in 54%, and creatinine kinase in 46%. Co-infection with SFTS virus was documented in 66% patients, and 8 of the 56 patients died.
Patients with CRT were not treated for infection because they were retrospectively identified. This was not a population-based study, and the results cannot be generalized to all patients with CRT.
Candidatus R tarasevichiae infection should be considered in the differential diagnosis of febrile patients with SFTS-like illness in endemic areas.
National Natural Science Foundation of China.
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