To compare the symptoms, laboratory indicators and prognostic outcomes between patients of fever with thrombocytopenia syndrome (SFTS) and scrub typhus.

The demographic and clinical characteristics (gender, age, occupation, clinical manifestations, laboratory test results and imaging examination results) of 33 patients with SFTS and 17 patients with scrub typhus admitted to the Department of Infectious Diseases, Zhongnan Hospital of Wuhan University from April to June 2025 were collected. The condition changes and outcomes of the patients from admission to day 28 were observed, while the survival time from onset to death of deceased patients were recorded. The cases were diagnosed by the nucleic acid of Dabie bandavirus and targeted next-generation sequencing detection methods. Patients with SFTS and scrub typhus were treated with favipiravir and omalizumab, respectively. Comparisons of quantitative data were performed by the independent samples t-test or rank sum test, while count data was analyzed by Fisher’s exact probability method. Survival period was analyzed by the Kaplan-Meier method, and survival processes were compared by log-rank test.

All patients with SFTS and scrub typhus were farmers, with no statistically significant differences in gender (P=0.327) or age at onset (t=1.673, P=0.101). Clinical manifestations: patients of both groups exhibited fever, but without statistically significant difference (P=1.000). Compared with patients of scrub typhus, the proportions of bleeding (39.4% vs. 0.0%: P=0.002) and neurological involvement (51.5% vs. 0.0%: P<0.001) of patients with SFTS were significantly higher, while the proportions of patients with rash (9.1% vs. 88.2%: P<0.001), eschar (0% vs. 29.4%: P=0.003) and muscle pain (33.3% vs. 64.7%: P=0.042) were significantly lower, all with significant differences. The differences of imaging examinations revealed pulmonary infection (P=0.129), hepatosplenomegaly (P=0.597) and lymphadenopathy (P=0.099) between the two groups were not statistically significant (by Fisher’s exact test). Among the 33 patients with SFTS, 22 were discharged after improvement and 11 died; 15 patients (45.5%) were admitted to ICU, and 6 of them underwent tracheal intubation after admission to ICU, all of whom died. All 17 patients with scrub typhus were clinically cured and discharged, and none were admitted to ICU. Log-rank test showed that the survival rate of patients with scrub typhus was higher than that of patients with SFTS, with significant difference (χ²=6.79, P=0.009). Compared with patients with scrub typhus, the counts of white blood cells (Z=4.07, P<0.001) and platelet (Z=5.04, P<0.001) were significantly decreased in patients with SFTS, while alanine aminotransferase, aspartate aminotransferase, creatine kinase isoenzyme, lactate dehydrogenase, amylase and troponin levels were significantly elevated (all P<0.05), the activated partial thromboplastin time (Z=4.62, P<0.001) and thrombin time (Z=4.92, P<0.001) were prolonged, all with significant differences.

Patients with SFTS often present hemorrhage and neurological involvement, and a high mortality rate. Laboratory tests of patients with scrub typhus mostly show mild abnormalities, with relatively minor organ damage. For patients with epidemiological history presenting rash + eschar + myalgia and suspected SFTS, empirical administration of tetracyclines is prioritized, which facilitates rapid disease control, reducing complications and improving the prognosis.