| Objective:To deepen the understanding of atypictal HFRS and to study the causes of misdiagnosis , the kinds of diseases of misdiagnosis ,and the effects of misdiagnosis on the prognosis of the patients. Methods:Retrospective analysis was made on the 40 cases of misdiagnosis with atypical HFRS and we summarized the characteristics of clinical manifestations and laboratory examination. To find the causes of misdiagnosis and to calculate the proportion of diseases of misdiagnosis by frequency number according to the kinds of the diseases of misdiagnosis,we compared the 40 cases of atypical HFRS (the group of misdiagnosis) with the 35 cases of HFRS in the same period (the group of confirmed diagnosis), and we used statistical method to explore the differences of clinical manifestations such as fever, pain in head, orbit and waist, flush in face,neck and upper chest, percussion pain in renal region, urine protein, leucocytosis, abnormal lymphocytes and thrombocytopeniabetween the group of misdiagnosis and the group of comfirmed diagnosis. We also used statistical method to explore the effects of misdiagnosis on the period of hospitalization, severe complication and fatality rate, and we reported 3 cases of atypical HFRS which were misdiagnosed in earlier period and analyzed the causes of misdiagnosis. Results:1. Misdiagnosed rate of atypical HFRS in earlier period was up to 53.30%, although all of the cases had fever, the cases were often misdiagnosed by marked clinical manifestations of some certain organs.2. The damage of liver was common in atypical HFRS(65.00%),but the severely impaired function was actually rare.3. The misdiagnosed diseases included 16 cases with upper respiratory infection (40.00%),4 cases with typhoid fever(10.00%),4 cases with hemorrhage of upper digestive tract(10.00%),6 cases with hepatitis(15.00%), 2 cases with acute renal failure (5.00%),6 cases with abdominal pain of unknown origin (15.00%),l case with acute cholecystitis(0.25%),l case with viral encephalitis(0.25%).4.The differences of appearance of pain in head,orbit and waist ,flush in face, neck and upper chest, percussion pain in renal region and leucocytosis between the group of misdiagnosis and the group of confirmed diagnosis were significant.5.The differences of the period of hospitalization and severecomplication between the group of misdiagnosis and the group ofconfirmed diagnosis were significant.Conclusions:1 .Because Hantaan virus is pantropic virus , the clinical manifestations of atypical HFRS are varied, and the disease is easy to be misdiagnosed .2.All the cases have fever and Hantaan virus can invade all human organs and systems, so the clinical manifestations such as jaundice, dark stools, pleural effusion and cerebral hemorrhage can appear. Although the proportion is only 2.50~15.00%, the clinical manifestations of HFRS are varied, and the marked clinical manifestations of some certain organs can appear.3.The damage of liver is common in atypical HFRS(65.00%),but the severe liver damage is actually rare.4.According to the characteristics of the clinical manifestations, atypical HFRS can be divided into the types of common cold and influenza, acute abdomen, acute gastroenteritis, pneumonia, hepatitis, massive hemorrhage, encephalitis, typhoid fever and so on. Most cases that are misdiagnosed don't have typical signs of pain in head, orbit and waist, flush in face, neck and upper chest, percussion pain in renal region and leucocytosis, so it is difficult to make correct diagnosis at once.5.Comparing the two groups, we find that in the group of misdiagnosis the period of hospitalization prolongs and severe complications increase,including massive hemorrhage in digestive tract, pulmonary edema, intracranial hemorrhage, acute respiratory distress syndrome and so on.6. The main cause of misdiagnosis is the fact that we do not understand well the clinical manifestations of atypical HFRS. When it is difficult to explain varied clinical manifestations by the other disease, we should pa...
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