{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:32:11Z","timestamp":1768339931001,"version":"3.49.0"},"reference-count":49,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Non-Profit Organization","award":["2020"],"award-info":[{"award-number":["2020"]}]},{"name":"Non-Profit Organization","award":["JP21fk0108081"],"award-info":[{"award-number":["JP21fk0108081"]}]},{"DOI":"10.13039\/100009619","name":"AMED","doi-asserted-by":"publisher","award":["2020"],"award-info":[{"award-number":["2020"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"AMED","doi-asserted-by":"publisher","award":["JP21fk0108081"],"award-info":[{"award-number":["JP21fk0108081"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Severe fever with thrombocytopenia syndrome (SFTS) and Japanese spotted fever (JSF; a spotted fever group rickettsiosis) are tick-borne zoonoses that are becoming a significant public health threat in Japan and East Asia. Strategies for treatment and infection control differ between the two; therefore, initial differential diagnosis is important. We aimed to compare the clinical characteristics of SFTS and JSF based on symptomology, physical examination, laboratory data, and radiography findings at admission. This retrospective study included patients with SFTS and JSF treated at five hospitals in Nagasaki Prefecture, western Japan, between 2013 and 2020. Data from 23 patients with SFTS and 38 patients with JSF were examined for differentiating factors and were divided by 7:3 into a training cohort and a validation cohort. Decision tree analysis revealed leukopenia (white blood cell [WBC] &lt; 4000\/\u03bcL) and altered mental status as the best differentiating factors (AUC 1.000) with 100% sensitivity and 100% specificity. Using only physical examination factors, absence of skin rash and altered mental status resulted in the best differentiating factors with AUC 0.871, 71.4% sensitivity, and 90.0% specificity. When treating patients with suspected tick-borne infection, WBC &lt; 4000\/\u00b5L, absence of skin rash, and altered mental status are very useful to differentiate SFTS from JSF.<\/jats:p>","DOI":"10.3390\/v14081807","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T02:48:23Z","timestamp":1660877303000},"page":"1807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Differentiation of Severe Fever with Thrombocytopenia Syndrome from Japanese Spotted Fever"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2508-0882","authenticated-orcid":false,"given":"Nana","family":"Nakada","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"},{"name":"Health Center, Nagasaki University, Nagasaki 852-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1357-1676","authenticated-orcid":false,"given":"Kazuko","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6159-4103","authenticated-orcid":false,"given":"Moe","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Ashizawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masataka","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asuka","family":"Umemura","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichi","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo 857-8511, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-9631","authenticated-orcid":false,"given":"Shungo","family":"Katoh","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Nagasaki Rosai Hospital, Sasebo 857-0134, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Sumiyoshi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Mihara","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Isahaya General Hospital, Isahaya 854-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsutomu","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Sasebo Chuo Hospital, Sasebo 857-1195, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuya","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuyuki","family":"Ashizawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"},{"name":"Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7872-8147","authenticated-orcid":false,"given":"Shotaro","family":"Ide","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Sasebo Chuo Hospital, Sasebo 857-1195, Japan"},{"name":"Infectious Disease Experts Training Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-390X","authenticated-orcid":false,"given":"Naoki","family":"Iwanaga","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-5386","authenticated-orcid":false,"given":"Takahiro","family":"Takazono","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan"},{"name":"Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-7679","authenticated-orcid":false,"given":"Masato","family":"Tashiro","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8102, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiko","family":"Nakamichi","sequence":"additional","affiliation":[{"name":"Health Center, Nagasaki University, Nagasaki 852-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konosuke","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koya","family":"Ariyoshi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki 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