REPORT
TSUTSUGAMUSHI DISEASE (SGRUB TYPHUS) YOSHIKI TANIGUCHI, M,D,, YUKO KANNO, M,D,, KATUHIKO ANDO, PH.D., SHIN INACHI, M,D,, AND MASAYUKI SHIMIZU, M.D.
Abstract Two patients with Tsutsugamushi disease (fever) were successfully treated with tetracycline derivatives after typical eschars were found, although one of the patients was initially misdiagnosed as having a drug reaction eruption. Prompt diagnosis and treatment are important because this disease can be associated with considerable morbidity and simple effective treatment is easily available, IntJ Dermatol 1992; 31:693-695 Tsutsugamushi disease (fever) is an acute infectious disease caused by Rickettsia tsutsugamushi transmitted tbrough the bite of larvae of certain trombiculid mites (chiggers). This disease has been recognized for more than a hundred years on the northern Honshu island of Japan as a serious endemic disease;' it is also seen in Southeast Asia, Indonesia, India, and Nepal. The classic tsutsugamushi disease occurs during the summer, has a high mortality rate, and is transmitted by Leptotrombidium akamushi. The so-called new type of tsutsugamushi disease, which is milder than the classic form, has been increasing in almost all parts of Japan since 1976, and annual registered cases to the Ministry of Health have reached 800 recently.^ This new tsutsugamushi disease is seen from autumn to spring and is transmitted by L. pallidum or L. scutellare. Increasing international travel makes it likely tbat recognition of rickettsial diseases by physicians in the West is becoming more important. Several cases of tsutsugamushi disease have been reported in Europe and North America recently.'''' We will report the typical lesions and the clinical course with problems based on our recent cases.
Figure 1. Typical primary lesion on the neck of patient 1. (Fig, 1), There was a walnut-sized erythema with induration and crust on the left side of her neck (Fig, 2), A pea-sized lymph node was also felt on the left side of the neck. Blood cell counts showed WBC and RBC within the normal range, but platelets were decreased (119 x 10^/|iL), Liver function tests showed slight elevation in GOT (98 U/L) and GPT (96 U/L), She was treated with minocycline initially. Although fever and eruption tended to subside gradually, minocycline was changed to doxycycline because of severe vertigo from the minocycline, Doxycycline was effective on the eruption and fever. Indirect immunofluorescence method for Rici
TSUTSUGAMUSHI DISEASE (SGRUB TYPHUS) YOSHIKI TANIGUCHI, M,D,, YUKO KANNO, M,D,, KATUHIKO ANDO, PH.D., SHIN INACHI, M,D,, AND MASAYUKI SHIMIZU, M.D.
Abstract Two patients with Tsutsugamushi disease (fever) were successfully treated with tetracycline derivatives after typical eschars were found, although one of the patients was initially misdiagnosed as having a drug reaction eruption. Prompt diagnosis and treatment are important because this disease can be associated with considerable morbidity and simple effective treatment is easily available, IntJ Dermatol 1992; 31:693-695 Tsutsugamushi disease (fever) is an acute infectious disease caused by Rickettsia tsutsugamushi transmitted tbrough the bite of larvae of certain trombiculid mites (chiggers). This disease has been recognized for more than a hundred years on the northern Honshu island of Japan as a serious endemic disease;' it is also seen in Southeast Asia, Indonesia, India, and Nepal. The classic tsutsugamushi disease occurs during the summer, has a high mortality rate, and is transmitted by Leptotrombidium akamushi. The so-called new type of tsutsugamushi disease, which is milder than the classic form, has been increasing in almost all parts of Japan since 1976, and annual registered cases to the Ministry of Health have reached 800 recently.^ This new tsutsugamushi disease is seen from autumn to spring and is transmitted by L. pallidum or L. scutellare. Increasing international travel makes it likely tbat recognition of rickettsial diseases by physicians in the West is becoming more important. Several cases of tsutsugamushi disease have been reported in Europe and North America recently.'''' We will report the typical lesions and the clinical course with problems based on our recent cases.
Figure 1. Typical primary lesion on the neck of patient 1. (Fig, 1), There was a walnut-sized erythema with induration and crust on the left side of her neck (Fig, 2), A pea-sized lymph node was also felt on the left side of the neck. Blood cell counts showed WBC and RBC within the normal range, but platelets were decreased (119 x 10^/|iL), Liver function tests showed slight elevation in GOT (98 U/L) and GPT (96 U/L), She was treated with minocycline initially. Although fever and eruption tended to subside gradually, minocycline was changed to doxycycline because of severe vertigo from the minocycline, Doxycycline was effective on the eruption and fever. Indirect immunofluorescence method for Rici
