Eschar: A Stepping Stone to Scrub Typhus

Abstract

A 9-year-old girl with a 5-day history of fever and headache presented to our emergency department. She did not report rhinorrhea, cough, abdominal pain, vomiting, or diarrhea. Physical examination revealed bilateral neck lymphadenopathy and nonpruritic macular rashes over her trunk and arms (Figure 1; available at www.jpeds.com). A painless papule was located on the buttock and eschar was diagnosed (Figure 2). Blood tests showed thrombocytopenia and elevated liver function

Use of eschar swabbing for the molecular diagnosis and genotyping of Orientia tsutsugamushi causing scrub typhus in Quang Nam province, Vietnam

“…Also, no rash was found in any of our confirmed cases of scrub typhus. Skin rash is reported to be present in approximately 45–50% of patients with scrub typhus [ 4 , 40 ]. However, its frequency seems to vary depending on the area.…”

Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017

“…Rash is a typical finding among patients suspected of having rickettsiosis and was among the inclusion criteria for our study. Rash is reported in ≈45%–50% of patients with scrub typhus ( 29 , 30 ). However, its frequency varies between areas, as seen in Japan (93%), Thailand (7%), and India (1.7%) ( 31 – 33 ).…”

Comparative effectiveness of azithromycin for treating scrub typhus

“…[1] It is estimated to infect 1 million people per year worldwide and may present as various clinical manifestations. [2,3] Early diagnosis of scrub typhus still remains a challenge for physicians, and the mortality of untreated cases is high. [4,5] There are several drugs to treat scrub typhus, including tetracyclines, chloramphenicol, azithromycin, and quinolones.…”