The eschar of scrub typhus

Abstract

A 9-yr-old boy presented with twelve days of highgrade intermittent fever with hepatosplenomegaly and a 0.5x0.5cm eschar over upper anterior abdominal wall (Fig. 1). Eschar preceded the fever with itch on the site and a papulovesicular lesion. This ruptured to form a dark brown to black crust over 2 days. Scrub typhus Elisa for IgM was positive. With oral doxycyclline his itch disappeared in 12 hrs and fever subsided in 36 hrs. On follow-up after 2 wk the eschar had resolved leaving a small scar.

Characteristics of Pediatric Scrub Typhus during an Outbreak in the North Eastern Region of India: Peculiarities in Clinical Presentation, Laboratory Findings and Complications

“…The authors noticed eschars in only 10 cases (41.7%). However, eschars have been described as the single most important diagnostic clue and therefore needs to be looked for in all febrile patients without localizing signs of the disease [12]. Though rash is considered as a hallmark of rickettsial disease, it is neither seen at presentation nor in all the patients [6,13,14].…”

Study on Clinico-Laboratory Profile of Children with Scrub Typhus

“…It begins as a small papule, enlarges, undergoes central necrosis, and acquires a blackened crust to form a lesion resembling a cigarette burn 30 . The reported percentages of eschar formation showed substantial variations across diff erent studies ranging from 15-100% [31][32][33][34] . Eschars can be detected relatively frequently in white skinned individuals.…”

“…We noticed eschars in only 9 cases (47.36%). However, eschars have been described as the single most important diagnostic clue and therefore needs to be looked for in all febrile patients without localizing signs of the disease 35 .…”

Effects of clarithromycin treatment in scrub typhus in children: comparison with chloramphenicol and azithromycin

“…An eschar is a 5–10 mm black scab that forms at the site of the trombiculid bite. The eschar is an important sign for the diagnosis of scrub typhus; as it is a symptom specific to scrub typhus, clinical diagnosis can be made even prior to serological diagnosis9). Although the eschar does not cause any pain or itching, some patients may feel tenderness in lymph nodes because of lymphatic drainage.…”

“…However, when diagnosed late, it causes systemic vasculitis from complications, which in turn can lead to pneumonia, acute renal failure, encephalomeningitis, upper gastrointestinal bleeding, and multiorgan failure. In severe cases, the complications can even result in death9).…”