Scrub Typhus (Tsutsugamushi Disease) Presenting as Fever with an Eschar

Clinical characteristics and effective treatments of scrub typhus-associated hemophagocytic lymphohistiocytosis in children

“…This was relatively higher as compared to other reports, which could be explained as follows: (1) The skin color may be a possible explanation for the absence of an eschar in scrub typhus; (2) physicians in our study were very familiar with eschar. Therefore, a careful examination of the entire body should be performed to identify eschar in patients from an endemic area [25]. In our study thorough body examination was carried out in each patient with suspected scrub typhus, which may contribute to the higher detection rate of eschar.…”

Epidemiological Distribution and Potential Risk Factors of Orientia tsutsugamushi Infection in Eastern Uttar Pradesh, India

“…If it goes undiagnosed, it can cause severe complications, including death in motion. An "Eschar" at the site of chigger-bite could be indicative of the disease, but its manifestation has been reported with a wide range of variations from 1% to 97% in various geographical regions, which does not make it a reliable manifestation of the disease (1,6). ST surfaced in India in early 90s but failed to bloom out much due to advances in the application of insecticides, improved lifestyle, and empiric management of PUO (1).…”

“…ST is often considered as occupational disease of rural population since the chances for exposure to infected chiggers are higher in rural areas (4).This disease usually exhibits a spectrum of the signs and symptoms including pyrexia (may or may not with chills), headache, myalgia body-ache, nausea, vomiting, abdominal pain, non-pruritic macular or maculo-papular rash (not always), eschar, and a pathognomonic sign of ST which is a dark scab like lesion at the site of bite (sometimes goes unnoticed) (5). However, other symptoms such as enlarged lymph nodes and alteration in mental status ranging from confusion and encephalitis to coma have been also reported (1,3,5,6).…”

Scrub typhus: the clinical significance of the eschar

“…As seen in this case, an infiltrative erythema with a 5–15 mm long black eschar at the site of the infected chigger bite can be often found on physical examination. Approximately 80% of patients have an eschar, which is of high diagnostic value, but patients themselves do not often notice the presence of the eschar, which may be found in obscure sites such as the pubis, axilla or lower legs; therefore, careful physical examination is necessary 4. For a definitive diagnosis, PCR of a serum or eschar sample is useful.…”