Scrub typhus is a potentially fatal mite-borne rickettsial infection caused by Orientia tsutsugamushi. It is endemic to the Asia–Pacific region, which has an ...NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListCMAJv.183(15);2011Oct18PMC3193135CMAJ.2011Oct18;183(15):e1152.doi: 10.1503/cmaj.101929PMCID:PMC3193135PMID:21911554Eschar:acluetoscrubtyphusChih-ChungShiao,MDandSeng-YiLin,MDAuthorinformationCopyrightandLicenseinformationDisclaimerDivisionsofNephrology(Shiao)andInfection(Lin),DepartmentofInternalMedicine,SaintMary’sHospital,Luodong,Taiwan;andSaintMary’sMedicine,NursingandManagementCollege(Shiao),Yilan,TaiwanCorrespondenceto:Dr.Chih-ChungShiao,wt.moc.oohay@1002yygnuhcCopyright©1995-2011,CanadianMedicalAssociationThisarticlehasbeencitedbyotherarticlesinPMC.AssociatedDataSupplementaryMaterialsOnlineAppendixsupp_183_15_E1152__index.html(742bytes)GUID: 509E6910-8D85-49D7-B0C8-E0D576E3432Bsupp_101929_image-shiao-1-at.pdf(30K)GUID: F537B20E-6E5F-46D4-98DB-4FE013C9D3C3A33-year-oldmanfromaruralTaiwanesevillagewasadmittedwithathree-dayhistoryoffever,headache,musclepainandskinrashes.Onexamination,hewasfebrile(39.2°C)withgeneralizedmacularpatchesandanescharmeasuring15mmontheleftlowerquadrantofhisabdomen(Figure1).Hisleukocytecountwasnormal,buthehadanelevatedC-reactiveproteinlevelof83(normal0–8)mg/L,anaspartateaminotransferaselevelof183(normal0–37)U/Landanalanineaminotransferaselevelof166(normal0–41)U/L.Hisbloodculturesshowednogrowth.OpeninaseparatewindowFigure1:Lowerabdomenofa33-year-oldfebrilemanfromaruralTaiwanesevillageshowinganeschar,anecroticlesioninducedbyamitebite,measuring15mm.Basedonaworkingdiagnosisofscrubtyphus,weprescribeddoxycycline.Thepatient’sconditionimproveddramaticallywithintwodays,andhehadafullclinicalrecoverybytheeighthdayoftreatment.Thediagnosisofscrubtyphuswasconfirmedserologicallyusingtheindirectfluorescentmethod,withagreaterthanfourfoldincreaseinant