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CLINICAL IMAGES
Year : 2014  |  Volume : 140  |  Issue : 6  |  Page : 792

Classical eschar in scrub typhus


Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry 605 006, India

Date of Web Publication3-Mar-2015

Correspondence Address:
Tamilarasu Kadhiravan
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry 605 006
India
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Source of Support: None, Conflict of Interest: None


PMID: 25758581

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How to cite this article:
Bafna P, Kadhiravan T. Classical eschar in scrub typhus. Indian J Med Res 2014;140:792

How to cite this URL:
Bafna P, Kadhiravan T. Classical eschar in scrub typhus. Indian J Med Res [serial online] 2014 [cited 2019 Jun 19];140:792. Available from: http://www.ijmr.org.in/text.asp?2014/140/6/792/152471

A 35-year-old man, a stone driller by occupation, presented to the outpatient clinic of the department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (Puducherry, India) in December 2013 with a history of fever, body aches, and headache since last 15 days. He reported no localizing symptoms. There was no icterus or lymphadenopathy.An eschar was noted on the upper abdomen ([Figure 1]). A faint blanching erythema was also apparent on the trunk and proximal limbs. Liver and spleen were palpable two cm below the costal margins. Except for a mild leucocytosis (11,910 WBCs per μl), his blood counts, renal and liver function tests were normal. An immunochromatographic test was positive for antibodies to Orientia tsutsugamushi. He was treated with oral doxycycline 100 mg twice a day for seven days, and the fever subsided on day 3.
Figure 1: Clinical photograph showing an erythematous papule (measuring 10×5 mm) on the right upper quadrant of the abdomen capped by a well-defined blackish scab (Eschar; see inset) and surrounded by a collar of desquamation; hypopigmented macules of tinea versicolor are also seen over the chest and shoulders.

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Scrub typhus is an underappreciated cause of acute febrile illness in many parts of India [1],[2] . It is caused by the rickettsial pathogen O. tsutsugamushi, which is transmitted by the bite of larval trombiculid mites inhabiting scrub vegetation. Often, it results in life-threatening complications such as acute respiratory distress syndrome, hepato-renal dysfunction, and meningoencephalitis [3] . The eschar represents the site of inoculation, where initial multiplication occurs before widespread dissemination. An eschar is typically painless and non-pruritic, and hence its presence is not reported by patients [4] . A diligent search for eschar is often rewarding. It clinches a diagnosis of scrub typhus, enabling early initiation of treatment.

 
   References Top

1.
Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E. Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med Res 2007; 126 : 128-30.  Back to cited text no. 1
    
2.
Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis 2006; 12 : 1590-2.  Back to cited text no. 2
    
3.
Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct 2010; 40 : 129-33.  Back to cited text no. 3
    
4.
Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY, et al. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg 2007; 76 : 806-9.  Back to cited text no. 4
    


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