A prospective study on distribution of eschar in patients suspected of scrub typhus

Abstract

Scrub typhus is an acute febrile illness caused by a tick bite infected with the bacteria Orientia tsutsugamushi. The clinical diagnosis is difficult as the symptoms are similar to other febrile illnesses such as dengue, typhoid, leptospirosis and so on. An eschar, if present, will narrow down the provisional diagnosis towards scrub typhus. There are no data on the preferential sites of tick bites in an Indian population. We present here the preferential sites of tick bites in a South Indian population of 123 cases positive for eschar. Geographically, clothing styles vary leading to the differences in the areas of skin exposed to the bite and thus the formation of eschars. Scrub typhus, if not treated, may lead to fatal complications. As scrub typhus is one of the most under-reported illnesses in the world, clinicians should look for the presence of an eschar in the preferential sites at least to narrow down the diagnosis and treatment.