Vol.100 No.9 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 100 No. 9 September 2007
A Case of Tsutsugamushi Disease Diagnosed not by
Serum Antibody Test but by Clinical Symptoms
Takeshi Morita, Akira Takagi and Kousaku Yamada
(Shizuoka General Hospital)
We report a case of Tsutsugamushi disease (scrub typhus) diagnosed not by serum antibody test but by the clinical symptoms and course. A 15-year-old boy was admitted to our hospital, complaining of general fatigue and severe submandibular swelling. Physical investigation showed a fever, and CT scanning revealed severe swelling of subcutaneous tissue and lymph nodes in the neck. Laboratory data revealed slight leukocytosis and elevated CRP. On the first day of hospitalization, submandibular cellulitis was suspected and treatment with intravenous cephem antibiotics was started. On the second day after hospitalization, we found eschar on his back and a rash on his face, neck and back. As he had stayed in the mountains 10 days before hospitalization, Tsutsugamushi disease was strongly suspected and treatment with tetracycline antibiotics was added. On the day ten, he had recovered completely from all symptoms and left the hospital.
To confirm the diagnosis of Tsutsugamushi disease, a serum antibody test using three classical serotypes of Kato, Karp and Gilliam strains was performed and was negative. Around Shizuoka prefecture, novel Kawasaki and Kuroki types have developed as major strains recently. A serological test or PCR method targeting these new serotypes was necessary for definitive diagnosis, but we could not perform those tests because we lacked blood samples from the acute phase.
Key words : Tsutsugamushi disease, scrub typhus, serotype, serological test