title: Nine cases of Japan spotted fever diagnosed at our hospital in 2008.
abstract: BACKGROUND
  The diagnosis of Japan spotted fever (JSF) is very difficult in some cases. The initial diagnosis of JSF is very important to treat.
  
  
  METHODS
  We report nine cases of Japan spotted fever (JSF) with variable clinical features diagnosed at our hospital in 2008.
  
  
  RESULTS
  Concerning clinical symptom, the most frequent symptoms were fever (8/9) and erythema of the whole body (8/9), followed by eschar (4/9). Palmar erythema, vomiting, and headache were observed in two cases. Purpura and lymph node swelling were observed in one case. Complication with Disseminated intravascular coagulation (DIC) was observed in one case. Laboratory findings revealed elevated plasma level of C-reactive protein (CRP) and liver dysfunction in all cases, and decreased platelet (7/9). Interestingly, all patients had a history of presumed infection in the Southern area of Miya River, where wild Japanese deer with ticks (vector of Rickettsia japonica) may reside.
  
  
  CONCLUSIONS
  Different procedures are performed to make a diagnosis of JSF. For an initial definite diagnosis and adequate treatment of JSF, PCR of samples taken from blood, and skin biopsy from erythema and eschar lesions are necessary. Paired serum to measure the titers of antibody against R. japonica is also important.
authors.affiliation: Department of Dermatology, Ise Municipal General Hospital, Ise, Mie 516-0064Japan. pjskt886@ybb.ne.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.forename: Masami
authors.initials: M
authors.lastname: Nishii
authors.forename: Esteban C
authors.initials: EC
authors.lastname: Gabazza
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kurokawa
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Akachi
mesh_terms: D000328:Adult; D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D016133:Polymerase Chain Reaction; D012282:Rickettsia Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis*