title: Tsutsugamushi disease caused by Shimokoshi-type Orientia tsutsugamushi: the first report in Western Japan.
abstract: An 85-year-old female farmer was admitted to our hospital for fever, general fatigue, and skin rash. Cephalosporin was not effective and minocycline was dramatically effective. An eschar was discovered on her inguinal region after the defervescence. Laboratory examination of serum taken 12 days after onset of the illness showed elevated titers of antibodies against the Shimokoshi strain of Orientia tsutsugamushi. The gene sequence analysis of specimen from the patient's eschar revealed high similarity to the Shimokoshi strain by nested polymerase chain reaction. Therefore, this patient was diagnosed as a case of Shimokoshi-type tsutsugamushi disease, which has not previously been reported in Western Japan. Recently, cases of this type have also been confirmed in northeastern Japan, suggesting the need for further epidemiological studies.
authors.affiliation: Division of Hematology and Oncology, Division of Infection Control and Senior Fellow Laboratory, University of Fukui, Fukui, Japan. sikegaya@u-fukui.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegaya
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takada
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Takanori
authors.initials: T
authors.lastname: Ueda
mesh_terms: D061605:Administration, Intravenous; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D002443:Ceftriaxone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007564:Japan; D008911:Minocycline / Q000008:administration & dosage; D012285:Orientia tsutsugamushi / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D016133:Polymerase Chain Reaction; D012612:Scrub Typhus / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D002443:Ceftriaxone; D008911:Minocycline