title: Multiple eschars in scrub typhus: a case report.
abstract: Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was not observed previously. An eschar in an acute febrile patient from the "tsutsugamushi triangle" is a valuable sign in scrub typhus diagnosis. A search for multiple eschars in scrub typhus must be made by clinicians.
authors.affiliation: Lecturer, Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Munegowda
authors.initials: M
authors.lastname: Koraluru
authors.affiliation: Intern, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Manideep
authors.initials: M
authors.lastname: Nandigam
authors.affiliation: Professor and Head, Department of Microbiology, MMMC, Manipal Campus, Manipal University, Manipal, Karnataka, India.
authors.forename: Indira
authors.initials: I
authors.lastname: Bairy
authors.affiliation: Professor and Unit Head, Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Vidyasagar
authors.affiliation: Professor and Unit Head, Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India drmuralidharvarma@yahoo.co.in.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Varma
mesh_terms: D000942:Antigens, Bacterial / Q000302:isolation & purification; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D012285:Orientia tsutsugamushi / Q000276:immunology / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis*; D012867:Skin / Q000473:pathology*
chemical_list: D000942:Antigens, Bacterial
keywords: Doxycycline; Scrub typhus; multiple eschars; polymerase chain reaction (PCR)