Division of Hematology and Oncology, Division of Infection Control and Senior Fellow Laboratory, University of Fukui, Fukui, Japan.
Am J Trop Med Hyg. 2013 Jun;88(6):1217-9. doi: 10.4269/ajtmh.12-0740. Epub 2013 Apr 15.
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.
一位 85 岁的女性农民因发热、全身乏力和皮疹而入院。头孢菌素治疗无效，米诺环素治疗效果显著。退热后在其腹股沟区发现一焦痂。发病 12 天后采集的血清实验室检查显示，对恙虫病东方体 Shimokoshi 株的抗体滴度升高。通过巢式聚合酶链反应对患者焦痂标本的基因序列分析显示与 Shimokoshi 株高度相似。因此，该患者被诊断为 Shimokoshi 型恙虫病，此前在日本西部尚未报告过这种疾病。最近，在日本东北地区也证实了这种类型的病例，表明需要进一步开展流行病学研究。
