Distribution of Eschar in Patients with Scrub Typhus

FENG Ji-hua; ZENG Cheng; ZHANG Jian-feng

doi:10.3969/j.issn.1002-3429.2015.04.003

Abstract：Objective To investigate the preferential sites of eschars over the bodies of patients with tsutsugamushi disease, in order to improve clinical diagnosis of scrub typhus. Methods In a retrospective analysis, we analyzed 249 pa-tients with scrub typhus in the first affiliated hospital of Guangxi Medical University and Liuzhou People's Hospital during Janu-ary 2009 and July 2014, focusing on the distribution of eschars and the relationships between gender, age and residence place. Results In our study, there were 3 patients with no eschar, accounting for 1. 2% and 246 patients (98. 8%) with es-char, 252 in total. The distribution of eschars over the body was: on perineum, genitalia, groin and buttocks, 76 cases (30. 2%);on chest and abdomen, 56 cases (22. 2%);on axillary fossa and breasts, 39 cases (15. 5%);on back, 31 ca-ses (12. 3%);on head, on neck and face there were 18 cases (7. 1%);on upper extremities 17 cases (6. 7%);on lower extremities, 15 cases (6. 0%). There was a difference in the distribution of eschars between males and females(P<0. 05), for males they were mainly distributed in the area of perineum and the groin, while for females, they were distributed in the ar-ea of breasts and axillary fossa. The distribution of eschars in different age and residence groups were mainly on perineum, genitalia, groin and buttocks, but the occurrence rate on back in the young and old group was higher than that of the adult group(P<0. 05), and the occurrence rate of the upper extremities in the rural group was higher than that of the urban group ( P<0. 05).Conclusion The eschar is an important clue in diagnosis of scrub typhus, and thorough examinations should be performed for the patients who run a fever accompanied with lymphadenopathy, enlarged liver and spleen and rash, especially over perineum, genitalia and groin in males, axillary fossa and breasts in females in order to prevent misdiagnosis.