Misdiagnosis of Tsutsugamushi Disease in Children and Literature Review

LI Xin; ZHANG Ting

doi:10.3969/j.issn.1002-3429.2025.05.003

Abstract：Objective To explore the causes and preventive measures of misdiagnosis of tsutsugamushi disease in children.Methods The clinical data of 2 misdiagnosed patients with tsutsugamushi disease treated in 2020 were retrospec-tively analyzed.Results Two patients were from tsutsugamushi epidemic area.A male child aged 1 year and 9 months devel-oped the disease in July.He was admitted to hospital with fever and rash for 10 days,hard swelling of both feet,and perianal peeling for 1 day,accompanied by conjunctival congestion,chapped mouth and perianal descalation.Kawasaki disease was in-itially diagnosed,and intravenous injection of gammaglobulin was ineffective.Physical examination after admission to our hos-pital revealed characteristic ulcers of tsutsugamushi disease in the left axilla,which was confirmed.The misdiagnosis lasted 12 days.Symptoms and signs improved rapidly after Doxycycline treatment.A female child aged 7 years and 10 months developed the disease in September,presented with fever for 7 days,and was diagnosed as tonsillitis in another hospital.She was admit-ted to our hospital after ineffective treatment with Ceftriaxone.Physical examination showed scattered congestive rash,con-junctival congestion,red lips,chapped lips,bayberry tongue,and no eschar in the whole body.The patient was confirmed as tsutsugamushi disease by the external field test,and the misdiagnosis lasted 9 days.She was discharged after treatment with erythromycin.Conclusion The symptoms of tsutsugamushi disease are not typical and it is more likely to be misdiagnosed.Strengthening the understanding of tsutsugamushi disease,being familiar with its pathogenesis,carefully searching for eschar(ulcer),inquiring about the history in detail,and perfecting the pathogen examination if necessary can help reduce or avoid the misdiagnosis and mistreatment of tsutsugamushi disease.