By Gary M. White, MD

Tsutsugamushi disease (TD) is caused by the bite of chiggers infected by Rickettsia tsutsugamushi.


Patients classically present with fever, a maculopapular rash, and a necrotic lesion (eschar) at the bite site.


Check with your local laboratory about how to demonstrate antibody elevation to R. tsutsugamushi antigens (e.g., complement fixation test, indirect immunofluorescent antibody test, indirect immunoperoxidase test, and ELISA).


When tsutsugamushi disease is suspected, empiric treatment with tetracycline or chloramphenicol should be considered. Minocycline has been used effectively.


A 54-year-old man presented with a high-grade fever. Physical examination showed a black eschar with an erythematous halo on the left leg. Emerg Infect Dis. 2011 Sep; 17(9): 1659–1663.

A 43-year-old man presented with a fever and rash of three day's duration. The rash began on the face and extended to involve other body areas. Careful examination showed a black eschar in one axilla. Dermatology Online Journal 3(2)
A 65-year-old woman presented with fever for 3 days and a rash for 1 day. On exam, an erosion 1.5 cm by 1.5 cm with a torn bulla was observed in the right axilla, and a generalized, nonpruritic, maculopapular rash was found over the whole body. Over time, erosion developed a black crust surrounded by an erythematous rim. NEJM image challenge


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