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Year : 2019  |  Volume : 17  |  Issue : 4  |  Page : 134-137

Eschar: A vital clue for diagnosis of scrub typhus


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_53_19

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The most pathognomonic sign of scrub typhus is the presence of an eschar, which represents the site of inoculation, where initial multiplication occurs before widespread dissemination. Transmission electron microscopy analysis of an eschar shows detectable Orientia tsutsugamushi in outermost layers of the perifocal inflamed skin and not in the central necrotic zone, which consists of dried skin layers only. The presence of eschar in a patient with scrub typhus varies widely in different studies from 9.5% to 86% of patients with higher values reported from the Orient. A characteristic difference is noted in the distribution of eschars over the body in both the sexes. In females, the chest (inframammary area) and abdomen are the most common sites of an eschar, while the axilla, groin, and genitalia are the most common sites of eschar in males. A thorough physical examination, especially of the hidden areas such as the genitalia, scalp, and postaural areas, is imperative in identifying this vital diagnostic clue of scrub typhus.


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