Forensic Medicine Department, School of Medicine, Chosun University, Gwang-ju, Korea. ysk7@chosun.ac.kr
Western District Office, National Institute of Scientific Investigation, Jangseung, Jeonnam, Korea.

Tsutsugamushi Disease, also known as Scrub typhus, is an acute febrile illness, endemic in Southeast Asia, that is caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi). Infection of humans occurs from bite of larval mites (chiggers) and it is characterized by eschar, fever, headache, cutaneous rash, and generalized lymphadenopathy. The clinical course of the disease varies from self-limited to serious or fatal, especially if the diagnosis is delayed and an appropriate therapeutic management is not initiated timely. The authors experienced 2 cases of fatalities by Tsutsugamushi Disease. During the treatment of severe traumatic injury, the clinical condition of the patients was deteriorated, and the clinicians found the eschar. Antiobiotic therapy was started, but it was in vain. The authors reviewed the clinical course of fatal cases of Tsutsugamushi disease and propose the separate traumatic injury as a possible cause of delayed diagnosis and fatal consequence.

Key words : traumatic injury, fatality, eschar, delayed diagnosis

Case report