Department of Paediatrics, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, N.T., Hong Kong, China
NC Sin ( 冼藝泉 ) MBChB, MRCP(UK), MRCPCH
FT Yau ( 邱徽道 ) MBBS, FRCP(E)(G), FHKCPaed, FHKAM, FRCPCH, M Med(Sing)
WK Luk ( 陸衛光 ) MBChB, FRCPA, FHKCPath, FHKAM(Pathology)
Correspondence to: Dr NC Sin
Received January 20, 2000
Scrub typhus is caused by Orientia tsutsugamushi which is transmitted by an arthropod vector - chigger. Cases in children were often missed or misdiagnosed as a result of atypical presentation. The typical eschar lesion (necrotic centre with an erythematous rim), found in less than half of cases, should alert doctors to the diagnosis of rickettsial infections. The case fatality rate may be as high as 7% in untreated patients. Treatment with doxycycline or chloramphenicol should be started for suspected cases as soon as possible.