Classifying Eschar Morphologies: Enhancing Early Diagnosis of Scrub Typhus

Area of Science:

• Infectious Diseases
• Dermatology
• Microbiology

Background:

• Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi.
• Eschar formation is a significant diagnostic indicator for scrub typhus.

Purpose of the Study:

• To systematically categorize eschar morphology and distribution in scrub typhus patients.
• To identify atypical eschar presentations that may complicate diagnosis.

Main Methods:

• Retrospective analysis of 81 confirmed scrub typhus cases.
• Classification of eschar morphology into five types: erythematous macules, vesicular, erosive/ulcerative, crusted, and sclerotic.
• Assessment of eschar distribution across body areas.

Main Results:

• The most common eschar type was crusted (74.1%), followed by erosive/ulcerative (13.6%).
• Anterior body (44.4%) and inguinal area (18.5%) were the most frequent eschar locations.
• Atypical eschars, lacking classical black crust, were observed in 25.9% of cases, impacting diagnosis.

Conclusions:

• Diverse eschar morphologies, including atypical forms, are present in scrub typhus.
• Comprehensive skin examinations are essential for accurate diagnosis.
• Increased awareness of atypical eschars can improve diagnostic accuracy and patient outcomes.