Tsutsugamushi Disease in a Non-endemic Season and Region: Suspected Indoor Exposure via Pet-associated Vector Entry

We report a case of tsutsugamushi disease in a 41-year-old woman diagnosed during a non-endemic season in a previously low-incidence region without any history of outdoor exposure. The patient owned five cats with close contact that moved freely between the indoor and outdoor environments, suggesting the possibility that infected chiggers were carried indoors by the cats and transmitted Orientia tsutsugamushi to the patient. This case suggests that tsutsugamushi disease may be under-recognized and under-reported in such regions. Even in the absence of typical histories such as outdoor exposure, a detailed examination of pet ownership may help raise clinical suspicion.