[A case of tsutsugamushi disease which occurred in south western Shikoku]

We report a case of tsutsugamushi disease found in south western Shikoku. A 64-year-old male who lived in Towa Village in Kochi, developed a fever and headache on April 6, 1994, and was admitted to Uwajima City Hospital on April 15, with a ten-day history of illness. He had an eschar on the right anterior side of the breast and an enlargement of the right axillary lymph node, without a rash. Laboratory data showed mild liver injury and atypical lymphocytes with 6% in peripheral blood. After his blood was drawn for rickettsial isolation, the minocycline was administered. His symptoms improved rapidly and was discharged in good condition. We successfully isolated the causative agent, Rickettsia tsutugamushi, and designated it as the Shiba strain. High antibody titer against the Kato, Karp and Gilliam strains was detected in serum on admission and increased during the course of the disease. In Shikoku, tsutsugamushi disease is rare and only 13 cases were reported during last ten years. Especially in south western district of Shikoku, there have been no case reported since 1960. This case is important epidemiologically and suggests that we should pay attention to this disease.