Journal of Postgraduate Medicine
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Year : 2013  |  Volume : 59  |  Issue : 4  |  Page : 342-343  

Eschar in scrub typhus: A valuable clue to the diagnosis

SK Raina 
 Department of Community Medicine, Dr. Rajendra Prasad Govt. Medical College, Tanda, Kangra, Himachal Pradesh, India

Correspondence Address:
S K Raina
Department of Community Medicine, Dr. Rajendra Prasad Govt. Medical College, Tanda, Kangra, Himachal Pradesh
India




How to cite this article:
Raina S K. Eschar in scrub typhus: A valuable clue to the diagnosis.J Postgrad Med 2013;59:342-343


How to cite this URL:
Raina S K. Eschar in scrub typhus: A valuable clue to the diagnosis. J Postgrad Med [serial online] 2013 [cited 2020 Feb 26 ];59:342-343
Available from: http://www.jpgmonline.com/text.asp?2013/59/4/342/123191


Full Text

Sir,

I have gone through a paper entitled, "Eschar in scrub typhus: A valuable clue to the diagnosis" published in J Post grad Med (2013;59:177-178). [1] The authors deserve to be congratulated for their effort. Studies in past have pointed to the presence of Eschar as an important finding for diagnosis of Rickettsial pox, scrub typhus, and other mite- or tick-borne rickettsiosis. [2],[3],[4]

Eschar at the inoculating site of the mite is considered pathognomonic of scrub typhus. [5] Therefore, this study is a valuable addition to the available literature on the utility of Eschar as a diagnostic tool in scrub typhus. However, a literature review in this regard reveals that Eschar is rarely seen in the south East Asia and Indian subcontinent regions. [5] Is this really a useful tool for diagnosing scrub typhus in our part of world?

The framework in which this study is conducted will not be able to answer this question adequately. The study should have been conducted on all patients of scrub typhus with or without Eschar. This would have provided us with the predictive value and accuracy of Eschar as a clue to diagnosis of scrub typhus. This study is unable to provide us with any inputs on the how good this clue (Eschar) is for the diagnosis of scrub typhus.

Without taking anything away from the quality of research conducted, a study on diagnostic utility of Eschar as a tool for diagnosing scrub typhus would have benefitted medical practitioners across India, wherein advanced diagnostic facilities for diagnosing scrub are not available.

References

1Kundavaram AP, Jonathan AJ, Nathaniel SD, Varghese GM. Eschar in scrub typhus: A valuable clue to the diagnosis. J Postgrad Med 2013;59:177-8.
2Saini R, Pui JC, Burgin S. Rickettsialpox: Report of three cases and a review. J Am Acad Dermatol 2004;51(Suppl 5):S137-42.
3Berman SJ, Kundin WD. Scrub typhus in South Vietnam. A study of 87 cases. Ann Intern Med 1973;79:26-30.
4Sayen JJ, Pond HS, Forrester JS, Wood FC. Scrub typhus in Assam and Burma. Medicine (Baltimore). 1946;25:155-214. .
5Narvencar KP, Rodrigues S, Nevrekar RP, Dias L, Dias A, Vaz M, et al. Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa. Indian J Med Res 2012;136:1020-4.

 
Wednesday, February 26, 2020
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