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Prevalence Rate and Distribution of Eschar in Patients with Scrub Typhus

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  • 1 Jeonbuk National University Medical School, Jeonju, South Korea;
  • | 2 Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea;
  • | 3 Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea;
  • | 4 Department of Industrial Design, Jeonbuk National University, Jeonju, South Korea;
  • | 5 Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
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ABSTRACT.

Eschar is used to establish the clinical diagnosis of scrub typhus. To identify the prevalence of eschar and its location in scrub typhus, we reviewed globally published peer-reviewed articles. We conducted a systematic literature review, using publications extracted from PubMed from January 1943 to August 31, 2019 with the keywords “scrub typhus” or “tsutsugamushi.” We collected articles associated with eschar prevalence and distribution in scrub typhus infection and reported on the body locations of eschar. A total of 458 articles containing information on the prevalence, geographical distribution, and body distribution of eschar were used for this review. The overall prevalence rate of eschar was 58.0% with the greatest prevalence in East Asia (78.7%) followed by Oceania (52.2%), Southeast Asia (41.4%), and then the lowest in South Asia (32.8%). The frequency of eschar distribution was highest in the inguinal area (28.5%), followed by the anterior area (28.0%), and the lower extremities (22.0%). The upper extremities (8.9%), back (6.6%), and head and neck (6.1%) regions had relatively low frequencies of distribution. We identified the prevalence of eschar differed by geographic locations and anatomical sites on the patient of scrub typhus.

Author Notes

Address correspondence to Sukhyun Ryu, Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, 35365, South Korea, E-mail: gentryu@onehealth.or.kror Chang-Seop Lee, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonjiro, Deokjin-gu, Jeonju, 54907 South Korea, E-mail: lcsmd@jbnu.ac.kr.

These authors contributed equally to this work.

Financial support: This research was supported by Biomedical Research Institute, Jeonbuk National University Hospital and by the Basic Science Research Programs (NRF-2015R1D1A1A01060251 and 2018R1D1A3B07049557) of the National Research Foundation of Korea, which is funded by the Ministry of Education.

Disclosure: The study was approved by the institutional review board of Jeonbuk National University Hospital (IRB registration number 2020-04-051).

Authors’ addresses: Jeong-Seop Yoo, Dain Kim, Hye-Yeon Choi, and Sunjong Yoo, Jeonbuk National University Medical School, Jeonju, South Korea, E-mails: jeongseopyoo@daum.net, saitkim10@naver.com, bennylove777@daum.net, and seanyoo0714@naver.com. Joo-Hee Hwang and Jeong-Hwan Hwang, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea, and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea, E-mails: zany78@naver.com and smilehwang77@hanmail.net. Seung-Hee Choi, Department of Industrial Design, Jeonbuk National University, Jeonju, South Korea, E-mail: designsopung@naver.com. Chiara Achangwa and Sukhyun Ryu, Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea, E-mails: ciaraacha@gmail.com and gentryu@onehealth.or.kr. Chang-Seop Lee, Jeonbuk National University Medical School, Jeonju, South Korea, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea, and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea, E-mail: lcsmd@jbnu.ac.kr.

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