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An 85-year-old female farmer was admitted to our hospital for fever, general fatigue, and skin rash. Cephalosporin was not effective and minocycline was dramatically effective. An eschar was discovered on her inguinal region after the defervescence. Laboratory examination of serum taken 12 days after onset of the illness showed elevated titers of antibodies against the Shimokoshi strain of Orientia tsutsugamushi. The gene sequence analysis of specimen from the patient's eschar revealed high similarity to the Shimokoshi strain by nested polymerase chain reaction. Therefore, this patient was diagnosed as a case of Shimokoshi-type tsutsugamushi disease, which has not previously been reported in Western Japan. Recently, cases of this type have also been confirmed in northeastern Japan, suggesting the need for further epidemiological studies.
Financial support: This work was supported by Grant-in-Aid for Scientific Research 24591478 and a grant from The Ministry of Health, Labour and Welfare, Japan.
Authors' addresses: Satoshi Ikegaya, University of Fukui, Division of Hematology and Oncology, Fukui, Japan, E-mail: firstname.lastname@example.org. Hiromichi Iwasaki, University of Fukui, Division of Infection Control, Fukui, Japan, E-mail: email@example.com. Nobuhiro Takada, University of Fukui, Senior Fellow Laboratory, Fukui, Japan, E-mail: firstname.lastname@example.org. Seigo Yamamoto, Miyazaki Perfectural Institute of Public Health, Division of Bacteria, Miyazaki, Japan, E-mail: email@example.com. Takanori Ueda, University of Fukui, Division of Hematology and Oncology, Fukui, Japan, E-mail: firstname.lastname@example.org.