{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:59:38Z","timestamp":1779339578147,"version":"3.51.4"},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:p>Scrub typhus and Japanese spotted fever\u2014both rickettsial diseases\u2014are endemic and notifiable in Japan and may cause a fatal outcome without prompt treatment. Here we present the first case of a concurrent sympatric infection of both diseases with grade II evidence. A 67-year-old woman, after a single event of potential exposure to the pathogens, presented with a 12-day history of fever, pharyngeal pain, papulo-erythematous rash, and pronounced fatigue. Her erythematous rash was distributed on her trunk and extremities, palms, and soles and eventually progressed to purpura. Fever persisted until doxycycline was administered on day 12. A significant &gt; 4-fold increase in immunoglobulin G and immunoglobulin M titers against multiple serotypes of <jats:italic>Orientia tsutsugamushi<\/jats:italic> and <jats:italic>Rickettsia japonica<\/jats:italic> were revealed by indirect immunoperoxidase assays. These clinical and serological data, even in the absence of molecular or isolation evidence, provided grade II evidence that this was a concurrent infection of sympatric scrub typhus and Japanese spotted fever.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0258","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T07:08:25Z","timestamp":1539068905000},"page":"1386-1389","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Concurrent Sympatric Scrub Typhus and Japanese Spotted Fever in Japan"],"prefix":"10.4269","volume":"99","author":[{"given":"Eiichiro","family":"Sando","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Kameda Medical Center, Chiba, Japan;"},{"name":"Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;"},{"name":"Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuka","family":"Oshikawa","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Kameda Medical Center, Chiba, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shungo","family":"Katoh","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;"},{"name":"Department of General Internal Medicine, Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakatsu","family":"Taira","sequence":"additional","affiliation":[{"name":"Chiba Prefectural Institute of Public Health, Chiba, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoko","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Chiba Prefectural Institute of Public Health, Chiba, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Mahara Institute of Medical Acarology, Tokushima, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makito","family":"Yaegashi","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Kameda Medical Center, Chiba, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Paris","sequence":"additional","affiliation":[{"name":"Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland,"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koya","family":"Ariyoshi","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;"},{"name":"Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Infectious Agent Surveillance Report (IASR)","first-page":"109","article-title":"Scrub typhus and Japanese spotted fever in Japan 2007\u20132016","author":"National Institute of Infectious Diseases J","year":"2017"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0003971","article-title":"A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi)","volume":"9","author":"Taylor","year":"2015"},{"key":"b3","series-title":"Intern 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