A Severe Case of Scrub Typhus

Mrs. E., aged 30, came under the observation of one of us (C. C. K.) on 29th September, 1936. She complained of a boil on the left side of her neck near the hair margin, and sore throat. On examination it was found that it was a cervical gland which was inflamed and tender. There was also general adenitis of cervical, axillary and inguinal regions. No superficial ulceration of the skin or the scalp was present nor was any lymphangitis detected anywhere on the body. Throat and eyes were congested and the spleen was just palpable and slightly tender. Temperature was normal. Pulse 72 per minute, regular and of good volume. The patient, however, stated that for two days previously she had felt indisposed and that her temperature on the 28th was 100?F. Blood examination did not reveal any malarial parasites. Total white blood corpuscles 5,000 per c.mm., polymorphonuclears 78 per cent and lymphocytes 22 per cent. No abnormal white cells were present. From 30th September the temperature began to rise in a step-ladder fashion till it reached a maximum of 103?F. in the second week. This was maintained with