The first fatal case of Japanese spotted fever confirmed by serological and microbiological tests in Awaji Island, Japan.

Japanese spotted fever is an important rickettsial disease in Japan (1). Japanese spotted fever was first reported by Mahara et al. (2,3) in 1984 in Anan City, Tokushima Prefecture , Japan. Since then, cases of Japanese spotted fever have been reported in many regions of the country. Yuzuruha Mountain in Awaji Island (Figure 1) is one of the areas heavily contaminated with Rickettsia japonica, and Japanese spotted fever cases are reported every summer in this area (4). In the present report, we describe the first fatal case of Japanese spotted fever confirmed by serological and microbiological methods. A 77-year-old male recognized loss of appetite as the initial symptom on September 2, 2005, which is defined as day 1 of his illness. Rash appeared on the lower thighs on day 2, and a high fever of 38.7°C, dysarthria, and gait disorder on day 4. The patient visited Awaji hospital on day 6, because the symptoms had worsened. The patient claimed that he had worked on farmland, but had not visited a forested area before he developed the illness.