Fig.1 Clinical course and therapy in the patient of case 1.63 year old female.

Key words: Spotted fever group rickettsiosis,weil-felix Test,Hemorrhagic exanthem, Rickettsial disease of man, Tick bite

Fig.1 Clinical course and therapy in the patient of case 1.63 year old female.

Fig.2 Clinical course and therapy in the patient of case 2.69 year old female.

1168 感染 症 学 雑誌 Photo Photo 1 Eschar on the right arm in the case 2. 3 became The th hospital Photo earm 2 Swelling was remarkable distal to the eschar over palms,the the trunk,relatively in great numbers ities.(the admission) face 第11号 characteristic in a few days(the rash case 2,4 day). for- and the rash was obser- ved on the extremities,the case 2,on the exanthem.the hemorrhagic 第59巻 Photo and 4 (third Eschar on the right hospital axilla in the case 3, day). on extrem- cmの 硬 結 が あ る(刺 し 口,Photo 節 の 腫 脹 は 認 め な い.胸 4).全 身 リンパ 腹 部 に は 特 記 す べ き所 見 を 認 め な か っ た. 入 院 時 検 査 成 績:尿 赤 沈48/99,白 宅 近 くの 畦 で 草 取 りを して い て右 腋 窩 部 を 虫 に刺 され た.7月24日 の 傾 向 に あ る.生 が あ り当 院初 診,解 熱 剤 の 投 与 に て 帰 宅,翌25日 LDH514と 全 身 倦 怠 高 度 の た め 入 院 とな る. あ っ た. 入 院 時 所 見:体 く,体 mmhg,眼 温37.8,脈 格栄 養 普通 わ 躯 全体 に生 気 無 拍96/分,整,血 圧110 74 瞼 結 膜 の 充 血 を認 め る.皮 疹 は 体 幹 部 経 過:熱 第1病 の 左 方 移 動 を 認 め る が,リ ンパ 球 は減 少 軽 度 肝 機 能 障 害 を み と め,CRP5+で 型 お よ び 治 療 経 過 をFig.3に 示 し た. 日 深 夜 か ら悪 寒 戦 標 を 伴 う40 を 越 え る 発 熱 が あ り,前2例 と 同 様 の 皮 疹 が,顔 か ら 全 身 に 拡 が っ た.抗 色 を呈 し痒 み を 伴 わ な い紅 斑 で,ガ 2病 ラ ス圧 に よ り 度 陽 性, 化 学 で は,GOT77,GPT35, に散 在 し,四 肢 に 多 い.米 粒 大 か ら小豆 大,淡 紅 消 退 す る.右 腋 窩 部 に中 心 が 潰 瘍 化 した直 径3 2 潜 血,軽 血 球 数5,100(L15%,ST35%,Seg 50%),核 頃 よ り全 身 倦 怠 感,微 熱(37.7 ) 蛋 白,尿 日,第3病 面,四 肢 生 物 質 投 与 に も 関 らず 第 日 と40度 を 越 え る 高 熱 が 稽 留 し, 全 身 状 態 の 急 激 な 悪 化 を 認 め,顔 面 浮 腫,意 識朦

Fig.3 Clinical course and therapy in the patient of case 3.62 year old female.

Table 1 Results of Weil-Felix Test&Immunoglobulin Contents Table 2 Spotted Fever Group Specific Complement Fixation Test R.rick.:Rickettsia rickettsi,n.d,:not done

6) Woodward, T. E. & Jackson, E. B.: Spotted fever rickettsiae. In viral and rickettsial infections of man, Fourth ed. (Horsfall, F.L. Jr. & Tamm, I., eds.), J. B. Lippincott Co., Philadelphia, 1965, p.1095-1129.

The First Report of the Rickettsial Infections of Spotted Fever Group in Japan; Three Clinical Cases Fumihiko MAHARA Mahara Hospital,Anan-city,Tokushima,Prefecture Keiichi KOGA Koga Hospital Anan-city,Tokushima,Prefecture Seizo SAWADA & Tetuzo TANIGUCHI Anan Medical Association Hospital Fumio SHIGEMI Department of Dermatology,School of Medicine,The University of Tokushima Tsunehisa SUTO Department of Microbiology,Akita University School of Medicine Yoshimasa TSUBOI&akira OOYA National Institute of Health Hazime KOYAMA,Tsuneo UCHIYAMA&Takahiro UCHIDA Department of Virology,School of Medicine,The University of Tokushima During the short period of summer,from the middle of May to July,1984,there were three cases of an acute febrile disease with the characteristic exanthem successively at Aratono area in Anan city, Tokushima prefecture.the onset was abrupt,with headache and witha sudden shaking rigor and the fever was 39 Žto 40 Žor more.the rash was not tender or didn't itch,and it appeared on extremities, face and trunk,relatively in great numbers on extremities.the erythematous lesions were macular and nonfixed and then became macropapular and hemorrhagic.a tick bite was noticed in one case and in two cases out of three,eschars were observed: the erythematous induration covered by a scab in one case and the ulcerated lesion located in a center of the indurated area in the others. The generalized lymphadenopathy was not detected,and the liver and spleen were not palpable. Agglutinins against Proteus OX2 with a significant rise were found in the sera of the patients by Weil- Felix test.it was proved by indirect immunoperoxidase reaction that the sera of all cases contained no antibody against any three strain of Rickettsia tsutsugamushi.after the treatment with doxycycline the patients became afebrile promptly and the response was dramatic. The clinical observations and serologic examinations were led to consider these cases to be the rickettsial infection of spotted fever group,the novel disease in our country.the diagnosis was confirmed by the complement fixation test using group specific rickettsial antigens of spotted fever group.