“Tsutsugamushi disease is a natural epidemic disease caused by the bite of scrub typhus mite larvae on the human body after the introduction of the pathogen “rickettsia tsutsugamushi”. The incubation period is 4 to 20 days, often 10 to 14 days. The disease is not contagious and is typically characterized by crusts and ulcers. The disease has a sudden onset, with a sudden fever of 39 or more and a persistent fever pattern lasting 1 to 3 weeks. The disease is accompanied by chills or fever, severe headache, body aches, fatigue, drowsiness, loss of appetite, nausea, vomiting, flushing of the face, conjunctival congestion, photophobia, insomnia, cough, or orbital pain. In severe cases, irritability, delirium, hearing loss, tonic spasms, drowsiness and coma may occur. Scrub typhus is important for early detection, and if detected late, multi-organ failure, especially acute renal failure, irreversible damage and finally death can occur. The above 3 deaths were all deaths due to late detection, unfortunately! Scrub typhus scab is characterized by round or oval shape, 2-10 mm in diameter, raised around like a dike, with necrotic scab in the center, and can occur on the skin of the whole body, especially in shady, warm and wet areas such as the groin, external genitalia, and armpits. The following pictures are some of the scabs taken by our emergency department in patients diagnosed with scrub typhus: typical scrub typhus scabs: perineum is the most common: hunter’s eye: open the buttock groove to find the scabs. Treatment of scrub typhus The special medicine for scrub typhus is doxycycline, 100 mg twice a day for 10 to 14 days. Prevention of scrub typhus The season of high rainfall and concentrated rainfall is likely to cause ground scrub typhus to spread. Field excursions and work should not sit, rest, stay long in the grass or sunbathe clothes, and do not place the removed clothes and hats on the grass, etc. When you work in the field, you must tighten the cuffs, leg openings, collars, etc. to avoid chiggers bites. In this rainy, high incidence of chiggers season, if there are field activities, unexplained high fever, must pay attention to whether the chiggers, promptly go to the doctor, early detection, is a few dozen dollars can be cured of minor diseases; if more than two weeks or even longer, there will be irreversible multi-organ functional damage, especially acute renal failure, to carry out 24-hour non-stop hemodialysis, spending hundreds of thousands are may not be able to save.