@article{oai:nagasaki-u.repo.nii.ac.jp:00001500,
 author = {Sando, Eiichiro and Ogawa, Tomoko and Tanaka, Atsushi and Yaegashi, Makito and Taira, Masakatsu and Ariyoshi, Koya and Fujita, Hiromi and Oshikawa, Yuka and Katoh, Shungo and Paris, Daniel H.},
 issue = {6},
 journal = {The American Journal of Tropical Medicine and Hygiene},
 month = {Dec},
 note = {Scrub typhus and Japanese spotted fever?both rickettsial diseases?are 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 > 4-fold increase in immunoglobulin G and immunoglobulin M titers against multiple serotypes of Orientia tsutsugamushi and Rickettsia japonica 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., American Journal of Tropical Medicine and Hygiene, 99(6), pp.1386-1389; 2018},
 pages = {1386--1389},
 title = {Case Report: Concurrent Sympatric Scrub Typhus and Japanese Spotted Fever in Japan},
 volume = {99},
 year = {2018}
}