On 24/6, doctor Hoang Cong Tinh from Intensive Care Unit 1 at Hoa Binh General Hospital reported on the patient's condition: respiratory failure, persistent high fever, chills, infection, and toxemia. A characteristic dry, scabby, and painless ulcer, resulting from a mite bite, was located in the patient's right popliteal fossa.

Medical tests revealed liver and kidney damage, along with bilateral pleural effusion. The patient was diagnosed with multi-organ failure caused by scrub typhus and required mechanical ventilation. After two weeks of treatment, the patient was successfully weaned off the ventilator, and organ functions recovered.

The dry, scabby, and painless wound made the patient complacent. *Photo: Hospital provided.*

The doctor highlighted this as a typical case where a patient's complacency regarding a small, painless ulcer led to delayed medical attention and subsequent life-threatening complications. Scrub typhus originates from the bacterium *Orientia tsutsugamushi*, a member of the Rickettsia family. Without prompt detection and treatment, the disease can lead to myocarditis, multi-organ failure, and fatality.

The characteristic scrub typhus ulcer is typically oval-shaped, measuring 0,5-2 cm. It presents with a black or shed scab, forming a raised ulcer with a pink base, minimal to no exudate, and is both painless and non-itchy. These ulcers frequently appear in soft skin areas like the armpit, chest, and neck. Other symptoms may include a skin rash, swollen lymph nodes, enlarged liver and spleen, occasional jaundice, cough, and difficulty breathing, which can escalate to acute respiratory failure.

Preventing scrub typhus involves clearing dense brush, eliminating breeding grounds, using insecticides, maintaining household hygiene, and washing clothes after use.

Thuy An