Medicine: Tsutsugamushi

The nearer the Army & Navy get to Japan, the more often they encounter tsutsugamushi (Japanese for “dangerous bug fever”). It is also known as scrub typhus, is related to epidemic typhus. Service doctors expect the worst infection in Formosa, Malaya, Japan itself. The disease is carried by the larva of the red mite, Trombicula akamushi, which bites only once, but perhaps fatally—the death rate is 4% to 55%, depending on the virulence of the epidemic. To teach their colleagues about this new danger, Lieuts. (j.g.) Donald S. Farner and Chris P. Katsampes discussed it in the current U.S. Naval Medical Bulletin.

The microscopic mites, much like U.S. chiggers, commonly live in the damp ground around the roots of the 10-to 20-foot kunai grass which covers many Southwest Pacific lowlands. After being bitten, a man usually notices nothing wrong for over a week. Then a sore develops at the bite, followed by fever, headache and swollen glands near the bite. Next come a rash, temperatures up to 105°, restlessness or apathy, perhaps delirium, pneumonia (20% of cases), temporary deafness, constipation, bronchitis, vomiting, heart inflammation. It is severe heart damage which causes most of the deaths. In other cases, the fever drops in about two weeks, but weakness persists for several months —the average patient loses 100 days from duty compared with 14 for malaria.

The only prevention is to cut down or burn off the kunai grass and wear tick-tight clothing smeared with insect repellent. The only treatment is good nursing care which, in one epidemic, cut deaths to 2%. In the same issue of the Bulletin, Captain Joseph Bruce Logue reported on an epidemic of 230 cases with 22 deaths. In his opinion, none of these tsutsugamushi patients were fit to stay in the combat zone, even after several weeks of light duty. He suspects that all have permanent heart damage.