Captured in a clinical setting, in the city of Shantou, on the eastern coast of Guangdong province, China, this 2011 image depicts a Chinese Field Epidemiology Training Program (CFETP) student in the process of conducting an interview with a female patient and her daughter. The mother had been diagnosed with a case of scrub typhus, caused by the rickettsial micro-organism, Orientia tsutsugamushi.
Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi. The disease occurs mainly in the large triangular region extending from Japan in the north to Australia in the southwest and the South Pacific Islands in the southeast. Humans are infected by the bite of the larva of the trombiculid mite harboring O. tsutsugamushi. This pathogen attacks endothelial cells resulting in vasculitis. The clinical manifestations are characterized by a papular rash, headache, fever, chills, and an eschar at the site of the chigger bite. The disease can be tested serologically.