The body is decidedly hyperaesthetic and the conjunctivae are injected. There is frequently deafness. About the seventh day a macular eruption appears first on the face and then spreads to chest, extremities and trunk. The eruption never becomes petechial. The tongue becomes dry and cracked. There is often a cough. The blood shows a leucopenia. The eruption disappears in from seven to ten days and the fever becomes remittent or intermittent and, after a few days, reaches normal. Parotitis may occur as a complication.
Schüffner has described a similar disease from Sumatra. The mortality is, however, only 3% as against the 30% in Japan. He thinks it is transmitted by a tick. In his cases the necrotic ulcer and glandular enlargements were followed by a roseola which reached its maximum on the eighth to tenth day and was most marked on the trunk and flanks. The nervous symptoms resembled typhoid fever and there was a lymphocytosis.
Symptoms in Detail
The Nervous System.—There is marked giddiness and headache at the onset. Hyperaesthesia of the body is quite characteristic. There is often delirium at night. Deafness is frequently noted.
The Cutaneous System.—A small necrotic ulcer about ⅙ inch in diameter, with a dusky red areola, is noted at the site of the bite of the larval mite. The healing of the ulcer is delayed well on into convalescence.
About one week after the onset a dusky macular eruption appears first on the face (cheeks), then going to the chest, legs, forearms and trunk. It is not marked on neck, arms or thighs. It never becomes petechial.
Fever Course.—The temperature, which on the first day or two reaches only 101° to 103°F., becomes later on higher and continuous. About the tenth day from the appearance of the eruption it begins to fall, becoming remittent and then intermittent.
The Lymphatic System.—Very characteristic is the swelling of the glands proximal to the initial ulcer. The connecting lymphatics may be inflamed. Later on other glands may show slight swelling and tenderness.
The spleen is usually enlarged.
The Blood.—There is no change in the red cells but there is a leucopenia.