Transmission of Rickettsia orientalis to man by Leptotrombidium akamushi at a scrub typhus endemic area in Akita Prefecture, Japan

During the summer seasons of 1956 through 1970, 93 larval trombiculid mites were removed from 386 individuals who had been bitten by chiggers in Jumonji, Akita Prefecture. All 87 larvae that were available for examination were identified as Leptotrombidium akamushi. Infestation of man occurred predominantly during July and August, but the period extended from June to November. The duration of attachment was approximately 1 to 3 days. Usually only 1 chigger was found on a victim but on occasion as many as 7 were removed at one time. Scrub typhus developed in 45 (11.7%) of the 386 farmers bitten by chiggers. Although patients with scrub typhus may have sustained multiple bites, only one eschar was found. However, 76% of the patients did not recognize a bite either at the site where an eschar subsequently appeared or elsewhere prior to the onset of disease. If it is assumed that workers who did not subsequently become ill were equally unaware of chigger bites, then the probable incidence of disease in chigger victims was 3.1%. The minimum infectivity rate of L. akamushi larvae in Akita Prefecture was estimated to be 2.3%. Based upon the assumption that infection was transmitted as the result of a single bite, the infective rate of chiggers attacking man was calculated to be 2.5%.