Case 168. Reference case 168A

　 　 　 　
　 Biopsy of the eschar, showing necrotizing ulceration with extensive inflammatory infiltration (HE). 　
　 　 　 　

　

 　 Classic Tsutsugamushi disease was endemic to the certain areas of Japan, including Akita, but the new type disorder is seen widely not only in Japan but also in Asia and Australia.