[Three Cases of Tsutsugamushi Disease in Miyakojima Island, Okinawa, Japan].

Tsutsugamushi disease (Scrub thyphus) has been reported from all over Japan except the Hokkaido area. In Okinawa, only one patient was reported in 2001, who was infected outside Okinawa Prefecture. The first case infected in Okinawa was reported at Miyakojima Island in 2008. We report herein on the second case diagnosed in 2010, and the third and fourth in 2011, and all three patients were suspected to have been infected at Ikemajima Island adjacent to the island of Miyakojima. The patients recovered without any severe complications after antibiotic therapy with tetracyclines. We should take Tsutsugamushi disease into consideration in the differential diagnosis for a patient with fever, skin rash, and/or eschar even in the Okinawa area. Implementation of appropriate information and education about the disease should be carried out for local residents and tourists.