key: cord-1024508-k6agxs0x
authors: Ihara, Shiichi; Shikino, Kiyoshi; Ikusaka, Masatomi
title: A case of availability bias for COVID‐19 causing scrub typhus diagnostic errors
date: 2021-06-21
journal: J Gen Fam Med
DOI: 10.1002/jgf2.474
sha: cc01f75667134c637392c82d763e5b6cfaed2313
doc_id: 1024508
cord_uid: k6agxs0x

Although patients with scrub typhus develop a maculopapular rash all over the body, patients with COVID‐19 may also show a similar rash. At the first visit, we did not fully inspect his trunk and extremities under his clothes. Although scrub typhus and COVID‐19 have some similar symptoms, an eschar is a characteristic symptom of the former, and careful inspection is important to distinguish between the diseases.[Image: see text]

In November 2020, a 70-year-old man, living in Chiba, visited our fever outpatient internal medicine clinic with a 7-day history of fever, cough, headache, arthralgia, and a generalized rash. The patient had dinner with a large number of individuals 10 days before the visit. 

O. tsutsugamushi and is distributed throughout the Asia-Pacific region. 1 In Japan, about 400 cases of scrub typhus were reported every

year from a broad geographic range. 2 Besides three major symptoms (fever, an eschar of chigger bite, and skin rash), patients sometimes complain of headache, fatigue, lymph node enlargement, macular or maculopapular rash, and cough (especially in severe case). 3 In this case, confirmation of the diagnosis was delayed from the initial visit. As a situational factor of the delayed diagnosis, the physician in the fever outpatient clinic was required to minimize the patient contact time with fully equipped personal protective equipment. The physician was likely to rely on system 1, which is an intuitive clinical reasoning process. In addition, as the number of patients with COVID-19 was increasing at the time, it is possible that the physician became accustomed to the situation. This could have made it difficult to recall differential diagnoses other than COVID-19 based on usability heuristics and availability bias. 5 Even for patients who complain of typical symptoms of COVID-19, it is important to proceed with differentiation through basic medical history taking and physical examination.

NA.

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

All authors had access to the data and a role in writing the manuscript.

The patient's consent for the case report was obtained after well informed. 

Estimating the burden of scrub typhus: a systematic review

Descriptive epidemiology of rickettsial infections in Japan: Scrub typhus and Japanese spotted fever

Human herpesvirus infection in children with fever and maculopapular rash

Cutaneous manifestations of coronavirus disease 2019 in 458 confirmed cases: a systematic review

Diagnostic error in internal medicine