Abstract: Objective To expand knowledge about tsutsugamushi disease by analysis of misdiagnosed cases.Methods Clinical data on 15 misdiagnosed cases of tsutsugamushi disease were retrospectively analyzed.Results Of the 15 patients,all had a history of field activity (e.g.,in grassland) and varying degrees of fever,14 had ulcers or eschar,10 had skin rashes,and 4 had lymphadenectasis.Tsutsugamushi disease was misdiagnosed as upper respiratory tract infection in 11 patients,typhoid fever in 2 patients,and septicemia in 2 patients.All the patients were cured after treatment.Conclusions Skin eschar is an important characteristic of tsutsugamushi disease.To strengthen understanding and to perform physical examination and epidemiological investigation carefully are important for the prevention of misdiagnosis of tsutsugamushi disease.