ObjectiveTo evaluate the clinical characteristics, diagnosis and treatment of Rickettsia tsutsugamushi pneumonia.MethodsClinical data of 10 patients with Rickettsia tsutsugamushi pneumonia were analysed retrospectively. ResultsThe onset time of 10 patients with Rickettsia tsutsugamushi pneumonia were 2 in July, 6 in August and 2 in September; all patients were  bitten  by chigger and had symptoms of fever, chest distress,  dyspneic respiration, cough; eschar and ulcer were found at leg, scrotum,anus,axillary fossa,upper arm and neck;bacteria were not detected from blood and bone marrow culture, multiply antimicrobial agents were ineffective for treating Rickettsia tsutsugamushi pneumonia. All patients were given tetracycline and expectant and supporting treatment, 2 patients died of acute respiratory failure, the other patients recovered and discharged.ConclusionAs one of the causes of Rickettsia pneumonia, Rickettsia tsutsugamushi should be paid attention, pneumonia with unknown casuses should consider excluding tsutsugamushi. The key to rescue patients successfully is early diagnosis and treatment.