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Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection.

Scrub typhus, caused by Orientia tsutsugamushi, has been thought to be geographically restricted to the “tsutsugamushi triangle” in the Asia–Pacific region. In this report, a potential focus in southern Chile is identified. Scrub typhus is a vector-borne zoonosis caused by Orientia tsutsugamushi . The infection is transmitted by “chiggers” (i.e., the larvae of trombiculid mites of the genus leptotrombidium). Although chiggers feed on various vertebrates, the main reservoir is the vector itself, which maintains orientia organisms through transstadial and transovarial transmission. 1 After the bite of an infective chigger, a characteristic necrotic inoculation lesion, termed eschar, can develop, which typically contains high bacterial loads. The microorganism then spreads through the lymphatic fluid and blood, causing systemic manifestations that include fever, rash, and laboratory abnormalities such as elevated levels of C-reactive protein and liver . . .

IntroductionRecent studies have demonstrated a beneficial role of steroids in severe community-acquired pneumonia, severe COVID-19 infection and acute respiratory distress syndrome (ARDS) of diverse aetiology. This multicentre randomised controlled trial in severe scrub typhus pneumonitis and ARDS will compare the effects of 6 mg of dexamethasone once per day with placebo, in addition to standard treatment, on ventilator-free days (VFD), mortality and ventilatory requirement.Methods and analysisThe study, involving six sites, will recruit 440 patients with severe scrub typhus pneumonitis or ARDS to concealed, block-randomised, site-specific assignment of dexamethasone or placebo for 4–7 days. The primary outcome will be VFD, defined as days alive and free of ventilation at 28 days. Secondary outcomes will include 28-day mortality, need and duration of ventilation, and treatment failure, defined as death, or escalation of respiratory support from simple devices (nasal cannula, mask) to non-invasive or invasive ventilation, or the use of open-labelled steroids for worsening shock. The study will also ascertain if antinuclear antibody (ANA) expression during the acute phase of illness will predict steroid responsiveness. Subgroup analyses will be conducted a priori on ANA expression and the need for ventilation. All analyses will be conducted on an intention-to-treat basis. The trial, which commenced in April 2025, would clarify the role of corticosteroids in scrub typhus pneumonitis.Ethics and disseminationThe Institutional Review Board and Ethics Committee of the lead site, Christian Medical College, Vellore, India, has approved the study (IRB Min No 15920 (INTERVE) dated 22 November 2023). The remaining five sites have obtained approval from their respective ethics committees. Study results will be published in an international peer-reviewed journal.Trial registration numberCTRI/2024/12/077709. Registered 5 December 2024.

Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.

To investigate local transmission of Orientia tsutsugamushi by chiggers in North Carolina, USA, we tested remnant serum specimens from patients with eschar undergoing testing for suspected tickborne disease. We identified 11 persons with O. tsutsugamushi antibodies, including 4 who were positive by both assays; none had severe clinical manifestations consistent with scrub typhus.

Scrub typhus (ST), an often-underdiagnosed zoonotic infection, poses significant diagnostic and management challenges, particularly in regions with endemic tropical infections like Malaysia. We report three fatal cases of ST in central region West Malaysia, highlighting diagnostic pitfalls and implications for clinical management. Three fatal cases of ST presented with respiratory distress and multiorgan failure were reported in this study. Laboratory investigations confirmed by positive Orientia tsutsugamushi (OT) PCR results. All three cases exhibited low PCR cycle threshold (Ct) values, suggesting high bacterial loads linked to severe disease. Phylogenetic analysis indicated two distinct genotypes, underscoring diverse circulating strains in Malaysia. Eschars were present but not initially detected in two cases. These cases emphasize critical diagnostic challenges in ST due to its nonspecific presentation and reliance on clinical recognition of eschar. Early identification and molecular confirmation are vital to improve diagnostic accuracy and reduce morbidity and mortality of ST.

Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile disease, reducing the incidence of potentially fatal complications. We conducted a hospital-based, case‒control study during October‒December 2015 in 11 scrub typhus‒prone districts. We identified harvesting cardamom as the major risk factor (odds ratio 1,519; p<0.001); other factors were traditional housing, largely caused by an outside toilet location, as well as owning a goat and frequently sitting on grass. Harvesting vegetables, herding cattle in the forest, and female sex were protective. Age had a nonlinear effect; children and the elderly were more likely to seek treatment for clinical scrub typhus. This study has informed public health policies and awareness programs for healthcare workers through development of National Guidelines for Prevention, Treatment and Control of Scrub Typhus in Bhutan.

Scrub typhus is a leading cause of severe undifferentiated fever in Asia. This community-based surveillance study assessed the epidemiologic characteristics of scrub typhus in an area of India where the disease is endemic.

Detection of scrub typhus, a vectorborne infectious disease, in Chile and Africa highlights the fact that we have heretofore paid too little attention to this systemic, life-threatening disease and have developed too little relevant expertise. Scrub typhus, a systemic, life-threatening disease with an enormous incidence in Asia and the islands of the Pacific and Indian Oceans, remains remarkably neglected. Discovery of this vectorborne infectious disease on Chiloé Island in Chile (see report by Weitzel et al., pages 954–61) and its detection in Africa highlight the fact that we have heretofore paid too little attention to it and developed too little relevant expertise. 1 The Allied armies were caught flat-footed during World War II when 18,000 of their troops became ill with scrub typhus in the Pacific theater, and the disease remained a major cause of severe, . . .

Scrub typhus, caused by Orientia spp., is a mite-borne disease historically restricted to the Asia-Pacific region. Autochthonous cases have been confirmed in southern Chile, while serological evidence has been reported in Peru, Honduras and Colombia, suggesting wider distribution in Latin America. Identifying recent exposure among febrile patients is essential to evaluate its role in acute undifferentiated febrile illness (AUFI) etiology. To assess the possible implication of Orientia infection as a cause of AUFI in Villeta, Colombia. Between September and December 2021, patients with AUFI were recruited. Whole-blood samples were tested for Orientia DNA by real-time PCR targeting the 16S rRNA gene. Acute and convalescent serum samples were analyzed for IgG antibodies by IFA and ELISA, with paired samples titration to assess seroconversion. Reactive sera were further confirmed by Western blot. Forty-one acute whole-blood samples were tested by qPCR; no Orientia DNA was detected. Serology identified antibodies in 27 % (11/41) of patients: six positive by ELISA, two by IFA, and three by both methods. Based on paired sera, eight cases (20 %) were classified as recent infections, including cases of seroconversion, and three (7 %) as previous exposures. Western blot confirmed specific reactivity against Orientia antigens in all positive samples. This study provides serological evidence of Orientia circulation among febrile patients in Villeta, Colombia, including clear cases of seroconversion. Western blot validated reactivity against immunodominant proteins. Findings suggest a local scrub typhus–like illness and highlight the need for pathogen isolation and genetic characterization to clarify its contribution to AUFI.