Scrub Typhus — Current Perspectives on Epidemiology, Diagnosis and Management

Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium Orientia tsutsugamushi and related species; it is transmitted by larval trombiculid mites (chiggers). Historically confined to the “tsutsugamushi triangle” in the Asia-Pacific region, the disease has demonstrated expanding geographic distribution and persistent public health importance. To provide an up-to-date, comprehensive review of scrub typhus covering microbiology, ecology, epidemiology, clinical features, diagnostics, treatment, prevention, and current research priorities. Narrative review synthesizing recent authoritative reviews, guideline-type resources, and representative primary studies to summarize current knowledge and identify gaps in surveillance, diagnostics, therapeutics, and vaccine development. Scrub typhus presents with nonspecific febrile illness, frequently with eschar, lymphadenopathy and rash, but clinical variability is wide and diagnosis requires laboratory confirmation. Serological assays (IFA, ELISA) remain widely used; PCR-based testing improves early detection but availability remains limited in endemic settings. Doxycycline is the mainstay of therapy; azithromycin is an alternative in pregnancy and childhood. Severe disease can progress to multi-organ dysfunction and death if untreated. Surveillance improvements and standardized diagnostics are urgent needs; vaccine development is ongoing but challenged by antigenic diversity. Early clinical suspicion and prompt empirical therapy in endemic areas reduce morbidity and mortality. Strengthening laboratory capacity, integrated vector/rodent control, improved surveillance, and continued vaccine and diagnostic research are priorities.