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Infect Chemother 2020 05 29. Epub 2020 May 29.

Department of Microbiology, Inha University, Incheon, Korea.

Tsutsugamushi disease is caused by the bacterium, and transmitted by chigger mites. In addition to the typical dark eschar, various forms of the eschar, including papules and vesicles, develop at chigger bite sites. Macular lesions were reported only in a human inoculation study; the inoculation lesions relapsed as erythematous macules or erythema-based papules concomitant with fever relapse. Read More

Indian J Med Res 2020 Apr;151(4):350-360

ICMR-National AIDS Research Institute, Pune, Maharashtra, India.

Background & Objectives: In India, acute encephalitis syndrome (AES) cases are frequently reported from Gorakhpur district in Uttar Pradesh. Scrub typhus is one of the predominant aetiological agents for these cases. In order to delineate the extent of the background of scrub typhus seroprevalence and the associated risk factors at community level, serosurveys during both lean and epidemic periods (phase 1 and phase 2, respectively) of AES outbreaks were conducted in this region. Read More

Indian J Med Res 2020 Apr;151(4):342-349

Department of Community Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.

Background & Objectives: Bacteraemia is a serious form of infection in patients presenting with fever, thus, there is a necessity for a biomarker for rapid diagnosis of bacteraemia in such patients to make better therapeutic decisions. This study was conducted to measure the serum procalcitonin (PCT) levels at the time of initial presentation as a biomarker for identifying bacteraemia and as a predictor of mortality in patients admitted with acute fever.

Methods: Four hundred and eighty patients, who presented with acute fever requiring admission to a tertiary care teaching hospital in south India, were prospectively studied. Read More

Am J Trop Med Hyg 2020 May 26. Epub 2020 May 26.

Department of Clinical Microbiology, Christian Medical College, Vellore, India.

Scrub typhus and spotted fever group rickettsioses are thought to be common causes of febrile illness in India, whereas murine typhus is rarely tested for. This cross-sectional study explored the risk factors associated with scrub typhus, tick-borne spotted fever, and murine typhus seropositivity in three different geographical settings, urban, rural, and hill villages in Tamil Nadu, South India. We enrolled 1,353 participants living in 48 clusters. Read More

Emerg Infect Dis 2020 Jun;26(6):1091-1101

Scrub typhus, a miteborne rickettsiosis, has emerged in many areas globally. We analyzed the incidence and spatial-temporal distribution of scrub typhus in China during 1952-1989 and 2006-2016 using national disease surveillance data. A total of 133,623 cases and 174 deaths were recorded. Read More

Indian J Med Microbiol 2019 Oct-Dec;37(4):584-586

Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.

Laboratory tests are necessary for diagnosis of scrub typhus (ST) especially in the absence of the distinctive eschar. Performance of an ELISA and ICT (immunochromatography) to detect IgM antibodies to scrub typhus was assessed using a panel of 346 sera chosen from healthy individuals, those with scrub typhus and scrub-typhus like illness. A sensitivity of 98. Read More

Korean J Parasitol 2020 Apr 30;58(2):153-159. Epub 2020 Apr 30.

Vector Laboratory, Institute of Pathogens and Vectors, Yunnan Provincial Key Laboratory for Zoonosis Control and Prevention, Dali University, Dali, Yunnan Province 671000, China.

The chigger mite Leptotrombidium sialkotense is one of the 6 main vectors of scrub typhus in China. Before present study, L. sialkotense was found in some parts of Hunan province, China with a narrow geographical distribution. Read More

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of General Medicine, Government Medical College and Hospital, Chandigarh, India.

Scrub typhus is a mite-borne rickettsial disease caused by a gram-negative coccobacilli transmitted through the bite of chigger mite. Scrub typhus has diverse clinical manifestations, often presenting either as a simple febrile illness or as a complicated multi-organ dysfunction. Neurological complications in scrub typhus are diverse but their exact incidence is unknown. Read More

BMC Infect Dis 2020 May 12;20(1):334. Epub 2020 May 12.

Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, No.1, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824, Taiwan.

Background: Although C-reactive protein (CRP) and procalcitonin (PCT) are widely used inflammatory markers for infectious diseases, their role and potential application for rickettsioses were rarely studied.

Methods: A retrospective chart review and serological study were conducted in patients with rickettsioses. The clinical presentations, characteristics, laboratory data, and treatment responses were recorded and their associations with CRP and PCT values were analyzed. Read More

Nat Commun 2020 May 11;11(1):2343. Epub 2020 May 11.

Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, 06520, USA.

Ubiquitin mediated signaling contributes critically to host cell defenses during pathogen infection. Many pathogens manipulate the ubiquitin system to evade these defenses. Here we characterize a likely effector protein bearing a deubiquitylase (DUB) domain from the obligate intracellular bacterium Orientia tsutsugamushi, the causative agent of scrub typhus. Read More

BMC Infect Dis 2020 May 6;20(1):322. Epub 2020 May 6.

Global Institute for Interdisciplinary Studies/Gandaki Medical College Teaching Hospital, Post Box: 24560, Sundhara, Kathmandu, Nepal.

Background: Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis. Read More

Heart Surg Forum 2020 03 31;23(2):E183-E186. Epub 2020 Mar 31.

Department of Extracorporeal Membrane Oxygenation Laboratory, Zhongshan City People's Hospital, Zhongshan, China.

A 68-year-old woman was diagnosed with scrub typhus and acute pneumonia. Acute respiratory distress syndrome (ARDS) occurred on day 4 after admission and was treated with extracorporeal membrane oxygenation (ECMO). After 7 days of ECMO assistance, her respiratory condition gradually improved, and ECMO was removed. Read More

Jpn J Infect Dis 2020 Apr 30. Epub 2020 Apr 30.

Department of Virology I, National Institute of Infectious Diseases.

Scrub typhus is a mite-borne rickettsiosis caused by the intracellular bacterium Orientia tsutsugamushi (OTS), which is classified as a biosafety level-3 (BSL-3) pathogen. For serological tests of scrub typhus, mouse fibroblast cells infected with the five prevalent serotypes of OTS in Japan are generally used as antigens for indirect immunofluorescent assay (IFA). In this study, sf-9 insect cells infected with the recombinant type-specific antigens (rTSA)-expressing baculovirus were applied for IFA. Read More

Trop Med Infect Dis 2020 Apr 27;5(2). Epub 2020 Apr 27.

The Office of Disease Prevention and Control 12, Songkhla Province (ODPC12), Department of Disease Control, Ministry of Public Health, Songkhla 90000, Thailand.

We present an approach to assess the disease ecology of rickettsial species by investigating open databases and by using data science methodologies. First, we explored the epidemiological trend and changes of human rickettsial disease epidemics over the years and compared this trend with knowledge on emerging rickettsial diseases given by published reviews. Second, we investigated the global diversity of rickettsial species recorded in humans, domestic animals and wild mammals, using the Enhanced Infectious Disease Database (EID2) and employing a network analysis approach to represent and quantify transmission ecology of rickettsial species among their carriers, arthropod vectors or mammal reservoirs and humans. Read More

JNMA J Nepal Med Assoc 2020 Mar;58(223):165-169

Department of Biochemistry, Nobel Medical College Teaching Hospital, Biratnagar, Nepal.

Introduction: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. Read More

IDCases 2020 30;20:e00751. Epub 2020 Mar 30.

Department of Paediatrics, Midnapore Medical College and Hospital, Paschim Medinipur, West Bengal, India.

We describe a rare haematological complication of pulmonary thromboembolism in a scrub typhus infection. There are very few case reports on scrub typhus infection causing deep venous thrombosis. Vasculitis and perivasculitis with endothelial dysfunction could be considered as the main pathologic mechanism causing this complication. Read More

BMC Infect Dis 2020 Apr 17;20(1):286. Epub 2020 Apr 17.

Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 22332, Republic of Korea.

Background: Henoch-Schönlein purpura (HSP) may be caused by several allergens. However, to date, HSP caused by Orientia tsutsugamushi has not been reported. Here, we report an unusual rash with features of HSP caused by Orientia tsutsugamushi. Read More

PLoS Negl Trop Dis 2020 Apr 14;14(4):e0008233. Epub 2020 Apr 14.

CNRS ISEM-CIRAD ASTRE, Faculty of Veterinary Technology, Kasetsart University, Bangkok, Thailand.

Background: Scrub typhus is a major cause of acute febrile illness in the tropics and is endemic over large areas of the Asia Pacific region. The national and global burden of scrub typhus remains unclear due to limited data and difficulties surrounding diagnosis.

Methodology/principal Findings: Scrub typhus reporting data from 2003-2018 were collected from the Thai national disease surveillance system. Read More

Trans R Soc Trop Med Hyg 2020 Apr 14. Epub 2020 Apr 14.

Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India.

Background: Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact.

Methods: Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Read More

Indian Pediatr 2020 Apr;57(4):314-316

Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.

Objective: We studied the clinical phenotypes and prevalent genotypes of Orientia tsutsugamushi in our area using indirect immunofluorescence assay (IFA).

Methods: We prospectively screened all febrile children presenting to our hospital over three years. From among children who were scrub typhus positive by ELISA we selected a sample of convenience for IFA testing to determine the genotypes of O. Read More

BMC Infect Dis 2020 Apr 7;20(1):270. Epub 2020 Apr 7.

Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China.

Background: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar.

Case Presentation: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. Read More

Trop Med Infect Dis 2020 Apr 5;5(2). Epub 2020 Apr 5.

Faculty of Tropical Medicine, Mahidol University (FTM, MU), Bangkok 10400, Thailand.

Scrub typhus, a disease caused by , affects more than one billion people globally with an average fatality rate of 6%. Humans are accidentally infected through the bite of trombiculid mite larvae (chiggers). Chiggers feed on hosts' extracellular fluid for survival and development. Read More

J Trop Pediatr 2020 Apr 6. Epub 2020 Apr 6.

Department of Medicine, Cairns Hospital, Cairns, Queensland 4870, Australia.

Rickettsial infections are an under-recognized cause of acute, undifferentiated fever in the tropics. In Asia, intensive care unit (ICU) admission rates as high as 21% and case-fatality rates of up to 5% have been reported. This 20-year retrospective audit of children and adults with serologically confirmed scrub typhus or spotted fever group (SFG) infection was performed at a tertiary-referral hospital in tropical Australia. Read More

Trop Med Infect Dis 2020 Apr 1;5(2). Epub 2020 Apr 1.

Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.

Scrub typhus and its etiological agents, species, have been around for a very long time. Historical reference to the rickettsial disease scrub typhus was first described in China (313 AD) by Hong Ge in a clinical manual (Zhouhofang) and in Japan (1810 AD) when Hakuju Hashimoto described tsutsuga, a noxious harmful disease in the Niigata prefecture. Other clinicians and scientists in Indonesia, Philippines, Taiwan, Australia, Vietnam, Malaysia, and India reported on diseases most likely to have been scrub typhus in the early 1900s. Read More

Int Immunopharmacol 2020 Jun 26;83:106431. Epub 2020 Mar 26.

CSIR-National Chemical Laboratory, Organic Chemistry Division, Pune 411008, Maharashtra, India.

The Global Program for Elimination Lymphatic Filariasis (GPELF) is in an advanced stage and requires tools for diagnosing infection, assessing transmission and certification. This study was aimed at developing an antibody-based assay using a chiemric antigen containing multi-B-cell epitopes from antigens highly expressed in different stages of Wuchereria bancrofti to detect LF infection and its transmission. The antigen was express cloned and two indirect ELISA based (IgG1 & IgG4 based) antibody assays were developed using the recombinant antigen. Read More

J Pediatr Hematol Oncol 2020 Mar 24. Epub 2020 Mar 24.

Departments of Pediatrics.

Objectives: The objectives of this study were to describe the clinical and etiological profile and outcomes of children with hemophagocytic lymphohistiocytosis (HLH) in a tertiary care hospital in South India.

Methods: This is a combined 2-year prospective (2017 to 2018) and 5-year retrospective (2012 to 2016) descriptive study in which children from birth to 18 years who satisfied the HLH-2004 diagnostic criteria were included. Case details from patient records were analyzed. Read More

J Child Neurol 2020 Jun 27;35(7):480-484. Epub 2020 Mar 27.

Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Opsoclonus, an uncommon clinical sign, and is often described in the context of opsoclonus myoclonus ataxia syndrome (OMAS). OMAS may be paraneoplastic or postinfectious. However, opsoclonus with or without OMAS may occur in association with a wide gamut of infections. Read More

Child Neurol Open 2020 Jan-Dec;7:2329048X20907754. Epub 2020 Mar 17.

Department of Paediatrics, Medical College and Hospital, Kolkata, India.

Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub typhus. Scrub typhus very rarely presents itself with CNS manifestations. Here, we present the case of a 7-year-old girl from the Hooghly district in West Bengal, who presented to us with the history of fever, cerebellar signs, and sudden onset of visual loss. Read More

J Spec Oper Med 2020 ;20(1):120-122

Scrub typhus, also known as tsutsugamushi disease, is caused by Orientia sp. and approximately 1 million new cases are reported annually. This article discusses the importance of scrub typhus and its clinical presentation, diagnosis, treatment, and prevention. Read More

J Korean Med Sci 2020 Mar 23;35(11):e77. Epub 2020 Mar 23.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality in East Asia. This study aimed to develop, for primary care providers, a prediction score using initial symptoms and basic laboratory blood tests to differentiate between SFTS and other endemic zoonoses in Korea.

Methods: Patients aged ≥ 18 years diagnosed with endemic zoonoses during a 3-year period (between January 2015 and December 2017) were retrospectively enrolled from 4 tertiary university hospitals. Read More

Indian J Public Health 2020 Jan-Mar;64(1):27-31

Scientist G and Director, ICMR-VCRC, Puducherry, India.

Background: Scrub typhus infection is endemic in India and reported to be the major cause for acute encephalitis syndrome (AES) in humans. Periodic occurrence of scrub typhus cases and presence of pathogen in rodents were also reported in areas with human cases of scrub typhus in Puducherry.

Objectives: This study was carried out to screen Orientia tsutsugamushi in rodent/shrew reservoirs and vectors in villages of Puducherry with no reports of human scrub typhus cases. Read More

Kidney Res Clin Pract 2020 Mar;39(1):54-59

Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea.

Background: Abnormal chest radiographs are frequently encountered in patients with scrub typhus. This study aimed to investigate whether chest radiography on admission is significant as a predictive factor for acute kidney injury (AKI) in patients with scrub typhus.

Methods: From 2010 to 2016, 467 patients were diagnosed with scrub typhus in our hospital. Read More

Indian J Hematol Blood Transfus 2020 Jan 25;36(1):171-173. Epub 2019 Jan 25.

2Department of Hematology, Madras Medical College, Chennai, India.

Pseudothrombocytopenia is an ex vivo EDTA-dependent artefactual thrombocytopenia, that has been described in association with several conditions. When EDTA-blood samples are drawn from patients with pseudothrombocytopenia and analysed by automated cell counters, low platelet counts are obtained (often below 50,000/mm). However, simultaneous heparinised samples show normal platelet counts, and peripheral smears show no reduction in numbers of platelets. Read More

Indian J Med Res 2020 01;151(1):104-106

Department of Microbiology, Government Medical College & Hospital, Nagpur 440 003, Maharashtra, India.

Indian J Med Res 2020 01;151(1):59-64

Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Background & Objectives: In India, spotted fever group rickettsiae (SFGR) are an underdiagnosed cause of acute febrile illness (AFI). The non-specific Weil-Felix test is the first diagnostic modality for the diagnosis of SFGR in many laboratories due to the lack of advanced diagnostic facilities in developing countries. The aim of this study was to detect SFGR using molecular methods in the patients, presenting with AFI in a tertiary care centre in north India. Read More

PLoS Negl Trop Dis 2020 03 2;14(3):e0007675. Epub 2020 Mar 2.

Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America.

Orientia tsutsugamushi infection can cause acute lung injury and high mortality in humans; however, the underlying mechanisms are unclear. Here, we tested a hypothesis that dysregulated pulmonary inflammation and Tie2-mediated endothelial malfunction contribute to lung damage. Using a murine model of lethal O. Read More

Cureus 2020 Jan 20;12(1):e6706. Epub 2020 Jan 20.

Radiology, Indira Gandhi Medical College & Research Institute, Pondicherry, IND.

Scrub typhus is a multisystem disease, and the respiratory system is commonly involved. Scrub typhus-related parkinsonism has been reported in three patients previously, and none of them underwent a lumbar puncture. Cerebral salt wasting is generally observed in vascular emergencies of the brain. Read More

Indian J Pediatr 2020 Feb 28. Epub 2020 Feb 28.

Department of Community Medicine, Indira Gandhi Medical College, Shimla, India.

Rickettsial diseases, caused by a variety of obligate intracellular, Gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are considered some of the most covert emerging and re-emerging diseases. Scrub typhus, murine flea-borne typhus and Indian tick typhus are commonly being reported and during the last decade. Scrub typhus (ST) has emerged as a serious public health problem in India. Read More

BMC Infect Dis 2020 Feb 13;20(1):138. Epub 2020 Feb 13.

Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.

Background: Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium, Orientia tsutsugamushi. Immunochromatography (ICT) and IgM ELISA are two of the routinely employed antibody based assays for diagnosis of Scrub typhus fever in Nepal, although the recommended gold standard diagnostic test is IgM Immunofluorescence assay (IFA). This study evaluated InBios Scrub Typhus Detect™ Immunoglobulin M (IgM) ELISA and IgM Immunofluorescence assays in single serum sample at the time of admission. Read More

QJM 2020 Feb 7. Epub 2020 Feb 7.

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh.

The pandemic (H1N1) influenza outbreak in the year 2009 coincided with typical scrub typhus season in north India. This led to diagnostic difficulties due to their similar and non-specific symptoms. We describe 3 patients with confirmed co-infection of pandemic (H1N1) influenza and scrub typhus who had presented with acute respiratory distress syndrome. Read More

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2019 Dec;31(12):1527-1530

Department of Intensive Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China. Corresponding author: Xiaoli Leyun, Email:

Objective: To explore the feasibility of difference between hematocrit and albumin (HCT-ALB) to evaluate the severity in patients with severe scrub typhus (Tsutsugamushi disease).

Methods: The clinical data of 408 patients with scrub typhus in 37 hospitals located in 15 prefectures of Yunnan Province from January 1st, 2017 to December 31st, 2018 were retrospectively collected. The patients were divided into the non-severe scrub typhus disease group (n = 265) and the severe scrub typhus disease group (n = 143) according to the diagnostic criteria. Read More

Indian J Med Microbiol 2019 Jul-Sep;37(3):438-441

Department of Paediatrics, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India.

Scrub typhus has re-emerged as an important cause of acute febrile illness in India. There is a dearth of information on strain diversity of Orientia tsutsugamushi from Karnataka, India, hence the present study sought to address this issue. One hundred clinically suspected cases of scrub typhus/rickettsiosis (as per the DHR-ICMR guidelines) were included. Read More

J Nepal Health Res Counc 2020 Jan 21;17(4):485-490. Epub 2020 Jan 21.

Medical Intensive Care Unit, Department of Nursing, Chitwan Medical College Teaching Hospital, Chitwan, Nepal.

Background: Age and serum creatinine are known to be predictors of mortality in scrub typhus patients admitted in intensive care unit. This study aimed to explore the factors predicting mortality in patients with scrub typhus requiring both ventilator and vasopressor support in our set up.

Methods: A retrospective analysis of 43 patients with scrub typhus (ELISA IgM positive, optical density ?0. Read More

Clin Infect Dis 2020 Jan 30. Epub 2020 Jan 30.

Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands.

Background: Rickettsial disease (RD) is a prevalent and underestimated cause of febrile illness worldwide, especially in the absence of an inoculation eschar. We attempted to quantify this under estimation at our clinic, by investigating past cases of febrile illness in travelers who had tested negative for leptospirosis, a disease that can initially present similar to non-eschar RD, and which we routinely consider when other important causes of unspecified febrile illness have tested negative.

Methods: We performed a retrospective analysis in febrile returned travelers from Asia, Africa or the Americas between 2010-2017, who had tested negative for leptospirosis. Read More

J Assoc Physicians India 2020 Jan;68(1):94

MVJ medical college and research hospital.

J Assoc Physicians India 2020 Jan;68(1):94

Ramakrishna Mission Seva Pratisthan, Vivekanenda Institute of Medical Sciences.

J Assoc Physicians India 2020 Jan;68(1):93

Govt Medical College, Kota.

J Assoc Physicians India 2020 Jan;68(1):84

Kalinga Institute of Medical Sciences.

J Assoc Physicians India 2020 Jan;68(1):84

VSSIMSAR, Burla.

Transbound Emerg Dis 2020 Jan 24. Epub 2020 Jan 24.

Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.

Scrub typhus is a life-threatening vector-borne disease. During the past decade, the number of areas affected by this disease has expanded in many countries. In this study, we aim to identify the spatiotemporal and demographic characteristics of scrub typhus in Southwest China, an emerging endemic region for scrub typhus. Read More