Scrub Typhus in India: A Critical Commentary

Keywords: Scrub Typhus, Public Health Challenge, Armed Forces


Scrub typhus in India, although, dates back to World War II, was nearly forgotten barring occasional reporting of outbreaks from the Indian Armed Forces, which kept the interest alive in the disease. Scrub typhus at that time was considered a formidable foe. It was credited with inflicting heavy casualties amongst troops in the China-Burma-India operational corridor, which forced the commanders to withdraw troops from these areas. This tended to alter the course of the war itself. An old foe indeed; scrub typhus continues to take a heavy toll on the vulnerable Armed Forces personnel who are posted in areas that enhance their vulnerability to the disease and has predictably also impacted the unsuspecting civil population too who are residing in such areas. Scrub typhus has undoubtedly emerged as a major public health challenge in India. Slow, yet steady, appreciation of the impact of scrub typhus though is being felt, however, professional efforts are still dismal and have failed to bring the disease to limelight and contain its insistent march. Scrub typhus, although an old foe, has reemerged albeit with new challenges.

How to cite this article:
Rina T. Scrub Typhus in India: A Critical Commentary. J Commun Dis 2020; 52(3): 33-37.



Tilak R, Kunte R. Scrub typhus strikes back - are we ready? MJAFI, 2019.

Vivekanandan M, Mani A, Sundara PY et al. Outbreak of Scrub Typhus in Pondicherry. The Journal of the

Association of Physicians of India 2010; 58: 24-28.

Sharma A, Mahajan S, Gupta ML et al. Investigation of an outbreak of scrub typhus in the Himalayan region

of India. Jpn J Infec. Dis 2005; 58: 208-210.

Kumar K, Saxena VK, Thomas TG et al. Outbreak investigation of scrub Typhus in Himachal Pradesh

(India). J Commun Dis 2004; 36(4): 277-283.

Dass R, Nayan Mani D, Sourabh Gohain D et al. Characteristics of pediatric scrub typhus during

an outbreak in the north eastern region of India: peculiarities in clinical presentation, laboratory findings

and complications. The Indian Journal of Pediatrics 2011; 78(11): 1365-1370.

Sinha P, Gupta S, Dawra R et al. Recent outbreak of scrub typhus in North Western part of India. Indian J

Med Microbiol 2014; 32: 247-250.

Gurung S, Pradhan J, Bhutia PY. Outbreak of scrub typhus in the North East Himalayan region-Sikkim:

An emerging threat. Indian J Med Microbiol 2013; 31: 72-74.

Ahmad S, Srivastava S, Verma SK et al. Scrub typhus in Uttarakhand, India: A common rickettsial disease in

an uncommon geographical region. Trop Doct 2010; 40: 188-190.

Mahajan SK, Rolain JM, Sankhyan N et al. Pediatricscrub typhus in Indian Himalayas. Indian J Pediatr.

; 75: 947-949.

Chaudhry D, Garg A, Singh I et al. Rickettsial diseases in Haryana: Not an uncommon entity. J Assoc Physicians India 2009; 57: 334-337.

Razak A, Sathyanarayanan V, Prabhu M et al. Scrub typhus in Southern India: Are we doing enough? Trop

Doct 2010; 40: 149-151.

Mathai E, Rolain JM, Verghese GM et al. Outbreak of scrub typhus in Southern India during the cooler

months. Ann N Y Acad Sci 2003; 990: 359-3564.

Sinha P, Gupta S, Dawra R et al. Recent outbreak of scrub typhus in North Western part of India. Indian J

Med Microbiol 2014; 32: 247-250.

van Eekeren LE, de Vries SG, Wagenaar JFP et al. Underdiagnosis of rickettsial disease in clinical practice: A

systematic review. Travel Medicine and Infectious Disease 2015; 26: 7-15.

Rahi M, Gupte MD, Bhargava A et al. DHR-ICMR guidelines for diagnosis & management of rickettsial

diseases in India. Indian J Med Res 2015; 141(4): 417-422.

Wangrangsimakul T, Phuklia W, Newton Paul N et al. Scrub typhus and the misconception of doxycycline

resistance. Clinical Infectious Diseases 2020; 70(11): 2444-9.

Kelly DJ, Fuerst PA, Richards AL. The historical case for and the future study of antibiotic-resistant scrub

typhus. Trop Med Infect Dis 2017; 2: 63.

Biswal M, Kumar A, Sharma N et al. Genetic diversity of Orientia tsutsugamushi strains from patients in North

India. International Journal of Infectious Diseases 2016; 45: 166-167.

Varghese George M, Janardhanan J, Mahajan Sanjay K, et al. Molecular epidemiology and genetic diversity of

Orientia tsutsugamushi from patients with Scrub typhus in 3 Regions of India. Emerging Infectious Diseases

; 21(1): 64-69.

Bora T, Khan SA, Lobsang J et al. Genetic diversity of Orientia tsutsugamushi strains circulating in Northeast

India. Transactions of The Royal Society of Tropical Medicine and Hygiene 2018; 112(1): 22-30.

Kumar A, Biswal M, Zaman K et al. Genetic diversity of Orientia tsutsugamushi strains from patients in north

India. International Journal of Infectious Diseases 2019; 84: 131-135.

Usha K, Kumar E, Kalawat U et al. Molecular characterization of Orientia tsutsugamushi serotypes

causing scrub typhus outbreak in southern region of Andhra Pradesh, India. Indian J Med Res 2016; 144:


Mahajan SK, Kashyap R, Kanga A et al. Relevance of Weil-Felix test in diagnosis of scrub typhus in India. J

Assoc Physicians India 2006; 54: 619-621.

Koh GCKW, Maude RJ, Paris DH, et al. Diagnosis of scrub typhus. Am J Trop Med Hyg 2010; 82(3): 368-670.

Sujatha SR, Tejashree A. Weil-Felix test: still a useful diagnostic test for scrub typhus? JMSCR 2019; 7(5):


Mehta DR. Studies on typhus in the Shimla Hills. Part VIII. Ectoparasites of rats and shrews with special

reference to their possible role in transmission of typhus. Indian J Med Res 1937; 25: 353-365.

Fernandes SJ, Kulkarni SM. Studies on the trombiculid mite fauna of India. Records of the Zoological Survey

of India 2003; 212: 1-539.

Tilak R, Kunwar R, Tyagi PK et al. Zoonotic surveillance for rickettsia in rodents and mapping of vectors of

rickettsial diseases in India: A multi-centric study. Indian J Public Health 2017; 61: 174-81.

Tilak R, Kunwar R, Wankhade UB et al. Emergence of Schoengastiella ligula as the vector of scrub typhus

outbreak in Darjeeling: Has Leptotrombidium deliense been replaced? Indian J Public Health 2011; 55: 92-99.

Kikuchi Y, Fukatsu T. Rickettsia infection in natural leech populations. Microb Ecol 2005; 49: 265-271.

Lo-Hsuan C, Wen-Jer W, Chi-Chien K et al. A checklist of chigger mites (Acari: Trombiculidae and

Leeuwenhökiidae) from Taiwan, with descriptions of three new species. Journal of Medical Entomology

; 52(6): 1241-1253.

Izzard L, Fuller A, Blacksell SD et al. Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient

infected in Dubai. J Clin Microbiol 2010; 48(12): 4404–9.

Maina AN, Farris CM, Odhiambo A et al. Q fever, scrub typhus, and rickettsial diseases in children, Kenya,

–2012. Emerg Infect Dis 2016; 22(5): 883-886.

Weitzel T, Dittrich S, López J, et al. Endemic scrub typhus in South America. N Engl J Med 2016; 375: 954-961.

Kocher C, Jiang J, Morrison AC et al. Serologic evidence of scrub typhus in the Peruvian Amazon. Emerg Infect

Dis 2017; 23: 1389-91.

Jiang J, Richards AL. Scrub typhus: no longer restricted to the Tsutsugamushi triangle. Trop Med Infect Dis

; 3(1): 11.