{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:57:08Z","timestamp":1787021828707,"version":"build-2736575974"},"reference-count":166,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["315982\/Z\/24\/Z"],"award-info":[{"award-number":["315982\/Z\/24\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rickettsial diseases, including scrub typhus and murine typhus, are major yet persistently under-recognised causes of acute febrile illness in Southeast Asia. Limited diagnostic capacity, ecological complexity, and non-specific clinical presentation have historically contributed to the underestimation of their burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We synthesised 25 years (2001\u20132025) of integrated epidemiological, clinical, diagnostic, molecular, ecological, and treatment research conducted across Southeast Asia. Evidence from prospective surveillance, hospital-based cohorts, seroepidemiology, molecular characterisation,\n                      <jats:italic>in vitro<\/jats:italic>\n                      isolation, genomic analyses, and randomised clinical trials was reviewed to identify convergent findings and policy-relevant lessons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Rickettsial infections account for 10%\u201325% of hospitalised acute febrile illness cases in many endemic settings and are important causes of central nervous system infection, severe disease, and adverse pregnancy outcomes. Diagnostic advances include calibrating IFA and ELISA cut-offs, evaluating rapid diagnostic tests and LAMP assays, developing highly sensitive real-time PCR platforms, and genomic analyses revealing extensive strain diversity. Whole-genome sequencing and multilocus typing demonstrate high recombination and weak geographic structuring of the core genome despite antigenic heterogeneity. Randomised trials confirm doxycycline as first-line therapy for scrub typhus, while azithromycin shows inferior efficacy for murine typhus. Integrated One Health investigations have clarified ecological drivers and vector-host dynamics, and community engagement initiatives have improved awareness in high-risk populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Sustained regional investment has transformed rickettsial research from fragmented studies into an integrated surveillance, diagnostic, and translational research framework. This experience provides a transferable model for addressing neglected vector-borne diseases and strengthening febrile illness management in endemic settings. Continued support for laboratory capacity, genomic surveillance, and clinical research is essential to maintain progress and improve regional health system resilience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014318","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:29:00Z","timestamp":1779816540000},"page":"e0014318","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6576-726X","authenticated-orcid":true,"given":"Stuart D.","family":"Blacksell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartika","family":"Saraswati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Perrone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Batty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jantana","family":"Wongsantichon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piengchan","family":"Sonthayanon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tri","family":"Wangrangsimakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul N.","family":"Newton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P. J.","family":"Day","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"8","key":"pntd.0014318.ref001","article-title":"Pathogenic Rickettsia, Anaplasma, and Ehrlichia in Rhipicephalus microplus ticks collected from cattle and laboratory hatched tick larvae","volume":"17","author":"J Xu","year":"2023","journal-title":"PLOS Negl Trop Dis"},{"issue":"3","key":"pntd.0014318.ref002","doi-asserted-by":"crossref","first-page":"451","DOI":"10.4269\/ajtmh.14-0191","article-title":"Rickettsial infections in Southeast Asia: implications for local populace and febrile returned travelers","volume":"91","author":"AK Aung","year":"2014","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0014318.ref003","doi-asserted-by":"crossref","first-page":"105282","DOI":"10.1016\/j.actatropica.2019.105282","article-title":"An overview of rickettsiae in Southeast Asia: vector-animal-human interface","volume":"202","author":"VL Low","year":"2020","journal-title":"Acta Trop"},{"issue":"1","key":"pntd.0014318.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012796","article-title":"Leptospirosis, melioidosis, and rickettsioses in the vicious circle of neglect","volume":"19","author":"T Tshokey","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014318.ref005","article-title":"Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi","author":"DJ Kelly","year":"2009","journal-title":"Clin Infect Dis"},{"issue":"3","key":"pntd.0014318.ref006","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2307\/3273264","article-title":"Tsutsugamushi disease in World War II","volume":"34","author":"CB Philip","year":"1948","journal-title":"J Parasitol"},{"key":"pntd.0014318.ref007","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/00005792-194605000-00003","article-title":"Scrub typhus in Assam and Burma; a clinical study of 616 cases","volume":"25","author":"JJ Sayen","year":"1946","journal-title":"Medicine (Baltimore)"},{"key":"pntd.0014318.ref008","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1172\/JCI102154","article-title":"Chloramphenicol (Chloromycetin) in the treatment of tsutsugamushi disease (Scrub typhus)","volume":"28","author":"JE Smadel","year":"1949","journal-title":"J Clin Invest"},{"issue":"11","key":"pntd.0014318.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000888","article-title":"Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border","volume":"4","author":"R McGready","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0014318.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006477","article-title":"Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand","volume":"12","author":"T Wangrangsimakul","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014318.ref011","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/jpids\/piz014","article-title":"Clinical characteristics and outcome of children hospitalized with scrub typhus in an area of endemicity","volume":"9","author":"T Wangrangsimakul","year":"2020","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"2","key":"pntd.0014318.ref012","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1089\/vbz.2008.0199","article-title":"First report of an Orientia tsutsugamushi type TA716-related scrub typhus infection in Thailand","volume":"10","author":"R McGready","year":"2010","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"3","key":"pntd.0014318.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0297373","article-title":"Serological detection of Rickettsia spp. and evaluation of blood parameters in pet dogs and cats from Bangkok and neighboring provinces","volume":"19","author":"C Fa-Ngoen","year":"2024","journal-title":"PLoS One"},{"issue":"4","key":"pntd.0014318.ref014","article-title":"Prevalence and molecular characterization of Rickettsia spp. from wild small mammals in public parks and urban areas of Bangkok Metropolitan, Thailand","volume":"6","author":"A Rungrojn","year":"2021","journal-title":"Trop Med Infect Dis"},{"issue":"3","key":"pntd.0014318.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010256","article-title":"Risk factors analysis for neglected human rickettsioses in rural communities in Nan province, Thailand: a community-based observational study along a landscape gradient","volume":"16","author":"K Chaisiri","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014318.ref016","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1186\/s12889-023-17313-z","article-title":"Prevalence of and factors associated with scrub typhus exposure among the hill tribe population living in high incidence areas in Thailand: a cross-sectional study","volume":"23","author":"N Tasak","year":"2023","journal-title":"BMC Public Health"},{"issue":"10","key":"pntd.0014318.ref017","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1089\/vbz.2024.0030","article-title":"Flea-borne rickettsioses and scrub typhus in patients with suspected arbovirus infection in Bangkok, Thailand","volume":"24","author":"P Rattanakomol","year":"2024","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"3","key":"pntd.0014318.ref018","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.diagmicrobio.2006.01.014","article-title":"Determination and geographic distribution of Orientia tsutsugamushi serotypes in Thailand by nested polymerase chain reaction","volume":"55","author":"J Manosroi","year":"2006","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"2","key":"pntd.0014318.ref019","doi-asserted-by":"crossref","first-page":"256","DOI":"10.3201\/eid1202.050900","article-title":"Rickettsial infections and fever, Vientiane, Laos","volume":"12","author":"S Phongmany","year":"2006","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"pntd.0014318.ref020","doi-asserted-by":"crossref","first-page":"898","DOI":"10.3201\/eid2505.180914","article-title":"Management of central nervous system infections, Vientiane, Laos, 2003-2011","volume":"25","author":"A Dubot-Peres","year":"2019","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"pntd.0014318.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(14)70289-X","article-title":"Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study","volume":"3","author":"S Dittrich","year":"2015","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pntd.0014318.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(13)70008-1","article-title":"Causes of non-malarial fever in Laos: a prospective study","volume":"1","author":"M Mayxay","year":"2013","journal-title":"Lancet Glob Health"},{"issue":"8","key":"pntd.0014318.ref023","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1111\/zph.12753","article-title":"Screening of ectoparasites from domesticated dogs for bacterial pathogens in Vientiane, Lao PDR","volume":"67","author":"HM Nguyen","year":"2020","journal-title":"Zoonoses Public Health"},{"issue":"8","key":"pntd.0014318.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009685","article-title":"A spatio-temporal analysis of scrub typhus and murine typhus in Laos; implications from changing landscapes and climate","volume":"15","author":"T Roberts","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"pntd.0014318.ref025","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1089\/vbz.2022.0029","article-title":"Orientia tsutsugamushi in chiggers and small mammals in Laos","volume":"22","author":"I Elliott","year":"2022","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"4","key":"pntd.0014318.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060634","article-title":"A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia","volume":"8","author":"K Chheng","year":"2013","journal-title":"PLoS One"},{"issue":"6","key":"pntd.0014318.ref027","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.3201\/eid3106.241752","article-title":"Clinical manifestations, risk factors, and disease burden of rickettsiosis, Cambodia, 2007-2020","volume":"31","author":"GC Kelly","year":"2025","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"pntd.0014318.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0095868","article-title":"Acute undifferentiated febrile illness in rural Cambodia: a 3-year prospective observational study","volume":"9","author":"TC Mueller","year":"2014","journal-title":"PLoS One"},{"issue":"9","key":"pntd.0014318.ref029","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1111\/tmi.70009","article-title":"Prevalence and risk factors for murine typhus, scrub typhus and spotted fever group rickettsioses among adolescent and adult patients presenting to Yangon General Hospital, Yangon, Myanmar","volume":"30","author":"TR Bowhay","year":"2025","journal-title":"Trop Med Int Health"},{"issue":"9","key":"pntd.0014318.ref030","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/tmi.70010","article-title":"Estimating scrub typhus and murine typhus incidence among adolescents and adults in Yangon, Myanmar","volume":"30","author":"WT Oo","year":"2025","journal-title":"Trop Med Int Health"},{"key":"pntd.0014318.ref031","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.ijid.2020.12.013","article-title":"Serological evidence indicates widespread distribution of rickettsioses in Myanmar","volume":"103","author":"PND Elders","year":"2021","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pntd.0014318.ref032","first-page":"29","article-title":"Spotted fever rickettsiosis in a wildlife researcher in Sabah, Malaysia: a case study","volume":"3","author":"M Salgado Lynn","year":"2018","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pntd.0014318.ref033","article-title":"Diagnosis of murine typhus by serology in peninsular Malaysia: a case report where rickettsial illnesses, leptospirosis and dengue co-circulate","volume":"4","author":"Y Yuhana","year":"2019","journal-title":"Trop Med Infect Dis"},{"issue":"5","key":"pntd.0014318.ref034","first-page":"77","article-title":"Rickettsial infections are neglected causes of acute febrile illness in Teluk Intan, Peninsular Malaysia","volume":"7","author":"MY Yuhana","year":"2022","journal-title":"Trop Med Infect Dis"},{"issue":"9","key":"pntd.0014318.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011412","article-title":"Geographical distribution of scrub typhus and risk of Orientia tsutsugamushi infection in Indonesia: evidence mapping","volume":"17","author":"K Saraswati","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014318.ref036","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1093\/trstmh\/traf017","article-title":"History of scrub typhus in Indonesia","volume":"119","author":"K Saraswati","year":"2025","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"2","key":"pntd.0014318.ref037","doi-asserted-by":"crossref","first-page":"267","DOI":"10.4269\/ajtmh.23-0475","article-title":"Estimating the seroincidence of scrub typhus using antibody dynamics after infection","volume":"111","author":"K Aiemjoy","year":"2024","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"pntd.0014318.ref038","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/trstmh\/trad094","article-title":"Scrub typhus in Indonesia: a cross-sectional analysis of archived fever studies samples","volume":"118","author":"K Saraswati","year":"2024","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"6","key":"pntd.0014318.ref039","article-title":"Systematic surveillance of rickettsial diseases in 27 hospitals from 26 provinces throughout Vietnam","volume":"7","author":"NV Trung","year":"2022","journal-title":"Trop Med Infect Dis"},{"issue":"10","key":"pntd.0014318.ref040","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.2460\/ajvr.1972.33.10.2091","article-title":"A serologic survey of military personnel and dogs in Thailand and South Vietnam for antibodies to Arboviruses, Rickettsia tsutsugamushi, and Pseudomonas pseudomallei","volume":"33","author":"WH Pryor","year":"1972","journal-title":"Am J Vet Res"},{"issue":"1","key":"pntd.0014318.ref041","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s40249-021-00893-6","article-title":"Ecological and behavioural risk factors of scrub typhus in central Vietnam: a case-control study","volume":"10","author":"HTD Tran","year":"2021","journal-title":"Infect Dis Poverty"},{"issue":"4","key":"pntd.0014318.ref042","doi-asserted-by":"crossref","first-page":"633","DOI":"10.3201\/eid2504.180691","article-title":"Clinical manifestations and molecular diagnosis of scrub typhus and murine typhus, Vietnam, 2015-2017","volume":"25","author":"NV Trung","year":"2019","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"pntd.0014318.ref043","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.4269\/ajtmh.16-0399","article-title":"Seroprevalence of scrub typhus, typhus, and spotted fever among rural and urban populations of northern Vietnam","volume":"96","author":"NV Trung","year":"2017","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"pntd.0014318.ref044","doi-asserted-by":"crossref","first-page":"972","DOI":"10.4269\/ajtmh.14-0806","article-title":"Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in northern Vietnam","volume":"92","author":"S Hamaguchi","year":"2015","journal-title":"Am J Trop Med Hyg"},{"issue":"11","key":"pntd.0014318.ref045","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1093\/trstmh\/tru145","article-title":"Scrub typhus in the northern provinces of Vietnam: an observational study of admissions to a national referral hospital","volume":"108","author":"B Nadjm","year":"2014","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"9","key":"pntd.0014318.ref046","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.3201\/eid1209.060071","article-title":"Murine typhus from Vietnam, imported into Japan","volume":"12","author":"M Azuma","year":"2006","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pntd.0014318.ref047","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/22221751.2019.1580539","article-title":"Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam","volume":"8","author":"N Le-Viet","year":"2019","journal-title":"Emerg Microbes Infect"},{"issue":"9","key":"pntd.0014318.ref048","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0044269","article-title":"Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review--terra incognita impairing treatment policies","volume":"7","author":"N Acestor","year":"2012","journal-title":"PLoS One"},{"issue":"1","key":"pntd.0014318.ref049","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1186\/s13071-019-3751-x","article-title":"Scrub typhus ecology: a systematic review of Orientia in vectors and hosts","volume":"12","author":"I Elliott","year":"2019","journal-title":"Parasit Vectors"},{"issue":"3","key":"pntd.0014318.ref050","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/S0035-9203(00)90322-5","article-title":"Antibodies to Orientia tsutsugamushi, Rickettsia typhi and spotted fever group rickettsiae among febrile patients in rural areas of Malaysia","volume":"94","author":"ST Tay","year":"2000","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"8","key":"pntd.0014318.ref051","article-title":"Antibody prevalence and factors associated with exposure to Orientia tsutsugamushi in different aboriginal subgroups in West Malaysia","volume":"7","author":"ST Tay","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0014318.ref052","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1086\/510585","article-title":"Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion","volume":"44","author":"SD Blacksell","year":"2007","journal-title":"Clin Infect Dis"},{"issue":"10","key":"pntd.0014318.ref053","article-title":"Diagnostic heterogeneity in scrub typhus serology: a scoping review of IFA thresholds and regional standardisation needs (2005-2024)","volume":"19","author":"KK Le","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0014318.ref054","first-page":"600","article-title":"Scrub typhus: chest radiographic and clinical findings in 130 Thai patients","volume":"89","author":"A Charoensak","year":"2006","journal-title":"J Med Assoc Thai"},{"key":"pntd.0014318.ref055","first-page":"11","article-title":"Clinical risk-scoring algorithm to forecast scrub typhus severity","volume":"7","author":"P Sriwongpan","year":"2013","journal-title":"Risk Manag Healthc Policy"},{"issue":"4","key":"pntd.0014318.ref056","doi-asserted-by":"crossref","first-page":"769","DOI":"10.4269\/ajtmh.16-0088","article-title":"Scrub typhus in northeastern Thailand: eschar distribution, abnormal electrocardiographic findings, and predictors of fatal outcome","volume":"95","author":"W Thipmontree","year":"2016","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pntd.0014318.ref057","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-022250","article-title":"Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand","volume":"8","author":"RC Greer","year":"2018","journal-title":"BMJ Open"},{"issue":"5","key":"pntd.0014318.ref058","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.4269\/ajtmh.20-1512","article-title":"Nationwide seroprevalence of scrub typhus, typhus, and spotted fever in young Thai men","volume":"106","author":"S Gonwong","year":"2022","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0014318.ref059","first-page":"29","article-title":"Surveillance for scrub typhus, rickettsial diseases, and leptospirosis in us and multinational military training exercise cobra gold sites in Thailand","author":"P Linsuwanon","year":"2018","journal-title":"US Army Med Dep J"},{"issue":"2","key":"pntd.0014318.ref060","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3201\/eid2102.140291","article-title":"Infectious causes of encephalitis and meningoencephalitis in Thailand, 2003-2005","volume":"21","author":"SJ Olsen","year":"2015","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"pntd.0014318.ref061","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008233","article-title":"The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)","volume":"14","author":"T Wangrangsimakul","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014318.ref062","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s10393-019-01409-3","article-title":"Distribution and ecological drivers of spotted fever group rickettsia in Asia","volume":"16","author":"J Satjanadumrong","year":"2019","journal-title":"Ecohealth"},{"issue":"1","key":"pntd.0014318.ref063","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s12879-020-05057-9","article-title":"Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results","volume":"20","author":"D Lokida","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"12","key":"pntd.0014318.ref064","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000909","article-title":"Contrasting spatial distribution and risk factors for past infection with scrub typhus and murine typhus in Vientiane City, Lao PDR","volume":"4","author":"J Vall\u00e9e","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0014318.ref065","doi-asserted-by":"crossref","first-page":"774","DOI":"10.3201\/eid1905.121445","article-title":"Scrub typhus outbreak, northern Thailand, 2006-2007","volume":"19","author":"W Rodkvamtook","year":"2013","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"pntd.0014318.ref066","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3201\/eid2402.171172","article-title":"Scrub typhus outbreak in Chonburi Province, Central Thailand, 2013","volume":"24","author":"W Rodkvamtook","year":"2018","journal-title":"Emerg Infect Dis"},{"issue":"6","key":"pntd.0014318.ref067","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1089\/vbz.2017.2180","article-title":"Molecular evidence of rickettsia in human and dog blood in Bangkok","volume":"18","author":"N Mongkol","year":"2018","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"2","key":"pntd.0014318.ref068","first-page":"18","article-title":"Rickettsiosis in southeast Asia: summary for international travellers during the COVID-19 pandemic","volume":"7","author":"T Ngamprasertchai","year":"2022","journal-title":"Trop Med Infect Dis"},{"key":"pntd.0014318.ref069","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2147\/RMHP.S52470","article-title":"Clinical indicators for severe prognosis of scrub typhus","volume":"6","author":"P Sriwongpan","year":"2013","journal-title":"Risk Manag Healthc Policy"},{"key":"pntd.0014318.ref070","article-title":"Orientia tsutsugamushi a likely contributor to stillbirths and neonatal deaths in Bangladesh, 2017-2024","author":"M Alam","year":"2026","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pntd.0014318.ref071","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012829","article-title":"Scrub typhus in pregnancy: a 10-year multicenter study in resource-limited settings in China","volume":"19","author":"P Zhao","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"pntd.0014318.ref072","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003327","article-title":"Pregnancy outcome in relation to treatment of murine typhus and scrub typhus infection: a fever cohort and a case series analysis","volume":"8","author":"R McGready","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"9","key":"pntd.0014318.ref073","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013552","article-title":"Scrub typhus in Nan province (Thailand): seventeen years of data to understand the impact of land cover change","volume":"19","author":"N Blache","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014318.ref074","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268819001390","article-title":"Diagnosis of spotted fever group Rickettsia infections: the Asian perspective","volume":"147","author":"MT Robinson","year":"2019","journal-title":"Epidemiol Infect"},{"issue":"5","key":"pntd.0014318.ref075","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1007\/s00284-011-9887-3","article-title":"Detection of Rickettsia and a novel Haemaphysalis shimoga symbiont bacterium in ticks in Thailand","volume":"62","author":"A Ahantarig","year":"2011","journal-title":"Curr Microbiol"},{"issue":"8","key":"pntd.0014318.ref076","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002163","article-title":"Concurrent infection with murine typhus and scrub typhus in southern Laos--the mixed and the unmixed","volume":"7","author":"K Phommasone","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0014318.ref077","doi-asserted-by":"crossref","first-page":"837","DOI":"10.4269\/ajtmh.2009.80.837","article-title":"Comparison of indirect immunofluorescence assays for diagnosis of scrub typhus and murine typhus using venous blood and finger prick filter paper blood spots","volume":"80","author":"R Phetsouvanh","year":"2009","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"pntd.0014318.ref078","doi-asserted-by":"crossref","first-page":"932","DOI":"10.4269\/ajtmh.12-0325","article-title":"Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus","volume":"88","author":"R Phetsouvanh","year":"2013","journal-title":"Am J Trop Med Hyg"},{"issue":"8","key":"pntd.0014318.ref079","doi-asserted-by":"crossref","DOI":"10.1093\/jtm\/taad143","article-title":"Diagnostic challenges and antibody kinetics in a paediatric traveller with scrub typhus","volume":"30","author":"P Looareesuwan","year":"2023","journal-title":"J Travel Med"},{"issue":"1","key":"pntd.0014318.ref080","first-page":"10","article-title":"A use of 56-kDa recombinant protein of Orientia tsutsugamushi karp serotype in serodiagnosis of scrub typhus by enzyme-linked immunosorbent assay in Thais","volume":"8","author":"P Chankate","year":"2022","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pntd.0014318.ref081","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1186\/s12879-017-2512-8","article-title":"An ELISA assay using a combination of recombinant proteins from multiple strains of Orientia tsutsugamushi offers an accurate diagnosis for scrub typhus","volume":"17","author":"C-C Chao","year":"2017","journal-title":"BMC Infect Dis"},{"key":"pntd.0014318.ref082","article-title":"Performance of SD Bioline Tsutsugamushi assays for the diagnosis of scrub typhus in Thailand","author":"S Silpasakorn","year":"2012","journal-title":"J Med Assoc Thai"},{"issue":"1","key":"pntd.0014318.ref083","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4269\/ajtmh.2012.11-0583","article-title":"Development of new, broadly reactive, rapid IgG and IgM lateral flow assays for diagnosis of scrub typhus","volume":"87","author":"S Silpasakorn","year":"2012","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"pntd.0014318.ref084","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006330","article-title":"Scrub typhus point-of-care testing: a systematic review and meta-analysis","volume":"12","author":"K Saraswati","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014318.ref085","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4269\/ajtmh.2010.09-0534","article-title":"Accuracy of rapid IgM-based immunochromatographic and immunoblot assays for diagnosis of acute scrub typhus and murine typhus infections in Laos","volume":"83","author":"SD Blacksell","year":"2010","journal-title":"Am J Trop Med Hyg"},{"issue":"2","key":"pntd.0014318.ref086","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1128\/CVI.00448-08","article-title":"Accuracy of AccessBio immunoglobulin M and total antibody rapid immunochromatographic assays for the diagnosis of acute scrub typhus infection","volume":"17","author":"SD Blacksell","year":"2010","journal-title":"Clin Vaccine Immunol"},{"issue":"3","key":"pntd.0014318.ref087","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1128\/CVI.05478-11","article-title":"Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection","volume":"19","author":"SD Blacksell","year":"2012","journal-title":"Clin Vaccine Immunol"},{"issue":"5","key":"pntd.0014318.ref088","doi-asserted-by":"crossref","first-page":"967","DOI":"10.4269\/ajtmh.14-0627","article-title":"Dot-ELISA rapid test using recombinant 56-kDa protein antigens for serodiagnosis of scrub typhus","volume":"92","author":"W Rodkvamtook","year":"2015","journal-title":"Am J Trop Med Hyg"},{"issue":"10","key":"pntd.0014318.ref089","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1128\/CVI.00390-15","article-title":"Comparative accuracy of the InBios scrub typhus detect IgM rapid test for the detection of IgM antibodies by using conventional serology","volume":"22","author":"HWF Kingston","year":"2015","journal-title":"Clin Vaccine Immunol"},{"issue":"2","key":"pntd.0014318.ref090","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1128\/CVI.00553-15","article-title":"Diagnostic accuracy of the InBios scrub typhus detect enzyme-linked immunoassay for the detection of IgM antibodies in Northern Thailand","volume":"23","author":"SD Blacksell","year":"2015","journal-title":"Clin Vaccine Immunol"},{"issue":"3","key":"pntd.0014318.ref091","first-page":"95","article-title":"Diagnostic accuracy of the InBios scrub typhus Detect\u2122 ELISA for the detection of IgM antibodies in Chittagong, Bangladesh","volume":"3","author":"SD Blacksell","year":"2018","journal-title":"Trop Med Infect Dis"},{"issue":"12","key":"pntd.0014318.ref092","article-title":"Diagnostic accuracy of an in-house Scrub Typhus enzyme linked immunoassay for the detection of IgM and IgG antibodies in Laos","volume":"14","author":"PND Elders","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014318.ref093","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1128\/JCM.02744-15","article-title":"Optimal cutoff and accuracy of an IgM enzyme-linked immunosorbent assay for diagnosis of acute scrub typhus in Northern Thailand: an alternative reference method to the IgM immunofluorescence assay","volume":"54","author":"SD Blacksell","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"5","key":"pntd.0014318.ref094","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.4269\/ajtmh.18-0675","article-title":"Determination of optimal diagnostic cut-offs for the naval medical research center scrub typhus IgM ELISA in Chiang Rai, Thailand","volume":"100","author":"M Phanichkrivalkosil","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"2","key":"pntd.0014318.ref095","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007158","article-title":"The validity of diagnostic cut-offs for commercial and in-house scrub typhus IgM and IgG ELISAs: a review of the evidence","volume":"13","author":"K Saraswati","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"pntd.0014318.ref096","doi-asserted-by":"crossref","first-page":"3663","DOI":"10.1128\/JCM.01680-15","article-title":"Optimal Cutoff Titers for Indirect Immunofluorescence Assay for Diagnosis of Scrub Typhus","volume":"53","author":"C Lim","year":"2015","journal-title":"J Clin Microbiol"},{"issue":"5","key":"pntd.0014318.ref097","article-title":"How to determine the accuracy of an alternative diagnostic test when it is actually better than the reference tests: a re-evaluation of diagnostic tests for scrub typhus using bayesian LCMs","volume":"10","author":"C Lim","year":"2015","journal-title":"PLoS One"},{"issue":"6","key":"pntd.0014318.ref098","doi-asserted-by":"crossref","DOI":"10.1016\/j.cmi.2019.10.022","article-title":"The temporal dynamics of humoral immunity to Rickettsia typhi infection in murine typhus patients","volume":"26","author":"K Phakhounthong","year":"2020","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"pntd.0014318.ref099","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4269\/ajtmh.19-0818","article-title":"Selection of diagnostic cutoffs for murine typhus IgM and IgG immunofluorescence assay: a systematic review","volume":"103","author":"S Dhawan","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"pntd.0014318.ref100","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.4269\/ajtmh.2006.75.1099","article-title":"Rapid diagnosis of scrub typhus in rural Thailand using polymerase chain reaction","volume":"75","author":"P Sonthayanon","year":"2006","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"pntd.0014318.ref101","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/j.1469-0691.2008.02671.x","article-title":"A highly sensitive quantitative real-time PCR assay based on the groEL gene of contemporary Thai strains of Orientia tsutsugamushi","volume":"15","author":"DH Paris","year":"2009","journal-title":"Clin Microbiol Infect"},{"issue":"2","key":"pntd.0014318.ref102","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.trstmh.2007.11.001","article-title":"Real-time multiplex PCR assay for detection and differentiation of rickettsiae and orientiae","volume":"102","author":"DH Paris","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"5","key":"pntd.0014318.ref103","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1128\/JCM.02181-16","article-title":"Use of multiplex real-time PCR to diagnose scrub typhus","volume":"55","author":"W Tantibhedhyangkul","year":"2017","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pntd.0014318.ref104","doi-asserted-by":"crossref","first-page":"351","DOI":"10.4269\/ajtmh.2004.70.351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi","volume":"70","author":"J Jiang","year":"2004","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pntd.0014318.ref105","doi-asserted-by":"crossref","first-page":"14299","DOI":"10.1038\/s41598-021-93541-w","article-title":"Clinical usefulness of 16S ribosomal RNA real-time PCR for the diagnosis of scrub typhus","volume":"11","author":"NR Yun","year":"2021","journal-title":"Sci Rep"},{"issue":"10","key":"pntd.0014318.ref106","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1086\/508464","article-title":"Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study","volume":"43","author":"D-M Kim","year":"2006","journal-title":"Clin Infect Dis"},{"key":"pntd.0014318.ref107","doi-asserted-by":"crossref","DOI":"10.3389\/fitd.2023.1146138","article-title":"Molecular diagnosis and genotyping of Orientia tsutsugamushi in Maesot and Chiangrai, Thailand","volume":"4","author":"A Rungrojn","year":"2023","journal-title":"Front Trop Dis"},{"issue":"9","key":"pntd.0014318.ref108","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001307","article-title":"Diagnostic accuracy of a loop-mediated isothermal PCR assay for detection of Orientia tsutsugamushi during acute Scrub Typhus infection","volume":"5","author":"DH Paris","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014318.ref109","doi-asserted-by":"crossref","first-page":"308","DOI":"10.4269\/ajtmh.12-0600","article-title":"A prospective evaluation of real-time PCR assays for the detection of Orientia tsutsugamushi and Rickettsia spp. for early diagnosis of rickettsial infections during the acute phase of undifferentiated febrile illness","volume":"89","author":"W Watthanaworawit","year":"2013","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pntd.0014318.ref110","doi-asserted-by":"crossref","first-page":"614","DOI":"10.4269\/ajtmh.2011.10-0473","article-title":"Accuracy of loop-mediated isothermal amplification for diagnosis of human leptospirosis in Thailand","volume":"84","author":"P Sonthayanon","year":"2011","journal-title":"Am J Trop Med Hyg"},{"issue":"8","key":"pntd.0014318.ref111","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003064","article-title":"Dissemination of Orientia tsutsugamushi and inflammatory responses in a murine model of scrub typhus","volume":"8","author":"CA Keller","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0014318.ref112","first-page":"113","article-title":"Assessment of a sensitive qPCR assay targeting a multiple-copy gene to detect Orientia tsutsugamushi DNA","volume":"4","author":"C-C Chao","year":"2019","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pntd.0014318.ref113","article-title":"A CRISPR-Cas12a-based universal rapid scrub typhus diagnostic method targeting 16S rRNA of Orientia tsutsugamushi","volume":"19","author":"BJ Park","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pntd.0014318.ref114","article-title":"Development of recombinase polymerase amplification assays for detection of Orientia tsutsugamushi or Rickettsia typhi","volume":"9","author":"C-C Chao","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0014318.ref115","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.3390\/bios13121021","article-title":"CRISPR\/Cas12a-based detection platform for early and rapid diagnosis of scrub typhus","volume":"13","author":"P Bhardwaj","year":"2023","journal-title":"Biosensors (Basel)"},{"issue":"4","key":"pntd.0014318.ref116","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.ijantimicag.2009.11.019","article-title":"Intrinsic fluoroquinolone resistance in Orientia tsutsugamushi","volume":"35","author":"W Tantibhedhyangkul","year":"2010","journal-title":"Int J Antimicrob Agents"},{"issue":"1","key":"pntd.0014318.ref117","first-page":"91","article-title":"Patient and sample-related factors that effect the success of in vitro isolation of Orientia tsutsugamushi","volume":"38","author":"R Luksameetanasan","year":"2007","journal-title":"Southeast Asian J Trop Med Public Health"},{"issue":"6","key":"pntd.0014318.ref118","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.4269\/ajtmh.2010.10-0332","article-title":"Diagnostic and treatment difficulties of pyelonephritis in pregnancy in resource-limited settings","volume":"83","author":"R McGready","year":"2010","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pntd.0014318.ref119","article-title":"The isolation of Orientia tsutsugamushi and Rickettsia typhi from human blood through mammalian cell culture: a descriptive series of 3,227 samples and outcomes in the Lao People\u2019s Democratic Republic","volume":"58","author":"DK Ming","year":"2020","journal-title":"J Clin Microbiol"},{"issue":"8","key":"pntd.0014318.ref120","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004009","article-title":"Improved quantification, propagation, purification and storage of the obligate intracellular human pathogen Orientia tsutsugamushi","volume":"9","author":"S Giengkam","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014318.ref121","doi-asserted-by":"crossref","first-page":"599","DOI":"10.4269\/ajtmh.2011.09-0768","article-title":"Isolation and characterization of Orientia tsutsugamushi from rodents captured following a scrub typhus outbreak at a military training base, Bothong district, Chonburi province, central Thailand","volume":"84","author":"W Rodkvamtook","year":"2011","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"pntd.0014318.ref122","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1574-695X.2007.00375.x","article-title":"Genetic typing of the 56-kDa type-specific antigen gene of contemporary Orientia tsutsugamushi isolates causing human scrub typhus at two sites in north-eastern and western Thailand","volume":"52","author":"SD Blacksell","year":"2008","journal-title":"FEMS Immunol Med Microbiol"},{"issue":"9","key":"pntd.0014318.ref123","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.3201\/eid1409.071259","article-title":"Genotyping of Orientia tsutsugamushi from humans with scrub typhus, Laos","volume":"14","author":"P Parola","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"3","key":"pntd.0014318.ref124","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/trstmh\/trx022","article-title":"The genotypes of Orientia tsutsugamushi, identified in scrub typhus patients in northern Vietnam","volume":"111","author":"HLK Nguyen","year":"2017","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"6","key":"pntd.0014318.ref125","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1089\/vbz.2012.1112","article-title":"Diversity of the 47-kD HtrA nucleic acid and translated amino acid sequences from 17 recent human isolates of Orientia","volume":"13","author":"J Jiang","year":"2013","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"7","key":"pntd.0014318.ref126","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006632","article-title":"Heterogeneity of Orientia tsutsugamushi genotypes in field-collected trombiculid mites from wild-caught small mammals in Thailand","volume":"12","author":"R Takhampunya","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pntd.0014318.ref127","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000752","article-title":"High rates of homologous recombination in the mite endosymbiont and opportunistic human pathogen Orientia tsutsugamushi","volume":"4","author":"P Sonthayanon","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pntd.0014318.ref128","doi-asserted-by":"crossref","first-page":"2584","DOI":"10.1128\/JCM.00355-11","article-title":"Genotype diversity and distribution of Orientia tsutsugamushi causing scrub typhus in Thailand","volume":"49","author":"T Ruang-Areerate","year":"2011","journal-title":"J Clin Microbiol"},{"issue":"5","key":"pntd.0014318.ref129","doi-asserted-by":"crossref","first-page":"512","DOI":"10.3390\/pathogens11050512","article-title":"A murine model of waning scrub typhus cross-protection between heterologous strains of Orientia tsutsugamushi","volume":"11","author":"NL Mendell","year":"2022","journal-title":"Pathogens"},{"issue":"10","key":"pntd.0014318.ref130","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1056\/NEJMp1608499","article-title":"Scrub typhus \u2013 scientific neglect, ever-widening impact","volume":"375","author":"DH Walker","year":"2016","journal-title":"N Engl J Med"},{"issue":"1","key":"pntd.0014318.ref131","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41541-023-00605-1","article-title":"A scrub typhus vaccine presents a challenging unmet need","volume":"8","author":"DH Walker","year":"2023","journal-title":"NPJ Vaccines"},{"key":"pntd.0014318.ref132","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.meegid.2015.01.005","article-title":"Orientia tsutsugamushi, agent of scrub typhus, displays a single metapopulation with maintenance of ancestral haplotypes throughout continental South East Asia","volume":"31","author":"P Wongprompitak","year":"2015","journal-title":"Infect Genet Evol"},{"issue":"8","key":"pntd.0014318.ref133","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004024","article-title":"The diversity and geographical structure of orientia tsutsugamushi strains from scrub typhus patients in Laos","volume":"9","author":"R Phetsouvanh","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014318.ref134","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006566","article-title":"Long-read whole genome sequencing and comparative analysis of six strains of the human pathogen Orientia tsutsugamushi","volume":"12","author":"EM Batty","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014318.ref135","doi-asserted-by":"crossref","first-page":"1387208","DOI":"10.3389\/fmicb.2024.1387208","article-title":"A proof of concept for a targeted enrichment approach to the simultaneous detection and characterization of rickettsial pathogens from clinical specimens","volume":"15","author":"AC Paskey","year":"2024","journal-title":"Front Microbiol"},{"issue":"12","key":"pntd.0014318.ref136","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013828","article-title":"Complete genomes of Rickettsia typhi reveal a clonal population","volume":"19","author":"C Keeratipusana","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014318.ref137","doi-asserted-by":"crossref","first-page":"408","DOI":"10.4269\/ajtmh.19-0383","article-title":"Oxford nanopore MinION sequencing enables rapid whole genome assembly of Rickettsia typhi in a resource-limited setting","volume":"102","author":"I Elliott","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"pntd.0014318.ref138","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004723","article-title":"Antigenic relationships among human pathogenic Orientia tsutsugamushi isolates from Thailand","volume":"10","author":"SL James","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014318.ref139","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/j.1365-2249.2008.03673.x","article-title":"Differential patterns of endothelial and leucocyte activation in \u201ctyphus-like\u201d illnesses in Laos and Thailand","volume":"153","author":"DH Paris","year":"2008","journal-title":"Clin Exp Immunol"},{"issue":"12","key":"pntd.0014318.ref140","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1111\/j.1469-0691.2011.03717.x","article-title":"Coagulation and inflammation in scrub typhus and murine typhus--a prospective comparative study from Laos","volume":"18","author":"DH Paris","year":"2012","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"pntd.0014318.ref141","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0054570","article-title":"An intradermal inoculation model of scrub typhus in Swiss CD-1 mice demonstrates more rapid dissemination of virulent strains of Orientia tsutsugamushi","volume":"8","author":"P Sunyakumthorn","year":"2013","journal-title":"PLoS One"},{"issue":"9","key":"pntd.0014318.ref142","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005846","article-title":"Strong interferon-gamma mediated cellular immunity to scrub typhus demonstrated using a novel whole cell antigen ELISpot assay in rhesus macaques and humans","volume":"11","author":"M Sumonwiriya","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0014318.ref143","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006305","article-title":"Characterization of the rhesus macaque (Macaca mulatta) scrub typhus model: susceptibility to intradermal challenge with the human pathogen Orientia tsutsugamushi Karp","volume":"12","author":"P Sunyakumthorn","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014318.ref144","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.4049\/jimmunol.1402244","article-title":"A nonhuman primate scrub typhus model: protective immune responses induced by pKarp47 DNA vaccination in cynomolgus macaques","volume":"194","author":"DH Paris","year":"2015","journal-title":"J Immunol"},{"issue":"8","key":"pntd.0014318.ref145","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010611","article-title":"A time-course comparative clinical and immune response evaluation study between the human pathogenic Orientia tsutsugamushi strains: Karp and Gilliam in a rhesus macaque (Macaca mulatta) model","volume":"16","author":"M Inthawong","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014318.ref146","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001466","article-title":"Orientia tsutsugamushi in human scrub typhus eschars shows tropism for dendritic cells and monocytes rather than endothelium","volume":"6","author":"DH Paris","year":"2012","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014318.ref147","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1017\/S0031182099005909","article-title":"Transmission of Orientia tsutsugamushi, the aetiological agent for scrub typhus, to co-feeding mites","author":"SP Frances","year":"2000","journal-title":"Parasitology"},{"issue":"3","key":"pntd.0014318.ref148","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0193163","article-title":"Autofluorescence microscopy for paired-matched morphological and molecular identification of individual chigger mites (Acari: Trombiculidae), the vectors of scrub typhus","volume":"13","author":"R Kumlert","year":"2018","journal-title":"PLoS One"},{"issue":"4","key":"pntd.0014318.ref149","first-page":"53","article-title":"Infection of rodents by Orientia tsutsugamushi, the agent of scrub typhus in relation to land use in Thailand","volume":"2","author":"K Chaisiri","year":"2017","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pntd.0014318.ref150","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1186\/s13071-021-05042-4","article-title":"Orientia tsutsugamushi dynamics in vectors and hosts: ecology and risk factors for foci of scrub typhus transmission in northern Thailand","volume":"14","author":"I Elliott","year":"2021","journal-title":"Parasit Vectors"},{"key":"pntd.0014318.ref151","doi-asserted-by":"crossref","first-page":"102086","DOI":"10.1016\/j.tmaid.2021.102086","article-title":"Assessing scrub typhus and rickettsioses transmission risks in the Chiang Rai province of northern Thailand","volume":"42","author":"P Linsuwanon","year":"2021","journal-title":"Travel Med Infect Dis"},{"issue":"9","key":"pntd.0014318.ref152","doi-asserted-by":"crossref","first-page":"3259","DOI":"10.1128\/AAC.00508-07","article-title":"Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus","volume":"51","author":"K Phimda","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"issue":"5","key":"pntd.0014318.ref153","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/cid\/ciy563","article-title":"A prospective, open-label, randomized trial of doxycycline versus azithromycin for the treatment of uncomplicated murine typhus","volume":"68","author":"PN Newton","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"9","key":"pntd.0014318.ref154","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1056\/NEJMoa2208449","article-title":"Intravenous doxycycline, azithromycin, or both for severe scrub typhus","volume":"388","author":"GM Varghese","year":"2023","journal-title":"N Engl J Med"},{"issue":"9020","key":"pntd.0014318.ref155","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/S0140-6736(96)02501-9","article-title":"Scrub typhus infections poorly responsive to antibiotics in northern Thailand","volume":"348","author":"G Watt","year":"1996","journal-title":"Lancet"},{"issue":"9235","key":"pntd.0014318.ref156","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S0140-6736(00)02728-8","article-title":"Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial","volume":"356","author":"G Watt","year":"2000","journal-title":"Lancet"},{"issue":"1","key":"pntd.0014318.ref157","first-page":"74","article-title":"Novel high-throughput screening method using quantitative PCR to determine the antimicrobial susceptibility of Orientia tsutsugamushi clinical isolates","volume":"74","author":"W Phuklia","year":"2019","journal-title":"J Antimicrob Chemother"},{"issue":"11","key":"pntd.0014318.ref158","doi-asserted-by":"crossref","first-page":"2444","DOI":"10.1093\/cid\/ciz972","article-title":"Scrub typhus and the misconception of doxycycline resistance","volume":"70","author":"T Wangrangsimakul","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pntd.0014318.ref159","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/ccr3.572","article-title":"Scrub typhus infection in pregnancy: the dilemma of diagnosis and treatment in a resource-limited setting","volume":"4","author":"W Watthanaworawit","year":"2016","journal-title":"Clin Case Rep"},{"issue":"3","key":"pntd.0014318.ref160","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1517\/14740338.2016.1133584","article-title":"Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation?","volume":"15","author":"R Cross","year":"2016","journal-title":"Expert Opin Drug Saf"},{"issue":"10","key":"pntd.0014318.ref161","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1093\/trstmh\/trae028","article-title":"Community engagement around scrub typhus in northern Thailand: a pilot project","volume":"118","author":"C Perrone","year":"2024","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0014318.ref162","doi-asserted-by":"crossref","first-page":"5737893","DOI":"10.1155\/2020\/5737893","article-title":"A bibliometric analysis of global scientific research on scrub typhus","volume":"2020","author":"TH Musa","year":"2020","journal-title":"Biomed Res Int"},{"key":"pntd.0014318.ref163","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/20477724.2025.2475278","article-title":"Temporal trends in diagnostic evolutions for rickettsial diseases including scrub typhus: a bibliometric study","volume":"119","author":"R Dixit","year":"2025","journal-title":"Pathog Glob Health"},{"issue":"8","key":"pntd.0014318.ref164","first-page":"204","article-title":"Beyond the fever: a serial report on moderate to severe murine typhus cases and diagnostic hurdles in Indonesia","volume":"10","author":"V Herwanto","year":"2025","journal-title":"Trop Med Infect Dis"},{"issue":"7","key":"pntd.0014318.ref165","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0283135","article-title":"Murine typhus is a common cause of acute febrile illness in Bandung, Indonesia","volume":"18","author":"SF Riswari","year":"2023","journal-title":"PLoS One"},{"issue":"12","key":"pntd.0014318.ref166","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.trstmh.2008.04.040","article-title":"Simple, rapid and sensitive detection of Orientia tsutsugamushi by loop-isothermal DNA amplification","volume":"102","author":"DH Paris","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:29:20Z","timestamp":1779816560000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014318"}},"subtitle":[],"editor":[{"given":"Bin","family":"Gong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":166,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014318","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}