{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:08:36Z","timestamp":1793171316847,"version":"4.5.0"},"reference-count":78,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus, caused by\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , is a mite-borne infection endemic to Asia, the Pacific Islands, and northern Australia. This study reports the first detection of\n                    <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    DNA in postmortem specimens from stillbirths and neonatal deaths collected through the CHAMPS surveillance project from 2017 to 2024 in Bangladesh.\n                    <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    DNA was detected in 11 cases including 1.7% of stillbirths (\n                    <jats:italic>n<\/jats:italic>\n                    = 461) and 0.7% of neonates (\n                    <jats:italic>n<\/jats:italic>\n                    = 443). Ninety percent of these deaths occurred between August and January; among stillbirths, detection was highest in cerebrospinal fluid samples (87.5%). Most stillbirths were preterm (75%) with low birth weight (87.5%), and maternal history of fever was recalled in 83.3% of stillbirth cases. These findings suggest scrub typhus may contribute to perinatal mortality in Bangladesh\u2019s endemic regions. Scrub typhus is treatable with inexpensive antibiotics such as doxycycline; early recognition and treatment could potentially reduce stillbirths and neonatal deaths in endemic areas.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0389","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:00:18Z","timestamp":1771351218000},"page":"654-661","source":"Crossref","is-referenced-by-count":2,"title":["Orientia tsutsugamushi a Likely Contributor to Stillbirths and Neonatal Deaths in Bangladesh, 2017\u20132024"],"prefix":"10.4269","volume":"114","author":[{"given":"Muntasir","family":"Alam","sequence":"first","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpita Shyama","family":"Deb","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsana","family":"Afrin","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afruna","family":"Rahman","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazi Munisul","family":"Islam","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Ishrat","family":"Jahan","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Kumamoto University, Kumamoto, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajib","family":"Biswas","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shammi","family":"Akter","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Sabbir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atique Iqbal","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Zahid","family":"Hossain","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafizur","family":"Rahman","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shams El","family":"Arifeen","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Gurley","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"N Engl J Med","first-page":"1089","article-title":"Incidence of scrub typhus in rural South India","volume":"392","author":"Devamani","year":"2025"},{"key":"b2","series-title":"Acta Trop","first-page":"107631","article-title":"Respiratory manifestations of rickettsial disease in tropical Australia; Clinical course and implications for patient management","volume":"266","author":"Gavey","year":"2025"},{"key":"b3","series-title":"IJID Reg","first-page":"100571","article-title":"Epidemiological features of scrub typhus and molecular characteristics of Orientia tsutsugamushi in north-central Bangladesh","volume":"14","author":"Nila","year":"2025"},{"key":"b4","series-title":"Trop Med Infect Dis","first-page":"49","article-title":"Scrub typhus: Historic perspective and current status of the worldwide presence of Orientia species","volume":"5","author":"Richards","year":"2020"},{"key":"b5","series-title":"J Family Med Prim Care","first-page":"764","article-title":"Scrub typhus in pregnancy \u2013 A threat to maternal and fetal outcome","volume":"13","author":"Bahadur","year":"2024"},{"key":"b6","series-title":"J Family Med Prim Care","first-page":"2081","article-title":"Materno-fetal impact of scrub typhus in pregnancy: Clinical profiles, laboratory parameters and biomarkers","volume":"14","author":"Matlani","year":"2025"},{"key":"b7","series-title":"BMC Vet Res","first-page":"158","article-title":"Detection and molecular identification of scrub typhus vectors and pathogens from rice field rats, a traditional food item of Mizo tribes in Mizoram, Northeast India","volume":"21","author":"Ropuia","year":"2025"},{"key":"b8","series-title":"Indian J Public Health","first-page":"92","article-title":"Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: Has Leptotrombidium deliense been replaced?","volume":"55","author":"Tilak","year":"2011"},{"key":"b9","series-title":"BMJ Glob Health","first-page":"e018998","article-title":"Spatiotemporal epidemiology and clinical manifestations of two decades of scrub typhus in India: A systematic review and meta-analysis","volume":"10","author":"Chaturvedi","year":"2025"},{"key":"b10","series-title":"Trans R Soc Trop Med Hyg","first-page":"814","article-title":"Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A systematic review","volume":"118","author":"Sengupta","year":"2024"},{"key":"b11","series-title":"Int J Gynaecol Obstet","first-page":"212","article-title":"Scrub typhus continues to be a threat in pregnancy","volume":"127","author":"Sengupta","year":"2014"},{"key":"b12","series-title":"Trans R Soc Trop Med Hyg","first-page":"570","article-title":"Case reports: Scrub typhus during pregnancy in India","volume":"97","author":"Mathai","year":"2003"},{"key":"b13","series-title":"PLoS Negl Trop Dis","first-page":"e3327","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":"McGready","year":"2014"},{"key":"b14","series-title":"Cureus","first-page":"e62867","article-title":"Unravelling the enigma of scrub typhus: A critical review and insights into epidemiology, clinical features, diagnostic advances, and emerging trends","volume":"16","author":"Tarale","year":"2024"},{"key":"b15","series-title":"Am J Trop Med Hyg","first-page":"580","article-title":"Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh","volume":"91","author":"Maude","year":"2014"},{"key":"b16","series-title":"PLoS One","first-page":"e0273902","article-title":"Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic","volume":"17","author":"Das","year":"2022"},{"key":"b17","series-title":"Int J Infect Dis","first-page":"53","article-title":"Kinetics of IgM and IgG antibodies after scrub typhus infection and the clinical implications","volume":"71","author":"Varghese","year":"2018"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"267","article-title":"Estimating the seroincidence of scrub typhus using antibody dynamics after infection","volume":"111","author":"Aiemjoy","year":"2024"},{"key":"b19"},{"key":"b20","series-title":"Lancet Glob Health","first-page":"e909","article-title":"Initial findings from a novel population-based child mortality surveillance approach: A descriptive study","volume":"8","author":"Taylor","year":"2020"},{"key":"b21","article-title":"CHAMPS Methodology."},{"key":"b22","series-title":"Clin Infect Dis","first-page":"S311","article-title":"Development and implementation of multiplex TaqMan Array Cards for specimen testing at Child Health and Mortality Prevention Surveillance site laboratories","volume":"69","author":"Diaz","year":"2019"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi.","volume":"70","author":"Jiang","year":"2004"},{"key":"b24","series-title":"Clin Infect Dis","first-page":"S333","article-title":"Overview and development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) process and DeCoDe diagnosis standards","volume":"69","author":"Blau","year":"2019"},{"key":"b25","series-title":"J Family Med Prim Care","first-page":"2768","article-title":"Seroprevalence of scrub typhus among patients with acute febrile illness: A study from northern districts of West Bengal","volume":"14","author":"Hazra","year":"2025"},{"key":"b26","series-title":"Lancet Glob Health","first-page":"e104","article-title":"Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: A prospective study","volume":"3","author":"Dittrich","year":"2015"},{"key":"b27","series-title":"J Travel Med","first-page":"taad143","article-title":"Diagnostic challenges and antibody kinetics in a paediatric traveller with scrub typhus","volume":"30","author":"Looareesuwan","year":"2023"},{"key":"b28","series-title":"J Clin Diagn Res","first-page":"SD05","article-title":"Scrub typhus in a new born","volume":"11","author":"Jajoo","year":"2017"},{"key":"b29","series-title":"Pediatrics","first-page":"965","article-title":"Neonatal scrub typhus: A case report","volume":"89","author":"Wang","year":"1992"},{"key":"b30","series-title":"Front Pediatr","first-page":"1251746","article-title":"Congenital scrub typhus: A case report and literature review","volume":"11","author":"Liang","year":"2023"},{"key":"b31","series-title":"Emerg Microbes Infect","first-page":"2542242","article-title":"Vertical transmission of scrub typhus: A case report of congenital infection","volume":"14","author":"Luo","year":"2025"},{"key":"b32","series-title":"Am J Trop Med Hyg","first-page":"56","article-title":"A qualitative assessment of community acceptability and its determinants in the implementation of minimally invasive tissue sampling in children in Quelimane City, Mozambique","volume":"108","author":"Maga\u00e7o","year":"2023"},{"key":"b33","series-title":"Clin Infect Dis","first-page":"S401","article-title":"Cost evaluation of minimally invasive tissue sampling (MITS) implementation in low- and middle-income countries","volume":"73","author":"Morrison","year":"2021"},{"key":"b34","series-title":"PLoS One","first-page":"e0259621","article-title":"Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study","volume":"16","author":"Munguambe","year":"2021"},{"key":"b35","series-title":"Clin Infect Dis","first-page":"S262","article-title":"Mortality surveillance methods to identify and characterize deaths in Child Health and Mortality Prevention Surveillance network sites","volume":"69","author":"Salzberg","year":"2019"},{"key":"b36","series-title":"PLoS Negl Trop Dis","first-page":"e0012829","article-title":"Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China","volume":"19","author":"Zhao","year":"2025"},{"key":"b37","series-title":"Epidemiol Infect","first-page":"e102","article-title":"Risk factors for scrub typhus infection in South India: Population-based cohort study","volume":"153","author":"Schmidt","year":"2025"},{"key":"b38","series-title":"J Obstet Gynaecol India","first-page":"82","article-title":"Clinical profile of scrub typhus in pregnancy in sub-Himalayan region","volume":"66","author":"Kumar","year":"2016"},{"key":"b39","series-title":"Expert Opin Drug Saf","first-page":"367","article-title":"Revisiting doxycycline in pregnancy and early childhood \u2013 Time to rebuild its reputation?","volume":"15","author":"Cross","year":"2016"},{"key":"b1","series-title":"N Engl J Med","first-page":"1089","article-title":"Incidence of scrub typhus in rural South India","volume":"392","author":"Devamani","year":"2025"},{"key":"b2","series-title":"Acta Trop","first-page":"107631","article-title":"Respiratory manifestations of rickettsial disease in tropical Australia; Clinical course and implications for patient management","volume":"266","author":"Gavey","year":"2025"},{"key":"b3","series-title":"IJID Reg","first-page":"100571","article-title":"Epidemiological features of scrub typhus and molecular characteristics of Orientia tsutsugamushi in north-central Bangladesh","volume":"14","author":"Nila","year":"2025"},{"key":"b4","series-title":"Trop Med Infect Dis","first-page":"49","article-title":"Scrub typhus: Historic perspective and current status of the worldwide presence of Orientia species","volume":"5","author":"Richards","year":"2020"},{"key":"b5","series-title":"J Family Med Prim Care","first-page":"764","article-title":"Scrub typhus in pregnancy \u2013 A threat to maternal and fetal outcome","volume":"13","author":"Bahadur","year":"2024"},{"key":"b6","series-title":"J Family Med Prim Care","first-page":"2081","article-title":"Materno-fetal impact of scrub typhus in pregnancy: Clinical profiles, laboratory parameters and biomarkers","volume":"14","author":"Matlani","year":"2025"},{"key":"b7","series-title":"BMC Vet Res","first-page":"158","article-title":"Detection and molecular identification of scrub typhus vectors and pathogens from rice field rats, a traditional food item of Mizo tribes in Mizoram, Northeast India","volume":"21","author":"Ropuia","year":"2025"},{"key":"b8","series-title":"Indian J Public Health","first-page":"92","article-title":"Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: Has Leptotrombidium deliense been replaced?","volume":"55","author":"Tilak","year":"2011"},{"key":"b9","series-title":"BMJ Glob Health","first-page":"e018998","article-title":"Spatiotemporal epidemiology and clinical manifestations of two decades of scrub typhus in India: A systematic review and meta-analysis","volume":"10","author":"Chaturvedi","year":"2025"},{"key":"b10","series-title":"Trans R Soc Trop Med Hyg","first-page":"814","article-title":"Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A systematic review","volume":"118","author":"Sengupta","year":"2024"},{"key":"b11","series-title":"Int J Gynaecol Obstet","first-page":"212","article-title":"Scrub typhus continues to be a threat in pregnancy","volume":"127","author":"Sengupta","year":"2014"},{"key":"b12","series-title":"Trans R Soc Trop Med Hyg","first-page":"570","article-title":"Case reports: Scrub typhus during pregnancy in India","volume":"97","author":"Mathai","year":"2003"},{"key":"b13","series-title":"PLoS Negl Trop Dis","first-page":"e3327","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":"McGready","year":"2014"},{"key":"b14","series-title":"Cureus","first-page":"e62867","article-title":"Unravelling the enigma of scrub typhus: A critical review and insights into epidemiology, clinical features, diagnostic advances, and emerging trends","volume":"16","author":"Tarale","year":"2024"},{"key":"b15","series-title":"Am J Trop Med Hyg","first-page":"580","article-title":"Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh","volume":"91","author":"Maude","year":"2014"},{"key":"b16","series-title":"PLoS One","first-page":"e0273902","article-title":"Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic","volume":"17","author":"Das","year":"2022"},{"key":"b17","series-title":"Int J Infect Dis","first-page":"53","article-title":"Kinetics of IgM and IgG antibodies after scrub typhus infection and the clinical implications","volume":"71","author":"Varghese","year":"2018"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"267","article-title":"Estimating the seroincidence of scrub typhus using antibody dynamics after infection","volume":"111","author":"Aiemjoy","year":"2024"},{"key":"b19"},{"key":"b20","series-title":"Lancet Glob Health","first-page":"e909","article-title":"Initial findings from a novel population-based child mortality surveillance approach: A descriptive study","volume":"8","author":"Taylor","year":"2020"},{"key":"b21","article-title":"CHAMPS Methodology."},{"key":"b22","series-title":"Clin Infect Dis","first-page":"S311","article-title":"Development and implementation of multiplex TaqMan Array Cards for specimen testing at Child Health and Mortality Prevention Surveillance site laboratories","volume":"69","author":"Diaz","year":"2019"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi.","volume":"70","author":"Jiang","year":"2004"},{"key":"b24","series-title":"Clin Infect Dis","first-page":"S333","article-title":"Overview and development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) process and DeCoDe diagnosis standards","volume":"69","author":"Blau","year":"2019"},{"key":"b25","series-title":"J Family Med Prim Care","first-page":"2768","article-title":"Seroprevalence of scrub typhus among patients with acute febrile illness: A study from northern districts of West Bengal","volume":"14","author":"Hazra","year":"2025"},{"key":"b26","series-title":"Lancet Glob Health","first-page":"e104","article-title":"Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: A prospective study","volume":"3","author":"Dittrich","year":"2015"},{"key":"b27","series-title":"J Travel Med","first-page":"taad143","article-title":"Diagnostic challenges and antibody kinetics in a paediatric traveller with scrub typhus","volume":"30","author":"Looareesuwan","year":"2023"},{"key":"b28","series-title":"J Clin Diagn Res","first-page":"SD05","article-title":"Scrub typhus in a new born","volume":"11","author":"Jajoo","year":"2017"},{"key":"b29","series-title":"Pediatrics","first-page":"965","article-title":"Neonatal scrub typhus: A case report","volume":"89","author":"Wang","year":"1992"},{"key":"b30","series-title":"Front Pediatr","first-page":"1251746","article-title":"Congenital scrub typhus: A case report and literature review","volume":"11","author":"Liang","year":"2023"},{"key":"b31","series-title":"Emerg Microbes Infect","first-page":"2542242","article-title":"Vertical transmission of scrub typhus: A case report of congenital infection","volume":"14","author":"Luo","year":"2025"},{"key":"b32","series-title":"Am J Trop Med Hyg","first-page":"56","article-title":"A qualitative assessment of community acceptability and its determinants in the implementation of minimally invasive tissue sampling in children in Quelimane City, Mozambique","volume":"108","author":"Maga\u00e7o","year":"2023"},{"key":"b33","series-title":"Clin Infect Dis","first-page":"S401","article-title":"Cost evaluation of minimally invasive tissue sampling (MITS) implementation in low- and middle-income countries","volume":"73","author":"Morrison","year":"2021"},{"key":"b34","series-title":"PLoS One","first-page":"e0259621","article-title":"Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study","volume":"16","author":"Munguambe","year":"2021"},{"key":"b35","series-title":"Clin Infect Dis","first-page":"S262","article-title":"Mortality surveillance methods to identify and characterize deaths in Child Health and Mortality Prevention Surveillance network sites","volume":"69","author":"Salzberg","year":"2019"},{"key":"b36","series-title":"PLoS Negl Trop Dis","first-page":"e0012829","article-title":"Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China","volume":"19","author":"Zhao","year":"2025"},{"key":"b37","series-title":"Epidemiol 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