{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:20:46Z","timestamp":1788355246173,"version":"build-2803163510"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus (ST), caused by\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , is an underdiagnosed cause of acute febrile illness in Southeast Asia. Acute febrile illness surveillance data from febrile patients presenting to health facilities in two Thailand border provinces (Tak [north] and Nakhon Phanom [northeast]) were analyzed to estimate ST prevalence and describe clinical and epidemiological characteristics and risk factors. Scrub typhus cases were classified as confirmed (polymerase chain reaction-positive), probable (acute-to-convalescent rise in ELISA IgM\/IgG plus \u22652 clinical features), or suspect (positive acute and convalescent sera results for anti-IgM\/IgG or for patients with only one sera sample, positive acute or convalescent sera results for anti-IgM\/IgG and \u22652 of these clinical features). All others were considered non-cases. The 75 ST cases were classified as confirmed (39) or probable (36). Scrub typhus prevalence was higher in Tak (6.9%; 95% CI: 4.8\u20139.4) than in Nakhon Phanom (1.3%, 95% CI: 0.6\u20132.3). Common symptoms included headache, fatigue, myalgia, and chills. Discharge diagnosis matched ST case designation 15% of the time. Approximately one-quarter (\n                    <jats:italic>n<\/jats:italic>\n                    = 18) of patients were coinfected with another bacterium (15, 20%) or virus (3, 4%). Appropriate antibiotics were administered to 56% (\n                    <jats:italic>n<\/jats:italic>\n                    = 9) of the 21% (\n                    <jats:italic>n<\/jats:italic>\n                    = 16) of patients who received antibiotics before study specimen collections. Participants in Tak were 4.2 (95% CI: 2.2\u20138.2) or 4.5 (95% CI: 2.4\u20138.5) times as likely to test positive for ST if they visited the forest or contacted farm animals, respectively, within the past 30 days. Findings confirm the persistent burden of ST along Thailand\u2019s borders. Targeted actions are needed to strengthen clinical management, access to diagnostics, and community-based prevention.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0551","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:11:24Z","timestamp":1784045484000},"page":"453-463","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Laboratory Features of Scrub Typhus among Adult Patients with Acute Febrile Illness in Tak and Nakhon Phanom Provinces, Thailand, 2017\u20132020"],"prefix":"10.4269","volume":"115","author":[{"given":"Adelaide F.","family":"Green","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"},{"name":"Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betsy","family":"Cadwell","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Bloss","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuttagarn","family":"Chuenchom","sequence":"additional","affiliation":[{"name":"Mae Sot Hospital, Tak, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supphachoke","family":"Khemla","sequence":"additional","affiliation":[{"name":"Nakhon Phanom Hospital, Nakhon Phanom, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumonmal","family":"Uttayamakul","sequence":"additional","affiliation":[{"name":"Department of Disease Control, Ministry of Public Health, Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pongpun","family":"Sawatwong","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornuma","family":"Sangwichian","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duangkamon","family":"Siludjai","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phanthaneeya","family":"Teepruksa","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Skaggs","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Y.","family":"Kato","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"MacArthur","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Heffelfinger","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Salyer","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saithip","family":"Bhengsri","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Thailand Ministry of Public Health-United States of America Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"6","key":"b1","series-title":"PLoS One","first-page":"e0127962","article-title":"Etiology of severe febrile illness in low- and middle-income countries: A systematic review","volume":"10","author":"Prasad","year":"2015"},{"issue":"8","key":"b2","series-title":"Clin Microbiol Infect","first-page":"815","article-title":"Febrile illness in Asia: Gaps in epidemiology, diagnosis and management for informing health policy","volume":"24","author":"Shrestha","year":"2018"},{"key":"b3","series-title":"Comp Immunol Microbiol Infect Dis","first-page":"101888","article-title":"Revisiting scrub typhus: A neglected tropical disease","volume":"90\u201391","author":"Bhandari","year":"2022"},{"issue":"9","key":"b4","series-title":"PLoS Negl Trop Dis","first-page":"e0005838","article-title":"Estimating the burden of scrub typhus: A systematic review","volume":"11","author":"Bonell","year":"2017"},{"issue":"8","key":"b5","series-title":"J Clin Microbiol","first-page":"e01728-17","article-title":"A concise review of the epidemiology and diagnostics of rickettsioses: Rickettsia and Orientia spp","volume":"56","author":"Abdad","year":"2018"},{"key":"b6","series-title":"Acta Trop","first-page":"105282","article-title":"An overview of rickettsiae in Southeast Asia: Vector-animal-human interface","volume":"202","author":"Low","year":"2020"},{"issue":"1","key":"b7","series-title":"Trop Med Infect Dis","first-page":"8","article-title":"A review of scrub typhus (Orientia tsutsugamushi and related organisms): Then, now, and tomorrow","volume":"3","author":"Luce-Fedrow","year":"2018"},{"issue":"6","key":"b8","series-title":"Am J Trop Med Hyg","first-page":"2472","article-title":"The characteristics and clinical course of patients with scrub typhus and Queensland tick typhus infection requiring intensive care unit admission: A 23-year case series from Queensland, Tropical Australia","volume":"103","author":"Bagshaw","year":"2020"},{"issue":"5","key":"b9","series-title":"PLoS Negl Trop Dis","first-page":"e0010281","article-title":"Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam","volume":"16","author":"Tran","year":"2022"},{"issue":"5","key":"b10","series-title":"Am J Trop Med Hyg","first-page":"1358","article-title":"Prevalence rate and distribution of eschar in patients with scrub typhus","volume":"106","author":"Yoo","year":"2022"},{"issue":"1","key":"b11","series-title":"PLoS Negl Trop Dis","first-page":"e2605","article-title":"Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India","volume":"8","author":"Kumar","year":"2014"},{"issue":"8","key":"b12","series-title":"Indian J Crit Care Med","first-page":"497","article-title":"Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission","volume":"18","author":"Griffith","year":"2014"},{"issue":"2","key":"b13","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"},{"issue":"4","key":"b14","series-title":"Trop Med Infect Dis","first-page":"63","article-title":"The historical case for and the future study of antibiotic-resistant scrub typhus","volume":"2","author":"Kelly","year":"2017"},{"issue":"7","key":"b15","series-title":"Emerg Infect Dis","first-page":"1409","article-title":"Rickettsioses as major etiologies of unrecognized acute febrile illness, Sabah, East Malaysia","volume":"26","author":"Grigg","year":"2020"},{"issue":"1","key":"b16","series-title":"BMC Infect Dis","first-page":"364","article-title":"Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: Observational study results","volume":"20","author":"Lokida","year":"2020"},{"issue":"8","key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0003971","article-title":"A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi)","volume":"9","author":"Taylor","year":"2015"},{"key":"b18","series-title":"BMJ","first-page":"k4766","article-title":"Assessment and initial management of acute undifferentiated fever in tropical and subtropical regions","volume":"363","author":"Bhargava","year":"2018"},{"issue":"3","key":"b19","series-title":"PLoS Negl Trop Dis","first-page":"e0010256","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":"Chaisiri","year":"2022"},{"issue":"3","key":"b20","series-title":"Am J Trop Med 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and clinical factors associated with bacterial or nonbacterial etiologies of acute undifferentiated febrile illness: Findings from a 3-year observational study in Thailand, 2017\u20132020","volume":"111","author":"Wodniak","year":"2024"},{"key":"b25","series-title":"Ann Med Surg (Lond)","first-page":"104903","article-title":"Clinical profile and biochemical abnormalities in Scrub Typhus: A cross-sectional study","volume":"84","author":"Shrestha","year":"2022"},{"key":"b26","series-title":"Indian J Med Res","first-page":"1020","article-title":"Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa","volume":"136","author":"Narvencar","year":"2012"},{"issue":"6","key":"b27","series-title":"QJM","first-page":"404","article-title":"Scrub typhus in patients with acute febrile illness: A 5-year study from India","volume":"113","author":"Thakur","year":"2020"},{"issue":"175","key":"b28","series-title":"Vital Health Stat","first-page":"1","article-title":"National Center for Health Statistics Data presentation standards for proportions","volume":"2","author":"Parker","year":"2017"},{"key":"b29","series-title":"Annual Epidemiologic Surveillance Report 2019. Scrub Typhus","year":"2019"},{"issue":"11","key":"b30","series-title":"PLoS Negl Trop Dis","first-page":"e888","article-title":"Arthropod borne disease: The leading cause of fever in pregnancy on the Thai-Burmese border","volume":"4","author":"McGready","year":"2010"},{"issue":"4","key":"b31","series-title":"Ann Trop Med Parasitol","first-page":"363","article-title":"Causes of acute, undifferentiated, febrile illness in rural Thailand: Results of a prospective observational study","volume":"100","author":"Suttinont","year":"2006"},{"issue":"4","key":"b32","series-title":"PLoS Negl Trop Dis","first-page":"e0008233","article-title":"The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)","volume":"14","author":"Wangrangsimakul","year":"2020"},{"key":"b33","series-title":"Travel Med Infect Dis","first-page":"102086","article-title":"Assessing scrub typhus and rickettsioses transmission risks in the Chiang Rai province of northern Thailand","volume":"42","author":"Linsuwanon","year":"2021"},{"key":"b34","article-title":"Data Preparation Project Forest Area Conditions Year 2020 \u2013 Complete Report 2563.","year":"2020"},{"issue":"1","key":"b35","series-title":"BMC Public Health","first-page":"2394","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":"Tasak","year":"2023"},{"issue":"1","key":"b36","series-title":"Infect Dis Poverty","first-page":"110","article-title":"Ecological and behavioural risk factors of scrub typhus in central Vietnam: A case-control study","volume":"10","author":"Tran","year":"2021"},{"issue":"5","key":"b37","series-title":"Am J Trop Med Hyg","first-page":"1363","article-title":"Nationwide seroprevalence of scrub typhus, typhus, and spotted fever in young Thai men","volume":"106","author":"Gonwong","year":"2022"},{"issue":"6","key":"b38","series-title":"Trop Med Infect Dis","first-page":"151","article-title":"The association between environmental factors and scrub typhus: A review","volume":"10","author":"Yang","year":"2025"},{"issue":"5","key":"b39","series-title":"J Med Assoc Thai","first-page":"464","article-title":"Etiologies of acute undifferentiated febrile illness in Thailand","volume":"87","author":"Leelarasamee","year":"2004"},{"issue":"4","key":"b40","series-title":"Am J Trop Med Hyg","first-page":"797","article-title":"Molecular confirmation of co-infection by pathogenic Leptospira spp. and Orientia tsutsugamushi in patients with acute febrile illness in Thailand","volume":"89","author":"Sonthayanon","year":"2013"},{"issue":"1","key":"b41","series-title":"Am J Trop Med Hyg","first-page":"43","article-title":"Sennetsu neorickettsiosis, spotted fever group, and typhus group rickettsioses in three provinces in Thailand","volume":"95","author":"Bhengsri","year":"2016"},{"issue":"3","key":"b42","series-title":"PLoS Negl Trop Dis","first-page":"e0006330","article-title":"Scrub typhus point-of-care testing: A systematic review and meta-analysis","volume":"12","author":"Saraswati","year":"2018"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/3\/article-p453.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/3\/article-p453.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/3\/article-p453.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:54:28Z","timestamp":1788353668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/3\/article-p453.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":42,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0551","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}