{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:47:13Z","timestamp":1785937633527,"version":"3.56.0"},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus, caused by\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , is a major cause of acute febrile illness in Asia and is associated with significant morbidity and mortality. A prospective observational study (July 2021 to October 2022) was conducted at a tertiary referral center in Northern India to determine the incidence of ocular manifestations and their association with in-hospital mortality. Patients aged \u226512 years with laboratory-confirmed scrub typhus were enrolled. Ocular examinations were performed within 24 hours of admission by a trained emergency physician and independently validated by an ophthalmologist. Clinical, laboratory, and outcome data were collected, and patients with ocular findings were re-examined at 3 months. Multivariable logistic regression was used to assess factors associated with in-hospital mortality. Of 250 screened patients with acute febrile illness, 89 met the inclusion criteria for scrub typhus. The mean age was 35 years, and 54% were female. Ocular manifestations were identified in 24 patients (27%), most commonly retinal hemorrhages (25%) and optic disc edema (17%); bilateral involvement occurred in 54%. At 3-month follow-up, 58% of ocular abnormalities were resolved, whereas in-hospital mortality was 9% (8\/89). Mortality was significantly higher among patients with ocular involvement (25% versus 3%;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.004). In adjusted analysis, ocular manifestations were independently associated with in-hospital mortality (odds ratio: 9.07; 95% CI: 1.69\u201376.8;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.018). Ocular involvement is common in scrub typhus and may serve as a simple, noninvasive marker of disease severity in resource-limited settings.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0578","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:36:41Z","timestamp":1781635001000},"page":"290-294","source":"Crossref","is-referenced-by-count":0,"title":["Ocular Manifestations of Scrub Typhus and Their Association with In-Hospital Mortality"],"prefix":"10.4269","volume":"115","author":[{"given":"Mani","family":"Rajendran","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan Kumar","family":"Hanumanthappa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basavaraj","family":"Tigari","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenakshi","family":"Rana","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avichal","family":"Rajpal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Behera","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok Kumar","family":"Pannu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh Chandrabhan","family":"Sharda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Biswal","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Manson\u2019s Tropical Diseases 24th Edition","first-page":"326","article-title":"Tropical Rickettsial infections","author":"Paris","year":"2024"},{"issue":"10","key":"b2","series-title":"Br J Ophthalmol","first-page":"537","article-title":"Some ocular complications of scrub typhus","volume":"29","author":"Macaskill","year":"1945"},{"key":"b3","series-title":"Br J Ophthalmol","first-page":"11","article-title":"Ocular findings in tropical typhus (Tsutsugamushi or Japanese river fever)","volume":"30","author":"Donegan","year":"1946"},{"key":"b4","series-title":"Trans Am Ophthalmol Soc","first-page":"637","article-title":"Ocular changes in scrub typhus. A study of 451 patients","volume":"45","author":"Scheie","year":"1947"},{"issue":"3","key":"b5","series-title":"Jpn J Ophthalmol","first-page":"196","article-title":"Conjunctival injection, episcleral vessel dilation, and subconjunctival hemorrhage in patients with new tsutsugamushi disease","volume":"41","author":"Kato","year":"1997"},{"issue":"12","key":"b6","series-title":"Indian J Ophthalmol","first-page":"1840","article-title":"Ocular manifestations of Rickettsia conorii in South India","volume":"66","author":"Balasundaram","year":"2018"},{"key":"b7","series-title":"J Res Med Dent Sci","first-page":"159","article-title":"Validation of a new scrub typhus rapid kit-standard Q Tsutsugamushi IgM\/IgG","volume":"7","author":"Stephen","year":"2019"},{"issue":"4","key":"b8","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"},{"issue":"1","key":"b9","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":"1","key":"b10","series-title":"R J","first-page":"570","article-title":"Reproducible summary tables with the gtsummary package","volume":"13","author":"Sjoberg","year":"2021"},{"issue":"43","key":"b11","series-title":"JOSS","first-page":"1686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","year":"2019"},{"issue":"3","key":"b12","series-title":"Neuroophthalmology","first-page":"212","article-title":"Bilateral neuroretinitis induced by scrub typhus in China","volume":"49","author":"Yue","year":"2025"},{"issue":"5","key":"b13","series-title":"Eur J Ophthalmol","first-page":"NP83","article-title":"Ocular inflammation in tsutsugamushi disease - a case report","volume":"34","author":"Chang","year":"2024"},{"key":"b14","series-title":"Front Immunol","first-page":"1129246","article-title":"Case report: Optic neuritis as the initial presentation of Orientia tsutsugamushi infection detected by metagenomic next-generation sequencing","volume":"14","author":"Sun","year":"2023"},{"issue":"1","key":"b15","series-title":"Oman J Ophthalmol","first-page":"99","article-title":"Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus?","volume":"15","author":"Sen","year":"2022"},{"issue":"3","key":"b16","series-title":"J Curr Ophthalmol","first-page":"227","article-title":"Ocular manifestations of emerging arthropod-borne infectious diseases","volume":"33","author":"Abroug","year":"2021"},{"issue":"1","key":"b17","series-title":"J Ophthalmic Inflamm Infect","first-page":"37","article-title":"Rickettsial retinitis\u2014An Indian perspective","volume":"5","author":"Kawali","year":"2015"},{"issue":"7","key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e2966","article-title":"A hematogenously disseminated Orientia tsutsugamsushi-infected murine model of scrub typhus","volume":"8","author":"Shelite","year":"2014"},{"issue":"8","key":"b19","series-title":"PLoS Negl Trop Dis","first-page":"e3064","article-title":"Dissemination of Orientia tsutsugamushi and inflammatory responses in a murine model of scrub typhus","volume":"8","author":"Keller","year":"2014"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/2\/article-p290.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/2\/article-p290.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/2\/article-p290.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:10:30Z","timestamp":1785935430000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/2\/article-p290.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":19,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0578","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}