{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:47:22Z","timestamp":1785937642614,"version":"3.56.0"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"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":[[2026,8,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus is a mite-borne rickettsial infection that typically presents with fever, rash, and eschar; however, atypical manifestations may lead to delayed or missed diagnosis. The present report involves a case of a 65-year-old woman who presented with persistent xerostomia (dry mouth) as the sole ongoing symptom at the time of evaluation, without rash, eschar, or ongoing fever. She had a history of outdoor exposure in an endemic area, and laboratory testing revealed transient liver dysfunction and hyponatremia associated with polydipsia. Although empiric antimicrobial therapy was not initiated because of spontaneous clinical improvement, paired serological testing revealed a more than 8-fold rise in antibody titers against\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , confirming the diagnosis of scrub typhus. A review of recent cases without classical findings highlights frequent diagnostic delay and heterogeneous clinical outcomes. The present case underscores the limitations of relying on classical clinical hallmarks and emphasizes the importance of epidemiological context and clinical reasoning when evaluating atypical presentations of scrub typhus in endemic regions.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0003","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:38:39Z","timestamp":1782837519000},"page":"295-298","source":"Crossref","is-referenced-by-count":0,"title":["Scrub Typhus Presenting with Isolated Xerostomia"],"prefix":"10.4269","volume":"115","author":[{"given":"Soushi","family":"Nishiura","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Narita","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Okinawa Nanbu Medical Center and Children\u2019s Medical Center, Haebaru, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Saishoji","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Hakujyuji Hospital, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasumori","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Clin Infect Dis","first-page":"S203","article-title":"Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi.","volume":"48","author":"Kelly","year":"2009"},{"key":"b2","series-title":"Inst Med Res Malays Bull","first-page":"25","article-title":"Scrub 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cases of scrub typhus with hemorrhage: A case report and literature review","volume":"51","author":"Chen","year":"2023"},{"key":"b22","series-title":"J Vector Borne Dis","first-page":"101","article-title":"Scrub typhus with bilateral sensorineural hearing loss: A unique case report","volume":"57","author":"Dixit","year":"2020"},{"key":"b23","series-title":"Travel Med Infect Dis","first-page":"102682","article-title":"Metagenomic capture sequencing helped diagnose a case of atypical scrub typhus misdiagnosed as acute osteomyelitis","volume":"57","author":"He","year":"2024"},{"key":"b24","series-title":"QJM","first-page":"465","article-title":"Coinfection of H1N1 influenza and scrub typhus: A review","volume":"113","author":"Jhuria","year":"2020"},{"key":"b25","series-title":"BMC Infect Dis","first-page":"1219","article-title":"mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: A case 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