Orientia tsutsugamushi a Likely Contributor to Stillbirths and Neonatal Deaths in Bangladesh, 2017-2024

Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne infection endemic to Asia, the Pacific Islands, and northern Australia. This study reports the first detection of O. tsutsugamushi DNA in postmortem specimens from stillbirths and neonatal deaths collected through the CHAMPS surveillance project from 2017 to 2024 in Bangladesh. O. tsutsugamushi DNA was detected in 11 cases including 1.7% of stillbirths (n = 461) and 0.7% of neonates (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's 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.