Scrub typhus in the Western Pacific region

Scrub typhus is widely endemic in Asia. Man's behaviour and climatic changes greatly influenced the occurrence of the disease. Increasing prevalences of scrub typhus have been reported from some Asian countries and may coincide with the widespread use of beta-lactam antibiotics or to improve diagnostic facilities and/or more urbanisation into rural areas. Many cases acquired in Asia surfaced in Europe and America. The disease probably is overlooked among paediatric patients. Most patients with scrub typhus present with acute fever of unknown origin (acute FUO). Eschars are rare among Southeast Asian patients. Complications usually develop after the first week of illness. The complications include pneumonitis, meningoencephalitis, renal failure and jaundice. Improved serologic and molecular diagnostic tests are now available. Although drug-resistant strain of Orientia tsutsugamushi has been reported, the infection usually responds to simple but unpopular drugs such as doxycycline or chloramphenicol.