Full Article - PDF

Published: 2021-02-11

Page: 96-109


Qujing Medical College, Qujing 655011, Yunnan Province, China.


Yunnan Provincial Health and Rehabilitation Center, Kunming 650300, Yunnan Province, China.


Qujing Medical College, Qujing 655011, Yunnan Province, China.


Qujing Medical College, Qujing 655011, Yunnan Province, China.


Qujing Medical College, Qujing 655011, Yunnan Province, China.

*Author to whom correspondence should be addressed.


Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is cumulatively recognized as an important cause of pyrexia in Asia, with an estimated one million infections occurring per year. Scrub typhus is a natural focus disease transmitted to humans after being bitten by chigger mites and its host were mainly rodents especially rats. It has a great influence on the combat effectiveness of the armed forces and had caused a large number of non-combat attrition in the past. It is considered an emerging or re‐emerging disease in several countries. There are no authorized vaccines, or vector control efforts in place. As a neglected disease, there is still a large gap in our knowledge of this disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a comprehensive review of current epidemiology of the disease all over the world to attract great attention of the governments.

Keywords: Scrub typhus, Orientia tsutsugamushi, epidemiology, all over the world.

How to Cite

PENG, P.-Y., CAI, Y.-P., XU, L., ZHA, Y.-J., & YANG, B.-S. (2021). THE EPIDEMIOLOGY OF SCRUB TYPHUS ALL OVER THE WORLD: A SYSTEMATIC LITERATURE REVIEW. Asian Journal of Advances in Research, 4(1), 96–109. Retrieved from


Download data is not yet available.


Traub R, Wisseman CL Jr. The ecology of chigger-borne rickettsiosis (scrub typhus). J Med Entomol. 1974;11:237-303.

Oaks SC Jr, Ridgway RL, Shirai A et al. Scrub typhus. Inst Med Res Malays Bull. 1983;21:1-98.

Megaw J. Scrub typhus as a war disease. British Medical Journal. 1945;2:109-112.

Peterson RKD. The real enemy: scrub typhus and the invasion of sansapor. Am Entomol. 2006;55:91-94.

Phasomkusolsil S, Tanskul P, Ratanatham S et al. Influence of Orientia tsutsugamushi infection on the developmental biology of Leptotrombidium imphalum and Leptotrombidium chiangraiensis (Acari: Trombiculidae). J Med Entomol. 2012;49:1270-1275.

Jeong YJ, Kim S, Wook YD et al. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics. 2007;27:161-172.

Kelly DJ, Richards AL, Temenak J et al. The past and present threat of rickettsial diseases to military medicine and international public health. Clin Infect Dis. 2002;34:145-169.

Kelly DJ, Fuerst PA, Ching WM et al. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48:S203-230.

Cracco C, Delafosse C, Baril L et al. Multiple organ failure complicating probable scrub typhus. Clin Infect Dis. 2000;31:191-192.

Premaratna R, Chandrasena TG, Dassayake AS et al. Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin Infect Dis. 2006;42:e6-e8.

Jamil M, Lyngrah KG, Lyngdoh M et al. Clinical manifestations and complications of scrub typhus: a hospital based study from north eastern India. J Assoc Physicians India. 2014;62:19-23.

Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16:429-436.

Xu G, Walker DH, Jupiter D et al. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017;11:e0006062.

Seong SY, Choi MS, Kim IS. Orientia tsutsugamushi infection: overview and immune responses. Microbes Infect. 2001;3:11-21.

Izzard L, Fuller A, Blacksell SD et al. Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai. J Clin Microbiol. 2010;48:4404-4409.

Kweon SS, Choi JS, Lim HS et al. Rapid increase of scrub typhus, South Korea, 2001-2006. Emerg Infect Dis. 2009;15:1127-1129.

Bonell A, Lubell Y, Newton PN et al. Estimating the burden of scrub typhus: A systematic review. PLoS Negl Trop Dis. 2017;11:e0005838.

Tilak R, Kunte R. Scrub typhus strikes back: Are we ready? Med J Armed Forces India. 2019;75:8-17.

Chen XR. Scrub typhus and Orientia tsutsugamushi. Military Medical Publishing House, Beijing; 2001.

Li GC, Li DM, Li Y et al. Epidemiological features of scrub typhus in China from 2006 to 2016. Dis Surveill. 2018;33:139-143.

Wei Y, Huang Y, Luo L et al. Rapid increase of scrub typhus: an epidemiology and spatial-temporal cluster analysis in Guangzhou City, Southern China, 2006-2012. PLoS One. 2014;9:e101976.

De W, Jing K, Huan Z et al. Scrub typhus, a disease with increasing threat in Guangdong, China. PLoS One. 2015;10:e0113968.

Yang LP, Liang SY, Wang XJ et al. Burden of disease measured by disability-adjusted life years and a disease forecasting time series model of scrub typhus in Laiwu, China. PLoS Negl Trop Dis. 2015;9:e3420.

Zhang SY, Song HB, Liu Y et al. Scrub typhus in previously unrecognized areas of endemicity in China. J Clin Microbiol. 2010;48:1241- 1244.

Wei JJ, Tong GZ, Shi SF. Study on Leptotrombidium gaohuensis sp. Nov. newly discovered vector of tsutsugamushi disease. Chin Med J. 1987;100:590-594.

Yang GR, Yu ZZ, Xie BQ. Investigation studies on the biological behaviour of Leptotrombidium deliense in Yunnan Province. Chin J Pest Control. 1991;7:7-12.

Wu G, Zhang Y, Guo H et al. The role of Leptotrombidium scutellare in the transmission of human diseases. Chin Med J. 1996;109:670-673.

Li J, Li XY, Liu YX. Epidemiology of scrub typhus and its transmitting vector research progress in China. Pract Prevent Med. 2005;12:1251-1253.

Fan MY, Walker DH, Yu SR et al. Epidemiology and ecology of rickettsial diseases in the People's Republic of China. Rev Infect Dis. 1987;9:823-840.

Ebisawa I. Current epidemiology and treatment of Tsutsugamushi disease in Japan. J Travel Med. 1995;2:218-220.

Kawamura A Jr, Tanaka H. Rickettsiosis in Japan. Jpn J Exp Med. 1988;58:169-184.

Ogawa M, Hagiwara T, Kishimoto T et al. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg. 2002;67:162-165.

Matsui T, Kramer MH, Mendlein JM. Evaluation of national tsutsugamushi disease surveillance-Japan, 2000. Jpn J Infect Dis. 2002;55:197-203.

Munro-Faure A, Missen MD. Scrub typhus in Korea. J Roy Army Med Corps. 1951;97:227-231.

Chang WH. Current status of tsutsugamushi disease in Korea. J Korean Med Sci. 1995;10:227-238.

Ree HI, Cho MK, Lee IY et al. Comparative epidemiological studies on vector/reservoir anomalies of tsutsugamushi disease between high and low endemic areas in Korea. Korean J Parasitol. 1995;33:27-36.

Ree HI, Lee IY, Jeon SH et al. Geographical distribution of vectors and sero-strains of tsutsugamushi disease at mid-south inland of Korea. Korean J Parasitol. 1997;35:171-179.

Jeong MA, Youn SK, Kim YK et al. Trends in the incidence of scrub typhus: the fastest growing vector-borne disease in Korea. Osong Public Health Res Perspect. 2013;4:166-169.

Lee HW, Cho PY, Moon SU et al. Current situation of scrub typhus in South Korea from 2001 -2013. Parasit Vectors. 2015;8:238.

Lee IY, Kim HC, Lee YS et al. Geographical distribution and relative abundance of vectors of scrub typhus in the Republic of Korea. Korean J Parasitol. 2009;47:381-386.

Min KD, Lee JY, So Y et al. Deforestation increases the risk of scrub typhus in Korea. Int J Environ Res Public Health. 2019;16:1518.

Tarasevich IV, Kulagin SM, Plotnikova LF et al. Studies on antigenic characteristics of Rickettsia tsutsugamushi isolated in the U.S.S.R. Acta Virol Praha. 1968;12:63-67.

Urakami H, Tamura A, Tarasevich IV et al. Decreased prevalence of Orientia tsutsugamushi in trombiculid mites and wild rodents in the Primorye region, Far East Russia. Microbiol Immunol. 1999;43:975-978.

Willcox PHA. Mite typhus fever in Assam and Burma, 1944-1946. Trans R Soc Trop Med Hyg. 1948;42:171-189.

Trishnananda M, Vasuvat C, Harinasuta C. Investigation of scrub typhus in Thailand. J Trop Med Hyg. 1964;67:215-219.

Traub R, Johnson P, Mirsse M et al. Isolation of Rickettsia tsutsugamushi from rodents from Thailand. Am J Trop Med Hyg. 1954;3:356-359.

Lerdthusnee K, Khuntirat B, Leepitakrat W et al. Scrub typhus: vector competence of Leptotrombidium chiangraiensis chiggers and transmission efficacy and isolation of orientia tsutsugamushi. Ann N Y Acad Sci. 20101;990:25-35.

Suputtamongkol Y, Suttinont C, Niwatayakul K et al. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci. 2009;1166:172-179.

Bureau of Epidemiology, Department of Disease Control, MoPH, Thailand.

Available: disease.php?dcontent=situation&ds=44.

Strickman D, Tanskul P, Eamsila C et al. Prevalence of antibodies to rickettsiae in the human population of suburban Bangkok. Am J Trop Med Hyg. 1994;5:149-153.

Johnson DE, Crum JW, Hanchalay S et al. Sero-epidemiological survey of Rickettsia tsutsugamushi infection in a rural Thai village. Trans R Soc Trop Med Hyg. 1992;76:1-3.

Wangrangsimakul T, Elliott I, Nedsuwan S et al. The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018). PLoS Negl Trop Dis. 2020;14:e0008233.

Cadigan FC Jr, Andre RG, Bolton M et al. The effect of habitat on the prevalence of human scrub typhus in Malaysia. Trans R Soc Trop Med Hyg. 1972;66:582-587.

Robinson DM, Gan E, Donaldson JR. The prevalence of scrub typhus antibodies in residents of West Malaysia. Trop Geogr Med. 1976;28:303-308.

Tay ST, Nazma S, Rohani MY. Diagnosis of scrub typhus in Malaysian aborigines using nested polymerase chain reaction. Southeast Asian J Trop Med Public Health. 1996;27:580-583.

Saunders JP, Brown GW, Shirai A et al. The longevity of antibody to Rickettsia tsutsugamushi in patients with confirmed scrub typhus. Trans R Soc Trop Med Hyg. 1980;74:253-257.

Brown GW, Shirai A, Jegathesan M et al. Febrile illness in Malaysia - an analysis of 1629 hospitalized patients. Am J Trop Med Hyg. 1984;33:311-315.

Taylor AC, Hii J, Kelly DJ et al. A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia. Southeast Asian J Trop Med Public Health. 1986;17:613-619.

Tay ST, Ho TM, Rohani MY et al. Antibody prevalence of Orientia tsutsugamushi, Rickettsia typhi and TT118 spotted fever group rickettsiae among febrile patients in rural areas of Malaysia. Trans R Soc Trop Med Hyg. 2000;94:280-284.

Deller JJ, Russell PK. An analysis of fevers of unknown origin in American soldiers in Vietnam. Ann Intern Med. 1967;66:1129-1143.

Colwell EJ, Brown JD, Russell PK et al. Catino D: Investigations on acute febrile illness in American servicemen in the Mekong Delta of Vietnam. Mil Med. 1969;134:1409-1414.

Hazlett DR. Scrub typhus in Vietnam: experience at the 8th Field Hospital. Mil Med. 1970;135:31-34.

Berman SJ, Irving GS, Kundin WD et al. Epidemiology of the acute fevers of unknown origin in South Vietnam: effect of laboratory support upon clinical diagnosis. Am J Trop Med Hyg. 1973;22:796-801.

Berman SJ, Kundin WD. Scrub typhus in South Vietnam. A study of 87 cases. Ann Intern Med. 1973;79:26-30.

Thiebaut MM, Bricaire F, Raoult D. Scrub typhus after a trip to Vietnam. N Engl J Med. 1997;336:1613-1614.

Hamaguchi S, Cuong NC, Tra DT et al. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in northern Vietnam. Am J Trop Med Hyg. 2015;92:972- 978.

Viet NL, Laroche M, Pham HLT et al. Use of eschar swabbing for the molecular diagnosis and genotyping of Orientia tsutsugamushi causing scrub typhus in Quang Nam province, Vietnam. PLoS Negl Trop Dis. 2017;11:e0005397.

Nadjm B, Thuy PT, Trang VD et al. Scrub typhus in the northern provinces of Vietnam: an observational study of admissions to a national referral hospital. Trans R Soc Trop Med Hyg. 2014;108:739-740.

Vallée J, Thaojaikong T, Moore CE et al. Contrasting spatial distribution and risk factors for past infection with scrub typhus and murine typhus in Vientiane City, Lao PDR. PLoS Negl Trop Dis. 2010;4:e909.

Phongmany S, Rolain JM, Phetsouvanh R et al. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis. 2006;12:256-262.

Mayxay M, Castonguay-Vanier J, Chansamouth V, et al. Causes of non-malarial fever in Laos: a prospective study. Lancet Glob Health. 2013;1:e46-54.

Mayxay M, Sengvilaipaseuth O, Chanthongthip A et al. Causes of fever in rural southern Laos. Am J Trop Med Hyg. 2015;93:517-520.

Delbove P, Canet J, Truong-van-Huan. A small epidemic of tropical typhus. (Scrub Typhus) in a group of plantations in Cambodia. Bull Soc Pathol Exot. 1938;31:457.

Corwin AL, Soeprapto W, Widodo PS et al. Short report: surveillance of rickettsial infections in Indonesian military personnel during peace keeping operations in Cambodia. Am J Trop Med Hyg. 1997;57:569-570.

Duong V, Mai TT, Blasdell K et al. Molecular epidemiology of Orientia tsutsugamushi in Cambodia and Central Vietnam reveals a broad region - wide genetic diversity. Infect Genet Evol. 2013;15:35-42.

Richards AL, Soeatmadji DW, Widodo MA et al. Seroepidemiologic evidence for murine and scrub typhus in Malang, Indonesia. Am J Trop Med Hyg. 1997;57:91-95.

Gunther CE. A survey of endemic typhus in New Guinea. Med J Aust. 1940;2:564-573.

Griffiths JT. A scrub typhus (tsutsugamushi) outbreak in Dutch New Guinea. J Parasitol. 1945;31:341-350.

Punjabi NH, Taylor WR, Murphy GS et al. Etiology of acute, non-malaria, febrile illnesses in Jayapura, northeastern Papua, Indonesia. Am J Trop Med Hyg. 2012;86:46-51.

Lawley BJ. The discovery, investigation and control of scrub typhus in Singapore. Trans R Soc Trop Med Hyg. 1957;51:56-61.

Philip CB, Woodward TE, Sullivan RR. Tsutsugamushi disease (scrub or mite-borne typhus) in the Philippine Islands during American re-occupation in 1944-45. Am J Trop Med Hyg. 1946;26:229-242.

Berge TO, Gauld RL, Kitaoka M. A field trial of a vaccine prepared from the Volner strain of Rickettsia tsutsugamushi. Am J Hyg. 1949;50:337-342.

Tattersall R. Tsutsugamushi fever on the India-Burma border. The Lancet. 1945;246:392-394.

Sinha P, Gupta S, Dawra R et al. Recent outbreak of scrub typhus in North Western part of India. Indian J Med Microbiol. 2014;32:247-250.

Singh P. Scrub typhus, a case report: Military and regional significance. Med J Armed Forces India. 2004;60:89-90.

Khan SA, Dutta P, Khan AM et al. Re-emergence of scrub typhus in northeast India. Int J Infect Dis. 2012;16:e889-890.

Sengupta M, Anandan S, Daniel D et al. Scrub typhus seroprevalence in healthy Indian population. J Clin Diagn Res. 2015;9:DM01-DM02.

Kalra S. Natural history of typhus fevers in India. Indian J Med Sci. 1952;6:569-575.

Lakshmi RMMVN, Dharma TV, Sudhaharan S et al. Prevalence of scrub typhus in a tertiary care centre in Telangana, south India. Iran J Microbiol. 2020;12:204-208.

Jajoo M, Kumar D, Manchanda S. Scrub Typhus in a New Born. J Clin Diagn Res. 2017;11:SD05-SD06.

Ranjan J, Prakash JAJ. Scrub typhus re-emergence in India: Contributing factors and way forward. Med Hypotheses. 2018;115:61-64.

Audy JR. A summary topographical account of scrub typhus 1908–1946. In: Bulletins from the Institute for Medical Research, Federation of Malaya, Kuala Lumpur. Government Press, Malaysia; 1949.

Lewis MD, Yousuf AA, Lerdthusnee K et al. Scrub typhus reemergence in the Maldives. Emerg Infect Dis. 2003;9:1638-1641.

Maude RR, Maude RJ, Ghose A et al. Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh. Am J Trop Med Hyg. 2014;9:580-583.

Faruque LI, Zaman RU, Gurley ES et al. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and Chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh. BMC Infect Dis. 2017;17:141.

Nasir AS. Entomological survey of the vectors of scrub typhus in West Pakistan. Pakistan J Health. 1965;14 (2):83-85.

Traub R, Wisseman CL Jr, Ahmad N. The occurrence of scrub typhus infection in unusual habitats in West Pakistan. Trans R Soc Trop Med Hyg. 1967;61:23-53.

Dasch GA, Halle S, Bourgeois AL. Sensitive microplate enzyme-linked immunosorbent assay for detection of antibodies against the scrub typhus rickettsia, Rickettsia tsutsugamushi. J Clin Microbiol. 1979;9:38-48.

Upadhyaya BP, Shakya G, Adhikari S et al. Scrub typhus: an emerging neglected tropical disease in Nepal. J Nepal Health Res Counc. 2016;14:122-127.

Thapa S, Sapkota LB, Hamal P. Threat of scrub typhus in post-earthquake Nepal. J Chitwan Med College. 2016;6:1-6.

Bajracharya L. Scrub Typhus in Children at Tribhuvan University Teaching Hospital in Nepal. Pediatric Health Med Ther. 2020;11:193-202.

Dorji T, Wangchuk S, Lhazeen K. Clinical characteristics of scrub typhus in Gedu and Mongar (Bhutan); 2010.

Available: Accessed 4 April 2018

Tshokey T, Choden T, Sharma R. Scrub typhus in Bhutan: asynthesis of data from 2009 to 2014. WHO South East Asia J Public Health. 2016;5:117-122.

Dorji K, Phuentshok Y, Zangpo T et al. Clinical and epidemiological patterns of scrub typhus, an emerging disease in Bhutan. Tro Med Infec Dis. 2019;4:56.

Tshokey T, Graves S, Tshering D et al. Scrub typhus outbreak in a remote primary school, Bhutan. 2014. Emerg Infect Dis. 2017;23:1412-1414.

Kularatne SAM, Edirisingha JS, Gawarammana IB et al. Emerging rickettsial infections in Sri Lanka: the pattern in the hilly Central Province. Trop Med Int Health. 2003;8:803-811.

Premaratna R, Loftis AD, Chandrasena TG et al. Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study. Int J Infect Dis. 2008;12:198-202.

Van Peenen PF, See R, Soysa PE et al. Seroepidemiological survey of hospital-associated populations in Colombo, Sri Lanka. Southeast Asian J Trop Med Public Health. 1976;(1):16-20.

Premaratna R, Rajapakse RP, Chandrasena TG et al. Contribution of rickettsioses in Sri Lankan patients with fever who responded to empirical doxycycline treatment. Trans R Soc Trop Med Hyg. 2010;104:368-370.

Kende M, Graves S. Survey of rickettsial antibodies at two local sites and review of rickettsiosis in Papua New Guinea. Papua New Guinea Med J. 2003;46:53-62.

Spicer PE, Taufa T, Benjamin AL. Scrub typhus (Orientia tsutsugamushi), spotted fever (Rickettsia australis) and dengue fever as possible causes of mysterious deaths in the Strickland Gorge area of Southern Highlands and West Sepik Provinces of Papua New Guinea. Papua New Guinea Med J. 2007;50:172-183.

Derrick EA. The incidence and distribution of scrub typhus in north Queensland. Aust Ann Med. 1961;10:256-267.

Mcbride WJH, Taylor CT, Pryor JA et al. Scrub typhus in north queensland. Med J Australia. 1999;170:318-320.

Graves S, Wang L, Nack Z et al. Rickettsia serosurvey in kimberley, western Australia. Am J Trop Med Hyg. 1999;60:786-789.

Campbell R, Domrow R. Rickettsioses in Australia: Isolation of Rickettsia tsutsugamushi and R. Australis from naturally infected arthropods. Trans R Soc Trop Med Hyg. 1974;68:397-402.

Currie B, Lo D, Marks P et al. Fatal scrub typhus from Litchfield Park, Northern Territory. Commun Dis Intell. 19969;20:420-421.

Frances SP. Rickettsial Diseases of Military Importance: An Australian Perspective. J Mili Veterans' Health. 2011;19:25-30

Miles J, Austin F, Jennings L. Scrub typhus in the Eastern Solomon Islands and Northern Vanuatu (New Hebrides). Am J Trop Med Hyg. 1981;30:849.

Marks M, Joshua C, Longbottom J et al. An outbreak investigation of scrub typhus in western province, solomon islands, 2014. Western Pac Surveill Response J. 2016;7:6-9.

Durand AM, Kuartei S, Togamae I et al. Scrub typhus in the Republic of Palau, Micronesia. Emerg Infect Dis. 2004;10:1838-40.

Demma LJ, Mcquiston JH, Nicholson WL et al. Scrub typhus, republic of palau. Emerg Infect Dis. 2006;12:290-295.

Jiang J, Richards AL. Scrub Typhus: No Longer Restricted to the Tsutsugamushi Triangle. Trop Med Infect Dis. 2018;3:11.

Richards AL, Jiang J. Scrub Typhus: Historic Perspective and Current Status of the Worldwide Presence of Orientia Species. Trop Med Infect Dis. 2020;5:49.

Balcells ME, Rabagliati R, Garcia P et al. Endemic scrub typhus-like illness, Chile. Emerg Infect Dis. 2011;17:1659-1663

Weitzel T, Dittrich S, Lopez J et al. Endemic scrub typhus in South America. N Engl J Med. 2016;375:954-961.

Lyu Y, Tian LL, Zhang LQ et al. A case control study of risk factors associated with scrub typhus infection in Beijing, China. PLoS One. 2013;8:e63668.

Weitzel T, Martínez-Valdebenito C, Acosta-Jamett G et al. Scrub Typhus in Continental Chile, 2016-2018. Emerg Infect Dis. 2019;25:1214-1217.

Gomez-Puerta LA, Olazabal J, Lopez-Urbina MT et al. Trombiculiasis caused by chigger mites Eutrombicula (Acari: Trombiculidae) in Peruvian alpacas. Vet Parasitol. 2012;190:294-296.

Kocher C, Jiang J, Morrison AC et al. Serologic evidence of scrub typhus in the peruvian amazon. Emerg Infect Dis. 2017;23:1389-1391.

Cosson JF, Galan M, Bard E et al. Detection of Orientia sp. DNA in rodents from Asia, West Africa and Europe. Parasit Vectors. 2015;8:172.

Thiga JW, Mutai BK, Eyako WK et al. High seroprevalence of antibodies against spotted fever and scrub typhus bacteria in patients with febrile Illness, Kenya. Emerg Infect Dis. 2015;21:688-691

Ghorbani RP, Ghorbani AJ, Jain MK et al. A case of scrub typhus probably acquired in Africa. Clin Infect Dis. 1997;25:1473-1474.

Groen J, Nur YA, Dolmans W et al. Scrub and murine typhus among Dutch travellers. Infection. 1999;27:291-292.

Osuga K, Kimura M, Goto H et al. A case of tsutsugamushi disease probably contracted in Africa. Eur J Clin Microbiol Infect Dis. 1991;10:95-96

Horton KC, Jiang J, Maina A et al. Evidence of Rickettsia and Orientia infections among abattoir workers in Djibouti. Am J Trop Med Hyg. 2016;95:462-465.