Scrub typhus: what you need to know after Anna University student's death

The death of an Anna University student at Government Kilpauk Medical College Hospital on Friday, September 18, 2026, from scrub typhus has brought the bacterial infection back into focus. University authorities have begun screening students for scrub typhus alongside dengue and leptospirosis.

What causes scrub typhus?

Scrub typhus is caused by the bacterium Orientia tsutsugamushi. It spreads through the bite of infected larval mites, commonly called chiggers, and is not transmitted by mosquitoes. The infection is not contagious.

Chiggers are found in grassy areas, thick vegetation, agricultural fields, plant litter and bare soil across rural parts of Asia. They typically feed on small mammals such as rats and shrews.

How big a problem is it in India?

Scrub typhus is a significant public health burden in South and Southeast Asia. A 2021 systematic review described it as a grossly under-recognised public health problem in India, noting that it accounted for 25.3% of acute undifferentiated febrile illness cases and that community seroprevalence stood at 34.2%. The review said the disease causes severe illness and a large number of deaths, with its burden underappreciated.

A 2025 multi-centre study of 587 children with acute encephalitis syndrome in Karnataka, Andhra Pradesh and Tamil Nadu found that scrub typhus is now the most common infectious cause of AES in southern India.

What are the symptoms?

Symptoms usually appear within 10 days of infection. They include fever and chills, headache, body aches and muscle pain, a dark scab-like region at the site of the chigger bite known as an eschar, mental changes ranging from confusion to coma, enlarged lymph nodes and a rash.

Without treatment, severe scrub typhus can lead to acute respiratory distress syndrome, shock, meningitis and kidney failure, which can be fatal. In India, mortality is high, largely because diagnosis and treatment are often delayed.

Diagnosis and treatment

Because its symptoms overlap with those of several other diseases, scrub typhus is often diagnosed late. Blood tests such as IgM ELISA or PCR can confirm the infection.

The antibiotics doxycycline or azithromycin are used to treat it, and they are effective if started in time. A 2023 trial across seven centres in India found that combining doxycycline and azithromycin led to faster resolution of complications than either drug alone, with lower rates of respiratory, renal, hepatic and central nervous system complications in the combination-therapy group.

Prevention

No vaccine exists for scrub typhus. Protective clothing, covered footwear and insect repellent can help prevent bites, while keeping surroundings clean and well maintained can reduce mite habitats.

The 2021 review stressed that early diagnosis and prompt treatment can significantly reduce complications and mortality, and called for good surveillance and appropriate control measures.