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Scrub Typhus

Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called Orientia tsutsugamushi. Scrub typhus is spread to people through bites of infected chiggers (larval mites). The most common symptoms of scrub typhus include fever, headache, body aches, and sometimes rash. Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or traveling to areas where scrub typhus is found could get infected.

Signs and Symptoms

Symptoms of scrub typhus usually begin within 10 days of being bitten. Signs and symptoms may include:

Scrub typhus eschar

Figure 1. Eschar at site of chigger bite

  • Fever and chills
  • Headache
  • Body aches and muscle pain
  • A dark, scab-like region at the site of the chigger bite (also known as eschar)
  • Mental changes, ranging from confusion to coma
  • Enlarged lymph nodes
  • Rash

People with severe illness may develop organ failure and bleeding, which can be fatal if left untreated.

Diagnosis and Testing

  • The symptoms of scrub typhus are similar to symptoms of many other diseases. See your health care provider if you develop the symptoms listed above after spending time in areas where scrub typhus is found.
  • If you have recently traveled, tell your health care provider where and when you traveled.
  • Your health care provider may order blood tests to look for scrub typhus or other diseases.
  • Laboratory testing and reporting of results can take several weeks, so your health care provider may start treatment before results are available.


  • Scrub typhus should be treated with the antibiotic doxycycline. Doxycycline can be used in persons of any age.
  • Antibiotics are most effective if given soon after symptoms begin.
  • People who are treated early with doxycycline usually recover quickly.


Adult and larval chiggers

Figure 2. Adult and larval chiggers (mites)

  • No vaccine is available to prevent scrub typhus.
  • Reduce your risk of getting scrub typhus by avoiding contact with infected chiggers.
  • When traveling to areas where scrub typhus is common, avoid areas with lots of vegetation and brush where chiggers may be found.

If you will be spending time outdoors:

  • Use Environmental Protection Agency (EPA)-registered insect repellents that contain 20% to 30% DEET, or other active ingredients registered for use against chiggers, on exposed skin and clothing.
    • Always follow product instructions.
    • Reapply insect repellent as directed.
    • Do not spray repellent on the skin under clothing.
    • If you are also using sunscreen, apply sunscreen before applying insect repellent.
  • If you have a baby or child:
    • Do not use insect repellent on babies younger than 2 months of age.
    • Dress your child in clothing that covers arms and legs, or cover crib, stroller, and baby carrier with mosquito netting.
    • Do not apply insect repellent onto a child’s hands, eyes, or mouth or on cuts or irritated skin.
    • Adults:  Spray insect repellent onto your hands and then apply to child’s face.
  • Treat clothing and gear with permethrin or purchase permethrin-treated items.
    • Permethrin kills chiggers and can be used to treat boots, clothing, and camping gear.
      o Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.
      o If treating items yourself, follow the product instructions carefully.
      o Do NOT use permethrin products directly on skin. They are intended to treat clothing.