Abstract
<title>Abstract</title> <p> Background: Scrub typhus, a potentially fatal infection spread by chiggers’ bites carrying <italic>Orientia tsutsugamushi</italic> , is under-reported in Malaysia. Methods: This retrospective, descriptive study analyzed 28 PCR-confirmed <italic>Orientia tsutsugamushi</italic> cases presented in Hospital Tuanku Ja’afar Seremban between 2023–2025, focusing data on socio-demographic data, clinical spectrum and outcome, and molecular analysis of the cohort. Results: The study found most patients were male (82%), Malaysian (68%), and from the Seremban area (71%). A significant portion (43%) worked in plantations, and 46% had rodent exposure. Initial diagnoses often missed scrub typhus, with common symptoms including acute fever (93%). About 21% of subjects had detectable eschars on physical examinations. Common laboratory abnormalities include elevated transaminases (89%), and renal impairment (36%). Severe complications like the need for mechanical ventilation (25%) were observed, with a mortality rate of 11%. PCR analysis showed Karp genotype formed the largest cluster of the cohort. Conclusions: The findings highlight the need for more local data and increased awareness among healthcare professionals and the public to better manage this neglected tropical disease. Delayed recognition of the disease likely contributes to severe complications as illustrated from the study. </p>