Rickettsial infections such as Scrub Typhus (ST), Spotted Fever (SF), Murine Typhus (MT) and Q Fever (QF) has recently emerged as one of the major public health issues globally. Scrub typhus is the most common of all the rickettsial infections and there has been a re-emergence in the last two decades are often being under diagnosed in the country. Scrub typhus, which was previously reported only in the tsutsugamushi triangle (Asia-Pacific rim), has been identified in other countries such as Dubai and Chile. It is estimated that over 2 billion people are at risk and more than 1million cases occur each year in the tsutsugamushi triangle.

In CMC, Vellore, 36% of the AUFI cases are scrub typhus followed by dengue and malaria. The symptoms of this infection may vary from having a low grade fever to severe multi-organ dysfunction syndrome (MODS) if untreated. Mortality among untreated cases is quite high, up to 70% depending on the severity of the disease. Spotted fever is next to the scrub typhus in terms of prevalence among other rickettsial infections and commonly seen in children. It presents as fever with rash which makes it very difficult to distinguish from other causes of exanthematous fevers. The other rickettsial infections such as Murine Typhus and Q Fever are less common. Doxycycline and azithromycin have proved to be very effective in treating all rickettsial infections and controlling the illness.

Therefore, the main challenge is in disease diagnosis, which is depended not only on lab expertise, but also clinical suspicion followed by a thorough clinical examination. As many institutes or hospitals or medical colleges lack of resources (expertise, equipment and reagent), they are unable to diagnose rickettsial infections effectively and in a timely manner.