NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListTropMedInfectDisv.3(1);2018MarPMC6136623TropMedInfectDis.2018Mar;3(1):11.Publishedonline2018Jan25.doi: 10.3390/tropicalmed3010011PMCID:PMC6136623PMID:30274409ScrubTyphus:NoLongerRestrictedtotheTsutsugamushiTriangleJuJiangandAllenL.Richards*AuthorinformationArticlenotesCopyrightandLicenseinformationDisclaimerViralandRickettsialDiseasesDepartment,NavalMedicalResearchCenter,503RobertGrantAvenue,SilverSpring,MD20910,USA;[email protected]*Correspondence:[email protected];Tel.:+1-301-319-7668Received2017Dec1;Accepted2018Jan21.Copyright©2018bytheauthors.LicenseeMDPI,Basel,Switzerland.ThisarticleisanopenaccessarticledistributedunderthetermsandconditionsoftheCreativeCommonsAttribution(CCBY)license(http://creativecommons.org/licenses/by/4.0/).ThisarticlehasbeencitedbyotherarticlesinPMC.Scrubtyphusisthemostimportantrickettsialdiseaseintheworld.ItspreviousendemicregionwasconsideredtobeinAsia,AustraliaandislandsintheIndianandPacificOceans;thisareawasreferredtoastheTsutsugamushiTriangle.Accumulationofserological,molecular,genetic,andculturedatahaveshownthatnotonlyisscrubtyphusnotlimitedtotheTsutsugamushiTriangle,butcanbecausedbyorientiaeotherthanOrientiatsutsugamushi.Thisreviewdescribesevidencecurrentlyavailablethatwillbeinstrumentaltoresearchers,healthcareprovidersandmedicalleadersindevelopingnewresearchprojects,performingdiagnosis,andpreventingscrubtyphusinlocationsnotpreviouslythoughttobeendemic.Keywords:scrubtyphus,Orientiatsutsugamushi,TsutsugamushiTriangle,endemicregionScrubtyphusistoday’smostimportantrickettsialdisease,worldwide.Approximatelyonemillioncasesoccureachyear,andoveronebillionpeopleareatriskofdisease[1].Scrubtyphusisamildtolife-threateningdiseasewithafatalityratewithouttreatmentashighas50%.Diseasepresentationconsistsofabrupthighfever,severeheadache,lymphadenopathy,generalizedmyalgia,eschar,andrash