Forgotten but Not Gone: Pediatric Scrub Typhus in an Urbanizing Tropical Region

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, transmitted to humans through the bite of infected larval trombiculid mites. Its nonspecific clinical presentation often leads to delayed diagnosis and treatment, increasing the risk of severe complications. As urbanization progresses and awareness declines, clinicians may overlook this diagnosis, particularly when characteristic findings such as an eschar are absent or have been resolved. We report the case of an 11-year-old boy from Vietnam who was admitted with recurrent fever persisting for two weeks, occasionally accompanied by abdominal distension. Further history revealed a previous insect bite that had resolved before admission and recent cases of scrub typhus among individuals living in the same neighborhood. Given the epidemiological context, targeted investigations were performed, leading to the identification of Orientia tsutsugamushi infection and confirmation of scrub typhus. Appropriate antibiotics resulted in significant clinical improvement. Thorough assessment of epidemiological exposure and early diagnostic testing are essential for timely diagnosis and treatment, thereby reducing morbidity and preventing potentially life-threatening complications.