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N Engl J Med. 2016 Sep 8;375(10):954-61. doi: 10.1056/NEJMoa1603657.

Endemic Scrub Typhus in South America.

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From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.).


Scrub typhus is a life-threatening zoonosis caused by Orientia tsutsugamushi organisms that are transmitted by the larvae of trombiculid mites. Endemic scrub typhus was originally thought to be confined to the so called "tsutsugamushi triangle" within the Asia-Pacific region. In 2006, however, two individual cases were detected in the Middle East and South America, which suggested that the pathogen was present farther afield. Here, we report three autochthonous cases of scrub typhus caused by O. tsutsugamushi acquired on Chiloé Island in southern Chile, which suggests the existence of an endemic focus in South America. (Funded by the Chilean Comisión Nacional de Investigación Científica y Tecnológica and the Wellcome Trust.).

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