You can find the first volume of this Research Topic here.

Scrub Typhus is a vector-borne zoonotic disease, mostly prevalent in rural Asia (seroprevalence ranging from 9.3% - 27.9%), across the Pacific rim. Scrub Typhus, when it remains undiagnosed and untreated, is a life-threatening disease and can account to a median mortality rate of 6%, up to as high as 13.6% in some cases with CNS involvement. With the changing population dynamics and urbanization, Scrub Typhus has been increasingly reported in regions outside of Asia, thus leading to a high chance of the diagnosis being missed. Interestingly, there has been an ongoing debate about possible drug-resistant Scrub Typhus circulating in the Asia-Pacific region.

Given the changing global dynamics, this Research Topic aims to explore the following aspects of this disease:
• The most recent epidemiological evidence of Scrub Typhus across the world, since there is growing evidence that it is shifting to urban areas and spreading outside of the Asia-Pacific region.
• To assess clinical manifestations and complications of Scrub Typhus: Scrub Typhus is a life-threatening disease with multisystem involvement. There have been case reports on myocarditis, encephalitis, hemophagocytic lymphohistiocytosis, and so on. Thus, it is a suitable time to explore the possible clinical manifestations of Scrub Typhus so that clinicians have a better index of suspicion, aiding in the correct diagnosis and management of the disease.
• To assess the most recent diagnostic options against Scrub Typhus: Traditionally, Scrub Typhus has been diagnosed based on clinical findings supported by the serology test, which is not the most sensitive test. PCR tests, being more sensitive and specific, could be the test of choice, but are only available in specialized centers. Recently, there has been use of Metagenomic next-generation sequencing (mNGS), CRISPR-Cas12a assay targeting 16S rRNA, loop-mediated isothermal amplification (LAMP), etc, as other methods for diagnosis. Recent developments in designing cost-effective and simple point-of-care kits will be explored in this topic.
• To assess therapeutic options, along with the possibility of drug resistance: Historically, Chloramphenicol was the drug of choice, later replaced by Doxycycline, with Azithromycin as an alternative. Recently, however, there has been some debate going on about the possibility of reduced susceptibility to Doxycycline, especially from Thailand.
• To assess the scope of vaccine development against Scrub Typhus: At present, there is no vaccine available for Scrub Typhus. However, there has been ongoing research and development in designing an effective vaccine against Scrub Typhus in recent years. With the most recent advancement in vaccine technologies such as vector vaccines, mRNA vaccines, and so forth, there is a hope that there will soon be a vaccine available against Scrub Typhus.

Topic Coordinator Prabhat Adhikari is the founder medical director of Novala Biotech Pvt Ltd, and founder and CEO of the Center for American Medical Specialists (CAMS) in Nepal. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

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Scrub Typhus & Its Changing Dynamics: Vol. 2