{"id":"https://openalex.org/W7166331371","doi":"https://doi.org/10.17179/excli2026-9514","title":"Eschar, enigma, and encephalopathy: a case series of atypical and fatal presentations of scrub typhus in young adults from Northern India","display_name":"Eschar, enigma, and encephalopathy: a case series of atypical and fatal presentations of scrub typhus in young adults from Northern India","publication_year":2026,"publication_date":"2026-06-27","ids":{"openalex":"https://openalex.org/W7166331371","doi":"https://doi.org/10.17179/excli2026-9514","pmid":"https://pubmed.ncbi.nlm.nih.gov/42459935","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13369890"},"language":"en","primary_location":{"id":"doi:10.17179/excli2026-9514","doi":"https://doi.org/10.17179/excli2026-9514","is_oa":true,"landing_page_url":"https://doi.org/10.17179/excli2026-9514","pdf_url":null,"source":{"id":"https://openalex.org/S39273986","display_name":"EXCLI journal","issn_l":"1611-2156","issn":["1611-2156"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","ddh","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313779","host_organization_name":"IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund","host_organization_lineage":["https://openalex.org/P4310313779"],"host_organization_lineage_names":["IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"EXCLI Journal","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","datacite","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://doi.org/10.17179/excli2026-9514","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5139467619","display_name":"Abhijeet Sharma","orcid":"https://orcid.org/0009-0003-6745-0049","observed_orcids":["https://orcid.org/0009-0003-6745-0049"]},"institutions":[{"id":"https://openalex.org/I2799707979","display_name":"Swami Vivekanand Subharti University","ror":"https://ror.org/053h7gw81","country_code":"IN","type":"education","lineage":["https://openalex.org/I2799707979"]},{"id":"https://openalex.org/I4210140167","display_name":"Subharti Medical College","ror":"https://ror.org/04dagd274","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I4210140167"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Abhijeet Sharma","raw_affiliation_strings":["Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","Department of Research, PearResearch, Dehradun, India"],"raw_orcid":"https://orcid.org/0009-0003-6745-0049","affiliations":[{"raw_affiliation_string":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","institution_ids":["https://openalex.org/I2799707979","https://openalex.org/I4210140167"]},{"raw_affiliation_string":"Department of Research, PearResearch, Dehradun, India","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5086140516","display_name":"Yashendra Sethi","orcid":"https://orcid.org/0000-0003-0345-3876","observed_orcids":["https://orcid.org/0000-0003-0345-3876"]},"institutions":[{"id":"https://openalex.org/I2799707979","display_name":"Swami Vivekanand Subharti University","ror":"https://ror.org/053h7gw81","country_code":"IN","type":"education","lineage":["https://openalex.org/I2799707979"]},{"id":"https://openalex.org/I4210140167","display_name":"Subharti Medical College","ror":"https://ror.org/04dagd274","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I4210140167"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Yashendra Sethi","raw_affiliation_strings":["Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","Department of Research, PearResearch, Dehradun, India","Vigyaved Healthcare, Dehradun, India"],"raw_orcid":"https://orcid.org/0000-0003-0345-3876","affiliations":[{"raw_affiliation_string":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","institution_ids":["https://openalex.org/I2799707979","https://openalex.org/I4210140167"]},{"raw_affiliation_string":"Department of Research, PearResearch, Dehradun, India","institution_ids":[]},{"raw_affiliation_string":"Vigyaved Healthcare, Dehradun, India","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5009830316","display_name":"S. Sharma","orcid":"https://orcid.org/0000-0003-4923-6631","observed_orcids":["https://orcid.org/0000-0003-4923-6631"]},"institutions":[{"id":"https://openalex.org/I2799707979","display_name":"Swami Vivekanand Subharti University","ror":"https://ror.org/053h7gw81","country_code":"IN","type":"education","lineage":["https://openalex.org/I2799707979"]},{"id":"https://openalex.org/I4210140167","display_name":"Subharti Medical College","ror":"https://ror.org/04dagd274","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I4210140167"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Shirobhi Sharma","raw_affiliation_strings":["Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India"],"raw_orcid":"https://orcid.org/0000-0003-4923-6631","affiliations":[{"raw_affiliation_string":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","institution_ids":["https://openalex.org/I2799707979","https://openalex.org/I4210140167"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5139488179","display_name":"Akansha Jain","orcid":"https://orcid.org/0009-0004-2646-1582","observed_orcids":["https://orcid.org/0009-0004-2646-1582"]},"institutions":[{"id":"https://openalex.org/I3056136","display_name":"Motilal Nehru Medical College","ror":"https://ror.org/03jmdp146","country_code":"IN","type":"education","lineage":["https://openalex.org/I3056136"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Akansha Jain","raw_affiliation_strings":["Moti Lal Nehru Medical College, Prayagraj, India"],"raw_orcid":"https://orcid.org/0009-0004-2646-1582","affiliations":[{"raw_affiliation_string":"Moti Lal Nehru Medical College, Prayagraj, India","institution_ids":["https://openalex.org/I3056136"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5139497098","display_name":"Prakhar Choudhry","orcid":"https://orcid.org/0009-0007-4533-0694","observed_orcids":["https://orcid.org/0009-0007-4533-0694"]},"institutions":[{"id":"https://openalex.org/I2799707979","display_name":"Swami Vivekanand Subharti University","ror":"https://ror.org/053h7gw81","country_code":"IN","type":"education","lineage":["https://openalex.org/I2799707979"]},{"id":"https://openalex.org/I2802464703","display_name":"Max Super Speciality Hospital","ror":"https://ror.org/00e7r7m66","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I2802464703","https://openalex.org/I307255591"]},{"id":"https://openalex.org/I4210140167","display_name":"Subharti Medical College","ror":"https://ror.org/04dagd274","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I4210140167"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Prakhar Choudhry","raw_affiliation_strings":["Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","Max Superspeciality Hospital Vaishali, Ghaziabad, India"],"raw_orcid":"https://orcid.org/0009-0007-4533-0694","affiliations":[{"raw_affiliation_string":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","institution_ids":["https://openalex.org/I2799707979","https://openalex.org/I4210140167"]},{"raw_affiliation_string":"Max Superspeciality Hospital Vaishali, Ghaziabad, India","institution_ids":["https://openalex.org/I2802464703"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5072604306","display_name":"Nidhi Uniyal","orcid":"https://orcid.org/0000-0001-9752-9338","observed_orcids":["https://orcid.org/0000-0001-9752-9338"]},"institutions":[{"id":"https://openalex.org/I60054993","display_name":"Graphic Era University","ror":"https://ror.org/03wqgqd89","country_code":"IN","type":"education","lineage":["https://openalex.org/I60054993"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Nidhi Uniyal","raw_affiliation_strings":["Graphic Era Institute of Medical Sciences, Dehradun, India"],"raw_orcid":"https://orcid.org/0000-0001-9752-9338","affiliations":[{"raw_affiliation_string":"Graphic Era Institute of Medical Sciences, Dehradun, India","institution_ids":["https://openalex.org/I60054993"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5089535563","display_name":"Pankaj Nand Choudhry","orcid":"https://orcid.org/0000-0002-0335-2664","observed_orcids":["https://orcid.org/0000-0002-0335-2664"]},"institutions":[{"id":"https://openalex.org/I2799707979","display_name":"Swami Vivekanand Subharti University","ror":"https://ror.org/053h7gw81","country_code":"IN","type":"education","lineage":["https://openalex.org/I2799707979"]},{"id":"https://openalex.org/I2802464703","display_name":"Max Super Speciality Hospital","ror":"https://ror.org/00e7r7m66","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I2802464703","https://openalex.org/I307255591"]},{"id":"https://openalex.org/I4210140167","display_name":"Subharti Medical College","ror":"https://ror.org/04dagd274","country_code":"IN","type":"healthcare","lineage":["https://openalex.org/I4210140167"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Pankaj N. Choudhry","raw_affiliation_strings":["Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","Max Superspeciality Hospital Vaishali, Ghaziabad, India"],"raw_orcid":"https://orcid.org/0000-0002-0335-2664","affiliations":[{"raw_affiliation_string":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India","institution_ids":["https://openalex.org/I2799707979","https://openalex.org/I4210140167"]},{"raw_affiliation_string":"Max Superspeciality Hospital Vaishali, Ghaziabad, India","institution_ids":["https://openalex.org/I2802464703"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5139509876","display_name":"Shivani Chopra","orcid":"https://orcid.org/0000-0002-2871-086X","observed_orcids":["https://orcid.org/0000-0002-2871-086X"]},"institutions":[{"id":"https://openalex.org/I85461943","display_name":"Saveetha University","ror":"https://ror.org/0034me914","country_code":"IN","type":"education","lineage":["https://openalex.org/I85461943"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Shivani Chopra","raw_affiliation_strings":["Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105, Tamil Nadu, India"],"raw_orcid":"https://orcid.org/0000-0002-2871-086X","affiliations":[{"raw_affiliation_string":"Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105, Tamil Nadu, India","institution_ids":["https://openalex.org/I85461943"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5071544574","display_name":"Hitesh Chopra","orcid":"https://orcid.org/0000-0001-8867-7603","observed_orcids":["https://orcid.org/0000-0001-8867-7603"]},"institutions":[{"id":"https://openalex.org/I74319210","display_name":"Chitkara University","ror":"https://ror.org/057d6z539","country_code":"IN","type":"education","lineage":["https://openalex.org/I74319210"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Hitesh Chopra","raw_affiliation_strings":["Centre for Research Impact & Outcome, Chitkara College of Pharmacy, Chitkara University, Rajpura, 140401, Punjab, India"],"raw_orcid":"https://orcid.org/0000-0001-8867-7603","affiliations":[{"raw_affiliation_string":"Centre for Research Impact & Outcome, Chitkara College of Pharmacy, Chitkara University, Rajpura, 140401, Punjab, India","institution_ids":["https://openalex.org/I74319210"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5139493730","display_name":"Pratik Agarwal","orcid":"https://orcid.org/0000-0002-1304-8332","observed_orcids":["https://orcid.org/0000-0002-1304-8332"]},"institutions":[{"id":"https://openalex.org/I193073490","display_name":"Siksha O Anusandhan University","ror":"https://ror.org/056ep7w45","country_code":"IN","type":"education","lineage":["https://openalex.org/I193073490"]}],"countries":["IN"],"is_corresponding":true,"raw_author_name":"Pratik Agarwal","raw_affiliation_strings":["Department of Psychiatry, Shikha 'O' Anusandhan University, Bhubaneshwar, India","Department of Research, PearResearch, Dehradun, India"],"raw_orcid":"https://orcid.org/0000-0002-1304-8332","affiliations":[{"raw_affiliation_string":"Department of Psychiatry, Shikha 'O' Anusandhan University, Bhubaneshwar, India","institution_ids":["https://openalex.org/I193073490"]},{"raw_affiliation_string":"Department of Research, PearResearch, Dehradun, India","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":8,"corresponding_author_ids":["https://openalex.org/A5139493730"],"corresponding_institution_ids":["https://openalex.org/I193073490"],"apc_list":null,"apc_paid":null,"fwci":5.1039,"has_fulltext":true,"cited_by_count":1,"citation_normalized_percentile":{"value":0.94576668,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":91,"max":95},"biblio":{"volume":"25","issue":null,"first_page":"957","last_page":"971"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10296","display_name":"Vector-borne infectious diseases","score":0.9922000169754028,"subfield":{"id":"https://openalex.org/subfields/2405","display_name":"Parasitology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},"topics":[{"id":"https://openalex.org/T10296","display_name":"Vector-borne infectious diseases","score":0.9922000169754028,"subfield":{"id":"https://openalex.org/subfields/2405","display_name":"Parasitology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T10166","display_name":"Mosquito-borne diseases and control","score":0.002300000051036477,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11899","display_name":"Brucella: diagnosis, epidemiology, treatment","score":0.0012000000569969416,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/scrub-typhus","display_name":"scrub typhus","score":1.0},{"id":"https://openalex.org/keywords/orientia-tsutsugamushi","display_name":"Orientia tsutsugamushi","score":0.925000011920929},{"id":"https://openalex.org/keywords/eschar","display_name":"eschar","score":0.8299999833106995},{"id":"https://openalex.org/keywords/acute-encephalitis-syndrome","display_name":"acute encephalitis syndrome","score":0.9559999704360962},{"id":"https://openalex.org/keywords/acute-respiratory-distress-syndrome","display_name":"acute respiratory distress syndrome","score":0.9940000176429749},{"id":"https://openalex.org/keywords/acute-kidney-injury","display_name":"acute kidney injury","score":1.0},{"id":"https://openalex.org/keywords/multiple-organ-failure","display_name":"multiple organ failure","score":0.8880000114440918},{"id":"https://openalex.org/keywords/serological-cross-reactivity","display_name":"serological cross-reactivity","score":0.8259999752044678},{"id":"https://openalex.org/keywords/doxycycline","display_name":"doxycycline","score":0.8579999804496765},{"id":"https://openalex.org/keywords/delayed-diagnosis","display_name":"delayed diagnosis","score":0.675000011920929},{"id":"https://openalex.org/keywords/young-adults","display_name":"young adults","score":0.5979999899864197},{"id":"https://openalex.org/keywords/fatal-outcome","display_name":"fatal outcome","score":0.5609999895095825},{"id":"https://openalex.org/keywords/zoonoses","display_name":"zoonoses","score":0.6489999890327454}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8902999758720398},{"id":"https://openalex.org/C2776407475","wikidata":"https://www.wikidata.org/wiki/Q1981783","display_name":"Pathognomonic","level":3,"score":0.7494000196456909},{"id":"https://openalex.org/C2779528086","wikidata":"https://www.wikidata.org/wiki/Q1194496","display_name":"Scrub typhus","level":2,"score":0.733299970626831},{"id":"https://openalex.org/C2781107259","wikidata":"https://www.wikidata.org/wiki/Q5508364","display_name":"Fulminant","level":2,"score":0.6385999917984009},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.5745999813079834},{"id":"https://openalex.org/C2780823208","wikidata":"https://www.wikidata.org/wiki/Q3018329","display_name":"Orientia tsutsugamushi","level":3,"score":0.5652999877929688},{"id":"https://openalex.org/C2776348555","wikidata":"https://www.wikidata.org/wiki/Q344873","display_name":"ARDS","level":3,"score":0.557699978351593},{"id":"https://openalex.org/C2779673711","wikidata":"https://www.wikidata.org/wiki/Q2633267","display_name":"Atypical pneumonia","level":3,"score":0.5133000016212463},{"id":"https://openalex.org/C2780472472","wikidata":"https://www.wikidata.org/wiki/Q424337","display_name":"Acute kidney injury","level":2,"score":0.5116000175476074},{"id":"https://openalex.org/C45189115","wikidata":"https://www.wikidata.org/wiki/Q502159","display_name":"Serology","level":3,"score":0.42149999737739563},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.42089998722076416},{"id":"https://openalex.org/C2778033228","wikidata":"https://www.wikidata.org/wiki/Q155098","display_name":"Leptospirosis","level":2,"score":0.4077000021934509},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.4020000100135803},{"id":"https://openalex.org/C83455156","wikidata":"https://www.wikidata.org/wiki/Q199615","display_name":"Encephalitis","level":3,"score":0.36640000343322754},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.3346000015735626},{"id":"https://openalex.org/C141983124","wikidata":"https://www.wikidata.org/wiki/Q188008","display_name":"Respiratory distress","level":2,"score":0.3310000002384186},{"id":"https://openalex.org/C81182388","wikidata":"https://www.wikidata.org/wiki/Q353963","display_name":"Complication","level":2,"score":0.32330000400543213},{"id":"https://openalex.org/C2777914695","wikidata":"https://www.wikidata.org/wiki/Q12192","display_name":"Pneumonia","level":2,"score":0.32269999384880066},{"id":"https://openalex.org/C2776353676","wikidata":"https://www.wikidata.org/wiki/Q182672","display_name":"Zoonosis","level":2,"score":0.3212999999523163},{"id":"https://openalex.org/C2780875844","wikidata":"https://www.wikidata.org/wiki/Q186235","display_name":"Myocarditis","level":2,"score":0.3206999897956848},{"id":"https://openalex.org/C2779744138","wikidata":"https://www.wikidata.org/wiki/Q961326","display_name":"Oliguria","level":3,"score":0.32010000944137573},{"id":"https://openalex.org/C137627325","wikidata":"https://www.wikidata.org/wiki/Q156318","display_name":"Etiology","level":2,"score":0.3086000084877014},{"id":"https://openalex.org/C2776779939","wikidata":"https://www.wikidata.org/wiki/Q1479485","display_name":"Hypoxemia","level":2,"score":0.3070000112056732},{"id":"https://openalex.org/C520017518","wikidata":"https://www.wikidata.org/wiki/Q178934","display_name":"Occult","level":3,"score":0.3068000078201294},{"id":"https://openalex.org/C2777234017","wikidata":"https://www.wikidata.org/wiki/Q1345792","display_name":"Goodpasture syndrome","level":5,"score":0.30570000410079956},{"id":"https://openalex.org/C2780873365","wikidata":"https://www.wikidata.org/wiki/Q496812","display_name":"Leukopenia","level":3,"score":0.299699991941452},{"id":"https://openalex.org/C2779379848","wikidata":"https://www.wikidata.org/wiki/Q917069","display_name":"Rhabdomyolysis","level":2,"score":0.29840001463890076},{"id":"https://openalex.org/C2780542935","wikidata":"https://www.wikidata.org/wiki/Q133841","display_name":"Leptospira","level":3,"score":0.2980000078678131},{"id":"https://openalex.org/C2777179404","wikidata":"https://www.wikidata.org/wiki/Q422442","display_name":"Doxycycline","level":3,"score":0.2858000099658966},{"id":"https://openalex.org/C2779215961","wikidata":"https://www.wikidata.org/wiki/Q310904","display_name":"Mycoplasma pneumoniae","level":3,"score":0.2849000096321106},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.27619999647140503},{"id":"https://openalex.org/C2778653478","wikidata":"https://www.wikidata.org/wiki/Q1054718","display_name":"Kidney disease","level":2,"score":0.26010000705718994},{"id":"https://openalex.org/C203014093","wikidata":"https://www.wikidata.org/wiki/Q101929","display_name":"Immunology","level":1,"score":0.2599000036716461},{"id":"https://openalex.org/C2778101375","wikidata":"https://www.wikidata.org/wiki/Q2845432","display_name":"Ehrlichiosis","level":3,"score":0.2574000060558319},{"id":"https://openalex.org/C2779310458","wikidata":"https://www.wikidata.org/wiki/Q1405631","display_name":"Fever of unknown origin","level":2,"score":0.2522999942302704},{"id":"https://openalex.org/C2909063110","wikidata":"https://www.wikidata.org/wiki/Q5348629","display_name":"Ehrlichia chaffeensis","level":4,"score":0.25220000743865967}],"mesh":[],"locations_count":5,"locations":[{"id":"doi:10.17179/excli2026-9514","doi":"https://doi.org/10.17179/excli2026-9514","is_oa":true,"landing_page_url":"https://doi.org/10.17179/excli2026-9514","pdf_url":null,"source":{"id":"https://openalex.org/S39273986","display_name":"EXCLI journal","issn_l":"1611-2156","issn":["1611-2156"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","ddh","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313779","host_organization_name":"IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund","host_organization_lineage":["https://openalex.org/P4310313779"],"host_organization_lineage_names":["IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"EXCLI Journal","raw_type":"journal-article"},{"id":"pmh:oai:www.excli.de:article/9514","doi":null,"is_oa":true,"landing_page_url":"https://www.excli.de/excli/article/view/9514","pdf_url":"https://www.excli.de/excli/article/download/9514/5739","source":{"id":"https://openalex.org/S39273986","display_name":"EXCLI journal","issn_l":"1611-2156","issn":["1611-2156"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","ddh","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313779","host_organization_name":"IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund","host_organization_lineage":["https://openalex.org/P4310313779"],"host_organization_lineage_names":["IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"1611-2156","raw_type":"info:eu-repo/semantics/article"},{"id":"pmid:42459935","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42459935","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"EXCLI journal","raw_type":"Case Reports"},{"id":"pmh:oai:pubmedcentral.nih.gov:13369890","doi":null,"is_oa":true,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42459935/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"EXCLI J","raw_type":"Text"},{"id":"doi:10.17179/excli2026-9514","doi":"https://doi.org/10.17179/excli2026-9514","is_oa":true,"landing_page_url":"https://doi.org/10.17179/excli2026-9514","pdf_url":null,"source":{"id":"https://openalex.org/S7407053513","display_name":"Leibniz-Institut f\u00fcr Arbeitsforschung an der TU Dortmund (IfADo)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"article-journal"}],"best_oa_location":{"id":"doi:10.17179/excli2026-9514","doi":"https://doi.org/10.17179/excli2026-9514","is_oa":true,"landing_page_url":"https://doi.org/10.17179/excli2026-9514","pdf_url":null,"source":{"id":"https://openalex.org/S39273986","display_name":"EXCLI journal","issn_l":"1611-2156","issn":["1611-2156"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","ddh","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313779","host_organization_name":"IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund","host_organization_lineage":["https://openalex.org/P4310313779"],"host_organization_lineage_names":["IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"EXCLI Journal","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/case-report","display_name":"Case Report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7166331371.pdf","grobid_xml":"https://content.openalex.org/works/W7166331371.grobid-xml"},"referenced_works_count":16,"referenced_works":["https://openalex.org/W146569882","https://openalex.org/W2057062947","https://openalex.org/W2087025094","https://openalex.org/W2169672577","https://openalex.org/W2419097521","https://openalex.org/W2607912825","https://openalex.org/W2744204647","https://openalex.org/W2758910468","https://openalex.org/W2937458136","https://openalex.org/W2984297705","https://openalex.org/W2995803175","https://openalex.org/W3103409265","https://openalex.org/W3105491562","https://openalex.org/W3184789847","https://openalex.org/W4322719497","https://openalex.org/W4402905178"],"related_works":["https://openalex.org/W7160047081","https://openalex.org/W4402905178","https://openalex.org/W3162804083","https://openalex.org/W7214106616","https://openalex.org/W2234476661","https://openalex.org/W4282002085","https://openalex.org/W3097673365","https://openalex.org/W2092936287","https://openalex.org/W3025219535","https://openalex.org/W2021018925"],"abstract_inverted_index":{"Scrub":[0],"typhus":[1,151],"is":[2,206],"a":[3,207],"re-emerging":[4],"but":[5],"often":[6],"underdiagnosed":[7],"tropical":[8],"zoonosis":[9],"in":[10,101,161,181],"India.":[11],"Its":[12],"clinical":[13,128],"heterogeneity,":[14],"serological":[15],"overlap":[16],"with":[17,48,67,113,132,164],"other":[18],"endemic":[19,172],"infections,":[20],"and":[21,31,39,45,51,83,96,116,138,146,152,189],"frequent":[22],"absence":[23,183],"of":[24,57,71,92,125,149,157,184,196,211],"pathognomonic":[25],"signs":[26],"contribute":[27],"to":[28,135],"delayed":[29],"diagnosis":[30],"high":[32],"complication":[33],"rates.":[34],"Central":[35],"nervous":[36],"system,":[37],"pulmonary,":[38,167],"renal":[40,169],"involvement":[41],"signify":[42],"severe":[43,212],"disease":[44],"are":[46],"associated":[47],"considerable":[49],"morbidity":[50],"mortality.":[52],"We":[53],"describe":[54],"three":[55],"cases":[56,142],"previously":[58],"healthy":[59],"young":[60],"adult":[61],"males":[62],"(ages":[63],"24-32)":[64],"who":[65],"presented":[66],"severe,":[68],"organ-threatening":[69],"complications":[70],"scrub":[72,150,202],"typhus:":[73],"acute":[74,78,84],"encephalitis":[75],"syndrome":[76,81],"(AES),":[77],"respiratory":[79],"distress":[80],"(ARDS),":[82],"kidney":[85],"injury":[86],"(AKI).":[87],"All":[88],"patients":[89,163],"had":[90],"evidence":[91],"systemic":[93],"inflammation,":[94],"thrombocytopenia,":[95],"multiorgan":[97,139],"dysfunction.":[98],"Eschars-although":[99],"present":[100],"all":[102],"cases-were":[103],"initially":[104],"missed":[105],"or":[106,168],"overlooked,":[107],"delaying":[108],"causal":[109],"diagnosis.":[110],"Serologic":[111],"cross-reactivity":[112],"dengue,":[114],"chikungunya,":[115],"leptospira":[117],"further":[118],"complicated":[119],"early":[120,123],"recognition.":[121],"Despite":[122],"initiation":[124],"doxycycline":[126,175],"upon":[127],"suspicion,":[129],"one":[130],"patient":[131],"ARDS":[133],"succumbed":[134],"progressive":[136],"hypoxemia":[137],"failure.":[140],"These":[141],"underscore":[143],"the":[144,154,182,192],"protean":[145],"fulminant":[147],"nature":[148],"highlight":[153],"diagnostic":[155],"importance":[156],"thorough":[158],"skin":[159],"examination":[160],"febrile":[162,213],"unexplained":[165],"CNS,":[166],"involvement.":[170],"In":[171],"settings,":[173],"empiric":[174],"should":[176],"be":[177],"considered":[178],"early,":[179],"even":[180],"classical":[185],"signs.":[186],"Early":[187],"recognition":[188],"treatment":[190],"remain":[191],"most":[193],"critical":[194],"determinants":[195],"survival.":[197],"Our":[198],"experience":[199],"reinforces":[200],"that":[201],"typhus,":[203],"though":[204],"elusive,":[205],"potentially":[208],"treatable":[209],"cause":[210],"illness":[214],"when":[215],"promptly":[216],"identified.":[217]},"counts_by_year":[{"year":2026,"cited_by_count":1}],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-06-28T00:00:00"}