ReviewClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Scrub Typhus and the Misconception of Doxycycline Resistance.
Review in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Systematic review of the scrub typhus treatment landscape: Assessing the feasibility of an individual participant-level data (IPD) platform.PLoS neglected tropical diseases · 2021Pooled it
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Antibiotic Antagonism inInfection & chemotherapy · 2026Review
- Evaluation of Oral Doxycycline, Azithromycin, or Sequential Doxycycline-Azithromycin Treatment for Scrub Typhus.Mediterranean journal of hematology and infectious diseases · 2026Article
- Development and internal validation of clinical prediction models for scrub typhus and doxycycline-treatable causes in paediatric acute encephalitis syndrome in Karnataka, India: a multicentre, prospective study.The Lancet regional health. Southeast Asia · 2025Article
- Beyond the Fever: A Serial Report on Moderate to Severe Murine Typhus Cases and Diagnostic Hurdles in Indonesia.Tropical medicine and infectious disease · 2025Article
- Associations of greenhouse gases, air pollutants and dynamics of scrub typhus incidence in China: a nationwide time-series study.BMC public health · 2025Article
- Retrospective analysis of spatiotemporal variation of scrub typhus in Yunnan Province, 2006-2022.PLoS neglected tropical diseases · 2024Article
- Orientia tsutsugamushi: An Unusual Intracellular Bacteria-Adaptation Strategies, Available Antibiotics, and Alternatives for Treatment.Current microbiology · 2024Review
- Gaps and inconsistencies in the current knowledge and implementation of biosafety and biosecurity practices for rickettsial pathogens.BMC infectious diseases · 2024Review
- Atypical presentation and response to treatment in scrub typhus: a series of 2 cases.Sudanese journal of paediatrics · 2024Article
- Scrub typhus, a salient threat: Needs attention.PLoS neglected tropical diseases · 2023Article
- Host transcriptomic profiling of CD-1 outbred mice with severe clinical outcomes following infection with Orientia tsutsugamushi.PLoS neglected tropical diseases · 2022Article
- Comparison of Lethal and Nonlethal Mouse Models ofTropical medicine and infectious disease · 2021Article
- Article
- A Brief History of the Major Rickettsioses in the Asia-Australia-Pacific Region: A Capstone Review for the Special Issue ofTropical medicine and infectious disease · 2020Review
- The neglected challenge: Vaccination against rickettsiae.PLoS neglected tropical diseases · 2020Review
- Reply to Watt.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Hacking the host: exploitation of macrophage polarization by intracellular bacterial pathogens.Pathogens and disease · 2020Review
- Vector-borne diseases in pregnancy.Therapeutic advances in infectious diseaseReview
Corrections and comments
- Commented on byReply to Watt.2020
- Commented on by
Authors and funding
5 authors at 3 institutions in 4 countries.
Funding
Abstract
Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi, is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi, assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.