Within the last few years there has been an increase of reports of scrub typhus-like cases outside the traditional Asian-Pacific geographic triangle. The observation of divergent genetic types indicate that the genus Orientia may not be confined to the Tsutsugamushi triangle. Two forms have already been confirmed. One, named Candidatus Orientia chuto, was isolated from a patient who visited Dubai, United Arab Emirates (UAE). The genome sequence of Candidatus O. chuto has already been determined, and shows significant divergence from the genome sequences of various isolates of O. tsutsugamushi. A second divergent type has been observed in Chile.
Serological evidence suggests that divergent scrub typhus-like exist in areas such as South America, and Africa. Less well defined evidence suggests the possibility of scrub typhus-like microbes in a number of localities. The map below indicates possible localities that have been the source of scrub typhus-like diseases that cannot be attributed solely to travel related acquisition of infection.
From Luce-Fedrow et al. 2018.