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Background: scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi, poses a diagnostic challenge in endemic regions due to its diverse clinical presentations and similarity to other infections. Regional epidemiologic data are vital for improving clinical suspicion and prompt management of scrub typhus. Materials and Methods: a retrospective observational study was conducted in the Department of Microbiology at Indira Gandhi Government Medical College, Nagpur, Maharashtra, between December 2021 and June 2025. A total of 5,262 suspected cases were screened using Immunochromatographic Tests (ICT) for Immunoglobulin M (IgM) and Immunoglobulin G (IgG), with IgM positive results confirmed by IgM Enzyme-Linked Immunosorbent Assay (ELISA). Data on demographics, clinical features, and laboratory results were analyzed using chi-square statistics. Results: out of 5,262 patients, 96 (1.82%) were confirmed as seropositive for scrub typhus. The highest annual positivity was in 2022. Most cases were from males aged 20-50 years, and 72% resided in rural areas. Seasonal peaks were observed in July and August. Fever, myalgia, and rash were common symptoms, while eschar was found in 28% of cases. Complications included pneumonitis, renal failure, and Acute Respiratory Distress Syndrome (ARDS), with no reported mortality. Conclusions: scrub typhus prevalence was lower than in prior Indian studies, likely due to regional distribution and increased post-COVID testing. The combination of rapid ICT and ELISA enhanced diagnostic accuracy. Early suspicion, timely doxycycline therapy, and improved diagnostics are essential for reducing morbidity. Continued research and expanded surveillance are needed for robust disease control.