The Pondicherry Institute of Medical Sciences is a 550- bedded teaching hospital serving the coastal town of Pondicherry and surrounding districts of Tamil Nadu with a population of nearly seven million. We did a retrospective analysis of all adult cases (≥16 years) of scrub typhus that were admitted in the hospital between February 2011 and January 2012. Computerized records of the Medical Records Department were searched using the terms, “scrub typhus”, “typhus”, “scrub typhus meningitis” and “rickettsial meningitis”. Confirmed cases of scrub typhus were selected based on a positive scrub IgM ELISA (Scrub Typhus Detect™ IgM ELISA, InBios India, detecting IgM antibodies to Orientia tsutsugamushi derived recombinant antigens), a positive Weil-Felix test (WFT), the presence of an eschar or a combination of the three in a patient with an acute febrile illness. Probable cases of scrub typhus without any of the above three were excluded from the study even if recovery following doxycycline was noted. Sixty nine adult cases were found- 65 of scrub typhus, three of Indian tick typhus and one of endemic typhus with none of the four having meningitis. There were no pediatric cases found during the study period. Sixty five cases were included in the study and divided into two groups based on the presence or absence of meningitis. The remaining four patients without scrub typhus