A large number of patients present to Indian hospitals with acute febrile illness and multisystem involvement. Acute kidney injury is an important component. Clinical manifestations do not allow distinction between infectious etiologies with overlapping presentations. Many of the cases remain undiagnosed and therefore are not treated, resulting in high mortality. Despite having all the elements of endemicity, scrub tuphus, caused by the rickettsia and transmitted to humans by the bites of trombiculid mite, is not regognized in Indian hospitals due to non-availability of locally validated diagnostic tests. Previous reports have been limited to serologyic testing, with high false positives due to past exposure rather than acute infection. Moreover, kidney involvement in this condition is not well known. We looked for scrub typhus DNA in 201 patients with an acute febrile illness. About 25% tested positive; kidney involvement was seen in over 80%, and acute kidney injury in 53%. Acute kidney injury was a predictor of mortality. All these are new findings of public health importance and suggest the need to include testing for this condition in the diagnostic armanetarium and development of local serological cutoffs.