Scrub typhus is a re-emerging zoonotic disease caused by Orientia tsutsugamushi, an obligate intracellular bacterium transmitted through the bite of infected chigger mites. Over the past decade, it has become an important cause of acute undifferentiated fever in many parts of India, including Telangana, with most cases occurring during the monsoon and post-monsoon seasons. Diagnosis is often challenging because the clinical signs resemble those of dengue, malaria, leptospirosis, typhoid and other febrile illnesses, while the characteristic eschar is not present in every patient. In Telangana, widespread agricultural activities, scrub vegetation, forest margins, abundant rodent hosts, and favourable climatic conditions support the survival of chigger mites and facilitate disease transmission. As a result, scrub typhus is being recognized as an emerging public health concern, particularly among rural and occupationally exposed populations. Timely diagnosis using IgM ELISA or molecular methods, together with early treatment using doxycycline, can prevent severe complications and significantly reduce mortality. This review outlines the current understanding of the epidemiology, risk factors, clinical features, diagnosis, treatment, and prevention of scrub typhus, with special emphasis on Telangana. It also highlights the importance of climate-sensitive surveillance and a One Health approach that integrates human, animal, and environmental health for effective disease control.