The electrocardiographic (EKG) manifestations of scrub typhus were prospectively evaluated in 29 adult patients who acquired Orientia tsutsugamushi infection in Chiang Rai, Northern Thailand. EKGs were normal in 22 of the 29 patients (76%); minor non-specific changes were found in the other 7 patients; ie ST segment/T wave changes (10%), U waves (7%), and premature ventricular contractions (4%). These results suggest that EKG changes in scrub typhus acquired in areas of diminished antibiotic susceptibility are similar to those observed in O. tsutsugamushi infection acquired elsewhere.