Background: There has been a gross under diagnosis of scrub typhus cases in India due to its non-specific and diverse clinical presentations, limited awareness, lack of high index of suspicion, and limited number of clinical studies. An early diagnosis and prompt institution of treatment can avert significant morbidity and mortality. Materials and Methods: This was an observational study of prospective design conducted in the Department of General Medicine, Government Medical College, Kozhikode over a period of 1½ years from 1^st January 2012 to 31^st June 2013. Patients with clinical features suggestive of scrub typhus with positive Weil-Felix OXK ≥160 or 4 fold increase in titre and/or positive IgM ELISA for scrub typhus were included in the study. Results: Out of 70 patients with clinical features suggestive of scrub typhus, 39 (56%) were males, and 31 (44%) were females. Most cases occurred during the cooler months of the year (October to February). Fever was the most prominent symptom (100%) followed by headache in 68 (98.6%) patients. The most common physical sign was lymphadenopathy in 44 (62.8%) cases, eschar was present in 32 (45.7%) cases with groin being the most common site (31.3%). Leucocytosis was observed in 28 (40%) and was associated with statistically significant mortality rate and increased complications like meningoencephalitis. Mortality rate was also higher in the patients with erythrocyte sedimentation rate >100 (46.2%) (P = 0.002) and in patients with serum albumin <2 g% (66.7%) (P = 0.001). An association between low serum albumin (<2 g%) and myocarditis was also observed. The complications observed in our study were myocarditis in 17.1%, meningoencephalitis in 14.3%, acute kidney injury in 44.3%, and adult respiratory distress syndrome in 8.5%. Totally, 62 (88.6%) patients responded to Doxycycline whereas 8 (11.4%) showed no response and were treated with Azithromycin or Chloramphenicol. There is an emerging resistance to Doxycycline in the community. The case fatality rate was 14.3%.