A 10-day-old male presented with high-grade fever and jaundice for six days and seizures for two days. On examination, the baby was febrile, irritable, icteric, and hepatomegaly without eschar, rash, or petechiae. The abdomen was distended. The axillary temperature was 39.3  C, the pulse rate was 176/min, and the respiration rate was 46/min. A complete blood count showed that the white blood cells (WBCs) count was 24.76x109/L with 76.4% lymphocytes, 12.1% neutrophils, and 8.1% monocytes. Tests showed that the total bilirubin level was 87.4 micromol/L, aspartate aminotransferase level was 336.6 U/L, alanine aminotransferase level was 1317.1 U/L, and lactate dehydrogenase level was 1477.6 U/L. Cerebrospinal fluid (CSF) examination showed a WBC count at 283x106/L with 95.1% mononuclear cells, 4.9% polymorphonuclear neutrophils, a protein concentration of 3.084 g/L and a glucose concentration of 1.18 mmol/L. Computed tomography (CT) showed patchy low-density areas in the bilateral frontal, temporal, and parietal lobes (Figure 1A). Tests for malaria, dengue, toxoplasmosis, leptospirosis, mycobacterium tuberculosis, rubella, cytomegalovirus, herpes simplex virus, and Japanese encephalitis virus were negative. A diagnosis of neonatal bacterial meningitis was made, and the patient was started on cefotaxime sodium combined with ampicillin and phenobarbital to control fever and seizures. On the third day of admission, his seizures and jaundice had subsided, but the fever persisted, and the CSF still showed abnormalities. We re-evaluated the family history and found that the patient's mother had anemia (Hb: 73 g/L) since the 28th week of pregnancy and reversed fever of unknown origin from three days before delivery to postpartum. On examination, there was an 1.2x0.8 cm eschar on her left groin (Figure 1B). The Weil-Felix test was positive for OXK 1:640 and 1:160 in the mother and baby, respectively, and both had positive IgM-ELISA 1:160 to the Karp antigen. Meanwhile, Metagenomic next-generation sequencing (mNGS) was positive for Orientia tsutsugamushi in both mother and baby (Supplementary Material). The final diagnosis of the baby was congenital infection of scrub typhus with bacterial meningitis. His treatment was immediately adjusted to intravenous azithromycin 10 mg/kg/day for three weeks and oral azithromycin for one week, and his mother was treated with oral tetracycline. After treatment, the baby and his mother's condition improved and stabilized. During the 4 weeks of hospitalization, the EEG, MRI, psychomotor assessment and Griffiths assessment were normal. No neurological sequelae were found after 6 months of follow-up. Written informed consent was obtained from the child's parents.