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Background: For both dengue and scrub typhus, acute respiratory failure (ARF) is a serious complication. The present study was carried out in order to investigate the clinical courses and outcomes of adult dengue and scrub typhus patients with ARF, and to identify the clinical differences between adult dengue and scrub typhus patients with ARF. Methods: We conducted a retrospective study of the serologically confirmed adult dengue or scrub typhus patients admitted between 1998 and 2008 at Kaohsiung Chang Gung Memorial Hospital. A total of 980 dengue and 102 scrub typhus adult patients were included in our study. Results: Eighteen of the 980 adult dengue patients and 8 of the 102 adult scrub typhus patients had ARF. There were significant differences that existed for eschar ( P = 0.001; dengue 0%; scrub 62.5%), cough ( P = 0.016; dengue 55.6%; scrub typhus 100%), white blood cell (WBC) count [ P = 0.026; dengue 7.40 ± 5.74; scrub typhus 11.84 ± 4.95 (×10/μL)], platelet count [ P = 0.008; dengue 42.2 ± 33.9; scrub typhus 104.1 ± 93.3 (×10/L)], prothrombin time (PT) [ P = 0.007; dengue 12.82 ± 1.36; scrub typhus 10.74 ± 0.98 (s)], activated partial thromboplastin time (APTT) [ P = 0.002; dengue 50.81 ± 10.08; scrub typhus 37.44 ± 4.06 (s)], blood urea nitrogen (BUN) [ P < 0.001; dengue 64.6 ± 43.2; scrub typhus 20.9 ± 9.1 (mg/dL)], creatinine [ P < 0.001; dengue 3.77 ± 3.37; scrub typhus 1.05 ± 0.37 (mg/dL)], admission day (A-day) [ P = 0.027; dengue 2.9 ± 1.3; scrub typhus 5.4 ± 2.6 (days)], and ventilator duration [ P = 0.022; dengue 9.4 ± 14.0; scrub typhus 14.8 ± 10.4 (days)] between both groups. Conclusions: This study provides relatively rare data regarding the clinical differences between adult dengue and scrub typhus patients with ARF. [ABSTRACT FROM AUTHOR]