Recent studies delineating bacterial causes of fever in rural Asia indicate a major role for several previously under-recognized pathogens, including Rickettsia and Leptospira. The use of blood culture for the first time to investigate patients with febrile illness in rural Asia has also revealed some unexpected findings, e.g. Staphylococcus aureus is the major cause of bacteraemia in children aged <1 year in Laos. The spread of antimicrobial-resistant pathogens such as MRSA into rural Asia has already occurred and requires monitoring. These factors have major implications for empirical therapy of fever. Initiatives are urgently needed to strengthen the infrastructure of microbiology in rural Asia.