I found one uniqueness in worldwide touhou fan vs japanese fan.
Japanese fan of touhou, tend to make doujinshi game that it isnt even danmaku like touhou main game itself, i mostly see the doujinshi is a hack version like touhoumon or not even a danmakufu itself. The danmakufu engine(I dont know, who made this actually? ZUN himself?, i need reference) like game that is inspired by touhou, is small i cant even find it. The closest one to it, is mostly fanmade phantasm stage of the main game. Its strange, that even though they can make fanmade phantasm stage like this, then why dont they make more danmakufu game? And they also tend to moe-ing the character...
Western fan instead, make a fangame that is using danmakufu but only a shy of them make game that is using touhou character. AN example can be seen in this forum, at tika and nitori section, most of the thread i see is a script boss or a danmakufu game but a story that is completely original, or part-touhou.