An acute febrile illness transmitted by mites. An initial skin lesion at the site of a mite bite, often associated with lymphadenopathy, is followed by fever; a disseminated vesicular skin rash appears, which generally does not involve the palms and soles, and lasts only a few days. It may be confused with chickenpox. Death is uncommon, and the infection is responsive to tetracyclines—though these cannot be used in children less than eight years of age. Acute hepatitis may be one of the leading symptoms before development of specific vesicular rash. Diagnosis is made by serology or by PCR, or by immunostains of biopsied tissues.