A papule forms at the site of the mite bite and develops a central vesicle that becomes a painless black-crusted eschar surrounded by an erythematous halo. Lymph nodes draining the region of the eschar enlarge.

• After an incubation period of 10-17 days, malaise, chills, fever, headache, and myalgia mark disease onset.
• A macular rash appears on day 2-6 of illness and evolves sequentially into papules, vesicles, and crusts that heal without scarring.
• If untreated, fever lasts 6-10 days.