The etiologic agent is Rickettsia akari, transmitted from the common house mouse to the patient via the hematophagous (bloodsucking) mite Liponyssoides sanguineus.
Few to many papulovesicles often accompanied by fever, malaise, and myalgia is characteristic. An eschar at the site of the mite bite may precede the eruption. Most cases are probably misdiagnosed as chickenpox which might be excluded by a negative Tzanck smear, DFA or culture of a blister. The diagnosis may be confirmed by an increase in serum antibody titers against R. akari in the convalescent phase.
The eruption is self-limited but responds to tetracycline.
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