▁ch ig gers . ▁The ▁inc idence ▁is ▁increasing ▁in ▁the ▁southern ▁part ▁of ▁the ▁Indian ▁sub cont inent ▁and ▁in ▁northern ▁areas ▁around ▁Dar je eling . ▁ ▁Di agn osis ▁ ▁In ▁en demic ▁areas , ▁diagn osis ▁is ▁generally ▁made ▁on ▁clin ical ▁grounds ▁alone . ▁ ▁However , ▁over shadow ing ▁of ▁the ▁diagn osis ▁is ▁quite ▁often ▁as ▁the ▁clin ical ▁sympt oms ▁overlap ▁with ▁other ▁inf ect ious ▁dise ases ▁such ▁as ▁ ▁den gue ▁fe ver , ▁par aty ph oid , ▁and ▁py re x ia ▁of ▁unknown ▁origin ▁( PU O ). ▁If ▁the ▁es char ▁can ▁be ▁identified , ▁it ▁is ▁quite ▁di agnostic ▁of ▁scr ub ▁ty ph us , ▁but ▁this ▁is ▁very ▁un re li able ▁in ▁the ▁native ▁population ▁who ▁have ▁dark ▁skin , ▁and ▁moreover , ▁the ▁site ▁of ▁es char ▁which ▁is ▁usually ▁where ▁the ▁m ite ▁bit es ▁is ▁often ▁located ▁in ▁covered ▁areas . ▁Unless ▁it ▁is ▁act ively ▁searched ▁for , ▁the ▁es char ▁most ▁likely ▁would ▁be ▁missed . ▁History ▁of ▁m ite ▁b ite ▁is ▁often ▁absent ▁since ▁the ▁b ite ▁does ▁not ▁inf lict ▁pain ▁and ▁the ▁mit es ▁are ▁almost ▁too ▁small ▁to ▁be ▁seen ▁by ▁the ▁n aked ▁eye . ▁Usually , ▁scr ub ▁ty ph us ▁is ▁often ▁label led ▁as ▁P U O ▁in ▁remote ▁en demic ▁areas , ▁since ▁blood ▁culture ▁is ▁often ▁negative , ▁yet ▁it ▁can ▁be ▁treated ▁effectively ▁with ▁ch lor am phen