A 26-year-old, intermittently febrile woman returned from the West to Boston, where a diagnosis of relapsing fever was established. The infection should be considered in travelers from the western states who manifest recurrent fever and weakness, often with splenomegaly and rash. The diagnosis is most directly established by demonstrating spirochetes in properly stained blood smears during the febrile periods.
Goodman RL, Arndt KA, Steigbigel NH. Borrelia in Boston. JAMA. 1969;210(4):722–724. doi:10.1001/jama.1969.03160300062020