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The occasion for differential diagnosis between typhus fever and Rocky Mountain spotted fever has recently assumed importance. Although it is stated in current textbooks1 that the likelihood of encountering both typhus and spotted fever in the same locality is extremely unlikely, newer studies have revealed that spotted fever is not localized in the Northwest but that a distinct variety is widespread east of the Appalachian Mountains.2 Cases have also been reported in Texas.3 Typhus fever, on the other hand, has been observed not only in the East and Southeast but also in California, in Minnesota4 and as far north as Montreal.5 The diagnosis of the latter two cases, however, was not proved. The Minnesota case was diagnosed on clinical grounds alone in 1915 before refinements for laboratory diagnosis had been developed. The case observed in Montreal was diagnosed from clinical and pathologic data, but no
REIMANN HA, ULRICH HL, FISHER LC. DIFFERENTIAL DIAGNOSIS BETWEEN TYPHUS AND SPOTTED FEVER: REPORT OF A CASE AND THE ISOLATION OF A NEW MILD TYPE OF SPOTTED FEVER VIRUS. JAMA. 1932;98(22):1875–1879. doi:10.1001/jama.1932.02730480025006
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