Diagnosis
In the differential diagnosis the limited geographical distribution should prevent error and, in particular, where one has the initial necrotic ulcer, with enlargement of the glands draining the region in which it is located, there should be little confusion. Of course plague may have a primary vesicle or ulcer with enlargement of neighboring glands; these glands however are matted together and are exquisitely tender.
Then too the eruption of tsutsugamushi and the early and more stuporous state of plague should differentiate, even without the aid of the laboratory.
It is usual to consider tsutsugamushi, typhus fever and spotted fever of the Rocky Mountains as having many characteristics in common. These diseases may best be differentiated by the fever course and eruption as shown in the following table:
| Fever course | Eruption | |
| Tsutsugamushi | Fever increases each day until reaching maximum about 4th or 5th day. Fall by lysis after fading of eruption. | Begins on face, then chest, legs, forearms and trunk. Does not become petechial. First appears about 7th day. |
| Tabardillo. Typhus fever. Brill’s disease. | Onset and termination of fever characterized by considerable abruptness. | Begins on abdomen, sides of chest, thence going to extremities. Petechial tendency. First appears about 5th day. |
| Spotted fever of the Rocky Mountains. | Gradual rise during a week with lysis. | Begins on forearms and leg. Petechial tendency. May have gangrene of prepuce and scrotum. First appears on 2d to 5th day. |
Treatment
There is no specific treatment. It may be necessary to use drugs to combat the insomnia.
The serum of monkeys which have recovered from the disease seems to have some value.