11), both from Levice (Table 1) A certain cross-reactivity with

11), both from Levice (Table 1). A certain cross-reactivity with other rickettsia-tested bacteria was detected, for example samples Nos 3, 5, 23, and 32, which also reacted with Bartonella and Borrelia antigens. However, the spectrum of detected bacteria was larger: one Bartonella henselae (no. 2, from the village of Plášt’ovce), two Bartonella quintana (no. 3 from the city of

Levice and no. 2 from Plášt’ovce), three Bartonella grahamii (no. 2 from Levice, no. 23 from Kukučínov, and no. 34 from Nové Zámky,) and four Bartonella elisabethae (no. 3 from Levice, no. 23 from Kukučínov, find more no. 32 from Svodín, and no. 34 from Nové Zámky) cases supposedly had positive IFA titers (≥ 1 : 50) (Fig. 1). In one serum of a patient from the city

of Levice (no. 5, Fig. 2) both Borrelia burgdorferi and Borrelia recurrentis antigens were recognized. Cross-reaction with Borrelia and Bartonella was seen in case no. 18 from Plášt’ovce. The same titer range as above was used to detect two C. burnetii-specific cases identified with phase I and phase II antigens (no. 37 from the village of Zemné, county of Nové Zámky, and no. 47 from the village of Vinice, county of Vel’ký Krtíš). The only Franciscella-positive serum sample originated from the city of Levice (no. 2). The problems of interpreting conventional diagnostic serology results highlight the need for diagnostics Cobimetinib in vivo with genetic and/or antigenic targets. PCR amplification of blood samples has the advantage of being able to detect infection if a seroconversion has occurred, and is especially important in endemic areas where high levels of background antibodies pose a challenge for serology. The rationale for selecting the IFA-positive samples for the PCR analysis included the presence of IgM antibodies with titers around 1 : 50 against any of the tested spotted fever group rickettsial antigens in the samples. Bacteria-specific PCR was used as a verification tool after IFA to diagnose the illness, although conflicting sensitivities were expected (Fournier & Nabilone Raoult, 2003). Indeed, the results obtained by IFA were only partly confirmed

by PCR, which confirmed five of 16 in IFA-positive rickettsial cases. Use of 16S rRNA genes and rickettsia-specific gltA genes enabled us to identify three R. helvetica-positive patient sera (no. 3 from Levice, no. 25 from Horča and no. 31 from Mankovce), one R. slovaca (no. 11 from the city of Levice), and one R. raoultii case (no. 46, from the county of Lučenec). Amplification of the fragment of the 16S–23S rRNA gene ITS region verified Ba. elisabethae in the serum of the patient no. 34 from Nové Zámky. Borrelia identified in serum by IFA (no. 5) was confirmed in PCR with primers Bf1 and Br1. However, species specificity (Bo. recurrentis ssp. A1, or Bo. burgdorferi) could not be satisfactorily distinguished. The single F. tularensis ssp. tularensis sample (no. 2), also obtained from the city of Levice, was detected by IFA only.

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