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Volume 14, Number 5—May 2008


Fatal Rickettsia conorii subsp. israelensis Infection, Israel

Miriam Weinberger*†Comments to Author , Avi Keysary‡, Judith Sandbank*, Ronit Zaidenstein*, Avi Itzhaki*, Carmela Strenger‡, Moshe Leitner‡, Christopher D. Paddock§, and Marina E. Eremeeva§
Author affiliations: *Assaf Harofeh Medical Center, Zerifin, Israel; †Tel Aviv University, Ramat Aviv, Israel; ‡Israel Institute for Biological Research, Ness-Ziona, Israel; §Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

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Diagnostic tests performed to identify spotted fever in the patient*

Day after disease onset Assay Specimen(s) tested Result Laboratory
IgM<100, IgG<100
11 (autopsy) IFA Serum IgM = 64, IgG<32 CDC‡
PCR Serum sediment
Liver, muscle, skin, lung, kidney
Liver, muscle, skin Rickettsia conorii subsp. israelensis
Spotted fever group rickettsiae
R. conorii subsp. israelensis CDC
IHC stain# Brain, kidney Positive CDC
Cell culture** Liver, lung Negative IIBR

*IFA, immunofluorescent assay; Ig, immunoglobulin; IIBR, Institute for Biological Research; CDC, Centers for Disease Control and Prevention; IHC, immunohistochemical.
†IFA performed (6). Cutoff values for IgM and IgG are 100.
‡IFA performed (7). Cutoff values for IgM and IgG are 64.
§Nested PCR for 17-kDa protein gene (8).
¶Nested and semi-nested PCR for 17 kDa protein gene and recombinant outer membrane protein A gene fragment, respectively, followed by sequencing (9).
#Three-micron sections cut from formalin-fixed, paraffin-embedded brain and kidney tissue samples were stained by using an immunoalkaline phosphatase technique with a hyperimmune rabbit anti–Rickettsia rickettsii antibody at a dilution of <500 (3).
**Homogenized samples from lung and liver were applied by centrifugation onto monolayer of Vero cells culture in 24-well plates and incubated for 2 weeks at 35°C in 5% CO2 atmosphere incubator.

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