, 2011). A final diagnosis of R. sibirica ssp. mongolitimonae

was obtained for five samples corresponding to four different patients with a diagnosis of LAR, including a person returning from Egypt (Socolovschi et al., 2010). The samples (three cutaneous biopsies, two eschar swabs) were positive for the set ‘SFG’. A final diagnosis of R. sibirica ssp. mongolitimonae was obtained using conventional PCR followed by sequencing because no specific primer set was available in our laboratory. A final diagnosis of R. australis was obtained for two samples (cutaneous swabs) corresponding to a single patient with a diagnosis of QTT. The samples were positive for both ‘SFG’ and ‘RAUS’. A final diagnosis of R. slovaca Metabolism inhibitor was obtained for four samples (cutaneous biopsies) corresponding to three different patients with a diagnosis of SENLAT. Three samples were positive for both the Saracatinib clinical trial ‘SFG’ and the ‘RSLO’ sets. One remaining sample (serum) was positive for the set ‘SFG’ and negative for ‘RSLO’; a final diagnosis of R. slovaca was obtained using conventional PCR followed by sequencing. A diagnosis of TG Rickettsia was obtained for one sample (serum) using the set ‘TG’; this sample corresponded to a patient with a diagnosis of murine typhus. Diagnosis at the species level was obtained by Western blot followed by cross-adsorption. The remaining eight samples (three cutaneous biopsies,

two cutaneous swabs, two total blood and one serum) were positive for the set ‘SFG’, but we could not discriminate at the species level using either molecular or serological techniques. These samples corresponded to eight patients with a diagnosis of rickettsiosis. For these eight samples, the Ct obtained using the set ‘SFG’ was significantly higher compared with the positive samples identified at the species level

(36.71/31.95, P = 0.0023). For one diagnosis of R. honei and five diagnoses of LAR, molecular diagnosis was performed by first screening using the ‘SFG’ set and then sequencing because specific primers and probes were not available. The need to resort to sequencing Dipeptidyl peptidase suggests the genomic databases must be updated regularly to develop new systems of primers and probes. Increased genomic data for Rickettsia species will permit the development of accurate qPCR tools. For eight clinical samples, a diagnosis of rickettsiosis was obtained by systematic screening using the ‘SFG’ set. However, identification at the species level (by different sets of species-specific qPCRs or by conventional PCRs targeting gltA and ompA) remained unsuccessful. We demonstrated that the Ct values for such samples are significantly higher, suggesting that the ‘SFG’ set is more sensitive than conventional PCR (Angelakis et al., 2009); however, molecular tools for diagnosis at the species level are not yet sufficiently sensitive.