Overall seroprevalence evaluated by immunofluorescence (IFA) using nine Bartonella, two Borrelia, six rickettsial (spotted fever and Pictilisib mw typhus group), two Coxiella, and one human granulocytic ehrlichiosis Anaplasma,Franciscella tularensis and Diplorickettsia massiliensis antigens, in rural and city populations of Slovak Republic,

was found to be 32% positive for spotted fever group rickettsiae. Only five (10%) of the rickettsia-positive cases evaluated by IFA were confirmed by polymerase chain reaction. Rickettsia helvetica,Rickettsia slovaca, and Rickettsia raoultii infection appear to be prevalent in Slovakia. Furthermore, Coxiella burnetii,Borrelia and, for the first time, Bartonella elisabethae were confirmed in Slovakia. The manifestation of clinical symptoms after a tick or insect bite, for example high fever, vomiting, diarrhea and headache, can probably be considered partly specific for hourly studied diseases. Nevertheless, similar

or the same symptoms manifest in several other diseases, including colds or flu, and thus can easily imitate the origin of the disease. Immunofluorescent antibody assay (IFA) using acute phase sera is generally regarded as the most convenient and sensitive serological procedure to identify AZD0530 clinical trial bacteria (Philip et al., 1978; Kovacova et al., 1994; McGill et al., 2001; Houhamdi & Raoult, 2005). The method can detect immunoglobulin G (IgG) and IgM antibodies with a sensitivity

rate of 84–100% (Beati et al., 1992; Teysseire & Raoult, 1992). However, even this technique can be limited by possible cross-reactions, as nonspecific lipopolysaccharide reactions have been found to involve immunoglobulin M (IgM) antibodies. A possibility of reduced species specificity can be circumvented by using a multiple-antigen IFA (Jensenius et al., 2004), and precision can be increased by the application of molecular genetic methods. We have used IFA to evaluate clinical specimens for Rickettsia, Bartonella, Borrelia, Coxiella, Anaplasma, Franciscella and Diplorickettsia. All serum samples included in this study were obtained from hospitalized patients second with ‘a disease of unknown etiology’ which had tested negative for viral infections. We have meticulously chosen the list of bacteria to test. Rickettsia are common tick parasites causing severe human diseases (Sekeyova et al., 1998; Kovacova et al., 2006; Santibanez et al., 2006; Sreter-Lancz et al., 2006; Spitalska et al., 2008; Chmielewski et al., 2009; Dobler & Wolfel, 2009), and Bartonella, which has been recovered from the blood of humans, is quite common in Europe (Vinson & Fuller, 1961; Chomel et al., 1997; Piemont & Heller, 1998, 1999; La et al., 2002). We have included also a ‘Pandora’s Box’ – expected pathogens in Ixodes ricinus ticks in Central Europe that have a high infectivity in the human population, for example Borrelia (Bhide et al.