He referred malaise

and fever since departure, and presumptive diagnosis of spotted fever rickettsiosis was done at admittance and blood aliquot was collected. The serum sample of the patient was analyzed using indirect immunofluorescence with antigens obtained from Vero cell-infected R rickettsii (Sheila Smith Strain). The antigens were prepared at the Adolfo Lutz Institute, São Paulo, Brazil. The IgM antibody titer ≥ 1:64 Neratinib clinical trial was considered positive. For culture, blood clot aliquot was centrifuged and the supernatant was inoculated in a confluent monolayer of Vero cells on circular slides adapted to the flat-bottomed tubes (shell vials). Infection of Vero H 89 supplier cells was monitored by immunofluorescence

reaction prepared with R rickettsii-positive human serum, which permitted us to observe the presence of fluorescent microorganisms in the form of intracellular bacteria, and SFG rickettsiae were isolated. For molecular characterization of the agent, DNA was extracted from the patient’s blood clot using QIAamp® DNA Blood (QIAGEN, Hilden, Germany), following the manufacturer’s protocol. Rickettsial DNA was detected by polymerase chain reaction (PCR) using the previously described conditions[6] and three sets of primers: CS-78 and CS-32, CS-239 and CS-1069, and Rr190.70p and Rr190.602n.[6, 7] The fragments were cloned into InsT/AcloneTM (Fermentas, Vilnius, Lithuania) and were sequenced in both forward and reverse directions using ABI Prism dGTP BigDye Terminator Ready Reaction Kit (Perkin Elmer, Foster City, CA, USA). The partial sequences of rickettsial ompA and gltA genes were compared with corresponding sequences available in the GenBank (Figure 1). The sequences were aligned with the Clustal W software (1.60). To obtain a better alignment, both pairwise and multiple alignments parameters

were changed from the default set. We used the DNA substitution matrix from the Clustal program, decreased the open gap penalty to 10, and also decreased the transition/transversion Methocarbamol rate to 0.25. The alignments were used to construct similarity trees of nucleotide distances estimated by the Neighbor Joining algorithm and number of differences using the MEGA software (Molecular Evolutionary Genetics Analysis, version 3.01). The PCR performed on DNA extracted from the patient blood sample yielded fragments with the expected lengths of gltA and ompA rickettsial genes. Partial sequence of gltA gene was 1,083 bp (GenBank access EU716648), and the nucleotide sequence of ompA gene fragment was 479 bp (GenBank access EU716649). The nucleotide sequences of ompA and gltA genes of our sample (R conorii ICB 1004) had more than 99% identity to the homologous sequences of three R conorii complex strains available in the GenBank.