P. Brouqui, F. Bacellar, G. Baranton, R. J. Birtles, A. Bjoërsdorff, J

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Guidelines for the diagnosis of tick-borne bacterial diseases in Europe P. Brouqui, F. Bacellar, G. Baranton, R.J. Birtles, A. Bjoërsdorff, J.R. Blanco, G. Caruso, M. Cinco, P.E. Fournier, E. Francavilla, M. Jensenius, J. Kazar, H. Laferl, A. Lakos, S. Lotric Furlan, M. Maurin, J.A. Oteo, P. Parola, C. Perez-Eid, O. Peter, D. Postic, D. Raoult, A. Tellez, Y. Tselentis, B. Wilske Clinical Microbiology and Infection Volume 10, Issue 12, Pages 1108-1132 (December 2004) DOI: 10.1111/j.1469-0691.2004.01019.x Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 Maculopapular rash of Mediterranean spotted fever. Note the inoculation eschar surrounded by a purpuric lesion. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 2 Typical eschar (‘tâche noire’) of tick-transmitted rickettioses. A scalp location of the eschar indicates tick-borne lymphadenopathy caused by Rickettsia slovaca. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 3 Western blotting and cross-absorption study to differentiate between Rickettsia conorii (RC) and Rickettsia africae (RA) infection. Once absorbed with RA, the antibodies that remain are those directed against RC; all antibodies disappeared following absorption with RC, indicating that antibodies contained in the sera were directed specifically against R. conorii. MWM, molecular size marker. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 4 Collection of samples and diagnostic tools for use in the diagnosis of rickettsial diseases transmitted by tick bite. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 5 The pathognomonic sign associated with Lyme borelliosis, which occurs early at the site of the tick bite in the form of a gradually extending erythematous lesion termed erythema migrans. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 6 Standardisation of immunoblots with reference sera. G, IgG; M, IgM; 1–11, monoclonal antibodies. The antigen used was Borellia afzelii (Pko Strain) [92]. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 7 Stepwise serodiagnosis of Lyme borelliosis [92]. IFA, immunofluorescent assay; IHA, immunohaemagglutination assay. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 8 Tularaemia: detail of the neck showing a typical lymphadenopathy. Clinical Microbiology and Infection 2004 10, 1108-1132DOI: (10.1111/j.1469-0691.2004.01019.x) Copyright © 2004 European Society of Clinical Infectious Diseases Terms and Conditions