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Some confirmed rickettsial infections require CDC notification. These include anaplasmosis, ehrlichiosis, Q fever, and spotted fever rickettsioses. The Weil-Felix test is not definitively diagnostic but can be included in the report as supporting information. The gold standard for diagnosis of rickettsial infections is indirect immunofluorescent IgG antibody assays of paired serum samples (one taken during the acute phase of the disease and one taken two to four weeks later in the convalescent phase), which has a much higher sensitivity and specificity. Other options for laboratory evaluation include polymerase chain reaction (PCR) and other nucleic acid amplification techniques, species-specific ELISA assays, or direct visualization of the bacteria in tissue samples with labeled antibodies. Culturing and isolating the obligate-intracellular rickettsiae is possible, but requires specialized methods that are not practical for routine diagnosis.[14][15]

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