Sending Specimens to CDC for Rickettsial Disease Testing

Rickettsial diseases can progress quickly, and several can be life-threatening. CDC's Rickettsial Diagnostic Laboratory, in the Division of Vector-Borne Diseases, is an internationally recognized reference lab for diagnosing them, and tests for approved agencies free of charge.

Rickettsia rickettsii bacteria (CDC Public Health Image Library 10953). Credit: CDC.

Never wait to treat

Do not delay or withhold treatment while waiting for lab results. Early recognition and treatment with doxycycline are critical.

When to use CDC

Many tests for rickettsial diseases are sold commercially, and most routine testing should be done by state or commercial labs. CDC's lab steps in for complex cases, when a test is not available commercially, or for issues of public health significance. To arrange testing of blood, serum, eschar swabs or tissue, contact your state or local health department, which decides whether samples should go to CDC.

How to submit

• Specimens go through, or with the approval of, the state or territorial public health laboratory. CDC sends final results back to that lab, which reports them to the original submitter.
• Submit either through the CDC Test Order and Reporting (CSTOR) web portal (preferred) or with the paper CDC Specimen Submission Form 50.34. Every specimen must come with a completed form 50.34.
• Use a separate form for each specimen and each test category (molecular detection or serology). If a category covers more than one organism, choose the main one under "suspected agent" and list the others in the Comments section on page 2.
• A clinical consultant reviews every request and may add molecular or serologic tests based on the clinical and exposure details provided.

The lab tests human specimens under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

What the form must include

Complete clinical and exposure information helps the lab decide whether to test for pathogens no one had considered.

Required:

• test order name (one per form);
• the state public health lab contact, with phone number, responsible for the sample and follow-up;
• patient's full name, sex and birth date;
• date symptoms began, and date the specimen was collected;
• specimen source — serum, whole blood, swab, tissue and so on;
• antibiotic given and the date it started;
• state of illness — active, recovered, fatal;
• a brief clinical summary of signs, symptoms and underlying illnesses.

Helpful if available: earlier commercial lab results and exam findings; travel within 4 weeks before symptoms began (or "No"/"Unknown"); and exposure to animals and arthropods.

Test codes

Each code lists acceptable specimen types and storage and shipping conditions. Submissions that don't meet them can be rejected.

Shipping

Send samples to the Specimen Triage and Tracking lab:

Centers for Disease Control and Prevention
SMB/STAT
ATTN: Rickettsial Diagnostic Laboratory, Rickettsial Zoonoses Branch (unit 78)
1600 Clifton Road, NE
Atlanta, GA 30329-4027

Time packages to arrive Tuesday through Friday, allowing for federal holidays; urgent samples can be accepted at other times with prior approval.

Non-CLIA testing

For public health purposes such as surveillance, the lab can run non-CLIA tests to identify species of Rickettsia, Ehrlichia, Anaplasma or Orientia not covered by CLIA tests, or on specimen types without a CLIA test. These results are for public health use only: they must not be used to diagnose or treat a patient, shared with patients or providers, or placed in medical records. Requests need approval in advance (test code CDC-10405).

Contacts

• Diagnostic test questions: rzbrefdxlab@cdc.gov
• Other questions: rzbepidiag@cdc.gov

CDC also publishes fact sheets on packaging rickettsial specimens, eschar-associated rickettsioses, and collecting skin biopsies and eschar swabs.

Sources

Based on "Submitting Specimens for Rickettsiosis Tests," Division of Vector-Borne Diseases, Centers for Disease Control and Prevention; a work of the United States government in the public domain.