▁reliable ▁when ▁a ▁four - fold ▁rise ▁in ▁ant ib ody ▁titre ▁is ▁found . ▁ ▁If ▁the ▁patient ▁is ▁from ▁a ▁non en demic ▁area , ▁then ▁diagn osis ▁can ▁be ▁made ▁from ▁a ▁single ▁ac ute ▁ser um ▁sample . ▁ ▁In ▁patients ▁from ▁en demic ▁areas , ▁this ▁is ▁not ▁possible ▁because ▁ant ib od ies ▁may ▁be ▁found ▁in ▁up ▁to ▁ 1 8 % ▁of ▁health y ▁individuals . ▁ ▁Other ▁methods ▁include ▁culture ▁and ▁polym er ase ▁chain ▁reaction , ▁but ▁these ▁are ▁not ▁rout in ely ▁available ▁and ▁the ▁results ▁do ▁not ▁always ▁correlate ▁with ▁ser ological ▁testing , ▁and ▁are ▁affected ▁by ▁prior ▁ant ib i otic ▁treatment . ▁The ▁currently ▁available ▁di agnostic ▁methods ▁ ▁have ▁been ▁summar ised . ▁ ▁Tre at ment ▁ ▁Without ▁treatment , ▁the ▁disease ▁is ▁often ▁fatal . ▁Since ▁the ▁use ▁of ▁ant ib iot ics , ▁case ▁fatal ities ▁have ▁decre ased ▁from ▁ 4 – 4 0 % ▁to ▁less ▁than ▁ 2 %. ▁ ▁The ▁drug ▁most ▁commonly ▁used ▁is ▁do xy cy cl ine ▁or ▁t et racy cl ine , ▁but ▁ch lor am phen icol ▁is ▁an ▁alternative . ▁ ▁Stra ins ▁that ▁are ▁resist ant ▁to ▁do xy cy cl ine ▁and ▁ch lor am phen icol ▁have ▁been ▁reported ▁in ▁northern ▁Th ailand . ▁ ▁R if amp ic in ▁and ▁az ith rom yc in ▁are ▁alternatives . ▁Az ith rom yc in ▁is ▁an ▁alternative ▁in ▁children ▁and