The diagnosis of Rickettsial retinitis (RR) was based on the Weil–Felix test (WFT) at titres of 1:160 or more [
1]. WFT at a titer of 1:320 has been shown to have poor sensitivity and specificity (46 %) when compared to the gold standard immunofluorescent antibody assay [
2]. WFT may also be positive in the healthy population (54 %) and patients with non-rickettsial fever (62 %) [
2]. The Indian Council of Medical Research guidelines [
3] considers a WFT titre of 1:80 for probable rickettsial infection. A fourfold rise of titres in paired sera or a titre of 1:320 has been traditionally used as a diagnostic cutoff for WFT; however, baseline titres need standardization according to geographic location [
4]. Using a WFT titre of 1:160 needs validation [
1]. Also, more definite tests like IgM and IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are available in India. However, we do understand that financial constraints of Indian patients are important barriers for the use of such tests.