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Test Code BART Bartonella Antibody Panel, IgG and IgM, Serum

Reporting Name

Bartonella Ab Panel, IgG and IgM

Useful For

Diagnosis of Bartonella infection, especially in the context of a cat scratch

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.5 mL


Specimen Minimum Volume

0.15 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 30 days
  Frozen  30 days

Reference Values

Bartonella henselae

IgG: <1:128

IgM: <1:20

 

Bartonella quintana

IgG: <1:128

IgM: <1:20

Day(s) and Time(s) Performed

Monday through Saturday; 9 a.m.

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

86611 x 4

LOINC Code Information

Result ID Test Result Name Result LOINC Value
15659 Bart Henselae IgG 6954-2
15660 Bart Henselae IgM 6955-9
15661 Bart Quintana IgG 44827-4
15662 Bart Quintana IgM 44825-8

Clinical Information

Bartonella henselae and Bartonella quintana are small, rod-shaped, pleomorphic, gram-negative bacteria. The human body louse (Pediculus humanis) is the proposed vector for B quintana. No animal reservoir has been determined for B quintana. The domestic cat is believed to be both a reservoir and vector for B henselae. Cats may infect humans directly through scratches, bites, or licks, or indirectly through an arthropod vector. Humans remain the only host in which Bartonella infection leads to significant disease.

 

The sight of entry for Bartonella is through openings in the skin. Microscopically, Bartonella lesions appear as rounded aggregates that proliferate rapidly. These aggregates are masses of Bartonella bacteria. Warthin-Starry-staining has shown that Bartonella organisms can be present within the vacuoles of endothelial cells, in macrophages, and between cells in areas of necrosis. Occasionally organisms are seen in the lumens of vessels. While cutaneous lesions are common, disseminated tissue infection by Bartonella has been seen in the blood, lymph nodes, spleen, liver, bone marrow, and heart. B henselae has been associated with cat scratch disease (CSD), peliosis hepatitis (PH), bacillary angiomatosis (BA), and endocarditis. B quintana has been associated with trench fever, BA, and endocarditis. BA is a vascular proliferative disease usually involving the skin and regional lymph nodes.

 

CSD begins as a cutaneous papule or pustule that usually develops within a week after an animal contact. Regional lymphadenopathy, which follows, is the predominant clinical feature of CSD. Trench fever, which was a significant problem during World War I and World War II, is characterized by a relapsing fever and severe pain in the shins. PH and febrile bacteremia syndrome are both syndromes that have afflicted patients with AIDS or those patients who are immunocompromised. While trench fever and CSD are usually self-limiting illnesses, the other Bartonella-associated diseases can be life-threatening.

 

Interest in B quintana and B henselae has recently increased since its increased prevalence in patients with AIDS, in transplant patients, and those with suppressed immunity.

Interpretation

A positive immunofluorescence assay (IFA) IgM (titer >1:20) suggests a current infection with either Bartonella henselae or B quintana.

 

A positive IgG (titer >1:128) suggests a current or previous infection. Increases in IgG titers in serial specimens suggest active infection.

 

Normal serum specimens usually have an IgG titer of less than 1:128. However, 5% to 10% of healthy controls exhibit a B henselae and B quintana titer of 1:128. Sera from healthy volunteers rarely show titers of 1:256 or greater. IgM titers in normal serum are typically less than 1:20. IgM titers at 1:20 or greater have not been seen in the normal population.

 

Molecular testing of tissue for Bartonella species nucleic acid is recommended in cases of suspected endocarditis.

Clinical Reference

1. Maurin M, Raoult D: Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev 1996;9:273-292

2. Maurin M, Birtles R, Raoult D: Current knowledge of Bartonella species. Eur J Clin Microbiol Dis 1997;16:487-506

3. Wolf LA, Cherry NA, Maggi RG, Breitschwerdt EB: In Pursuit of a Stealth Pathogen: Laboratory Diagnosis of Bartonellosis. Clin Micro Newsletter. 2014.36;5:33-39

Analytic Time

Same day/1 day

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

Mild OK; Gross reject

Icterus

NA

Other

NA

Testing Algorithm

Includes Bartonella henselae and Bartonella quintana.

 

See Infectious Endocarditis: Diagnostic Testing for Identification of Microbiological Etiology in Special Instructions.

Method Name

Immunofluorescence Assay (IFA)