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HelpTest Code BARRP Bartonella, Molecular Detection, PCR, Varies
Reporting Name
Bartonella PCRUseful For
Aiding in the diagnosis of Bartonella infection
Testing Algorithm
For more information see Infective Endocarditis: Diagnostic Testing for Identification of Microbiological Etiology.
Method Name
Real-Time Polymerase Chain Reaction (PCR)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
VariesOrdering Guidance
If this test result is negative and there is a strong suspicion of disease caused by these organisms, consider BART / Bartonella Antibody Panel, IgG and IgM, Serum and Warthin-Starry tissue stain (PATHC / Pathology Consultation) testing.
Necessary Information
Specimen source is required.
Specimen Required
The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by Bartonella species DNA is unlikely.
Submit only 1 of the following specimens:
Specimen Type: Fresh tissue or biopsy
Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule
Container/Tube: Sterile container
Specimen Volume: Entire collection or 5 mm(3) - approximately the size of a pencil eraser
Collection Instructions:
1. Collect fresh tissue specimen.
2. Submit tissue only, do not add fluid to tissue.
3. Refrigerate or freeze specimen.
Specimen Stability Information: Refrigerated (preferred) <7 days/ Frozen <7 days
Preferred Paraffin-embedded tissue block:
Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)
Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule
Supplies: Tissue Block Container (T553)
Container/Tube: Tissue block
Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block to be cut and returned.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Acceptable: Paraffin-embedded tissue block:
Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)
Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule
Container/Tube: Sterile container for each individual cut section (scroll).
Collection Instructions: Perform microtomy and prepare five separate 10-micron sections. Each section (scroll) must be placed in a separate sterile container for submission.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Specimen Type: Fluid
Sources: Cerebrospinal or ocular (eg, vitreous humor fluid)
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Specimen Stability Information: Refrigerated (preferred) <7 days/Frozen <7 days
Collection Instructions: For CSF, submit specimen from collection vial 2.
Specimen Type: Synovial fluid
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Pink top (EDTA), royal blue top (EDTA), sterile vial containing EDTA-derived aliquot, red clot tube (no anticoagulant), or sterile container
Specimen Volume: 0.5 mL
Collection Instructions: Send specimen in original tube (preferred).
Specimen Stability Information: Refrigerated (preferred) <7 days /Frozen <7 days
Specimen Minimum Volume
Fresh tissue or biopsy: 5 mm(3)
Paraffin-embedded tissue block: two 10-micron sections
Fluid: See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | ||
Reject Due To
| Tissue in formalin, formaldehyde, or acetone Bone marrow Slides |
Reject |
Special Instructions
Reference Values
Not applicable
Day(s) Performed
Monday through Friday
CPT Code Information
87801
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BARRP | Bartonella PCR | 48864-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| SRC51 | Specimen source | 31208-2 |
| 84440 | Bartonella PCR | 48864-3 |
Clinical Information
Bartonella henselae and Bartonella quintana are small, pleomorphic Gram stain-negative bacilli that are difficult to isolate by culture due to their fastidious growth requirements. B henselae has been associated with cat scratch disease, bacillary angiomatosis, peliosis hepatitis, and endocarditis. B quintana has been associated with trench fever, bacillary angiomatosis, and endocarditis.
The diagnosis of Bartonella infection has traditionally been made by Warthin-Starry staining of infected tissue or serology. However, these methods may be falsely negative or nonspecific, respectively. Culture is insensitive.
Evaluation of infected tissue using polymerase chain reaction (PCR) has been shown to be an effective tool for diagnosing Bartonella infection. Mayo Clinic Laboratories has developed a real-time PCR test that permits rapid identification of Bartonella species. The assay targets a unique sequence of the citrate synthase gene present in Bartonella species.
Interpretation
A positive result indicates the presence of Bartonella species DNA.
A negative result indicates the absence of detectable Bartonella DNA but does not negate the presence of the organism and may occur due to inhibition of the polymerase chain reaction, sequence variability underlying primers or probes, or the presence of Bartonella DNA in quantities less than the limit of detection of the assay.
Cautions
This test does not differentiate between Bartonella henselae and Bartonella quintana.
Test results should be used as an aid in diagnosis. The single assay should not be used as the only criteria to form a clinical conclusion, but results should be correlated with patient symptoms and clinical presentation. A negative result does not negate the presence of the organism or active disease.
Inhibition of less than 2% has been noted in formalin-fixed, paraffin-embedded tissues. In a study of 178 ocular fluids, no inhibition was detected, although this is a possibility due to the relatively small number of specimens tested.
Method Description
Bacterial nucleic acid is extracted from the specimen using the automated MagNA Pure instrument. The purified DNA is placed on the LightCycler instrument, which amplifies and monitors by fluorescence the development of target nucleic sequences after each polymerase chain reaction (PCR) cycle. A specific target sequence from Bartonella species is amplified and the resulting segment is detected using specific hybridization probes. Detection of the Bartonella target is performed through melting curve analysis using the LightCycler software.(Cockerill FR, Uhl JR: Applications and challenges of real-time PCR for the clinical microbiology laboratory. In: Reischl U, Wittwer C, Cockerill F, eds. Rapid Cycle Real-Time PCR Methods and Applications. Springer-Verlag; 2002:3-27; Dumler JS, Carroll KC, Patel R: Bartonella. In: Carroll KC, Pfaller M, eds. Manual of Clinical Microbiology. 12th ed. ASM Press; 2019:893-904)