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HelpTest Code BART Bartonella Antibody Panel, IgG and IgM, Serum
Reporting Name
Bartonella Ab Panel, IgG and IgMUseful For
Diagnosis of Bartonella infection, especially in the context of a cat scratch
Testing Algorithm
For information see Infective Endocarditis: Diagnostic Testing for Identification of Microbiological Etiology.
Method Name
Immunofluorescence Assay (IFA)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumSpecimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Centrifuge and aliquot serum into plastic vial.
Specimen Minimum Volume
0.15 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 30 days | |
| Frozen | 30 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
Special Instructions
Reference Values
BARTONELLA HENSELAE
IgG: <1:128
IgM: <1:20
BARTONELLA QUINTANA
IgG: <1:128
IgM: <1:20
Day(s) Performed
Monday through Saturday
CPT Code Information
86611 x 4
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BART | Bartonella Ab Panel, IgG and IgM | 90251-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 15659 | Bart Henselae IgG | In Process |
| 15660 | Bart Henselae IgM | In Process |
| 15661 | Bart Quintana IgG | In Process |
| 15662 | Bart Quintana IgM | In Process |
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 animal contact. Regional lymphadenopathy follows and is the predominant clinical feature of CSD. Trench fever was a significant problem during World War I and World War II and 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 and 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, a transplanted organ, or suppressed immunity.
Interpretation
A positive immunofluorescence assay (IFA) IgM (titer >1:20) suggests a current infection with either Bartonella henselae or Bartonella 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.
Method Description
The Euroimmun indirect immunofluorescence test is a standardized, in vitro assay for the determination of specific antibodies against Bartonella henselae and Bartonella quintana. BIOCHIP Mosaics are coated with B henselae and B quintana infected cells positioned next to each other in one reaction field. Samples are diluted and incubated on the substrate slides. If the reaction is positive, specific antibodies of class IgG and IgM attach to the antigens. In a second step, the attached antibodies are stained with fluorescein-labeled anti-human antibodies and made visible using fluorescence microscopy. Semiquantitative endpoint titers are obtained by testing serial dilutions of positive specimens.(Unpublished Mayo method)