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Diagnosing Bartonella infection
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. Bartonella henselae has been associated with cat scratch disease, bacillary angiomatosis, peliosis hepatitis, and endocarditis. Bartonella 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 PCR has been shown to be an effective tool for diagnosing Bartonella infection. Mayo Medical 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.
A positive test indicates the presence of Bartonella species DNA.
A negative test indicates the absence of detectable DNA, but does not negate the presence of the organism or recent disease as false-negative results may occur due to inhibition of PCR, sequence variability underlying primers or probes, or the presence of Bartonella DNA in quantities less than the limit of detection of the assay.
This test does not differentiate between Bartonella henselae and Bartonella quintana.
Inhibition of <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.
BART / Bartonella Antibody Panel, IgG and IgM, Serum and 9943 / Warthin-Starry Stain of tissue should be considered if PCR is negative and there is a strong suspicion of disease caused by these organisms.
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