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Diagnosing Bartonella infection where Bartonella DNA would be expected to be present in blood, especially endocarditis
Bartonella henselae and Bartonella quintana are small, pleomorphic, gram-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 and serology. However, these methods may be nonspecific or falsely negative, especially in the early stages of disease.
Evaluation of infected tissue or blood 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 (gltA) 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 and/or probes, or the presence of Bartonella DNA in quantities less than the limit of detection of the assay.
BART / Bartonella Antibody Panel, IgG and IgM, Serum and/or 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.
This test does not differentiate between Bartonella henselae and Bartonella quintana.
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