Specimen:

Serum

Collection Medium:

Minimum:

Adult preferred minimum: 1 mL
Adult absolute Minimum:  0.5 mL
Pediatric minimum: 0.15 mL

Rejection Criteria:

Severely lipemic, contaminated, or hemolyzed specimens.

Analytic Time:

10 days

Reference Range:

IgG:
< 1:64: Negative. No significant level of Bartonella quintana IgG 
antibody detected.

1:64-1:128: Equivocal. Questionable presence of Bartonella quintana IgG
antibody detected. Repeat testing in 10-14 days may be helpful.

Is greater than or equal to 1:256: Positive. Presence of IgG antibody 
to Bartonella quintana detected, suggestive of current or past 
infection.

IgM:
< 1:16: Negative. No significant level of Bartonella quintana IgM 
antibody detected.

Is greater than or equal to 1:16: Positive. Presence of IgM antibody to
Bartonella quintana detected, suggestive of recent infection.

Comments:

Acute and convalescent specimens must be labeled as such; parallel 
testing is preferred and convalescent specimens must be received within 
30 days from receipt of the acute specimens. Please mark specimens 
plainly as "acute" or "convalescent."

Test
Limitations:

Bartonella (Rochalimaea) species have recently become associated with 
four clinical syndromes:
  Bacillary angiomatosis (BA)
  Bacillary peliosis hepatitis (BHP)
  Relapsing fever with bacteremia
  Cat-scratch disease (CSD)

Individuals at risk for BA, BHP, bacteremia, and CSD infections include 
adults with human immunodeficiency virus, transplant patients, and 
other immuno-compromised patients. Immunocompetent adults and children 
may also develop CSD.

In primary or relapsed trench fever, only antibodies to Bartonella 
quintana are present. Bartonella quintana antibodies may be 
cross-reactive with Rickettsia vinsonii, and cross-reactions are 
obtained with approximately 50 percent of typhus group (Rickettsia 
prowazekii and Rickettsia mooseri), as well as 66 percent of scrub 
typhus (Rickettsia tsutsugamushi) sera. Bartonella quintana sera, 
however, are not commonly cross-reactive with sera from spotted fever
group organisms (Rickettsia rickettsia and Rickettsia akari). 
Bartonella quintana antibodies may be seen in patients with bacillary 
angiomatosis and/or parenchymal bacillary peliosis.

A low positive suggests past exposure or infection, while high positive 
results may indicate recent or current infection, but are inconclusive 
for diagnosis.  Seroconversion between acute and convalescent sera is 
considered strong evidence of recent infection. The best evidence for 
infection is a significant change on two appropriately timed specimens 
where both tests are done in the same laboratory at the same time. 
While the presence of IgM antibodies suggest recent infection, low 
levels of IgM antibodies may ccasionally persist for more than 12 
months post-infection.

Methodology:

Indirect Fluorescent Antibody

CPT Code:

86611(x2)