Use of Bartonella antigens for serologic diagnosis of cat-scratch disease at a national referral center.
BACKGROUND
Bartonella henselae (formerly the genus Rochalimaea) has recently been isolated from patients with cat-scratch disease and their cats, and since September 1992 the Centers for Disease Control and Prevention has offered an indirect fluorescent antibody assay for Bartonella-specific antibody.


METHODS
Physicians submitted serum samples from patients suspected of having cat-scratch disease or other Bartonella-associated illness and completed a questionnaire that recorded clinical information. Indirect fluorescent antibody assay was performed with the use of antigen derived from three Bartonella species: B henselae, Bartonella quintana, and Bartonella elizabethae.


RESULTS
During 16 months, 3088 serum samples were received. The largest numbers of specimens and the highest percentages positive (titer, > or = 64) were observed in the fall and winter. Clinical histories of the first 600 patients for whom serum samples and completed information forms were received were examined in detail; seropositivity was significantly associated with cat contact, cat age of less than 1 year, cat scratch, presence of an inoculation papule, and regional adenopathy. Of 91 patients whose illness met a strict clinical definition of cat-scratch disease, 86 (95%) had titers of 64 or greater to either B henselae or B quintana. A fourfold rise or fall in titer was observed in 87 of 132 patients with paired serum samples.


CONCLUSIONS
The indirect fluorescent antibody assay for Bartonella-specific antibody is sensitive for the diagnosis of cat-scratch disease. Redefinition of cat-scratch disease on the basis of cause and use of this assay as a diagnostic criterion is recommended.
Dalton
M J
MJ
Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
Robinson
L E
LE
Cooper
J
J
Regnery
R L
RL
Olson
J G
JG
Childs
J E
JE
D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000097:blood*; D018416:Bartonella henselae / Q000276:immunology*; D002372:Cat-Scratch Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
D000942:Antigens, Bacterial