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Clin Microbiol Infect. 2007 Mar 22;
Serological testing for Bartonella henselae infections in The
Netherlands: clinical evaluation of immunofluorescence assay and ELISA.
* Vermeulen MJ,
* Herremans M,
* Verbakel H,
* Bergmans AM,
* Roord JJ,
* van Dijken PJ,
* Peeters MF.
Department of Pediatrics, VU University Medical Center, Amsterdam, The
Netherlands.
Cat-scratch disease (CSD), caused by Bartonella henselae infection, can
mimic malignancy and can manifest atypically. Reliable serological testing
is therefore of great clinical importance. The diagnostic performance of
immunofluorescence assay (IFA) and ELISA was evaluated in a group of Dutch
patients with proven CSD (clinical diagnosis confirmed by PCR). Sera of 51
CSD patients and 56 controls (patients with similar symptoms, but who were
B. henselae PCR-negative and had an alternative confirmed diagnosis) were
tested for anti-B. henselae IgM and IgG by IFA and ELISA.
A commercially
available IFA test for IgM had a sensitivity of 6%. In-house assays for IgM
showed specificities of 93% (IFA) and 91% (ELISA), but with low
sensitivities (53% and 65%, respectively). With a specificity of 82% (IFA)
and 91% (ELISA), in-house IgG testing showed a significantly higher
sensitivity in IFA (67%) than in ELISA (28%, p less than0.01). Sensitivity was
higher for genotype I (38-75%) than for genotype II (7-67%) infections, but
this was only statistically significant for IgG ELISA (p less than0.05).
In
conclusion, detection of IgM against B. henselae by in-house ELISA and IFA
was highly specific for the diagnosis of CSD. The high seroprevalence in
healthy individuals limits the clinical value of IgG detection for
diagnosing CSD. Given the low sensitivity of the serological assays,
negative serology does not rule out CSD and warrants further investigation,
including PCR. Adding locally isolated (e.g., genotype II) B. henselae
strains to future tests might improve the sensitivity.
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