Bartonella Species Antibodies (IgG, IgM) with Reflex to Titers

Test Code
34251


CPT Codes
86611 (x4)

Includes
Bartonella henselae Antibodies (IgG, IgM) with Reflex to Titers
Bartonella quintana Antibodies (IgG, IgM) with Reflex to Titers

If B. henselae (IgG) Screen is positive, then B. henselae (IgG) titer will be performed at an additional charge (CPT code(s): 86611).
If B. henselae (IgM) Screen is positive, then B. henselae (IgM) titer will be performed at an additional charge (CPT code(s): 86611).

If B. quintana (IgG) Screen is positive, then B. quintana (IgG) titer will be performed at an additional charge (CPT code(s): 86611).
If B. quintana (IgM) Screen is positive, then B. quintana (IgM) titer will be performed at an additional charge (CPT code(s): 86611).


Preferred Specimen
1 mL serum


Minimum Volume
0.2 mL


Transport Temperature
Room temperature


Specimen Stability
Room temperature: 7 days
Refrigerated: 14 days
Frozen: 30 days


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Grossly lipemic • Grossly Icteric


Methodology
Immunofluorescence Assay (IFA)

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule
Monday-Saturday Morning
Report available: Next Day


Limitations
B. quintana and B. henselae as well as chlamydia species and Coxiella burnetii may cross-react and produce false-positive results.


Reference Range
B. henselae (IgG) Screen Negative
B. quintana (IgG) Screen Negative
B. henselae (IgM) Screen Negative
B. quintana (IgM) Screen Negative


Clinical Significance

This antibody panel helps diagnose infections with Bartonella henselae and Bartonella quintana. This panel includes IgM and IgG antibodies with reflexes to titers for positive results.

B henselae causes cat scratch disease, a self-limiting bacterial infection transmitted via exposure to cats or cat fleas. B quintana causes trench fever, a febrile bacteremic illness transmitted via body lice. B henselae and B quintana are the 2 Bartonella species that most frequently cause blood culture-negative endocarditis. In immunocompromised individuals, infections with B henselae and B quintana may present as bacillary angiomatosis, a vasculoproliferative disease of the skin [1-4].

Because of the fastidious nature of B henselae and B quintana, recovery of these bacteria is rarely successful, especially from blood. Serology is commonly used for diagnosing Bartonella infections [1,3]. Confirmation of recent or current infection with either B henselae or B quintana may require testing of serial specimens to demonstrate a 4-fold increase of IgG titers or the presence of IgM. A B henselae or B quintana IgG titer of 1:800 has been proposed as a major criterion for diagnosing Bartonella endocarditis [4].

IgG cross-reactivity between B henselae and B quintana often occurs [1,3]. Qualitative real-time polymerase chain reaction is a highly specific and sensitive method to detect the presence of Bartonella species DNA in clinical specimens and can differentiate between B henselae and B quintana.

The results of this test should be interpreted in the context of pertinent clinical history and physical examination findings.

References
1. Dumler JS, et al. Bartonella. In: Carroll KC, et al, eds. Manual of Clinical Microbiology. 12th ed. ASM Press; 2019. https://www.clinmicronow.org/doi/book/10.1128/9781683670438.MCM.ch50
2. Centers for Disease Control and Prevention. Bartonella infection (cat scratch disease, trench fever, and Carrion's disease). Last reviewed December 18, 2019. Accessed January 28, 2022. https://www.cdc.gov/bartonella/clinicians/index.html
3. Miller JM, et al. Clin Infect Dis. 2018;67(6):813-816.
4. Okaro U, et al. Clin Microbiol Rev. 2017;30(3):709-746.



Performing Laboratory
Quest Diagnostics Nichols Institute
14225 Newbrook Drive
Chantilly, VA 20153



The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.