Bartonella Species Antibody (IgG, IgM) w/Reflex to Titers (BARABS)

If Bartonella henselae and Bartonella quintana IgG and IgM screens are positive, titers will be performed at an additional charge (CPT code(s): 86611 for each titer performed).

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.