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Mayo Test ID BARRP Bartonella, Molecular Detection, PCR, Varies


Ordering Guidance


If this test result is negative and there is a strong suspicion of disease caused by these organisms, consider BART / Bartonella Antibody Panel, IgG and IgM, Serum and Warthin-Starry tissue stain (PATHC / Pathology Consultation) testing.



Necessary Information


Specimen source is required.



Specimen Required


The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by Bartonella species DNA is unlikely.

 

Submit only 1 of the following specimens:

 

Specimen Type: Fresh tissue or biopsy

Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule

Container/Tube: Sterile container

Specimen Volume: Entire collection or 5 mm(3) - approximately the size of a pencil eraser

Collection Instructions:

1. Collect fresh tissue specimen.

2. Submit tissue only, do not add fluid to tissue.

3. Refrigerate or freeze specimen.

Specimen Stability Information: Refrigerated (preferred) <7 days/ Frozen <7 days

 

Preferred Paraffin-embedded tissue block:

Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)

Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule

Supplies: Tissue Block Container (T553)

Container/Tube: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block to be cut and returned.

Specimen Stability Information: Ambient (preferred)/Refrigerated

 

Acceptable: Paraffin-embedded tissue block:

Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)

Sources: Heart valve, liver, lymph node, spleen, or skin tissue papule/lesion/nodule

Container/Tube: Sterile container for each individual cut section (scroll).

Collection Instructions: Perform microtomy and prepare five separate 10-micron sections. Each section (scroll) must be placed in a separate sterile container for submission.

Specimen Stability Information: Ambient (preferred)/Refrigerated

 

Specimen Type: Fluid

Sources: Cerebrospinal or ocular (eg, vitreous humor fluid)

Container/Tube: Sterile vial

Specimen Volume: 0.5 mL

Specimen Stability Information: Refrigerated (preferred) <7 days/Frozen <7 days

Collection Instructions: For CSF, submit specimen from collection vial 2.

 

Specimen Type: Synovial fluid

Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Pink top (EDTA), royal blue top (EDTA), sterile vial containing EDTA-derived aliquot, red clot tube (no anticoagulant), or sterile container

Specimen Volume: 0.5 mL

Collection Instructions: Send specimen in original tube (preferred).

Specimen Stability Information: Refrigerated (preferred) <7 days /Frozen <7 days


Useful For

Aiding in the diagnosis of Bartonella infection

Method Name

Real-Time Polymerase Chain Reaction (PCR)

Reporting Name

Bartonella PCR

Specimen Type

Varies

Specimen Minimum Volume

Fresh tissue or biopsy: 5 mm(3)
Paraffin-embedded tissue block: two 10-micron sections
Fluid: See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reject Due To

Tissue in formalin, formaldehyde, or acetone
Bone marrow
Slides		 Reject

Clinical Information

Bartonella henselae and Bartonella quintana are small, pleomorphic Gram stain-negative bacilli that are difficult to isolate by culture due to their fastidious growth requirements. B henselae has been associated with cat scratch disease, bacillary angiomatosis, peliosis hepatitis, and endocarditis. B quintana has been associated with trench fever, bacillary angiomatosis, and endocarditis.

 

The diagnosis of Bartonella infection has traditionally been made by Warthin-Starry staining of infected tissue or serology. However, these methods may be falsely negative or nonspecific, respectively. Culture is insensitive.

 

Evaluation of infected tissue using polymerase chain reaction (PCR) has been shown to be an effective tool for diagnosing Bartonella infection. Mayo Clinic Laboratories has developed a real-time PCR test that permits rapid identification of Bartonella species. The assay targets a unique sequence of the citrate synthase gene present in Bartonella species.

Reference Values

Not applicable

Interpretation

A positive result indicates the presence of Bartonella species DNA.

 

A negative result indicates the absence of detectable Bartonella DNA but does not negate the presence of the organism and may occur due to inhibition of the polymerase chain reaction, sequence variability underlying primers or probes, or the presence of Bartonella DNA in quantities less than the limit of detection of the assay.

Cautions

This test does not differentiate between Bartonella henselae and Bartonella quintana.

 

Test results should be used as an aid in diagnosis. The single assay should not be used as the only criteria to form a clinical conclusion, but results should be correlated with patient symptoms and clinical presentation. A negative result does not negate the presence of the organism or active disease.

 

Inhibition of less than 2% has been noted in formalin-fixed, paraffin-embedded tissues. In a study of 178 ocular fluids, no inhibition was detected, although this is a possibility due to the relatively small number of specimens tested.

Clinical Reference

1. Liesman RM, Pritt BS, Maleszewski JJ, Patel R: Laboratory diagnosis of infective endocarditis. J Clin Microbiol. 2017 Sep;55(9):2599-2608. doi: 10.1128/jcm.00635-17

2. Dumler JS, Carroll KC, Patel R: Bartonella. In: Carroll K, Pfaller M, eds. Manual of Clinical Microbiology. 12th ed. ASM Press; 2019:chap 50

Method Description

Bacterial nucleic acid is extracted from the specimen using the automated MagNA Pure instrument. The purified DNA is placed on the LightCycler instrument, which amplifies and monitors by fluorescence the development of target nucleic sequences after each polymerase chain reaction (PCR) cycle. A specific target sequence from Bartonella species is amplified and the resulting segment is detected using specific hybridization probes. Detection of the Bartonella target is performed through melting curve analysis using the LightCycler software.(Cockerill FR, Uhl JR: Applications and challenges of real-time PCR for the clinical microbiology laboratory. In: Reischl U, Wittwer C, Cockerill F, eds. Rapid Cycle Real-Time PCR Methods and Applications. Springer-Verlag; 2002:3-27; Dumler JS, Carroll KC, Patel R: Bartonella. In: Carroll KC, Pfaller M, eds. Manual of Clinical Microbiology. 12th ed. ASM Press; 2019:893-904)

Day(s) Performed

Monday through Friday

Report Available

2 to 7 days

Specimen Retention Time

1 week

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

87801

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BARRP Bartonella PCR 48864-3

 

Result ID Test Result Name Result LOINC Value
SRC51 Specimen source 31208-2
84440 Bartonella PCR 48864-3