PEDIATRICS Vol. 96 No. 6 December 1995, pp. 1137-1142
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Serologic Responses to Bartonella and Afipia Antigens in Patients With Cat Scratch Disease

Cynthia M. Szelc-Kelly MD1, Simin Goral MD2, Guillermo I. Perez-Perez DSc3, Bradley A. Perkins MD4, Russell L. Regnery PhD5, and Kathryn M. Edwards MD2

1 Division of Pediatric Infectious Diseases, Department of Pediatrics, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA 23507
2 Division of Pediatric Infectious Diseases, Department of Pediatrics, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
3 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
4 Divisions of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
5 Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Objective. To assess the serologic response to Afipia and Bartonella, previously named Rochalimaea, in patients with cat scratch disease (CSD) and a healthy control group.

Design. Prospective, controlled trial.

Setting. Referral clinic and hospitalized patients in a university medical center.

Participants. Eighty patients with CSD and 57 healthy control subjects of similar age.

Main Outcome Measures. The immune responses to Afipia felis and Bartonella henselae were evaluated by a newly developed enzyme-linked immunosorbent assay (ELISA) in patients with CSD and healthy control subjects. Responses to B henselae were also measured by indirect fluorescent antibody (IFA) tests. Antibody levels to Bartonella quintana were measured by ELISA and IFA in a limited number of patients and control subjects.

Results. Of the 80 patients with clinical CSD, 56 had positive results of CSD skin tests. ELISA antibody levels to A felis did not differ between patients and control subjects, but immunoglobulin M (IgM) and IgG ELISA antibodies to B henselae and B quintana were significantly higher in patients than in control subjects. IFA responses to B henselae and B quintana were also significantly higher in patients than in control subjects.

Conclusion. Patients with CSD had significant serologic responses to B henselae and B quintana but not to A felis, suggesting that the causative agent of CSD is antigenically related to the Bartonella genus and not to Afipia. The Bartonella IgM ELISA and IFA assay were both sensitive and specific and may be used to establish the diagnosis of CSD.

Submitted on September 16, 1994
Accepted on December 5, 1994




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