Herremans M, Bakker J, Vermeulen M J, Schellekens J F P, Koopmans M P G
Laboratory for Infectious Diseases and Perinatal Screening, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2009 Feb;28(2):147-52. doi: 10.1007/s10096-008-0601-8. Epub 2008 Aug 5.
Cat scratch disease (CSD) is caused by Bartonella henselae infection and is a common cause of regional lymphadenopathy. The diagnosis of CSD largely depends on serology, but detection of B. henselae in an affected lymph node by PCR is also an important diagnostic tool. We evaluated an IgM in-house ELISA protocol and analyzed its performance in routine CSD serology. Serum samples from PCR-positive patients (n = 126), PCR-negative patients (n = 123), and age-matched controls (n = 126) were used for evaluation. The sensitivity of the IgM ELISA was only 56%, showing that the performance of B. henselae serology under routine laboratory settings is low, probably caused by the wide variability in disease duration in patients suspected of CSD whose samples were submitted to our laboratory. Most patients (46%) with a positive IgM response were between 0 and 20 years of age. We conclude that the serodiagnosis of B. henselae is hampered by the low sensitivity and specificity of the assays when used in a routine laboratory setting. For this reason, a negative IgM or PCR result can never exclude CSD, especially with late sample collection.
猫抓病（CSD）由汉赛巴尔通体感染引起，是局部淋巴结病的常见病因。CSD的诊断很大程度上依赖血清学检查，但通过聚合酶链反应（PCR）检测受累淋巴结中的汉赛巴尔通体也是一种重要的诊断工具。我们评估了一种自制的IgM酶联免疫吸附测定（ELISA）方法，并分析了其在CSD常规血清学检测中的性能。采用来自PCR阳性患者（n = 126）、PCR阴性患者（n = 123）以及年龄匹配的对照者（n = 126）的血清样本进行评估。IgM ELISA的敏感性仅为56%，这表明在常规实验室条件下汉赛巴尔通体血清学检测的性能较低，这可能是由于提交到我们实验室的疑似CSD患者的病程差异很大所致。大多数IgM反应阳性的患者（46%）年龄在0至20岁之间。我们得出结论，在常规实验室条件下使用这些检测方法时，其低敏感性和特异性阻碍了汉赛巴尔通体的血清学诊断。因此，IgM或PCR结果为阴性绝不能排除CSD，尤其是在样本采集较晚的情况下。
