La Scola B, Raoult D
Unité des Rickettsies, Faculté de Médecine, Centre National de la Recherche Scientifique, Marseille, France.
J Clin Microbiol. 1996 Sep;34(9):2270-4. doi: 10.1128/jcm.34.9.2270-2274.1996.
The clinical manifestations of Q fever and bartonelloses can be confused, especially in cases of infectious endocarditis. Differential diagnosis of the diseases is important because the treatments required for Q fever and bartonelloses are different. Laboratory confirmation of a suspected case of either Q fever or bartonelloses is most commonly made by antibody estimation with an indirect immunofluorescence assay. With an indirect immunofluorescence assay, 258 serum samples from patients with Q fever were tested against Bartonella henselae and Bartonella quintana antigens, and 77 serum samples from patients with infection by Bartonella sp. were tested against Coxiella burnetii antigen. Cross-reactivity was observed: more than 50% of the chronic Q fever patients tested had antibodies which reacted against B. henselae antigen to a significant level. This cross-reaction was confirmed by a cross-adsorption study and protein immunoblotting. However, because the levels of specific antibody titers in cases of Bartonella endocarditis are typically extremely high, low-level cross-reaction between C. burnetii antibodies and B. henselae antigen in cases of Q fever endocarditis should not lead to misdiagnosis, provided serology testing for both agents is performed.
Q热和巴尔通体病的临床表现可能会相互混淆，尤其是在感染性心内膜炎的病例中。对这两种疾病进行鉴别诊断很重要，因为Q热和巴尔通体病所需的治疗方法不同。疑似Q热或巴尔通体病病例的实验室确诊最常见的是通过间接免疫荧光试验进行抗体检测。采用间接免疫荧光试验，对258份Q热患者的血清样本进行针对汉赛巴尔通体和五日热巴尔通体抗原的检测，对77份感染巴尔通体属细菌的患者血清样本进行针对伯氏考克斯体抗原的检测。观察到了交叉反应：超过50%的慢性Q热患者检测出的抗体与汉赛巴尔通体抗原发生了显著反应。这种交叉反应通过交叉吸附研究和蛋白质免疫印迹得到了证实。然而，由于巴尔通体心内膜炎病例中特异性抗体滴度通常极高，因此在Q热心内膜炎病例中，伯氏考克斯体抗体与汉赛巴尔通体抗原之间的低水平交叉反应不应导致误诊，前提是对两种病原体都进行血清学检测。
