Professional Documents
Culture Documents
P170
Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA,
2
and Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
ABSTRACT
METHODS
Background: Cat scratch disease (CSD) is largely due to infection with Bartonella henselae (BH).
Since BH is difficult to culture, the diagnosis of CSD relies mainly on clinical, serological and/or
histological evaluation. The latter requires stellate suppurative granulomas. Silver stains (e.g.
Warthin-Starry or Steiner) for bacteria are cumbersome to perform and hard to interpret.
Molecular testing is not readily available. A monoclonal antibody (mAB) to BH has become
commercially available. The aim of this study was to evaluate the utility of immunohistochemistry
(IHC) to diagnose CSD on routine surgical specimens.
INTRODUCTION
Cat scratch disease (CSD) is largely due to infection with Bartonella
henselae.
Since Bartonella henselae is difficult to culture, the diagnosis of CSD relies
mainly on clinical, serological and/or histological evaluation. The latter
requires stellate suppurative granulomas.
Silver stains (e.g. Warthin-Starry or Steiner) for bacteria are cumbersome to
perform and hard to interpret.
Molecular testing is not readily available1.
Immunohistochemistry using a monoclonal antibody (mAB) to Bartonella
henselae has become commercially available2-4.
OBJECTIVE
The aim of this study was to evaluate the utility of immunohistochemistry
(IHC) to diagnose CSD on routine surgical specimens.
RESULTS
Five (19%) study cases were positive by IHC. Immunoreactive bacteria were
mainly cocci located predominantly within suppurative granulomas (Figure 2).
Nine (35%) study cases were positive by PCR, only one of which was also
positive by IHC (at 1:100 dilution only) (Table 1).
All controls were negative for both PCR and IHC.
Two cases were identified as positive by IHC at 1:4000, 1:800 and 1:100
dilutions, while were negative on PCR.
A third case was identified as positive by IHC only at a 1:100 dilution.
The third case was the only one that was positive both on IHC and PCR, and
that case was identified on IHC at a 1:100 dilution only.
IHC - (dilution)
PCR +
1(1:100)
PCR -
CONCLUSIONS
These data show that although the overall diagnostic sensitivity of
immunohistochemistry and PCR is low for CSD, PCR is more sensitive than
immunohistochemistry using mAB for Bartonella henselae.
Cases that were positive with mAB for Bartonella henselae but had a
negative PCR may be attributed to sampling from non-representative
lesional tissue.
We recommend performing PCR on all IHC negative cases suspected of
having CSD.
REFERENCES
1. Qian X, Jin L, Hayden RT, Macon WR, Lloyd RV. Diagnosis of cat scratch disease with Bartonella
henselae infection in formalin-fixed paraffin-embedded tissues by two different PCR assays. Diagn
Mol Pathol. 2005 Sep;14(3):146-51.
2. Cheuk W, Chan AK, Wong MC, Chan JK. Confirmation of diagnosis of cat scratch disease by
immunohistochemistry. Am J Surg Pathol. 2006 Feb;30(2):274-5.
3. Min KW, Reed JA, Welch DF, Slater LN. Morphologically variable bacilli of cat scratch disease are
identified by immunocytochemical labeling with antibodies to Rochalimaea henselae. Am J Clin
Pathol. 1994 May;101(5):607-10.
4. English CK, Wear DJ, Margileth AM, Lissner CR, Walsh GP. Cat-scratch disease. Isolation and
culture of the bacterial agent. JAMA. 1988 Mar 4;259(9):1347-52.