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J Clin Microbiol. 1996 Sep; 34(9): 2270–2274.
PMCID: PMC229230

Serological cross-reactions between Bartonella quintana, Bartonella henselae, and Coxiella burnetii.


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.

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Selected References

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  • Blondeau JM, Williams JC, Marrie TJ. The immune response to phase I and phase II Coxiella burnetii antigens as measured by western immunoblotting. Ann N Y Acad Sci. 1990;590:187–202. [PubMed]
  • Brouqui P, Dupont HT, Drancourt M, Berland Y, Etienne J, Leport C, Goldstein F, Massip P, Micoud M, Bertrand A, et al. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med. 1993 Mar 8;153(5):642–648. [PubMed]
  • Cooper MD, Hollingdale MR, Vinson JW, Costa J. A passive hemagglutination test for diagnosis of trench fever due to Rochalimaea quintana. J Infect Dis. 1976 Dec;134(6):605–609. [PubMed]
  • Drancourt M, Mainardi JL, Brouqui P, Vandenesch F, Carta A, Lehnert F, Etienne J, Goldstein F, Acar J, Raoult D. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med. 1995 Feb 16;332(7):419–423. [PubMed]
  • Dupuis G, Petite J, Péter O, Vouilloz M. An important outbreak of human Q fever in a Swiss Alpine valley. Int J Epidemiol. 1987 Jun;16(2):282–287. [PubMed]
  • Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200–209. [PubMed]
  • Finidori JP, Raoult D, Bornstein N, Fleurette J. Study of cross-reaction between Coxiella burnetii and Legionella pneumophila using indirect immunofluorescence assay and immunoblotting. Acta Virol. 1992 Oct;36(5):459–465. [PubMed]
  • GIMENEZ DF. STAINING RICKETTSIAE IN YOLK-SAC CULTURES. Stain Technol. 1964 May;39:135–140. [PubMed]
  • Hackstadt T, Peacock MG, Hitchcock PJ, Cole RL. Lipopolysaccharide variation in Coxiella burnetti: intrastrain heterogeneity in structure and antigenicity. Infect Immun. 1985 May;48(2):359–365. [PMC free article] [PubMed]
  • Hadfield TL, Warren R, Kass M, Brun E, Levy C. Endocarditis caused by Rochalimaea henselae. Hum Pathol. 1993 Oct;24(10):1140–1141. [PubMed]
  • Harris PJ. Intracerebral bacillary angiomatosis in HIV. Ann Intern Med. 1992 Nov 1;117(9):795–795. [PubMed]
  • Holmes AH, Greenough TC, Balady GJ, Regnery RL, Anderson BE, O'Keane JC, Fonger JD, McCrone EL. Bartonella henselae endocarditis in an immunocompetent adult. Clin Infect Dis. 1995 Oct;21(4):1004–1007. [PubMed]
  • Joblet C, Roux V, Drancourt M, Gouvernet J, Raoult D. Identification of Bartonella (Rochalimaea) species among fastidious gram-negative bacteria on the basis of the partial sequence of the citrate-synthase gene. J Clin Microbiol. 1995 Jul;33(7):1879–1883. [PMC free article] [PubMed]
  • Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA. 1994 Feb 16;271(7):531–535. [PubMed]
  • Koehler JE, Quinn FD, Berger TG, LeBoit PE, Tappero JW. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med. 1992 Dec 3;327(23):1625–1631. [PubMed]
  • Kosatsky T. Household outbreak of Q-fever pneumonia related to a parturient cat. Lancet. 1984 Dec 22;2(8417-8418):1447–1449. [PubMed]
  • Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature. 1970 Aug 15;227(5259):680–685. [PubMed]
  • Lucey D, Dolan MJ, Moss CW, Garcia M, Hollis DG, Wegner S, Morgan G, Almeida R, Leong D, Greisen KS, et al. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations. Clin Infect Dis. 1992 Mar;14(3):683–688. [PubMed]
  • Maurin M, Roux V, Stein A, Ferrier F, Viraben R, Raoult D. Isolation and characterization by immunofluorescence, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, western blot, restriction fragment length polymorphism-PCR, 16S rRNA gene sequencing, and pulsed-field gel electrophoresis of Rochalimaea quintana from a patient with bacillary angiomatosis. J Clin Microbiol. 1994 May;32(5):1166–1171. [PMC free article] [PubMed]
  • Musso D, Drancourt M, Raoult D. Lack of bactericidal effect of antibiotics except aminoglycosides on Bartonella (Rochalimaea) henselae. J Antimicrob Chemother. 1995 Jul;36(1):101–108. [PubMed]
  • Musso D, Raoult D. Coxiella burnetii blood cultures from acute and chronic Q-fever patients. J Clin Microbiol. 1995 Dec;33(12):3129–3132. [PMC free article] [PubMed]
  • Peacock MG, Philip RN, Williams JC, Faulkner RS. Serological evaluation of O fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis. Infect Immun. 1983 Sep;41(3):1089–1098. [PMC free article] [PubMed]
  • Raoult D, Marrie T. Q fever. Clin Infect Dis. 1995 Mar;20(3):489–496. [PubMed]
  • Regnery R, Martin M, Olson J. Naturally occurring "Rochalimaea henselae" infection in domestic cat. Lancet. 1992 Aug 29;340(8818):557–558. [PubMed]
  • Regnery RL, Anderson BE, Clarridge JE, 3rd, Rodriguez-Barradas MC, Jones DC, Carr JH. Characterization of a novel Rochalimaea species, R. henselae sp. nov., isolated from blood of a febrile, human immunodeficiency virus-positive patient. J Clin Microbiol. 1992 Feb;30(2):265–274. [PMC free article] [PubMed]
  • Slater LN, Welch DF, Hensel D, Coody DW. A newly recognized fastidious gram-negative pathogen as a cause of fever and bacteremia. N Engl J Med. 1990 Dec 6;323(23):1587–1593. [PubMed]
  • Spach DH, Callis KP, Paauw DS, Houze YB, Schoenknecht FD, Welch DF, Rosen H, Brenner DJ. Endocarditis caused by Rochalimaea quintana in a patient infected with human immunodeficiency virus. J Clin Microbiol. 1993 Mar;31(3):692–694. [PMC free article] [PubMed]
  • Spach DH, Kanter AS, Daniels NA, Nowowiejski DJ, Larson AM, Schmidt RA, Swaminathan B, Brenner DJ. Bartonella (Rochalimaea) species as a cause of apparent "culture-negative" endocarditis. Clin Infect Dis. 1995 Apr;20(4):1044–1047. [PubMed]
  • Spach DH, Panther LA, Thorning DR, Dunn JE, Plorde JJ, Miller RA. Intracerebral bacillary angiomatosis in a patient infected with human immunodeficiency virus. Ann Intern Med. 1992 May 1;116(9):740–742. [PubMed]
  • Tissot Dupont H, Raoult D, Brouqui P, Janbon F, Peyramond D, Weiller PJ, Chicheportiche C, Nezri M, Poirier R. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med. 1992 Oct;93(4):427–434. [PubMed]
  • Dupont HT, Thirion X, Raoult D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol. 1994 Mar;1(2):189–196. [PMC free article] [PubMed]
  • Welch DF, Pickett DA, Slater LN, Steigerwalt AG, Brenner DJ. Rochalimaea henselae sp. nov., a cause of septicemia, bacillary angiomatosis, and parenchymal bacillary peliosis. J Clin Microbiol. 1992 Feb;30(2):275–280. [PMC free article] [PubMed]

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