{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:03:22Z","timestamp":1768514602120,"version":"3.49.0"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Cat scratch disease (CSD), caused by Bartonella henselae, usually presents as regional lymphadenopathy\/lymphadenitis, known as typical CSD or as atypical CSD, which includes, among others, neurological manifestations. Serology for anti-B. henselae IgG antibodies is the most commonly used diagnostic tests for CSD. Intravenous immunoglobulin (IVIG) is given for an increasing number of medical conditions and may cause interference with serological testing. We report six patients with neurological manifestations and two patients with Kawasaki disease mimicking typical CSD, mistakenly diagnosed as CSD due to false-positive serology following IVIG therapy. Bartonella IgG serology was positive one to six days after IVIG administration and reverted to negative in seven of eight patients or significantly decreased (1 patient) \u226430 days later. In patients with CSD, IgG titers remained essentially unchanged 15\u201378 days after the positive serum sample. An additional eight patients treated with IVIG for various conditions were evaluated prospectively. All were seronegative one day pre-IVIG infusion, five patients demonstrated an increase in the IgG titers one to three days after IVIG administration, one interpreted as positive and four as intermediate, whereas three patients remained seronegative, suggesting that false seropositivity after IVIG therapy may not occur in all patients. Treatment with IVIG can result in false-positive serology for B. henselae. Increased awareness to the misleading impact of IVIG is warranted to avoid misinterpretation. Repeat testing can distinguish between true and false serology. Preserving serum samples prior to IVIG administration is suggested.<\/jats:p>","DOI":"10.3390\/pathogens11020177","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T22:00:56Z","timestamp":1643320856000},"page":"177","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Misleading Positive Serology for Cat Scratch Disease following Administration of Intravenous Immunoglobulin"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1587-7310","authenticated-orcid":false,"given":"Michal","family":"Yakubovsky","sequence":"first","affiliation":[{"name":"Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel"},{"name":"The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Golan","sequence":"additional","affiliation":[{"name":"Tufts Medical Center, The Tufts University School of Medicine, Boston, MA 02446, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Guri","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaplan Medical Center, Rehovot 76100, Israel"},{"name":"The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem 7661041, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itzhak","family":"Levy","sequence":"additional","affiliation":[{"name":"The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Pediatric Infectious Disease Unit, Schneider Children\u2019s Medical Center, Petah Tiqva 4920235, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8006-5845","authenticated-orcid":false,"given":"Daniel","family":"Glikman","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Padeh Poriya Medical Center, Poriya 1528001, Israel"},{"name":"The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moshe","family":"Ephros","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Unit, Carmel Medical Center, Haifa 3436212, Israel"},{"name":"The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Giladi","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel"},{"name":"The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.7326\/0003-4819-118-5-199303010-00002","article-title":"Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease","volume":"118","author":"Dolan","year":"1993","journal-title":"Ann. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1128\/CMR.10.2.203","article-title":"Bartonella spp. as emerging human pathogens","volume":"10","author":"Anderson","year":"1997","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","first-page":"2824","article-title":"Bartonella, including Cat Scratch Disease","volume":"Volume 2","author":"Bennett","year":"2020","journal-title":"Mandell, Douglas, and Bennett\u2019s Principles and Pactice of Infectious Diseases"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e20192543","DOI":"10.1542\/peds.2019-2543","article-title":"Infectious and Autoimmune Causes of Encephalitis in Children","volume":"145","author":"Erickson","year":"2020","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1001\/archpedi.1991.02160010104026","article-title":"Cat-scratch disease. Acute encephalopathy and other neurologic manifestations","volume":"145","author":"Carithers","year":"1991","journal-title":"Am. J. Dis. Child"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1086\/519998","article-title":"Transverse myelitis in 2 patients with Bartonella henselae infection (cat scratch disease)","volume":"45","author":"Baylor","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/01.inf.0000195642.28901.98","article-title":"Bartonella henselae infection associated with Guillain-Barre syndrome","volume":"25","author":"Massei","year":"2006","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1016\/0140-6736(92)92032-B","article-title":"Serological response to \u201cRochalimaea henselae\u201d antigen in suspected cat-scratch disease","volume":"339","author":"Regnery","year":"1992","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.jaci.2016.09.023","article-title":"Update on the use of immunoglobulin in human disease: A review of evidence","volume":"139","author":"Perez","year":"2017","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_10","first-page":"529","article-title":"Passively acquired antibody to hepatitis B surface antigen. Pitfall in evaluating immunity to hepatitis B viral infections","volume":"113","author":"Devine","year":"1989","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Parker, S., Gil, E., Hewitt, P., Ward, K., Reyal, Y., Wilson, S., and Manson, J. (2014). Case report: Passive transfer of hepatitis B antibodies from intravenous immunoglobulin. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-99"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1016\/j.jaad.2011.03.032","article-title":"False-positive hepatitis B serology following IVIG therapy: Forgotten but not gone!","volume":"66","author":"Benton","year":"2012","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.5858\/2002-126-1237-PATAFI","article-title":"Passively acquired treponemal antibody from intravenous immunoglobulin therapy in a pregnant patient","volume":"126","author":"Rossi","year":"2002","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3423","DOI":"10.1128\/JCM.37.10.3423-3424.1999","article-title":"Intravenous immunoglobulin therapy: Confounding effects on serological screening for toxoplasmosis during pregnancy","volume":"37","author":"Pelloux","year":"1999","journal-title":"J. Clin. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Suresh, J., and Kyle, B.D. (2021). Clinical false positives resulting from recent intravenous immunoglobulin therapy: Case report. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05986-z"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"114952","DOI":"10.1016\/j.diagmicrobio.2019.114952","article-title":"Impact of IVIG therapy on serologic testing for infectious diseases","volume":"96","author":"Hanson","year":"2020","journal-title":"Diagn Microbiol Infect. Dis."},{"key":"ref_17","first-page":"e524","article-title":"Cat-scratch disease: Ocular manifestations and treatment outcome","volume":"96","author":"Trivizki","year":"2018","journal-title":"Acta. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3611","DOI":"10.1002\/art.21411","article-title":"Cat-scratch disease-associated arthropathy","volume":"52","author":"Giladi","year":"2005","journal-title":"Arthritis Rheum."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1086\/324162","article-title":"Enzyme immunoassay for the diagnosis of cat-scratch disease defined by polymerase chain reaction","volume":"33","author":"Giladi","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1086\/378738","article-title":"Long-term serological analysis and clinical follow-up of patients with cat scratch disease","volume":"37","author":"Kletter","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1542\/peds.96.6.1137","article-title":"Serologic responses to Bartonella and Afipia antigens in patients with cat scratch disease","volume":"96","author":"Goral","year":"1995","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1001\/archinte.1995.00430150164017","article-title":"Use of Bartonella antigens for serologic diagnosis of cat-scratch disease at a national referral center","volume":"155","author":"Dalton","year":"1995","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1128\/jcm.35.8.1931-1937.1997","article-title":"Pitfalls and fallacies of cat scratch disease serology: Evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay","volume":"35","author":"Bergmans","year":"1997","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/BF00918268","article-title":"Immunoglobulin replacement in patients with chronic lymphocytic leukemia (CLL): Kinetics of immunoglobulin metabolism","volume":"12","author":"Chapel","year":"1992","journal-title":"J. Clin. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ejps.2018.03.007","article-title":"Pharmacokinetics of a novel human intravenous immunoglobulin 10% in patients with primary immunodeficiency diseases: Analysis of a phase III, multicentre, prospective, open-label study","volume":"118","author":"Melamed","year":"2018","journal-title":"Eur. J. Pharm. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/BF00918706","article-title":"Alterations in the half-life and clearance of IgG during therapy with intravenous gamma-globulin in 16 patients with severe primary humoral immunodeficiency","volume":"6","author":"Schiff","year":"1986","journal-title":"J. Clin. Immunol."},{"key":"ref_27","first-page":"CD011367","article-title":"Intravenous immunoglobulin for the treatment of childhood encephalitis","volume":"10","author":"Iro","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/1346-8138.12785","article-title":"False-positive serology following intravenous immunoglobulin and plasma exchange through transfusion of fresh frozen plasma in a patient with pemphigus vulgaris","volume":"42","author":"Nomura","year":"2015","journal-title":"J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s11845-019-02115-3","article-title":"Transient derangements in Hepatitis B serology in patients post-intravenous immunoglobulin therapy-a case-based review","volume":"189","author":"King","year":"2020","journal-title":"Ir. J. Med. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.7861\/clinmedicine.15-2-125","article-title":"False interpretation of diagnostic serology tests for patients treated with pooled human immunoglobulin G infusions: A trap for the unwary","volume":"15","author":"Bright","year":"2015","journal-title":"Clin. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2818","DOI":"10.1093\/cid\/ciz1137","article-title":"Cat scratch disease presenting as fever of unknown origin is a unique clinical syndrome","volume":"71","author":"Landes","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3462","DOI":"10.1128\/JCM.42.8.3462-3468.2004","article-title":"Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis","volume":"42","author":"Avidor","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e02217-20","DOI":"10.1128\/JCM.02217-20","article-title":"Laboratory Diagnosis of 37 Cases of Bartonella Endocarditis Based on Enzyme Immunoassay and Real-Time PCR","volume":"59","author":"Shapira","year":"2021","journal-title":"J. Clin. Microbiol."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/2\/177\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:09:26Z","timestamp":1760134166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/2\/177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["pathogens11020177"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11020177","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]}}}