BAPGM culture + PCR testing platform is the most sensitive diagnostic test available for the detection of active Bartonella spp. infection.  

Because of their fastidious nature and characteristically slow growth in cell culture or on a blood agar plate, Bartonella species are difficult or, in many cases, impossible to detect using traditional microbiological diagnosis by bacterial isolation. Despite the exceptional sensitivity of conventional or real-time PCR (polymerase chain reaction or PCR), extremely low level infections can be missed. This problem can been solved with the pre-enrichment growth of bacteria following inoculation of prepared samples (blood, prepared tissue, and other fluids) into a liquid-based insect tissue culture growth medium, Bartonella Alpha Proteobacteria Growth Medium (BAPGM; pronounced bap-gee-em). This media supports the growth of many Bartonella species and facilitates the detection and isolation of Bartonella species in 7 days rather than 7 weeks.  BAPGM provides the ideal growth environment for these fastidious, insect-borne pathogens. 

BAPGM was envisioned, refined and patented by research scientists at the North Carolina State University College of Veterinary Medicine's Vector Borne Disease Diagnostics Laboratory as a result of ongoing efforts to enhance the growth of these highly fastidious (difficult to isolate) bacteria from animal and human patient samples.  Conventional PCR testing is largely ineffective at detecting the presence of Bartonella spp. infection, especially in immunocompetent patients.  NCSU-CVM research scientists were able to overcome the low detectability problem by combining a BAPGM enrichment culture step with a highly sensitive PCR testing.  As Bartonella species have a dividing time of approximately 24 hours, a diagnostic sample that contains one bacteria will contain only 2 after 24 hours, 4 after 48 hours, 8 after 72 hours, etc.  On a practical basis, this means that time (at least 7- 10 days) is required to increase the number of bacteria in the patient’s BAPGM culture to a level in which there is enough DNA to be detected by PCR (polymerase chain reaction).  Our research indicates that use of the BAPGM pre-enrichment culture increases the diagnostic sensitivity of Bartonella species detection by 50 to 80 times when compared to direct extraction and PCR amplification from a patient blood sample.

Below is a short list of references regarding the development and analytic validity of the BAPGM enrichment media.  Further information on the use of liquid culture for the detection of Bartonella infection and regarding Bartonella spp bacteria and associations with specific clinical indications can be found on PubMed and WebMD. 

Breitschwerdt EB, Maggi RG, Sigmon B, Nicholson WL. (2007) Isolation of Bartonella quintana from a woman and a cat following putative bite transmission. J Clin Microbiol 45:270-272. 

Cadenas, M. B., R. G. Maggi, et al. (2007). "Identification of bacteria from clinical samples using Bartonella alpha-Proteobacteria growth medium." J Microbiol Methods 71(2): 147-155. 

Diniz PPVP, Maggi RG, Schwartz DS, Cadenas MB, Bradley JM, Hegarty BC, Breitschwerdt EB. (2007) Canine bartonellosis: Serological and molecular prevalence in Brazil and evidence of coinfection with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Vet Research 38:697-710.  

Duncan AW, Maggi RG, Breitschwerdt EB. (2007) A combined approach for the enhanced detection and isolation of Bartonella species in dog blood samples: Pre-enrichment culture followed by PCR and subculture onto agar plates. J Microbiol Meth 69: 273-281.  

Maggi, R. G., A. W. Duncan, et al. (2005). "Novel chemically modified liquid medium that will support the growth of seven bartonella species." J Clin Microbiol 43(6): 2651-2655. 

Sontakke Sushama; Cadenas Maria B; Maggi Ricardo G; Diniz Pedro Paulo VP; Breitschwerdt Edward B. (2009) Use of broad range16S rDNA PCR in clinical microbiology.  J Microbiol Meth 76(3):217-25.