Bartonella sp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction

Abstract

We detected infection with a Bartonella species (B. henselae or B. vinsonii subsp. berkhoffii) in blood samples from six immunocompetent patients who presented with a chronic neurological or neurocognitive syndrome including seizures, ataxia, memory loss, and/or tremors. Each of these patients had substantial animal contact or recent arthropod exposure as a potential risk factor for Bartonella infection. Additional studies should be performed to clarify the potential role of Bartonella spp. as a cause of chronic neurological and neurocognitive dysfunction.Bartonella henselae causes a prototypical illness characterized by fever and regional lymphadenopathy following a cat scratch or bite (8, 9). Cat scratch disease (CSD) is usually self-limited, and antibiotic therapy has minimal impact on the clinical course (11, 34). However, a spectrum of neurological manifestations, including ischemic stroke, cerebral arteritis, transverse myelitis, radiculitis, grand mal seizures, epilepsia partialis continua, status epilepticus, coma, and fatal encephalitis, in patients with CSD have been described previously (21,34). Chronic neurological or neurocognitive syndromes associated with persistent Bartonella bacteremia are less well characterized. Neurological symptoms following a cat scratch have also been described in association with B. quintana infection, and recent evidence indicates that cats can harbor B. quintana (6,13,32,37).Although CSD is considered to be self-limiting, persistent intravascular infection of a child with B. henselae for 4 months after a cat scratch has been reported previously (2). Furthermore, we recently described chronic intravascular infection with both B. henselae and B. vinsonii subsp. berkhoffii in immunocompetent people with occupational animal contact and arthropod exposure (5). Cats are the primary reservoir hosts for B. henselae, whereas to date, B. vinsonii subsp. berkhoffii has been isolated only from dogs, coyotes, foxes, or people (9, 27). Domestic and wild canines serve as the primary environmental reservoir for B. vinsonii subsp. berkhoffii, and dogs can be involved in the transmission of B. vinsonii subsp. berkhoffii and B. henselae to people (7,9,10,27,36).In this study, we report the isolation of B. henselae or B. vinsonii subsp. berkhoffii from, or the molecular detection of these pathogens in, blood samples from six people who exhibited a spectrum of neurological and neurocognitive abnormalities. MATERIALS AND METHODSBlood and serum samples from six individuals and cerebrospinal fluid from one patient were submitted by an attending physician to the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, for attempted isolation of a Bartonella species. We used a previously described approach incorporating preenrichment culture of blood in BartonellaAlphaproteobacteria growth medium (BAPGM) and PCR (16). Bacterial isolation, PCR amplification, and cloning were p...

Isolation of Candidatus Bartonella melophagi from Human Blood1

“…Nonspecifi c abnormalities, including diffi culty sleeping, muscle weakness, joint pain, and facial tremors, have been reported in association with isolation of B. henselae and B. vinsonii subsp. berkhoffi i (2,12). Pericardial or pleural effusions are infrequent complications of B. henselae infection in association with classical cat-scratch disease (13,14).…”

Bartonella Species Bacteremia in Two Patients with Epithelioid Hemangioendothelioma

“…berkhoffii in an EHE patient (8), a liver biopsy specimen (case 1 only) and blood and serum samples from this EHE patient and an EHE patient from England (case 2) were submitted by the attending physicians to the North Carolina State University Intracellular Pathogens Research Laboratory (IPRL) for attempted isolation or molecular detection of a Bartonella species. A DNeasy tissue kit protocol (Qiagen Inc., Valencia, CA) was used to extract DNA from tissue scrolls cut from the paraffin-embedded liver tissues containing the EHE tumor from patient 1, followed by PCR targeting the 16S-23S intergenic spacer (ITS) region (3,7,31).…”

“…We used a previously described microbiological approach incorporating enrichment cultures of patient blood and serum in Bartonella alphaproteobacteria growth medium (BAPGM), followed by PCR targeting the 16S-23S ITS region (3,7,14,16). The BAPGM diagnostic platform consists of PCR analysis performed following direct extraction of DNA from blood and serum, enrichment cultures from days 7 and 14, and PCR when colony growth is seen following subculture growth on blood agar plates.…”

Seroprevalence of Bartonella vinsonii subsp. berkhoffii in Urban and Rural Dogs in Turkey

“…B. vinsonii subsp. berkhoffii was isolated from an endocarditis lesion on the heart valve of a man [21] and in neurological and neurocognitive dysfunction and immunocompetent human patients [5,6], raising new concerns about the zoonotic potential of this organism. The first isolation of B. vinsonii subsp.…”