Relapsing Illness Due to Rochalimaea henselae in Immunocompetent Hosts: Implication for Therapy and New Epidemiological Associations

Abstract

Two previously healthy, immunocompetent men had persistent Rochalimaea henselae bacteremia with clinical relapses after courses of antibiotics to which the isolates were ultimately demonstrated susceptible in vitro. Both had sustained tick bites prior to their illnesses, thus demonstrating an association not previously identified, although suspected. The first patient had relapsing fever, constitutional symptoms, and an episode of aseptic meningitis despite therapy with amoxicillin, then with doxycycline, and then with ceftriaxone. Thereafter, he spontaneously became asymptomatic during a span of 2 months of persistent bacteremia. Finally, after 2 weeks of therapy with ceftriaxone plus gentamicin, followed by 4 weeks of therapy with oral ciprofloxacin, his bacteremia was cured. The second man had relapsing fever and constitutional symptoms after courses of tetracycline, then of chloramphenicol, and then of doxycycline. He became permanently asymptomatic after serial 2-week courses of chloramphenicol and erythromycin. The greater efficacy of lysis-centrifugation blood cultures in the recovery of R. henselae was noted.

Seroprevalence of Bartonella henselae and Toxoplasma gondii Infections among Pet Cats in Kanagawa and Saitama, Prefectures.

“…The causative agent of CSD, however, remained unknown for a long time after the disease was reported by Debré et al in 1950 [8]. Recent investigations suggested that a fastidious bacterium Bartonella henselae is a causative agent for bacillary angiomatosis (BA) and bacillary peliosis (BP) in HIV-positive patients [18,21,29]. Furthermore, serological investigations strongly suggested that B. henselae is a causative agent of CSD [25,31] and the organism was isolated from typical CSD patients in immunocompetent status [10].…”

Transmission ofBartonella henselaebyIxodes ricinus

“…B. henselae causes cat-scratch disease, possibly the most common zoonosis acquired from domestic animals in industrialized countries and is becoming increasingly associated with other syndromes, particularly ocular infections and endocarditis (2)(3)(4)(5)(6). Although cat fl eas are well-established vectors for B. henselae (7)(8)(9)(10), transmission by other arthropods, in particular ticks, has been suggested (11)(12)(13). Ixodes ricinus is the most widespread and abundant ixodid tick in western Europe and is frequently associated with bites in humans.…”

Cat scratch disease complicated with aseptic meningitis and neuroretinitis

“…The better described manifestation is encephalopathy occurring in 2%-3% of patients. A syndrome of aseptic meningitis is rarely described and we have found three cases in the literature, one reported by Lucey et al in immunocompetent patient whose CSF analysis revealed 19 leukocytes/mm 3 (100% mononuclear), a protein level of 62 mg/dL, and a glucose level of 76 mg/dL [1]. The other two cases were reported by Wong et al one in HIV-positive patient [2].…”

“…So far only three cases have been described in the literature, two of them in patients with HIV infection [1,2]. We report a case of aseptic meningitis in a previously healthy patient, HIV negative, who also had visual loss due to neuroretinitis, a far more common complication of CSD.…”