Neurological presentations of Bartonella henselae infection
Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome.
Material and methods
We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established.
Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery.
NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.
KeywordsBartonella Neurobartonellosis Cat-scratch disease Neuroretinitis
- 9.Ulug M (2015) Evaluation of cat scratch disease cases reported from Turkey between 1996 and 2013 and review of the literature. Cent Eur J Public Health 23(2):146–151Google Scholar
- 12.Wong MT, Dolan MJ, Lattuada CP Jr, Regnery RL, Garcia ML, Mokulis EC, LaBarre RA, Ascher DP, Delmar JA, Kelly JW et al (1995) Neuroretinitis, aseptic meningitis, and lymphadenitis associated with Bartonella (Rochalimaea) henselae infection in immunocompetent patients and patients infected with human immunodeficiency virus type 1. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 21(2):352–360CrossRefGoogle Scholar
- 14.Bergmans AM, Peeters MF, Schellekens JF, Vos MC, Sabbe LJ, Ossewaarde JM, Verbakel H, Hooft HJ, Schouls LM (1997) Pitfalls and fallacies of cat scratch disease serology: evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay. J Clin Microbiol 35(8):1931–1937PubMedPubMedCentralGoogle Scholar
- 16.Breitschwerdt EB, Sontakke S, Hopkins S (2012) Neurological manifestations of bartonellosis in immunocompetent patients: a composite of reports from 2005–2012. J Neuro-Oncol 3:1–15Google Scholar
- 18.Raihan AR, Zunaina E, Wan-Hazabbah WH, Adil H, Lakana-Kumar T (2014) Neuroretinitis in ocular bartonellosis: a case series. Clin Ophthalmol (Auckland, NZ) 8:1459–1466Google Scholar
- 34.Lucey D, Dolan MJ, Moss CW, Garcia M, Hollis DG, Wegner S, Morgan G, Almeida R, Leong D, Greisen KS, Welch DF, Slater LN (1992) Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations. Clin Infect Dis 14(3):683–688PubMedCrossRefGoogle Scholar
- 39.Schaller JL, Burkland GA, Langhoff PJ (2007) Do bartonella infections cause agitation, panic disorder, and treatment-resistant depression? MedGenMed 9, 54(3)Google Scholar
- 50.Bass JW, Freitas BC, Freitas AD, Sisler CL, Chan DS, Vincent JM, Person DA, Claybaugh JR, Wittler RR, Weisse ME, Regnery RL, Slater LN (1998) Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J 17(6):447–452PubMedCrossRefGoogle Scholar