Bartonella: Psychiatric Symptoms & Neurological Symptoms

If you ask most psychiatrists or neurologist about Bartonella, I doubt if many would think it is a common infection in the USA. Even elite physicians who understand that Bartonella ("cat scratch fever") is not rare, would not call in the CDC or report it routinely to anyone. It is carried in many organisms including tiny poppy-seed sized ticks and a mere flea, and is common in many states in the USA. Of course, do not expect this to be discussed much since progressive clinical physicians are often those with no time or a desire to fight with government agencies.

So why care about Bartonella?

First, it routinely causes psychiatric symptoms that fail typical treatments. Antidepressants offer no full cures. Anti-anxiety agents might just help 50%. Individuals with Bartonella can feel depressed, irritable, hostile, aggressive and can have rage attacks and panic attacks. Hallucinations, strokes and seizures are possible but not routine.

If you find that good and sincere physicians are saying, "We do not know why you have _________." Then you should consider being tested for Bartonella. Of course, like most infections carried by ticks, the quality of the lab matters a great deal. Have the testing done at a facility which both specializes in tick disease and which has solid licensing, e.g., Medicare approved, NY State approved and California state approved lab. Only one lab appears to meet these criteria--IGeneX labs at (800 832 3200).

Below are some examples of extreme disease from Bartonella. If it can hurt you severely as is seen in the abstracts below, it can hurt you in a more subtle manner, with psychiatric symptoms.

J Clin Psychiatry. 1995 Apr;56(4):161-6.

Bacillary angiomatosis: a treatable cause of acute psychiatric symptoms in human immunodeficiency virus infection.

Baker J, Ruiz-Rodriguez R, Whitfeld M, Heon V, Berger TG.

Department of Psychiatry, San Francisco General Hospital, CA 94110, USA.

BACKGROUND: Bacillary angiomatosis is a systemic infection that has been most commonly reported in the setting of immunosuppression, especially human immunodeficiency virus (HIV) disease. METHOD: We report two patients who had bacillary angiomatosis who presented with psychiatric symptoms. RESULTS: The first patient presented with marked exacerbation of previous depressive disease. The second patient presented with new psychotic symptoms. In both cases psychiatric symptoms did not resolve until antibiotic treatment was given. CONCLUSION: Our report expands the clinical spectrum of bacillary angiomatosis and identifies a new cause of treatable psychiatric disease in HIV-infected persons.

Publication Types:

  • Case Reports

PMID: 7713855 [PubMed - indexed for MEDLINE]

Presse Med. 2005 Feb 26;34(4):297-8.

[Bartonella hensalae encephalopathy]

[Article in French]

Angibaud G, Balague JP, Lafontan JF.

Service de neurologie, Clinique du Pont de Chaume, 82 017 Montauban, France.

INTRODUCTION: Bartonella hensalae is a poorly known cause of encephalopathy in young subjects. OBSERVATION: A 17 year-old adolescent was admitted in a state of emergency because of frequent convulsive seizures and inter-critical drowsiness. The diagnosis of encephalopathy was made on the association of these clinical signs and electro-encephalographic abnormalities. The presence of a cat in his home, a right axillary lymph node that had appeared in a context of fever, and positive serological kinetics related this encephalopathy to a bartonellosis. The course was good. DISCUSSION: Diagnosis of a Bartonella hensalae encephalopathy is based on a range of anamnesic, clinical and microbiological arguments. The potential interest of antibiotic therapy and its modalities remains to be established.

Publication Types:

  • Case Reports

PMID: 15798550 [PubMed - indexed for MEDLINE]

Braz J Infect Dis. 2004 Jun;8(3):263-6. Epub 2004 Sep 29.

Acute hemiplegia associated with cat-scratch disease.

Rocha JL, Pellegrino LN, Riella LV, Martins LT.

Department of Infectious Disease, Nossa Senhora das Gracas Hospital, Curitiba, PR, Brazil. [email protected]

Cat scratch disease (CSD) is an infectious illness caused by a Gram-negative rod named Bartonella henselae. Typical CSD is characterized by a small skin lesion at the site of a scratch or a bite, followed by regional lymphadenopathy, one to two weeks later. Atypical forms may present as ocular manifestations, neurological manifestations, hepatosplenic involvement and vertebral osteomyelitis. Among neurological complications, encephalopathy is by far the most common. Other neurological manifestations are very rare. We report a case of an 11-year-old boy, with a posterior cervical lymphadenopathy and fever. Cat scratch disease was diagnosed and treated after a positive "Whartin-Starry" stain on lymph node biopsy. Two weeks after treatment, the patient was readmitted presenting an acute episode of left hemiplegia. A brain MRI demonstrated a right subcortical fronto-parietal lesion with no contrast enhancement. Complete recovery was observed after corticosteroid treatment.

Publication Types:

  • Case Reports

PMID: 15476060 [PubMed - indexed for MEDLINE]

Seizure. 2004 Apr;13(3):191-5.

Epilepsia partialis continua in cat scratch disease.

Puligheddu M, Giagheddu A, Genugu F, Giagheddu M, Marrosu F.

Department of Cardiovascular and Neurological Sciences, University of Cagliari, SS 554, Bivio Sestu, 09042 Monserrato, Cagliari, Italy.

Cat scratch disease (CSD) is a world-wide, diffuse, non-epidemic infection caused by the Gram-negative bacillus Bartonella henselae. The occurrence of encephalopathy represents an infrequent and atypical complication, whose manifestations include ischemic strokes, transverse myelitis and epileptic seizures. Status epilepticus has been described as the most frequent emergency in CSD encephalopathy. In this report, we describe a case of CSD complicated by an epilepsia partialis continua (EPC) manifested as rhythmic movements of the flexor muscles of the left hand. Although CSD is a benign, self-limited disease and a complete neurological recovery usually occurs, in the present case the EPC resulted in a partial epilepsy. Magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and back-averaged EEG data recorded during myoclonic activity document this CSD complication.

Publication Types:

  • Case Reports

PMID: 15010059 [PubMed - indexed for MEDLINE]

J Neuroimaging. 2003 Jan;13(1):79-82.

Diffusion-weighted magnetic resonance imaging abnormalities in Bartonella encephalopathy.

Singhal AB, Newstein MC, Budzik R, Cha JH, Rordorf G, Buonanno FS, Panzara MA.

Department of Neurology, Massachusetts General Hospital, Biogen, Inc. (MAP), Boston, USA. [email protected]

The authors describe 2 patients with new-onset, refractory status epilepticus and serological evidence for Bartonella infection. Brain magnetic resonance imaging (MRI) in patient 1 showed transient diffusion abnormalities in the posterior (pulvinar) thalami. In patient 2, brain MRI showed several enhancing cortical lesions, of which one lesion was bright on diffusion-weighted imaging (DWI). In patients with unexplained, refractory seizures, the presence of DWI abnormalities warrants a search for unusual infectious or inflammatory disorders, like Bartonella encephalitis.

Publication Types:

  • Case Reports

PMID: 12593136 [PubMed - indexed for MEDLINE]

Pediatrics. 2002 Aug;110(2 Pt 1):e21.

Acute disseminated encephalomyelitis in children.

Murthy SN, Faden HS, Cohen ME, Bakshi R.

Department of Neurology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

OBJECTIVE: To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM). METHODS: A 6-year retrospective chart review of children with the diagnosis of ADEM was conducted. RESULTS: Eighteen cases were identified. Sixteen patients (88%) presented in either winter or spring. Thirteen children (72%) had a recent upper respiratory tract illness. Patients presented most often with motor deficits (77%) and secondly with altered consciousness (45%). Spinal fluid abnormalities occurred in 70%. Despite rigorous microbiologic testing, a definite microbiologic diagnosis was established only in 1 child with Epstein-Barr virus disease and probable or possible diagnoses in 3 children with Bartonella henselae, Mycoplasma pneumoniae, or rotavirus disease. Brain magnetic resonance imaging identified lesions in the cerebral cortex in 80%, in subcortical white matter in 93%, in periventricular white matter in 60%, in deep gray matter in 47%, and in brainstem in 47% of patients. Eleven patients (61%) were treated with corticosteroids, and 2 were treated with intravenous immunoglobulins. All patients survived. Three patients (17%) had long-term neurologic sequelae. CONCLUSIONS: Epidemiologic evidence from this study suggests an infectious cause for ADEM. The agent is most likely a difficult-to-diagnose winter/spring respiratory virus. Magnetic resonance imaging was the neuroimaging study of choice for establishing the diagnosis and for following the course of the disease. Prognosis for survival and outcome was excellent. Recurrent episodes of ADEM must be differentiated from multiple sclerosis.

PMID: 12165620 [PubMed - indexed for MEDLINE]

J Forensic Sci. 2002 May;47(3):640-4.

Fatal meningitis and encephalitis due to Bartonella henselae bacteria.

Gerber JE, Johnson JE, Scott MA, Madhusudhan KT.

Forensic Medical, Nashville, TN 37216, USA.

Bacterial infection due to Bartonella henselae commonly develops in children and young adults following cat/dog contacts and/or cat/dog scratches. Regional lymphadenopathy is its most common clinical expression. However, encephalitis and Parinaud's syndrome (oculoglandular syndrome) have also been reported as has systemic illness. A review of the international literature in all languages revealed no fatal complications in immunocompetent hosts. A four-year-old white child with no underlying illness began to have seizure-like activity. She was taken to a local hospital and subsequently transferred to a medical center. The child was treated aggressively for seizures and fever of unknown origin. However, her condition rapidly declined and she died without a specific diagnosis. At autopsy there was marked cerebral edema with no gross evidence of acute meningitis. Microscopic exams revealed multiple granulomatous lesions as well as a meningitis and encephalitis. A variety of cultures and stains were negative for acid fast and fungal organisms. Warthin-Starry stains of involved tissue including brain and liver revealed pleomorphic rod shaped bacilli consistent with Barronella henselae. Analysis of brain tissue with polymerase chain reaction (PCR) and Southern blot for the deoxyribonucleic acid (DNA) was definitive for DNA of Bartonella henselae bacteria.

Publication Types:

  • Case Reports

PMID: 12051353 [PubMed - indexed for MEDLINE]

Kansenshogaku Zasshi. 2002 Feb;76(2):113-7.

[A case of cat scratch disease with encephalopathy]

[Article in Japanese]

Touyama M, Uezu K, Nakamoto A, Shinzato T, Higa F, Tateyama M, Saito A, Nakamura M, Tsuneoka H, Tsukahara M.

First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus.

We report an atypical case of cat scratch disease (CSD), accompanied with encephalopathy that is a rare complication of CSD. A 17-year old man consulted a doctor for his right axillary lymphadenopathy. [Big lymph nodes] The history of his contact with cats and the sign of lymphnode swelling and fever suggested a suspect of cat scratch disease. Administration of ampicillin improved his clinical symptoms, but a few days later he suddenly fell into coma after an episode of convulsion. The CT scan of the brain and laboratory tests showed no significant findings except the slightly elevated cell counts and concentration of protein in his cerebrospinal fluid. He was referred to our hospital on the next day for further examinations and treatments for his coma of unknown cause. The physical examination on admission revealed slight neck stiffening and hypertonicity of his right lower limb, but radiological and laboratory tests showed no significant findings. He gradually recovered from his coma without apparent sequelae in three weeks. Indirect fluorescence antibody titers for CSD in his serum showed a significant elevation to 1:160 of IgM and 1:512 of IgG, and his clinical features were compatible to these of CSD with complications of the central nervous system.

Publication Types:

  • Case Reports

PMID: 11904996 [PubMed - indexed for MEDLINE]

Infect Immun. 2001 Jan;69(1):564-9.

Infection of fetal feline brain cells in culture with Bartonella henselae.

Munana KR, Vitek SM, Hegarty BC, Kordick DL, Breitschwerdt EB.

Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27606, USA. [email protected]

Bartonella henselae is known to cause central nervous system (CNS) disease in humans, and neurological signs have been observed in experimentally infected cats. However, the pathogenesis of CNS disease remains unclear. This study was undertaken to determine whether B. henselae infects feline fetal brain cells in vitro. Microglial-cell- and astrocyte-enriched cultures were inoculated with B. henselae. Gimenez staining identified bacterial organisms within microglial cells by day 7 postinoculation. The viability of the intracellular bacteria was demonstrated by incubating cultures with gentamicin and plating cell lysate on agar. Electron microscopy identified intracellular organisms with characteristic Bartonella morphology but identified no ultrastructural abnormalities within infected microglial cells. No evidence of infection was seen in Bartonella-inoculated astrocyte cultures. These findings suggest a role for microglia in the pathogenesis of B. henselae-associated neurological disease.

PMID: 11119554 [PubMed - indexed for MEDLINE]

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