Bartonella Associated Cutaneous Lesions (BACL) in People with Neuropsychiatric Symptoms.

Edward B Breitschwerdt,Paul Reicherter,Julie M Bradley,Erin Lashnits,Ricardo G Maggi

doi:10.3390/pathogens9121023

Edward B Breitschwerdt, Paul Reicherter + Show 3 more

Open Access

https://doi.org/10.3390/pathogens9121023

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Abstract

Bartonella species are globally important emerging pathogens that were not known to infect animals or humans in North America prior to the human immunodeficiency virus (HIV) epidemic. Ongoing improvements in diagnostic testing modalities have allowed for the discovery of Bartonella species (spp.) DNA in blood; cerebrospinal fluid; and the skin of patients with cutaneous lesions, fatigue, myalgia, and neurological symptoms. We describe Bartonella spp. test results for participants reporting neuropsychiatric symptoms, the majority of whom reported the concurrent development of cutaneous lesions. Study participants completed a medical history, a risk factor questionnaire, and provided cutaneous lesion photographs. Bartonella spp. serology and Bartonella alpha proteobacteria enrichment blood culture/PCR were assessed. Within a 14-month period, 33 participants enrolled; 29/33 had serological and/or PCR evidence supporting Bartonella spp. infection, of whom 24 reported concurrent cutaneous lesions since neuropsychiatric symptom onset. We conclude that cutaneous lesions were common among people reporting neuropsychiatric symptoms and Bartonella spp. infection or exposure. Additional studies, using sensitive microbiological and imaging techniques, are needed to determine if, or to what extent, Bartonella spp. might contribute to cutaneous lesions and neuropsychiatric symptoms in patients.

Highlights

Fever, lymphadenopathy, and a history of a cat scratch/bite are the prototypical manifestations of Cat Scratch Disease (CSD), an acute onset illness caused by Bartonella henselae [1,2]
Between August 2018 and October 2019, participants experiencing neurological or neuropsychiatric symptoms were enrolled after contacting the investigators requesting inclusion in a research study entitled “Detection of Bartonella Species in the blood of healthy and sick people”
A cross-sectional study was performed to determine the seroprevalence to six Bartonella species/genotypes

Summary

Introduction

Lymphadenopathy, and a history of a cat scratch/bite are the prototypical manifestations of Cat Scratch Disease (CSD), an acute onset illness caused by Bartonella henselae [1,2]. A spectrum of other dermatological lesions, including maculopapular and urticarial eruptions, granuloma annulare, erythema nodosum, erythema marginatum, thrombocytopenic purpura, leukocytoclastic vasculitis, multiple granulomatous lesions, and erythema annulare, have been reported in CSD patients [3]. A spectrum of cutaneous lesions has been historically associated with CSD. Bartonella spp. has been reported in patients with cardiovascular, neurological, and rheumatological diseases [1,2,4]. To what extent, persistent Bartonella spp. infection might result in cutaneous manifestations in patients with neuropsychiatric symptoms has not been determined. Linear cutaneous lesions were first clinically associated with B. henselae infection in 2002 in 10 pediatric

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