Bartonellaspp. Bacteremia and Rheumatic Symptoms in Patients from Lyme Disease–endemic Region

C Ben Beard,Lyle R Petersen,Paul S Mead,Christina A Nelson

doi:10.3201/eid1811.120675

Abstract

To the Editor: We believe the recent article by Maggi et al. (1) contains serious flaws in content and underlying message, including a poorly defined study population, lack of appropriate controls, improper use of the term bacteremia, and incongruent laboratory findings. Selection criteria were vague: the authors state only that participants were a “biased” collection of “patients selected by a rheumatologist,” with no control population included for comparison. The diagnosis of Lyme disease and other previously diagnosed conditions was solely by self-report. Although blood samples were collected from every participant, the authors apparently neglected to perform standardized testing for Borrelia burgdorferi or other conditions.

Highlights

Bartonella spp. infection has been reported in association with an expanding spectrum of symptoms and lesions
Because epidemiologic evidence supports an association between rheumatic symptoms and catscratch disease and because arthritis is a primary disease manifestation of Borellia burgdorferi infection (Lyme disease), we explored whether antibodies against and bacteremia with Bartonella spp. can be detected in patients examined for arthropathy or chronic myalgia
We identified unexpectedly high serologic and molecular prevalence for B. henselae, B. koehlerae, and B. vinsonii subsp. berkhoffii in patients who had been examined by a rheumatologist, of whom more than half

Summary

Introduction

Bartonella spp. infection has been reported in association with an expanding spectrum of symptoms and lesions. B. henselae bacteremia was significantly associated with prior referral to a neurologist, most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities, whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician This cross-sectional study cannot establish a causal link between Bartonella spp. infection and the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy in this population; the contribution of Bartonella spp. infection, if any, to these symptoms should be systematically investigated. Because epidemiologic evidence supports an association between rheumatic symptoms and catscratch disease and because arthritis is a primary disease manifestation of Borellia burgdorferi infection (Lyme disease), we explored whether antibodies against and bacteremia with Bartonella spp. can be detected in patients examined for arthropathy or chronic myalgia. This study was conducted in conjunction with North Carolina State University Institutional Review Board approval (IRB# 164–08–05)

Methods

Results

Conclusion