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

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.

Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study

“…95 Breitschwerdt et al described 29 patients who had serological and/or PCR evidence of Bartonella infection, 24 of whom described the onset of cutaneous lesions since the onset of neuropsychiatric symptoms. 96 The majority of those lesions were similar to the striae that this patient manifested on presentation. Bartonella immunoreactivity has been detected in skin-tissue biopsies in these lesions.…”

Bartonella henselae Detected in Malignant Melanoma, a Preliminary Study

“…IFA antigens. Previous studies have confirmed variation in the sensitivity of IFA assays depending upon the strain type used as antigen [30,37]. In addition, and for reasons that lack clarity, a subset of patients with persistent Bartonella spp.…”

“…As all patients were diagnosed with melanoma years before study entry, and because recent studies have found Bartonella spp. bloodstream infections in healthy individuals [ 30 ], the medical relevance of the association of this genus of bacteria with melanoma awaits future studies. In addition to the small number of study participants, only two FFPE tissue blocks were retrievable, limiting documentation of tumor-associated Bartonella spp.…”

“…can induce chronic intravascular infections in humans, including symptomatic and healthy immunocompetent individuals [ 26 , 27 , 28 ]. In recent years, documentation of persistent bloodstream infection has been reported in “immunocompetent” blood donors and healthy veterinary workers [ 29 , 30 ]. What remains incompletely understood is the biological consequences of persistent bloodstream infection.…”

Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery

“…He was subsequently diagnosed with neurobartonellosis after he developed cutaneous lesions, which has been documented as common in individuals reporting neuropsychiatric symptoms and Bartonella spp. infection or exposure ( 10 ). He was treated with a combination of antimicrobials and experienced a gradual progressive decrease in neuropsychiatric symptoms and was able to discontinue all psychotropic drugs ( 11 ).…”