Nandhakumar Balakrishnan, Marna Ericson, Ricardo Maggi, and Edward B. Breitschwerdt

Vasculitis, cerebral infarction and persistent Bartonella henselae infection in a child

In a case report found in the link above, an 11 year old rural Canadian girl initially developed flu-like symptoms followed by sudden-onset headaches, difficulty walking, left sided paresis and an ataxic gait (lack of voluntary coordinated muscle movement) after cleaning a purulent abscess on the neck of an adopted feral dog daily for a few weeks.  Later, she developed gastrointestinal symptoms with abdominal pain, bloating and constipation which persisted throughout her illness.  She also developed chest pain, visual and auditory hallucinations, anxiety, ocular floaters, severe depression, fatigue, partial paralysis, seizures, laryngitis, severe confusion, difficulty swallowing, blindness in half her field of vision, and muscle weakness.  She initially was diagnosed with idiopathic vasculitis, Guillain-Barre syndrome, MS, and Acute disseminated encephalomyelitis (ADEM).  

Please see link above for the full, lengthy case report, but let’s suffice it to say things finally turned around for the poor girl when the mother requested her daughter be entered into an Institutional Review Board (North Carolina State University, College of Veterinary Medicine, IRB #164-08-05, NCSU-CVM IRB) approved research study….in short, was saved by Dr. Breitschwerdt, the Bart Guru who is the leading expert on Bartonella and understands the complexities in testing, diagnosis, and treatment.

Initial testing was either inconclusive or normal.  It wasn’t until Breitschwerdt used his specific testing methods that  B. henselae was found in brain tissue; however, causation cannot be established by a case report.

It is also important to note that the researchers say it is possible that,

B. henselae initially induced a vasculitis, resulting in secondary cerebral infarction, tissue necrosis and surgical resection.  Bartonellabacteremia, potentially spanning a 12-year time frame, in conjunction with the therapeutic administration of immunosuppressive drugs may have resulted in a progression and potentiation of the neurological disease that was partially reversible following antibiotic administration.”

“Based upon DNA sequence comparison, B. henselae was successfully PCR amplified from the FFPE brain tissue and from a blood specimen obtained in 2012. Using a previously described technique [11], B. henselae organisms could be visualized in FFPE surgical brain tissue by laser scanning confocal microscopy. Additional indirect support for a diagnosis of neurobartonellosis was provided by the historical deterioration in neurological status that followed administration of immune suppressive drugs, as compared to gradual improvement in neurological status after the initiation of antimicrobial therapy.”

“The extent to which repeated, corticosteroid-induced suppression of immune function contributed to additional or progressive neurological damage is unknown. However, there are case reports in which patients treated with immunosuppressive drugs based upon a “positive” autoimmune disease test result subsequently developed B. henselae endocarditis [13, 14]. There are also recent case reports that describe the medical complexities associated with differentiating occult, intravascular infection with a Bartonella sp. from autoimmune diseases [15]. The extent to which repeated administration of IVIG prevents or enhances disease progression in patients with occult infection also deserves critical consideration. IVIG administration to a child with Guillain-Barre syndrome did not halt the progressive paralysis prior to an apparent reversal in the disease process after initiation of antibiotic therapy [16].”

“Although unproven, chronic intravascular infection with Bartonella spp. may induce a degree of immunological anergy, resulting in an undetectable level of organism-specific antibodies in naturally-infected human patients or other mechanisms may contribute to seronegativity.
The source of B. henselae infection was not established for this patient. Although cats are most often implicated in the transmission of B. henselae to humans (Cat Scratch Disease), dogs have been infrequently reported as a source of infection.”