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Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome
BACKGROUND: With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423671/ https://www.ncbi.nlm.nih.gov/pubmed/30911227 http://dx.doi.org/10.1177/1179573519832014 |
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author | Breitschwerdt, Edward B Greenberg, Rosalie Maggi, Ricardo G Mozayeni, B Robert Lewis, Allen Bradley, Julie M |
author_facet | Breitschwerdt, Edward B Greenberg, Rosalie Maggi, Ricardo G Mozayeni, B Robert Lewis, Allen Bradley, Julie M |
author_sort | Breitschwerdt, Edward B |
collection | PubMed |
description | BACKGROUND: With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation). METHODS: In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections. RESULTS: For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient’s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities. CONCLUSIONS: This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients. |
format | Online Article Text |
id | pubmed-6423671 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-64236712019-03-25 Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome Breitschwerdt, Edward B Greenberg, Rosalie Maggi, Ricardo G Mozayeni, B Robert Lewis, Allen Bradley, Julie M J Cent Nerv Syst Dis Case Report BACKGROUND: With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation). METHODS: In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections. RESULTS: For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient’s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities. CONCLUSIONS: This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients. SAGE Publications 2019-03-18 /pmc/articles/PMC6423671/ /pubmed/30911227 http://dx.doi.org/10.1177/1179573519832014 Text en © The Author(s) 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Case Report Breitschwerdt, Edward B Greenberg, Rosalie Maggi, Ricardo G Mozayeni, B Robert Lewis, Allen Bradley, Julie M Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title | Bartonella henselae Bloodstream Infection in a Boy
With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title_full | Bartonella henselae Bloodstream Infection in a Boy
With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title_fullStr | Bartonella henselae Bloodstream Infection in a Boy
With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title_full_unstemmed | Bartonella henselae Bloodstream Infection in a Boy
With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title_short | Bartonella henselae Bloodstream Infection in a Boy
With Pediatric Acute-Onset Neuropsychiatric Syndrome |
title_sort | bartonella henselae bloodstream infection in a boy
with pediatric acute-onset neuropsychiatric syndrome |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423671/ https://www.ncbi.nlm.nih.gov/pubmed/30911227 http://dx.doi.org/10.1177/1179573519832014 |
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