Maggi et al. Parasites & Vectors 2013, 6:101http://www.parasitesandvectors.com/content/6/1/101
Bartonella henselae bacteremia in a mother and son potentially associated with tick exposure
Ricardo G Maggi1,3*, Marna Ericson2, Patricia E Mascarelli1, Julie M Bradley1 and Edward B Breitschwerdt1
Background: Bartonella henselae is a zoonotic, alpha Proteobacterium, historically associated with cat scratch
disease (CSD), but more recently associated with persistent bacteremia, fever of unknown origin, arthritic and
neurological disorders, and bacillary angiomatosis, and peliosis hepatis in immunocompromised patients. A family
from the Netherlands
contacted our laboratory requesting to be included in a research study (NCSU-IRB#1960),
designed to characterize Bartonella spp. bacteremia in people with extensive arthropod or animal exposure. All four
family members had been exposed to tick bites in Zeeland, southwestern Netherlands
. The mother and son were
exhibiting symptoms including fatigue, headaches, memory loss, disorientation, peripheral neuropathic pain, striae
(son only), and loss of coordination, whereas the father and daughter were healthy.
Methods: Each family member was tested for serological evidence of Bartonella exposure using B. vinsonii subsp.
berkhoffii genotypes I-III, B. henselae and B. koehlerae indirect fluorescent antibody assays and for bacteremia using
the BAPGM enrichment blood culture platform.
Results: The mother was seroreactive to multiple Bartonella spp. antigens and bacteremia was confirmed by PCR
amplification of B. henselae DNA from blood, and from a BAPGM blood agar plate subculture isolate. The son was
not seroreactive to any Bartonella sp. antigen, but B. henselae DNA was amplified from several blood and serum
samples, from BAPGM enrichment blood culture, and from a cutaneous striae biopsy. The father and daughter were
seronegative to all Bartonella spp. antigens, and negative for Bartonella DNA amplification.
Conclusions: Historically, persistent B. henselae bacteremia was not thought to occur in immunocompetent
humans. To our knowledge, this study provides preliminary evidence supporting the possibility of persistent
B. henselae bacteremia in immunocompetent persons from Europe. Cat or flea contact was considered an unlikely
source of transmission and the mother, a physician, reported that clinical symptoms developed following tick
exposure. To our knowledge, this is the first time that a B. henselae organism has been visualized in and amplified
from a striae lesion. As the tick bites occurred three years prior to documentation of B. henselae bacteremia, the
mode of transmission could not be determined.
Keywords: Bartonella, BAPGM, Bacteremia, Striae, Neuropathy, Neurological disorder