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Concurrent Infection of the Central Nervous System by Borrelia burgdorferi and Bartonella henselae
Evidence for a Novel Tick-borne Disease Complex
Eugene Eskow, MD;
Raja-Vemkitesh S. Rao, PhD;
Eli Mordechai, PhD
Arch Neurol. 2001;58:1357-1363.
Objectives To investigate Bartonella henselae as a potential human
tick-borne pathogen and to evaluate its role as a coinfecting agent of the
central nervous system in the presence of neuroborreliosis.
Design Case report study.
Setting A primary health care center in Flemington, NJ, and the Department of
Research and Development at Medical Diagnostic Laboratories LLC in Mt Laurel,
NJ.
Subjects Two male patients (aged 14 and 36 years) and 2 female patients (aged
15 and 30 years, respectively) with a history of tick bites and Lyme disease.
Main Outcome Measures Laboratory and diagnostic findings before and after antimicrobial therapy.
Results Patients residing in a Lyme-endemic area of New Jersey with ongoing
symptoms attributed to chronic Lyme disease were evaluated for possible coinfection
with Bartonella species. Elevated levels of B henselae–specific antibodies were found in these patients using the immunofluorescent
assay. Bartonella henselae–specific DNA was detected in
their blood. None of these patients exhibited the clinical characteristics
of cat-scratch disease. Findings of cerebrospinal fluid analysis revealed
the presence of both B henselae– and Borrelia burgdorferi–specific DNA. Bartonella henselae–specific
DNA was also detected in live deer ticks obtained from the households of 2
of these patients.
Conclusions Our data implicate B henselae as a potential human tick-borne
pathogen. Patients with a history of neuroborreliosis who have incomplete
resolution of symptoms should be evaluated for B henselae infection.
From Hunterdon Medical Center (Dr Eskow) and the Vector-Borne Disease
Research Institute LLC (Drs Eskow and Mordechai), Flemington, NJ, and the
Medical Diagnostic Laboratories LLC, Mt Laurel, NJ (Drs Rao and Mordechai).
Corresponding author and reprints: Eli Mordechai, PhD, Medical Diagnostic
Laboratories LLC, 133 Gaither Dr, Suite C, Mt Laurel, NJ 08054 (e-mail:
emordechai{at}aol.com).
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