Related Experiment Video
Updated: Jan 27, 2026
Author Spotlight: Oral Candida Diagnosis to Advance Clinical Treatment Regimen for pSS Patients
Published on: March 1, 2024
Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome
Edward B Breitschwerdt1, Rosalie Greenberg2, Ricardo G Maggi1
1Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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.
Insights
This case study shows that Bartonella henselae bloodstream infections can cause severe neuropsychiatric symptoms in children, mimicking Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Prompt antimicrobial treatment led to symptom resolution and recovery.
Area of Science:
- Neuroinfectious diseases
- Pediatric neurology
- Infectious disease diagnostics
Background:
- Bartonella spp. infections are increasingly recognized in patients with neurological symptoms.
- Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is defined by abrupt cognitive, behavioral, or neurological symptom onset.
- A 14-year-old boy presented with sudden-onset psychotic behavior unresponsive to conventional treatments.
Observation:
- The patient exhibited severe psychotic symptoms for 18 months, including hallucinations and suicidal ideation.
- Despite multiple psychiatric medications and immunosuppressive therapy, his condition did not improve.
- Cutaneous lesions suggestive of Bartonellosis appeared, prompting further investigation.
Findings:
- Research-based Bartonella spp. serology and PCR detected Bartonella henselae DNA in the patient's blood and blood cultures.
- Bartonella henselae serology was negative, highlighting the limitations of antibody-based testing.
- Combination antimicrobial chemotherapy resulted in gradual symptom improvement, resolution of lesions, and cessation of psychiatric medications.
Implications:
- Bartonella henselae bloodstream infection is a potential cause of recalcitrant neuropsychiatric symptoms in PANS.
- Early diagnosis and targeted antimicrobial therapy are crucial for managing neurobartonellosis.
- This case underscores the importance of considering infectious etiologies in pediatric neuropsychiatric disorders.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion