title: Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse hunter spider bites.
abstract: BACKGROUND
  Bartonella species comprise a group of zoonotic pathogens that are usually acquired by vector transmission or by animal bites or scratches.
  
  
  METHODS
  PCR targeting the Bartonella 16S-23S intergenic spacer (ITS) region was used in conjunction with BAPGM (Bartonella alpha Proteobacteria growth medium) enrichment blood culture to determine the infection status of the family members and to amplify DNA from spiders and woodlice. Antibody titers to B. vinsonii subsp. berkhoffii (Bvb) genotypes I-III, B. henselae (Bh) and B. koehlerae (Bk) were determined using an IFA test. Management of the medical problems reported by these patients was provided by their respective physicians.
  
  
  RESULTS
  In this investigation, immediately prior to the onset of symptoms two children in a family experienced puncture-like skin lesions after exposure to and presumptive bites from woodlouse hunter spiders. Shortly thereafter, the mother and both children developed hive-like lesions. Over the ensuing months, the youngest son was diagnosed with Guillain-Barre (GBS) syndrome followed by Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). The older son developed intermittent disorientation and irritability, and the mother experienced fatigue, headaches, joint pain and memory loss. When tested approximately three years after the woodlouse hunter spider infestation, all three family members were Bartonella henselae seroreactive and B. henselae DNA was amplified and sequenced from blood, serum or Bartonella alpha-proteobacteria (BAPGM) enrichment blood cultures from the mother and oldest son. Also, B. henselae DNA was PCR amplified and sequenced from a woodlouse and from woodlouse hunter spiders collected adjacent to the family's home.
  
  
  CONCLUSIONS
  Although it was not possible to determine whether the family's B. henselae infections were acquired by spider bites or whether the spiders and woodlice were merely accidental hosts, physicians should consider the possibility that B. henselae represents an antecedent infection for GBS, CIDP, and non-specific neurocognitive abnormalities.
authors.affiliation: Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Mascarelli
authors.forename: Ricardo G
authors.initials: RG
authors.lastname: Maggi
authors.forename: Sarah
authors.initials: S
authors.lastname: Hopkins
authors.forename: B Robert
authors.initials: BR
authors.lastname: Mozayeni
authors.forename: Chelsea L
authors.initials: CL
authors.lastname: Trull
authors.forename: Julie M
authors.initials: JM
authors.lastname: Bradley
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Hegarty
authors.forename: Edward B
authors.initials: EB
authors.lastname: Breitschwerdt
mesh_terms: D016917:Angiomatosis, Bacillary / Q000150:complications / Q000175:diagnosis*; D000818:Animals; D018416:Bartonella henselae / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D001098:Spider Bites / Q000150:complications*; D013112:Spiders / Q000382:microbiology