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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.

Bartonella henselae bacteremia in a mother and son potentially associated with tick exposure