| Abstrakt: |
Rochalimaea henselae, a recently described pathogen thought to cause syndromes as varied as bacillary angiomatosis, parenchymal bacillary peliosis, fever with bacteremia, and cat-scratch disease, is associated with CNS diseases including cerebral and retinal bacillary angiomatosis, as well as cat-scratch-related encephalitis, myelitis, cerebral arteritis, and retinitis. We used a newly developed enzyme immunoassay and the polymerase chain reaction to investigate the association of R henselaeinfection with HIV-related CNS disease and found that whereas seroprevalence rates in HIV-positive patients unselected for neurologic disease were 4 to 5.5, those with neurologic disease had seroprevalence rates of 32. The ratio of organism-specific antibodies in CSF compared with serum suggested intra-blood-brain-barrier synthesis of these antibodies. CSF specimens containing only R henselaeIgM had 16S rDNA specific for R henselae. Stored serum from one of these patients indicated he had developed R henselae-reactiveIgM antibodies 10 months prior to the onset of neurologic disease. In the 14 patients for whom clinical data were available, evidence of CNS invasion by R henselaewas accompanied by acute and subacute mental status changes including hallucinations, disorientation, and rapidly progressive dementia. |
