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Section of Infectious Diseases (Dr. Schwartzman), UCLA Department of Medicine, Los Angeles; the Veterans Administration Medical Center (Dr. Schwartzman), Sepulveda; and Specialty Laboratories, Inc (Drs. Patnaik, Barka, and Peter), Santa Monica, CA.
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 henselae infection 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 henselae IgM had 16S rDNA specific for R henselae. Stored serum from one of these patients indicated he had developed R henselae-reactive IgM 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 henselae was accompanied by acute and subacute mental status changes including hallucinations, disorientation, and rapidly progressive dementia.
Address correspondence and reprint requests to Dr. William A. Schwartzman, Infectious Diseases Section, Sepulveda VA Medical Center (111-D), 16111 Plummer St., Sepulveda, CA 91343.
Supported by a grant from the University of California Universitywide AIDS Task Force #R90LA129.
Received August 16, 1993. Accepted in final form January 14, 1994.
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