Central Nervous System Infection Associated WithBartonella quintana: A Report of Two Cases

Bartonella quintana is a fastidious Gram-negative bacillus first identified as a cause of a febrile illness, trench fever, among troops engaged in World War I.1 Infection with this agent in immunocompetent hosts, after an incubation period of 5 to 20 days, may result in one of four clinical patterns: 1) 4- to 5-day febrile illness, 2) periodic febrile illness with three to eight episodes lasting 4 to 5 days each, 3) prolonged febrile illness, or 4) afebrile bacteremia.2 Associated symptoms are nonspecific and include headache, conjunctivitis, maculopapular rash, organomegaly, arthralgias, myalgias, and bone pain (shin bone fever). The infection is globally endemic, and outbreaks are associated with poor sanitation and hygiene. There is no known nonhuman reservoir, and the body louse Pediculus humanus is the only known vector.1Infection of immunocompromised hosts with B quintana or B henselae has been associated with angioproliferative disease of the skin and internal organs, including cutaneous bacillary angiomatosis3-6 and bacillary peliosis of the spleen, liver, bone marrow, and central nervous system (CNS).7-10Endocarditis has also been reported in this population.11-13 We report two cases of CNS disease associated with B quintana . The patient in case 1 presented with a granulomatous process involving the right thalamus and surrounding tissues, and in case 2 with encephalopathy without evidence of focal involvement. B quintana was identified from the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR), with nucleotide sequencing demonstrating >99% homology with a segment of the B quintana citrate synthase gene segment. These two cases represent distinctive CNS pathology and broaden the clinical spectrum of B quintana infection. ### Case 1 A 19-year-old male presented to the emergency room with a complaint of frontal headache, left-side weakness, and slurred speech. Over a period of several weeks, the patient had developed clumsiness and …