{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T12:38:40Z","timestamp":1789907920123,"version":"4.0.1"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"State of North Carolina Employer for Breitschwerdt, Maggi and Bradley"},{"name":"donations to the Bartonella\/Vector Borne Disease Research Fund, NCSU Veterinary Medical Foundation"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cent Nerv Syst Dis"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and\/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>For 18\u2009months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient\u2019s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1179573519832014","type":"journal-article","created":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T06:11:13Z","timestamp":1552889473000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":44,"title":["<i>Bartonella henselae<\/i>\n                    Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3506-0279","authenticated-orcid":false,"given":"Edward B","family":"Breitschwerdt","sequence":"first","affiliation":[{"name":"Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Medical Arts Psychotherapy Associates P.A., Summit, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo G","family":"Maggi","sequence":"additional","affiliation":[{"name":"Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B Robert","family":"Mozayeni","sequence":"additional","affiliation":[{"name":"Translational Medicine Group PC, North Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Lewis","sequence":"additional","affiliation":[{"name":"Sancta Familia Center for Integrative Medicine, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M","family":"Bradley","sequence":"additional","affiliation":[{"name":"Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,3,18]]},"reference":[{"key":"bibr1-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-6976.2012.00324.x"},{"key":"bibr2-1179573519832014","doi-asserted-by":"publisher","DOI":"10.3201\/eid2203.150269"},{"key":"bibr3-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1093\/ilar\/ilu015"},{"key":"bibr4-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00832-08"},{"key":"bibr5-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00833-11"},{"key":"bibr6-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.977"},{"key":"bibr7-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0073"},{"key":"bibr8-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00123-13"},{"key":"bibr9-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2011.09.001"},{"key":"bibr10-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2013.1512"},{"key":"bibr11-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1097\/IPC.0000000000000384"},{"key":"bibr12-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1111\/j.1939-1676.2004.tb00134.x"},{"key":"bibr13-1179573519832014","doi-asserted-by":"publisher","DOI":"10.2460\/ajvr.73.9.1403"},{"key":"bibr14-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1038\/srep34221"},{"key":"bibr15-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.05009-11"},{"key":"bibr16-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-016-1546-x"},{"key":"bibr17-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-222511"},{"key":"bibr18-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1186\/1756-3305-6-101"},{"key":"bibr19-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1186\/1746-1596-9-62"},{"key":"bibr20-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003467"},{"key":"bibr21-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1002\/art.21411"},{"key":"bibr22-1179573519832014","doi-asserted-by":"publisher","DOI":"10.3201\/eid1805.111366"},{"key":"bibr23-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3524-2"},{"key":"bibr24-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcpa.2012.12.003"},{"key":"bibr25-1179573519832014","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2017.00078"},{"key":"bibr26-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01029-10"},{"key":"bibr27-1179573519832014","doi-asserted-by":"publisher","DOI":"10.1186\/1756-3305-6-103"},{"key":"bibr28-1179573519832014","doi-asserted-by":"publisher","DOI":"10.4303\/jnp\/235640"},{"key":"bibr29-1179573519832014","first-page":"566","volume":"7","author":"Swedo 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