Table 3.

Polyneuropathic conditions associated with Bartonella species infection

Peripheral neuropathies: polyneuropathic conditions
Diagnosis	Patient age/sex	Initial symptoms/ clinical findings	Elapsed time to neurological symptoms	Key diagnostic results	Bartonella serology/PCR	Treatment/duration	Outcome	Refs.
Guillain-Barré syndrome	10/F	Fever and emesis	4 days Difficulty walking and myalgia progressed to generalized weakness, loss of deep tendon reflexes in lower limbs, and pelvic and truncal weakness over pursuant 3 days	CBC: mild neutrophilic leukocytosis and thrombocytosis CSF and AUS NSF Infectious/immune disease panel NSF1 Reduced motor n. conduction velocity/amplitude	Bh IgG 1:1024 IgM +  CSF PCR neg	IVIG × 5 days	Rapid resolution of neurological signs with no remaining deficits, Bh IgG titer dropped, and specific IgM disappeared	[58]
Vasculitic polyneuropathy	40/M	Acute onset arthralgia, swelling and pain in hands, Raynaud’s syndrome, swelling and ulceration of digit 2 right foot, livedo reticularis bilateral lower limbs	2 years Progressive asymmetric polyneuropathy, hyperesthesia and hyperalgesia of right leg, lower left leg, fingertips	Reduced nerve conduction velocity in legs, neurogenic changes to skeletal muscle Biopsy: axonal neuropathy with inflammation ↑ACE and IgA. ↓ C3 CSF NSF Borrelia burgdorferi and Treponema pallidum neg	No testing	High-dose corticosteroids	No change to neurological signs	[64]
		5 years after initial onset: developed recurrent digital ulcer	Persistent neurological deficits	No diagnostics	No testing	None	No treatment sought
		7 years after initial onset: recurrent digital ulcer, night sweats and weight loss	Persistent neurological deficits	↓ WBC and Fe, ↑ IgA and IgA immune complexes Extensive infectious/immune panel NSF2 Biopsy of ulcer: vascular proliferation	Bh IgG > 1024 Bq IgG 1:128	Erythromycin × 4 months	Improvement with residual pain in ulcerated toe, livedo reticularis and digital hypothermia
					Bh titer dropped to 1:256	Doxycycline × 3 weeks	No recurrent ulceration with minimal residual polyneuropathy and Raynaud’s syndrome for following 4 years

¹Negative to EBV, CMV, Campylobacter jejuni, Mycoplasma pneumoniae, rubella, measles, mumps, influenza, parainfluenza, parvovirus B19, Coxsackie B virus. Campylobacter jejuni negative in fecal study

²CBC, lymphocyte subsets, standard chemistries, sedimentation rate, CRP, IgG, IgM, IgE, C3, C4, ACE, B-2 microglobulin, RF, C-ANCA, P-ANCA, C1q binding immune complexes, cryoglobulins, cold agglutinins, anti-cardiolipin, ANA, d-DNS, RNP, Ro, La, SCL 70, CENP-B and Jo all nsf. Hep-B, G, HIV, HHV-8 neg. Borrelia burgdorferi IgG ELISA positive with inconclusive WB

CBC complete blood count, CSF cerebrospinal fluid, AUS abdominal ultrasound, NSF no significant findings, Bh Bartonella henselae, PCR polymerase chain reaction, IVIG intravenous immunoglobulin, ACE angiotensin converting enzyme, C3 complement 3, WBC white blood cells, Fe iron, WB Western blot