ROCHALIMAEA ANTIBODIES IN HIV-ASSOCIATED NEUROLOGIC DISEASE

Rochalimaea henselae, a recently described pathogen thought to cause s yndromes as varied as bacillary angiomatosis, parenchymal bacillary pe liosis, fever with bacteremia, and cat-scratch disease, is associated with CNS diseases including cerebral and retinal bacillary angiomatosi s, as well as cat-scratch-related encephalitis, myelitis, cerebral art eritis, and retinitis. We used a newly developed enzyme immunoassay an d the polymerase chain reaction to investigate the association of R he nselae infection with HIV-related CNS disease and found that whereas s eroprevalence rates in HIV-positive patients unselected for neurologic disease were 4% to 5.5%, those with neurologic disease had seropreval ence rates of 32%. The ratio of organism-specific antibodies in CSF co mpared with serum suggested intra-blood-brain-barrier synthesis of the se antibodies. CSF specimens containing only R henselae IgM had 16S rD NA specific for R henselae. Stored serum from one of these patients in dicated 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 w as accompanied by acute and subacute mental status changes including h allucinations, disorientation, and rapidly progressive dementia.