Manifestaciones Neurológicas Atípicas por Bartonella henselae

Abstract: Bartonella henselae, the aetiological agent of cat-scratch disease, presents with regional lymphadenopathy as a classic manifestation, however, atypical neurological complications (defined by rare anatomical involvement, chronic course or exceptional severity) represent a diagnostic and therapeutic challenge, being associated with significant morbidity and high healthcare costs. This systematic review analysed PubMed, EMBASE, SciELO, LILACS, Cochrane Library (1990-2025), grey literature and conference registries (2018-2025), using MeSH/DeCS terms that integrated B. henselae with neurological manifestations, excluding typical presentations. Studies with microbiological confirmation and quantifiable clinical data were selected, extracting demographic, diagnostic and therapeutic variables for statistical analysis. The main atypical presentations included encephalitis/encephalomyelitis, transverse myelitis, cranial neuropathies, polyneuropathies, vasculitis, neuroretinitis, psychiatric symptoms and brain abscesses. Low epidemiological frequency but high clinical impact was demonstrated, with diagnostic delay attributable to technical limitations. Gaps persist in unexplained pathophysiological mechanisms, lack of reliable biomarkers and lack of controlled trials. Research priorities include development of ultra-sensitive molecular techniques and comparative studies of antibiotic regimens.