A bacterial infection from cat scratches can cause brain fog, rage, insomnia, and foot pain for years. Nobody tests for it.
Bartonella henselae. The bacteria behind cat scratch fever. 15 to 40% of cats carry it depending on age and flea exposure. Most doctors think the infection is mild and self-limiting. In some people it isn't.
It's an intracellular pathogen. Hides inside red blood cells and the endothelial cells lining your blood vessels, including the ones in your brain. Your immune system can't see it properly. It sits there causing chronic neuroinflammation for months or years.
Edward Breitschwerdt's lab at NC State has been documenting this for over a decade.
The research:
A 2019 case study: a boy developed sudden psychosis and seizures from confirmed Bartonella in his blood. Treated with antibiotics. Resolved.
A 2024 review from his lab called Neurobartonelloses: emerging from obscurity catalogued the full neurological damage - encephalitis, peripheral neuropathy, cerebral vasculitis, psychiatric symptoms including psychosis.
A 2024 study from Columbia and NC State tested 116 people. Patients with psychotic disorders were three times more likely to have Bartonella DNA in their blood than healthy controls (43% vs 14%, p=0.021).
A 2021 pilot study at UNC and NC State found the same thing. 65% of schizophrenia patients had Bartonella DNA, 8% of controls.
Two independent research groups. Two separate patient populations. Same result.
Why testing misses it:
Standard testing is an IFA antibody test. But Bartonella hides inside cells and your immune system may never mount a detectable antibody response. The Columbia study proved this directly — the antibody test could not distinguish patients with psychosis from healthy controls. The PCR could. Same blood, same patients, different test, different answer.
A negative IFA does not rule out Bartonella. It rules out a detectable antibody response. Those aren't the same thing.
Better tests: enrichment PCR or droplet digital PCR (ddPCR). Most doctors have never heard of either. You have to ask.
The symptom pattern:
- Brain fog that started suddenly, not lifelong
- Rage or irritability that doesn't fit your personality
- Anxiety or panic that SSRIs don't touch
- Insomnia the wired kind, not the tired kind
- Unexplained foot pain (endothelial inflammation and peripheral neuropathy)
- Linear raised marks on shins or thighs (look at your legs)
- Headaches that track the same timeline
Any one of these means nothing. Four or more with cat or flea exposure warrants testing.
The antibiotic clue nobody talks about:
If you've ever taken antibiotics for something unrelated dental infection, UTI, sinus infection and your brain fog temporarily improved, that's meaningful. Random antibiotics can partially suppress Bartonella. Most patients and doctors read this as evidence that the dental issue was the problem. It can also be evidence of a bacterial cause hiding underneath.
Treatment:
Chronic Bartonella requires targeted antibiotics for weeks, not days. The specific drugs and duration vary by species, severity, and individual response. This needs a doctor familiar with intracellular infection protocols. Herxheimer reactions (feeling worse before better) are common as bacteria die off.
What to ask your doctor:
- Enrichment PCR (BAPGM) or ddPCR testing, not just IFA
- Cat scratch history, not just "do you have pets"
- Whether any prior antibiotic course coincided with symptom improvement
Bartonella isn't responsible for every case of brain fog. It's worth checking when the symptom pattern fits and the fundamentals have already been addressed.
What about the cat
I'm not a vet. But here's what I learned when I went down this road.
Most cats that carry Bartonella show no symptoms at all. Your cat isn't sick. It's a carrier. You won't know by looking at it.
Kittens are higher risk than adult cats. They carry higher bacterial loads and they scratch more. Rescue kittens with fleas are the highest risk combination. That was my situation exactly.
Cats can be tested. A vet can run PCR on blood to check for Bartonella. But a negative doesn't mean they never had it. Cats can clear the bacteria on their own over time. A cat that infected you 6 months ago might test clean today.
The single most important thing you can do is flea control. Bartonella lives in flea feces. Fleas defecate on the cat. Feces gets under the claws. Cat scratches you. That's the transmission chain. Break it at the flea step and the rest doesn't happen.
Topical or oral flea preventative. Year round. Not just summer.
Beyond that. Keep claws trimmed. Don't let cats lick open wounds. If you get scratched wash it immediately and thoroughly. Don't play rough with kittens using your hands.
Don't get rid of your cat. That's not the message here. The message is keep the cat flea-free, handle scratches properly, and if you develop unexplained neuropsychiatric symptoms with the timeline and symptoms I described, tell your doctor you have cat exposure.
SOURCES
- Breitschwerdt EB et al. Bartonella henselae bloodstream infection in a boy with PANS. J Central Nervous System Disease. 2019. DOI: 10.1177/1179573519832014
- Lashnits E et al. Schizophrenia and Bartonella spp. Infection: A Pilot Case-Control Study. Vector-Borne and Zoonotic Diseases. 2021. PubMed: 33728987
- Bush JC, Robveille C, Maggi RG, Breitschwerdt EB. Neurobartonelloses: emerging from obscurity. 2024. PubMed: 39369199
- Delaney S et al. Bartonella species bacteremia in association with adult psychosis. Frontiers in Psychiatry. 2024. DOI: 10.3389/fpsyt.2024.1388442
- Breitschwerdt EB et al. One Health Zoonotic Vector Borne Infectious Disease Family Outbreak Investigation. Pathogens. 2025. DOI: 10.3390/pathogens14020110
- Breitschwerdt EB et al. Bartonella Associated Cutaneous Lesions in People with Neuropsychiatric Symptoms. Pathogens. 2020. DOI: 10.3390/pathogens9121023






