Saturday, July 18, 2009

Bartonella re-visited

Bartonella is a facultative (difficult to culture), gram negative intracellular bacteria. New strains--known to cause human disease are being discovered on a regular basis. Standard serologic (antibody) tests ordered by physicians for Bartonella test only antibodies against B. henselae and B. quintana. A quick survey of medical literature shows a long list of Bartonella species with exotic sounding names: B. clarrideiae, B. koehlerae, B. vinsoni, B. berkhoffi, B. elizabethe, B. bovis, B. rochalimae, B. melophagi, B. facilliformis and others. The "species PCR Bartonella" test could miss other Bartonella species whose DNA is different. A CDC (Lyme-division) representative, recently said that new species of Bartonella in mice are being discovered on a regular basis. The CDC plans to publish a point-counterpoint piece regarding the significance of Bartonella in human disease.

Could the mystery bacteria seen in blood wet mounts and smears of many tick borne disease patients be yet unclassified forms of Bartonella? I think the answer is YES. These small bacteria stain gram negative and do not culture. Although Bartonella are intracellular organisms--live in cells, Bartonella species can exhibit prolonged bacteremia (bacteria in the blood).

Is the treatment of Bartonella different than that for Lyme? Both Lyme-Borrelia burdorferi and Bartonella are gram negative bacteria. The medical literature claims that both bacteria can for the most part be treated with the same antibiotics: Doxycyline, Biaxin, Zithromax, Rocephin, Levaquin and others. These drugs are bacteriostatic. Only two drugs are reputed to be bactericidal: Gentamycin and Rifampin. The standard medical literature also claims that Bartonella can be treated with short courses of antibiotics (similar to claims for Lyme). The literature indicates that Bartonella can cause brain infection but states that there is only one reported mortality. It is recommended that such cases should be treated more aggressively.

Back to the CDC. Most readers of this BLOG are familiar with the concept of tick borne disease. This concept is foreign to the CDC, despite a web-page which is misleading . The groups which study Lyme and co-infections are separated, even geographically(Colorado versus Georgia). Lyme is linked with spirochete diseases. Ehrlichia/Anaplasmosis are in a Rickettsia group. Babesia is in a parasite/protozoa group and Bartonella is in another group. The CDC admits it has never studied how multiple tick borne infections interact in a single host.

But I digress.

We don't really know what the germs (mystery bugs) are, what their role in disease is and how best to treat them.

A new patient, one who is extremely sick, was recently referred to my practice by one of my difficult patients--who is finally getting better--thanks.

This patient has a long history of chronic Lyme disease with pain and severe encephalopathy. She is only 45 years old but has moderate to severe dementia. Her previous physician, a well known Lyme treating doctor had prescribed a prolonged course of Rocephin--without benefit and essentially informed the patient and family that there was nothing else he could do.

I agreed to take the patient on to see if I could help. Based on experience I know that some patients respond to IV Zithromax even when IV Rocephin has failed. Perhaps this is a manifestation of the "Bartonella" syndrome.
There was a response. Within two weeks her pain was 50% better. Her encephalopathy worsened--a Baronella brain Herx?? At least it was something. These results are contemporaneous with this entry; adjustments in therapy are being made.

Clearly, there are patients who respond better to: Bactrim, IV Zithromax, Rifampin, Cipro, Levaquin and other drugs. LLMDS and their patients will attest to this.

Many patients are clinically diagnosed with the triad of: Lyme-Babesia-Bartonella--frequently on clinical grounds.

If there is a method to my madness I have found that patients respond best when the treatment strategy targets: Lyme then Babesia then Bartonella and then back to Lyme. Of course it may be desirable to use drugs which overlap in their ability to address the collection of infections. And so it goes.

13 comments:

merium said...

I frequent the Germantown area often (grew up in Gaithersburg)--is there any way I can get a referral to your practice? You mention on your profile that new patients are welcome, are you able to email me information? I have just been diagnosed with MS yet Lyme has not been thoroughly ruled out. Had a WB done from a local hospital lab, the only band found was IGg 41kda. Of course the Drs I am in contact with said "definitely not Lyme" and sent me on my merry way. I'd appreciate some way to contact you for a consult. Thank you so much and please keep up the blogging, it is refreshing to hear this side of the Lyme issue discussed.

gale said...

About Bartonella Serology

I believe there is a chance that the standard commercial Bartonella kits cross- reacts with the other/ unknown/"new" Bartonellas.
I had high titers for bartonella H and Q wheras tests were negative in with the more specific tests for these pathogenes in a reference lab.

Max said...

I am curious have you ever tried immunomodulators (such as pyrogenal for example) to enchance the action of abx?

Since I got the positive western blot I spend all my time reading about it and what I find is that seems no one gets better for real from the standard treatments (courses of various abx for long time). So it looks to me like this approach is flawed - seems like it just alleviates the symptoms without really addressing the cause. And long term abx do lot more harm ,so end result could be worse ( though I shudder to think that I can be worse then now) .

But I also read a lot about treatment of various chronic infections (including syphilis) and seems there is much success of combining the abxs with such drugs as pyrogenal. In fact syphilis was originally treated with malaria.

It is strange that this approach seems to be completely unknown ( english wikipedia entry is very brief , google search reveals no better results) .While I can find dozens of protocols and articles in my native language (russian) . It seems to be highly successfull, though I could not find anything related to lyme.

choosingtohaveagoodday said...

Doctor, Have you ever had a patient who developed kidney problems from either the lyme/co-infections or the IV meds themselves? My hemoglobin is between 5 and 7 and my EPO is 200, my iron sat is 5, so I guess that means my kidneys are not producing enough red blood cells. I was on IV rocephin and levequin when all this started happening.

sloborabas said...

Don't know where to add this comment since it is more of a request for info, than an actual comment.

What I am wondering is if you can post any commentaries on:

1: Bacteriophages (such as http://jb.asm.org/cgi/content/full/183/16/4771)

2: What skin problems you typically see in Lyme patients. I have Schamberg's disease on my legs (purpura), and several other minor skin conditions. Maybe it is just aging, but my skin seems very dull and lifeless overall.

MJ said...

And who is going to finally take a look at the "wet mounts" and say what are they and how to treat them?
Is a government outside somewhere to help?
Anxiously waiting for the public hearing this 30th of July 2009; are they going to at least consider opinions from Doctors like you?
Hope they do; don't think so, but hope, just hope...!

gale said...

LymeMD
I am aware that it is not that simple- uncomplicated for somebody like you to make the CDC etc take an interest in the in the organisms you discuss.
For patients it is impossible.
I think you should try.
Gale

carystus said...

@ choosingtohaveagoodday
You need to check out the toxicity of Fluoroquinolones (Ciprofloxacin and Levaquin belong to that class). They cause widespread damage in all who takes them. Fluroquinolones are tenotoxic, causing enzymatic degradation of collagen by way of mmp1, mmp13, collagenase and caspase-3. They cause apoptosis of tenocytes and fibroblasts (resulting in tendon rupture for some patients), disrupt neurotransmitters, GABA receptors and nerve tissue in general. They can cause irreversible cartilage damage, and damage to many organs, including kidneys. Adverse reactions are not rare, just under reported and suppressed. All fluroquinolones are toxic to all people, the
toxicity is a class effect.

Tendon damage happen to 100% of those who take them , as do vasculitis and damage to many other
tissues. In some people the damage is so extensive it causes overt symptoms, in some not. Effects
can be delayed up to 6-12 month or more due to vasculitis and loss of remodeling capability. Severe reactions can come from a very short course of treatment, even one dose (I am not referring to an allergic reaction). "The association between ciprofloxacin and Achilles tendon disease appears to be idiosyncratic rather than dose related" (St. Vincent's Hospital, Sydney).

If you choose to take Fluoroquinolones: Steroids dramatically increase the risk of severe injuries. NSAID's are vasoconstrictors, they amplify the negative effects of fluoroquinolones.
Take Magnesium; the cartilage damage is related to Magnesium being depleted by fluoroquinolones.
FDA now say patients should stop taking the medication if they develop any tendon pain, swelling or inflammation. Sidney Wolfe, head of the consumer group Public Citizen says ...pain in the
tendon is an early sign that leads to rupture.

Until recently, T. Boomers web site fluoroquinolones.org was active, and you could download his extensive 253 page flox report. His site is inactive now, but his report can be found elsewhere. Search for "flox report", it's a pdf. There are other good sites, e.g. fqresearch.org.
FDA has issued a warning in 2008, ordering makers of fluoroquinolones to add a 'black box' warning to there products. You can find it at Newsvine.com.

@ LymeMD
I am concerned that what is seen as a Jarisch Herxheimer reaction in patients may be an adverse
reaction to the medication. Some doctors use the assumed Herx as a measure of success, either as a sign that they have found the right medication, or as a confirmation that it is indeed a spirochete infection that is being treated.
But fluoroquinolones can cause poisoning reactions such as nausea and general malaise, that may be mistaken for a Herx. Few doctors have seen a real Jarisch Herxheimer reaction, and may not be able to tell the difference. The patient may have read about it, and may interpret any adverse reaction as Herxing, a popular term these days. It may even be that the patient does not have a spirochete disease at all, and if the doctor or patient insist on continuing treatment on basis of the apparent successful herxing...not a pretty picture.

MJ said...

Absolutely agree: "may interpret any adverse reaction as Herxing, ..." and with this increase the illness and the problem. I think is contradictory to base the recovery on how bad someone feels after treatment; my opinion!
There's a group of radical believers in curing "through pain", I mean, their blogs show more masochism that scientificity.
I have based my recovery in how good I am, I'm doing good today thank you!

AngiS said...

I'm very symptomatic of some type of tick-borne illness. Lyme was only positive on IgG 41 and IgM 41 so of course it was ruled out. My husband (who is a veterinarian) told me to contact Dr. Ed Breitschwerdt at NC State University to see if he could help me. If you have never heard of him, he is the country's (if not the world's) leading tick-borne disease specialist. He is a professor at NC State and a professor of Infectious Disease at Duke University. After hearing my symptoms and test results, he thinks I have Bartonella spp. He is studying Bartonella at a dizzying pace. He is currently doing a research study on it for animals and humans (which I am fortunate enough to be a part of) and he has the most state-of-the-art, cutting edge, patented testing technology to test the many faces of Bartonella. If anyone is interested in information about his work they should read his numerous published studies or contact him via e-mail at NC State. He (and this staff) has been wonderful to work with and I'm looking forward to getting my results back soon. The interesting (and scary) things that I've been reading are that there are documented cases of people being diagnosed with fibromyalgia, MS, bi-polar disorder, etc. and they end up testing positive for Bartonella. Three+ months of hardcore antibiotics and they're symptoms were gone. Simply amazing...
P.S. I agree about NOT taking Cipro - - it causes irreversible damage to your body. Do not take it if you're diabnosed with a tick-borne disease!!!

Platinum said...

Please help! I am at wits' end...

I have been sick for 1.5 years. I have been on omnicef and Dr. K's lyme cocktail for 5 months. That seems to have lyme in control.

But I have these frequent flare ups: encepholophay, neuropathy, strange wave of sensations. It is dibilitating. I have high VEGF (lab corp). I have tried rifampin + Bactrim DS, I can get it under control. VEGF has come back to normal range. I am at 80%. After two months of treatment, I stopped, and it came raging back.

Most of my symptoms are encephalopathy, neuropathy... I then tried Levaquin + lost of vitamin C. It worked like a magic for a week. Then it slowly came back. Now I am in my third week, levaquin does not seem to be working. I am heading downhill again. Symptoms got worse when I added Plaquinil to Levaquin. I stopped both. I am hoping someone could provide some explaination. Why levaquin works for one week, but then it does not work anymore... hongjiangwork@gmail.com

Platinum said...

Please help! I am at wits' end...

I have been sick for 1.5 years. I have been on omnicef and Dr. K's lyme cocktail for 5 months. That seems to have lyme in control.

But I have these frequent flare ups: encepholophay, neuropathy, strange wave of sensations. It is dibilitating. I have high VEGF (lab corp). I have tried rifampin + Bactrim DS, I can get it under control. VEGF has come back to normal range. I am at 80%. After two months of treatment, I stopped, and it came raging back.

Most of my symptoms are encephalopathy, neuropathy... I then tried Levaquin + lost of vitamin C. It worked like a magic for a week. Then it slowly came back. Now I am in my third week, levaquin does not seem to be working. I am heading downhill again. Symptoms got worse when I added Plaquinil to Levaquin. I stopped both. I am hoping someone could provide some explaination. Why levaquin works for one week, but then it does not work anymore...Thanks. hongjiangwork@gmail.com

ReBorn Again said...

Since all it takes is a flea bite or mosquito bite to transfer Bartonella from a pet to its human owner, everyone who is sick with Bartonella-like symptoms ought to get their housepets tested and treated as necessary!

Nothing like treating someone for months only to have them get reinfected again, and again!