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Tuesday, March 10, 2015

What is Bartonella?



What is Bartonella? When one forays into the world of chronic Lyme disease the word Bartonella immediately comes up. What is it? I have written about it from time to time and treated it for a long time. What do we know?  Medical textbooks and published papers are at odds with “Lyme” literature. Bartonella is classified as a new and emerging infectious disease. Clinical infection is largely seen as opportunistic. This means that Bartonella under normal circumstances is unlikely to cause clinical disease: it has low pathogenicity. Commercial laboratories only offer serological tests for two species, B. henselae and B. quintana.  Newer information informs us that numerous other species, including: B. koehlerae, B. vinsonii and B. berkhoffi have been found in the blood of Lyme patients. Doctors have known about the prevalence of Bartonella species in some populations for some time. A study published in 1996 looked at the incidence of three species of Bartonella found in inner-city IV drug users in Baltimore: 33% showed antibodies for Bartonella elizabethae, 11% B. henselae and 10% B. quintanta. This population was not tested for scores of other Bartonella species; infection may be universal in this population. Unlike Lyme, it is well known that Bartonella is transmitted by other biting insects, fleas, flies and mosquitoes, not just ticks. IDSA types still like to argue about whether or not Bartonella is a tickborne illness. Some people like to argue about everything. It is fact, not conjecture, that Bartonella may be transmitted by tick bite. Severe forms of the disease are well described by mainstream medicine: cat scratch fever, trench fever, angiomatosis, endocarditis and others. The more nuanced forms of disease, including those seen in Lyme sufferers, are invisible to mainstream medicine. Mainstream doctors need to look a little closer.  In 2007 a paper in “Infection,” described vasculitis and polyneuropathy caused by B. henselae. A well-known paper published in a CDC journal in 2012 made connections between Bartonella and Lyme. The paper connected non-specific symptoms: fatigue, neurologic and neurocognitive abnormalities and joint and muscle pain previously described in occupationally at-risk patient populations.  The Bartonella I think of has greater specificity. A characteristic rash, shown below, parallel red lines or discolored stretch marks, is not described in mainstream medical literature. Red bumps or papules may be seen in life-threatening disease (angiomatosis) according to the usual sources, not the rash pictured below. The Bartonella which causes tendinitis, typically plantar fasciitis (pain on the bottom of the feet) and shin splints is not described in mainstream medical literature. 

 Bartonella, as I know it, is frequently associated with specific neuropsychiatric symptoms, which may include:  irritability, anxiety, rage and many others. This too is not described in mainstream literature. Bartonella as a potential cause of other medical syndromes, for example, interstitial cystitis is also not described in mainstream in medical literature. Then there is the issue of treatment. Bartonella is supposed to respond to tetracycalines and Biaxin according to standard sources. In my world Bartonella responds best to Rifampin and the other drugs do not work.

Although many think of Bartonella as primarily a red blood cell bacteria, it actually primarily resides primarily within endothelial cells, the cells that line the inside of blood vessels. The bacteria is transmitted by an influx of red blood cells which play a role in its life-cycle.  Because of its intracellular locus Bartonella can be as intractable as the other Lyme-associated microbes. 

Here is a snapshot from one of my patients last week. 

This 30 year old male had been in clinical remission from Lyme disease for over a year, after 2 years of extensive treatment. A perfect storm of emotionally stressful events occurred in his life and symptoms returned. He complained of severe fatigue, cognitive difficulties, muscle and joint pains and severe depression. He suffered with anxiety, most Lyme patients do, but he denied irritability, anger, rage and foot pain. And, he had never had a rash like this before. He does have a history of a prior Bull’s eye rash.


Bartonella causes inflammation of blood vessels, a form of vasculitis which likely causes this characteristic rash, undiscovered by mainstream medicine. Vasculitis in the brain is well known to cause neuropsychiatric symptoms, for example, lupus vasculitis. The mechanism of synergy, by which Lyme and Bartonella seem to cause specific psychiatric symptoms is unknown. 

In this patient, Bartonella was always there, even though clinical Lyme was conquered.  Unfortunately, emotional stress weakened the immune system and the tiger got of the cage. 

Specific treatment may not always be needed; therapy decisions are based on the clinical scenario of the patient undergoing treatment.

Here are some general pointers regarding treatment. I have found that rifampin works the best. It must always be given with another antibiotic (to prevent rapidly occurring resistance). Commonly prescribed co-therapies include Zithromax, doxycycline and Bactrim. Bactrim has mild anti-Bartonella effects and is a good add on to rifampin.  Quinolones, including the widely touted Levaquin may be used. I do not like to use this class of drugs because of side effects, which include: spontaneous tendon rupture and high rate of causing C. diff colitis. When I do use a quinolone I usually reach for Cipro because it is a little less toxic and can be started at lower doses and gradually ramped up. When these measure failure, gentamycin or tobramycin are usually very effective. These drugs can only been given IV or IM, have toxicity and requiring close monitoring. 

Atypical syndromes, like interstitial cystitis, may respond best to combinations of Zithromax, rifampin and doxycycline or minocycline. 

The question, “what is Bartonella?” has certainly not fully been answered. But, clinical approaches to what I like to call “Bartonella syndrome,” have evolved and generally perform well in the clinical setting. 

Much of this piece is based on the clinical experience of many doctors and patients, not what is considered medical "evidence." A patient I spoke with last week thought this kind of information constituted evidence as defined by evidence based medicine. "Evidence based medicine," which underpins mainstream medical practices relies on published studies but primarily on the opinion of experts who have interpreted the published studies, especially the ones they like.



29 comments:

Pearl said...

Thanks for this post. You mention some of the more serious manifestations of Bartonella, but left out Peliosis Hepatis. I rarely see this mentioned, and yet if doctors were more aware of it, perhaps more patients could be diagnosed with a liver scan. Many Bart patients do have liver/URQ abdominal pain.

I encourage you to check out UCSF's papers going back to the late 90's on Bartonella in AIDS patients, esp. the one on Peliosis Hepatis. (UCSF is where Dr. Jane Koehler researches Bartonella.)

They acknowledge that they see the same severe illness in occasional immune competent patients, too. I think the medical world mostly ignored their discoveries about Bartonella thinking that it was just an opportunistic infection in AIDS patients.

My Bartonella has been quite variable. Relapse symptoms were quite different than original symptoms. Rifampin does very little for me. Rifabutin is a bit better. Levaquin was awesome, but I can't take it anymore due to tendon pain. Thought the Bart was gone, but a year later it came roaring back much, much worse. I'm still surprised how miserable it made me.

Invanz caused a severe die off, so it was obviously working. IV Cipro helped. I saw the most improvement on weekly increasing doses of Ivermectin. I doubt I'll ever get rid of it completely.

Tabitha said...

Anyone who wants the most up-to-date information about bartonella needs to read Dr. Ed Breitswerdt's work. He is a researcher at NCSU in veterinary medicine who has been studying bartonella for more than 30 years. He has written many journal articles, is currently conducting research projects, and is working on creating better testing methods. He has some talks on YouTube, as well.

My experience with bartonella was both classic and invisible to the many different specialists I saw over the last several years. I have dozens of pictures of bizarre "red streak" rashes, swollen and bruised-looking veins, oddly colored "bruises" that lasted for weeks and were not caused by any injury, stretch marks that were not stretch marks...the soles of my feet felt like I had been walking on hot, rough concrete all day when I first got out of bed in the morning...my personality changed completely, to the point that my family did not know who I was anymore...I experienced panic attacks and anxiety for the first time in my life, for no reason...and this is all besides the joint and neurological and cardiac issues that led to misdiagnoses of rheumatoid arthritis, multiple sclerosis, TIAs, osteoarthritis, and huge shrugs and "I have no idea what THAT is."

I had graduated at the top of my class at an Ivy league university, homeschooled my 10 children, and worked part time as a doula and childbirth educator--and I was reduced to pure survival, constant pain, and feeling my mind slipping away. Bartonella is no joke. Because I was breastfeeding and pregnant by the time I was clinically diagnosed, I was limited to Ceftin and Flagyl for Lyme (after months of IV Rocephin) and azithromycin for the bartonella. I had thought I was better, but symptoms have been creeping back, even though I am still taking Ceftin and Flagyl. My hope is that by being part of NCSU's research study, I will get better direction in how to get completely better.

Anonymous said...

My son got M.E., as a result of the swine flu vacc 5 yrs ago, He is 18, approx 2 yrs ago - the bartonella time rashes appeared on his trunk. He has a cpap at night time, because he also developed sleep apnea. He has brain lesions, punctuates, bowing. Immune dysfunction in the T cells. There are numerous questions, but I am also interested in treatment. At the moment we are getting none - we live in Ireland and no help or medical is available, though we are hoping at some stage to get funds to move back to the US so that we can avail of treatments there.

Jane said...

Bridget, please look into the Cowden protocol for Lyme and other confections. I know of many who have had success with this. It is all herbal and can be done without a Doctor. http://www.nutramedix.ec/ns/lyme-protocol.
Good luck to you and your son!

Unknown said...

Hello,

My dear friend Heather has been battling severe chronic Lyme for a few years now. In Canada chronic Lyme is not recognized or treated forcing patients like Heather to seek treatment, out of pocket, in the USA. She travels to see her Lyme doctor every three months for her life saving antibiotics.

I'm hosting a fundraiser with Indiegogo for Heather's medical expenses. Would you be willing to share her campaign on your blog? I am not by any means asking or expecting you to make a donation to the campaign. I'm simply trying to gain as much exposure as possible to Heather's story, the horrors of Lyme and injustice faced by all Lyme patients. Even one simple blog post or a share on social media can help change a life. I am truly sorry that you have been affected Lyme. It's an illness I wouldn't wish upon anyone.

You can view Heather's campaign and read her story at the following link:

https://www.indiegogo.com/projects/help-heather-beat-lyme-disease--2/x/10091480

Thank you for your time,

Rebecca

Tickled333 said...

Does anyone know if successfully treated bartonella can leave scars in place of the bart rash? My son's rash has faded and is no longer red, but has turned to very light silvery marks. Was treated for 1.5 yrs. Doc says it is gone. He has never had any other symptoms, so I can't gauge by that.
TIA

Unknown said...
This comment has been removed by the author.
Unknown said...

Im curious as to your thoughts regarding rifampin dosing schedule. I see some llmds using rifampin at 600mg as a single daily dose but then others using it 300 mg bid. I know in things like tuberculosis and MAC, dosing seems to be 600mg all at once so im wondering why it seems to vary so much regarding which doctor you ask. Im well aware about pairing it with another antibiotic to prevent rapid resistance to the organism but Im curious about the dosing. It makes sense to me that dosing it all once daily would give you a higher bactericidal effect on the organism but then I feel like you may lose potential for sustaining high concentrations of the drug throughout the entire day. Im curious how you generally use it with your patients. Any thoughts would be greatly appreciated.

Rick said...

Top Bart Doc recommends 600mg Rifampin 2x per day (with Biaxin) --yes total of 1200 mg for 160 lbs

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angelaoscar06@gmail.com

Obohesan said...

HOW I GOT CURED OF HIV AND HERPES UNBELIEVABLE BUT TRUE!!! We all know that HIV and Herpes is a sexually transmitted virus that primarily infects the mouth and the genitals, I have been diagnosed with HIV and Herpes. 2 life long diseases ( or so doctors say ) and even scientifically proven incurable..I couldn't help but feel that these doctors nowadays are only in it for money and don't really care for our health so i feel like they don't tell you everything you could possibly know to give you a full recovery because if you're completely healthy and don't need a doctor..how will they get paid..( get the picture ?) With that being said, after my long nights of research I ended up in this testimony by a Canadian lady just like the one am making now about an Herbal Doctor from far somewhere around acient africa who helped her got cured of HIV within 6months of administering his herbal medicine at first when i saw her testimoney i was vary skeptical to believe her story because it has never been heard medically that someone was cured of HIV but later i decided to contact her directly and she showed me all the proof i needed to see only then did i beg her to give me direct contact to the doctors which she agreed and gave me his emal address which is[ obohesan@gmail.com ],which personally gave me more hope than my doctors did, it is Better to know than to be blind of other paths that could have been right in front of us for thousands of years and we were brainwashed to notice Nature has the best solutions to human problems.most people are so afraid that everything is fake because there are many people trying to scam and profit off of our hurt and pain.you have the right to be skeptical about everything but don't be naive..How many coincidences can there be before it isn't a coincidence anymore?..I don't know about you but I was completely determined to get that mess out of my body not treat it and feed it for the rest of my life and thank God today what humans would call being too inquisitive about the impossible has finally wiped tears of my eyes and now i am no longer in bondage i can proudly and boldly say i am now free from HIV and herpes from being positve to both to NEGATIVE. if you are having any type of this disease or infection like HIV,CANCER OR ANY disease kindly email obohesan@gmail.com or whatsapp +2348089281017

Rabi Ladan said...

The greatest Joy in my life today is that i have been cured of Herpes by a Doctor called Dr.Kudera, I was infected with HERPES Disease in 2020, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution, so that my body can be okay. Until one faithful day as i was browsing on the internet I saw a testimony on how Dr.Kudera has helped people in curing Herpes and other diseases, quickly I copied his WhatsApp number so i contacted him for solution for my Herpes disease, So Dr.Kudera told me that his going to prepare his herbal medicine for my health which he sent to me, luckily after 2 week my Herpes was cured. Dr.Kudera is well recognize as one of the best herbalist doctor in Africa, you don't have to be sad anymore or share your tears anymore on this disease when the cure is available. The medicine has NO SIDE EFFECT,there's no special diet when taking the medicine. He also cure ALS, HIV AIDS, CANCER, HPV, DIABETES and lots more.
For enquiries:
WhatsApp: +2348146552606

ELIZABETH LINDA said...

I still don’t know the right words to express my gratitude to this great man DR.IMOUDU. After been diagnosed of HERPES SIMPLEX VIRUS in 3months ago, i was given so many health prescription and advice with no improvement, I totally lost hope, until i found testimonies of Great DR.IMOUDU online research and on Facebook, Like anybody would be, I was very skeptical about contacting him, but i later did and he opened up to me and told me what was involved and he started the remedies for my health. Thank God, I was cured from herpes by the herbal medication I received from him. I never thought that herpes can be cured from the bottom of my heart. I'm truly grateful, i pray you have a long life so you can help many more people on earth with your herbal medical support, You can Email him via email DR.IMOUDUHEALERTEMPLE@GMAIL.COM or for easy and fast communication you can also call or add him on whats-app with this mobile number +2348109609753, one thing i love most about DR.IMOUDU is honestly, and he is very polite with his patience, everything he told me was what he did, and his herbal medicine are very affordable.

Tanner said...

! I'm Very Much Excited To Let Ya Know You're A God Sent To My Life.  After Living With HSV - 2 For The Past eight years.  I'm Finally Cured After Using Your Herbal Medicine And The Native Soap.  First Week The Cold Sores In My Genital Area Dried Up And After 3weeks I Got Tested And It Was Absolutely True.  My leg Number Is Now 0.70.1 Just want to Say Thank You Very Much For Restoring Back My Health.  I Promise To Share Your GreatWork To The Whole World That You Are The Best.  Thank You So Much Dr Agbonhale Im Gonna Publish Your Medicine To Blog Because It's The Real Deal. Thank You Very Much Herbalist Agbonhale you can contact him via WhatsApp +2349073130326 or email dragbonhaleherbalhome@gmail.com.

kate marcus said...

Hello, everyone! I,m here to explore blogs and forum about wonderful and most safe cure for (Herpes Virus).I was positive to the deadly virus called herpes and i lost hope because i was out casted and rejected even by my closet friends.i searched on-line to know and enquirer about cure for Herpes and i read someone testimony on how he was cured from Herpes so i decided to contact the same herbalist because i know that nature has the power to heal everything.i contacted him to know how he can help me and he told me never to worry that he will heal me with the natural herbs from God!after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via DHL and it got to me after 3 days!i used the med as he instructed me (MORNING and EVENING) and i was cured!its really like a dream but i am so happy!thats the reason i decided to also add more comment of Him so that more can be saved just like me!and if you need his help, you can email him on drehimare3@gmail.com, or whatsapp +1 (267) 691-1087 I,m neme amber and you can get in touch with me via drehimare3@gmail.com..Contact him for help at Herpes virus HIV/AIDS CANCER COPD BRAIN TUMOR All kind of virus and disease Dr Ehimare