Bartonella revisited

I am getting a lot of questions about Bartonella. Many Lyme docs view chronic Lyme as a complex in which Bartonella and Babesia play a crucial role. This is my take on Bartonella. It is primarily an opportunistic infection. This means it causes infection in persons with significant immunosuppression, such as those with HIV, AIDS. Everyone is exposed to Bartonella on a regular basis. It comes from fleas, flies and mosquitoes in addition to ticks. If one's immune system is functioning reasonably well, I don't believe it should be a major player. It is a typical gram negative bacteria. It does not possess all the tricks of Lyme to circumvent the immune system. It may be hard to eradicate because we are constantly re-exposed to it. The conventional wisdom in Lyme therapy is that co-infections should be addressed when patients do not respond to Lyme therapy as expected. My experience has been that many patients are undertreated for Lyme. For example intravenous antibiotics are not used. And these same patients are extensively treated for Bartonella without getting better. Intensive Lyme therapy should probably include intravenous antibiotics before one starts to look seriously at Bartonella as an explanation for poor clinical response. It may make sense at some point to try Lyme drugs which are also known to be active against Bartonella: two for the price of one. For example Cipro covers both germs whereas Levaquin does not cover Lyme well. Rifampin covers Lyme, Bartonella and CPN. It is a useful add on. Bactrim only covers Bartonella so I do not use it.