Chronic Bartonella Coinfection
Coinfection management often is the key to success in improving quality of life in difficult to treat Lyme patients. Management and identification of all other persisting infections is often crucial.
A study published in Emerging Infectious Diseases in 2012 described the incidence of bartonella exposure (as measured by the immune system's production of antibodies against bartonella) as well as the incidence of finding bartonella in the blood stream in a rheumatologist referral practice. 62% of the time antibodies were found, and astonishingly 41% of the time there was evidence of bartonella still in the blood of these patients. The patient population in this study included chronic fatigue, Lyme disease, arthritis and fibromyalgia.
Bartonella symptoms are wide ranging, but most often mimic neurological Lyme symptoms as well as cause pronounced neurological pain. As such, common bartonella symptoms are:
• Cognitive difficulties and brain fog
• Auditory and visual hallucinations
• Anxiety and panic attacks
• Pronounced neurological pain, shooting sensations, sensations of being plugged into an electrical current, vibratory sensations
• Severe headaches
• Light and sound sensitivity
• Blurred vision
• Decreased peripheral vision
Some key note physical exam findings that often clue into bartonella treatment include:
• Sore soles, especially in the morning, with the sensation of walking on pebbles
• Stretch mark like rashes on the trunk (linear tracts)
• Vascular growths and lesions
• Subcutaneous tender nodules just under the skin that come and go
The most common test for bartonella is an indirect test that looks for antibodies against the bacterium. Unfortunately, the sensitivity is very limited and thus it misses many if not most cases. However, if the titres are elevated, they can typically be followed and see them lowered with resolving infection. I have seen this in a few patients.
PCR for the DNA of bartonella can be done. However the sensitivity limitations are typically even worse, as a small sample of blood from the entire supply is not likely to have the bartonella unless there is an overwhelming infection. There is a newer PCR assay that involves culture on a proprietary medium first, and a triple draw over one week does seem to have quite good sensitivity.
Elispot testing can be done as well, althoug
There are herbal and drug options for treatment of bartonella. Herbal bartonella treatment is very similar to Lyme, with some success being found with the standard cats claw / samento. Japanese knotweed seems to have a good effect on these symptoms, and in terms of bartonella treatment it may be useful because of direct anti microbial action, protective effects on the brain and neurological tissue, and anti-inflammatory effects on the blood vessels. Herbs that are more specific for bartonella include Byron White Herbals ABART formula, as well as the houttuynia formula from Nutramedix. Beyond Balance has excellent formulations including MC-BAR-1 and MC-BAR-2.
Antibiotics can be useful in select cases, but most have a good response to the above herbals alongside support for the foundations of health (such as diet, micronutrients, sleep), removal of toxins (supporting excretion, sauna, identification of other toxins including mycotoxins, biotoxins), and stimulation of homeostatic mechanisms (ozone therapy, and when improved exercise therapy). The most potent drugs used in bartonella treatment include the fluoroquinolone antibiotics, which include ciprofloxacin, levofloxacin, and moxifloxacin. Unfortunately, these can have severe side effects that are difficult to distinguish from a Herxheimer ore die off response. The side effects include tendon and connective tissue pain, which can culminate in rupture. Mozayeni has published on protocols including rifampin and macrolide antibiotics. Longer term antibiotics have the possibility of significant effects on the gut microbiome, as well as contributing to resistance, and thus the other options discussed should be considered first. I have found herbal options to be very good options as alternatives to the drug therapy.
The fatigue and neurological difficulties of bartonella may be helped by oxidative therapies, including ozone therapy by major autohemotherapy as well as by intravenous vitamin c. These seem to not only be useful in managing Herxheimer type reactions in bartonella treatment, but the peroxides delivered may be able to penetrate most tissue and get inside the cells, promoting an effective stimulus for homeostasis (bocci et al).
Rheumatological presentation of Bartonella koehlerae and Bartonella henselae bacteremias: A case report.
Medicine (Baltimore). 2018 Apr;97(17):e0465
Mozayeni BR, Maggi RG, Bradley JM, Breitschwerdt EB.
Neurological and immunological dysfunction in two patients with Bartonella henselae bacteremia.
Clin Case Rep. 2017 Apr 26;5(6):931-935
Kaufman DL, Kogelnik AM, Mozayeni RB, Cherry NA, Breitschwerdt EB.
Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse hunter spider bites.
Mascarelli PE, Maggi RG, Hopkins S, Mozayeni BR, Trull CL, Bradley JM, Hegarty BC, Breitschwerdt EB.
Parasit Vectors. 2013 Apr 15;6:98