Chronic Bartonella Coinfection
Coinfection management often is the key to success in improving quality of life in difficult Lyme patients. While medication and therapies directed against Lyme are often the tip of the spear in chronic Lyme treatment, 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 patients 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
• 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.
Most of the time, bartonella diagnosis and treatment is based on clinical signs, in patients with lab or historical evidence of tick borne infection.
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.
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.
I find good success with rifampin. It can be a difficult drug to tolerate due to fatigue and effects on the liver, but with the proper liver detoxification support it can be very useful. There is some evidence in other infections, including MRSA (resistant staph infections) that the combination of doxycycline and rifampin is particularly useful. One case report of a bartonella positive patient involved treatment with doxycycline 100 mg twice a day and rifampin 300 mg twice a day for 8 weeks and then 6 weeks. The patient went from having daily hallucinations to every two weeks, was able to extend her fingers again (previously not possible due to worsening stiffness) and her psychiatrist was able to decrease her antipsychotic medications. Rifampin 300 mg twice daily and azithromycin 250 mg daily was continued for 4 months. By the end of the bartonella treatment, and at 9 month follow up, there were no further hallucinations, vision and touch sense was restored.
Azithromycin is also very useful and is quite well tolerated, and this can be given intravenously as well if a central line is in place. The old sulfa type antibiotics, trimethoprim sulfamethoxazole also can be a very useful adjunct in bartonella treatment.
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, being an effective direct treatment for the bartonella infection.
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