Will There be Cake?

I have Lyme. I’d like to not have it anymore. I also just want cake.

Bah Bah Bah, Bah Bartonella

Welp, now I’ve got that song stuck in my head. Great. It’s preventing me from thinking of a catchy first sentence to draw you all in. I feel like I need one because I’m gonna invite you all in to an internet lecture hall and talk about Bartonella. Nobody (except complete geeks like me) willingly walk in to lecture halls. You see, I’m trying to get posts out devoted to individual infections that we often collect and squeeze together under the umbrella term of “Lyme”. I already did one on Babesia. Things are going… slowly with this goal. Sometimes I get a bee in my bonnet and end up re-finishing the dining room chairs and putting away the 5 stacks of laundry sitting in front of my closet and running around town to three different grocery stores because I like different things from each one, but most days I will stand before you and confess that I frequently debate even brushing my teeth for the day.  Most of the time it’s not even because I’m too sick to do so. I think two years of letting a lot of things go, like personal hygiene, because it was legitimately difficult to keep up with, has created some sort of insidious procrastination within me. Guys, I honestly just want to sleep. That’s all. I’m going to soothe my conscious now by telling myself sleep is more important. Per doctor’s orders. Lazy Tara shall reign. giphy (4)

Ok so Bartonella. What is it?

Let’s call it Bart for short (see, lazy). Bart is a gram-negative bacteria (let’s talk about that in another post, but basically it refers to the structure of their outer cell membranes) that currently comprises around two-dozen species. Cat Scratch Disease, Trench Fever, Carrion’s Disease… all stem from species of Bart. Not all species are known to infect us humans, but many researchers have discovered “bartonella-like organisms” on top of the already identified species. These have been found in human blood. What I’m saying is… lotsa Bart out there in the world. And lotsa stuff we don’t entirely know about them yet. But here is what we do know. Bart is an intracellular parasite that particularly likes to infect erythrocytes (red blood cells) and endothelial cells (cells that line the enterior surfaces of our blood vessels and lymphatic system) in humans. To be more specific, every five days some of the Bartonella bacteria in the endothelial cells are released into the blood stream where they then infect your red blood cells (perhaps this is why I would tend to break out in a fever every 5-7 days?). The bacteria then invade a specific membrane inside the red blood cells where they will eat, drink, and be merry (and multiply) until they reach a critical population density. Then, they simply wait until they are either taken up by another blood-sucking bug or the red blood cell dies. Consequently, your Bart be er’where.

giphy (1)

Not actual Bart. Bart probably doesn’t have a face. Probably.

Where do we get the Bart? We know that Bartonella is found in a wide range of wild and domestic animals, many of which we come in contact with either directly or indirectly on a regular basis. Cattle, rodents, dogs, and cats tend to be the big players. And I’m sure you cat lovers are aware (if not, I’m so sorry to break it to you) that cats are the main reservoir for Bartonella Henselae, the most commonly found species to infect humans (Hence, Cat Scratch Disease). But really, it’s Bart disease ya’ll.  People do run a risk of getting it from cat scratches or bites. I’ve grown up around a handful of kitties, I’ve been bitten and scratched more than I can count. And although I never (that I can recall) developed an acute illness from any of these possible exposures, I tend to believe that it’s highly likely I acquired my little Bart colony from a cat scuffle as much as a tick bite. Bartonella is extremely common and usually asymptomatic, but it is known to be quite the little pistol as an opportunistic infection – waiting for weakness in the host and exploding thereafter. Because of this, it’s important to remember that as with Lyme and any of it’s co-infections, the number of us that do not develop an “acute illness” shortly after the time of exposure is unknown, but likely very high.

2011-02-11_Bakterium_der_Gattung_Bartonella

Actual Bartonella.

Other vectors of Bart that do not include your beloved furry friend are fleas (most common), biting flies, lice, and ticks. We like to think of ticks as little bugs overflowing with spirochetes, but a 2004 PCR analysis of I. Scapularis ticks in New Jersey discovered that a higher percentage of ticks were infected with B. henselae than any other pathogen. (Source)

Testing

As with Lyme (Borrelia), serological testing for Bartonella remains a coin-toss. The immunocomprimization (is that a word? I’m making it a word) of patients with long-standing or latent Lyme disease (or other conditions) will substantially limit any antibody responses and therefore present a false-negative result on an antibody-based test. Tests include a western blot (antibody based), immunoflourescent antibody assays (antibody based), immunohistochemical staining (trying to visualize the bacteria), blood, spinal fluid, urine, or tissue PCR (looking for bacterial DNA), or culturing. There are some issues with the antibody testing for Bart, as cross reactions may occur with Q Fever, Chlamydia, and some rickettsial infections. Immunohistochemical staining is rarely done, and culturing Bart has it’s own difficulties as the bacteria is usually slow-growing in a laboratory setting.

What I’m probably trying to get at here is… as with Borrelia, a clinical diagnosis has an important place in the diagnosis of this infection. Go on with your testing, but don’t always trust a negative. If you’re reading this blog you’ve likely snooped around the internet long enough to already know this, but broken record I must be.

Tell me the Symptoms!

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Click image to enlarge

I get it. This list is totally overwhelming and when one has Lyme disease, so many symptoms between various infections overlap. But there are a few notable Bart maladies that tend to stand above the rest.

Rashes. let’s talk about rashes. giphy (2)Bart tends to be the main offender when it comes to pesky skin thingies that just come and go, come and stay, or come and migrate, disappear and reappear, you get the point. Being that this organism has a not-so-secret love affair for infiltrating our vascular system, that includes our millions of highways of capillaries. Vascular inflammatory responses are responsible for a lot of these “Ew” rashes, although actual skin involvement happens too. Type “Bartonella” into a Google Image search and you will get rash and gross skin pictures that only a pathologist would love (I’m positive it would disgust even your dermatologist). Aside from the hallmark “stretch mark” rashes Bart makes, (distinguished from real stretch marks by their come and go attitude or their deep purple or red color – real stretch marks are more white than anything else) additional manifestations can be quite benign in appearance and so small or subtle you may not even notice them. Although I do indeed, have some form(s) of Bartonella, I never got the crazy stretch mark rashes. Mine were more sneaky and always vascular. I developed a ton of petechiae (a small red or purple spot caused by bleeding into the skin) after getting sick. Babesia is known to cause this type of rash as well as Bartonella as both fight over red blood cells and can alter platelet levels just enough to cause these super tiny bleeds from capillaries. I also got some weird things that Dr. J has confirmed was Bartonella. In fact he seemed excited to identify them in the pictures I snapped… true infectious disease doctor at heart, that guy. Because not everyone wants to be visually assaulted with rash pictures, I’ll just include links below for you to click, should you be so voyeuristic.

  1. Claw mark-like, painless rash that frequently appears in the heat or shortly after knocking back some antibiotics, as in this case (all hail the herx rash). Disappears fairly quickly after popping up.
  2. Circular, painless, bruise-like rashes that would appear on my feet only and would last anywhere from 12-24 hours.
  3. Spidery, “tiny chicken wire” looking rash that frequently appears in the heat, after physical activity, or after antibiotic dosing. Also painless and disappears within an hour or two. 

It is important to note that the presence of rashes is not positively indicative of a Bartonella infection as other health conditions or infections can cause similar issues. They must be viewed along with other symptoms and diagnostic measures for a proper diagnosis.

Secondly, Bart is known for Psychiatric… issues. I know one Lyme specialist to have said something to the effect of “if a patient comes to me with the majority of their symptoms to be from the chest up, I immediately suspect Bart”. Um, this very much was me. I didn’t become a psycho or run the streets sans pants (I won’t deny a part of my brain certainly felt headed in that direction at times), but I did have some very notable problems and episodes in this department. Some of my very first symptoms were sudden-onset Panic Disorder, Sensory Overload, and Sympathetic Overdrive. I’ve experienced waves of depression not yet known to me and at times even personality or behavioral changes. Normally quite the peaceful person, I suddenly began noticing unusual irritability and even rage, sometimes in response to slight annoyances but often directed at nothing at all. I felt my brain was no longer mine. It began responding like someone else’s brain. The brain of someone who would throw chairs. giphy (5)Thank goodness those days are behind me. But during that era of my illness, I thankfully maintained an awareness of my psychiatric changes but counted one of my big struggles with Lyme disease to be the daily attempts at containing those issues as best as I could. I also became extremely emotional. Just compliment my shirt or something and I will weep over your kindness. No exaggeration. Throughout the course of my diagnosis and treatment I have also been diagnosed with encephalitis, seizure disorders, loss of fine motor skills, issues with coordination, and other similar neurological problems that can arise when inflammation is present in the brain. All are subsiding. Praises to my doctor.

But if you are like me, you like to ask why. Or how. You stay up late at night wondering the mechanisms behind your symptoms. I couldn’t find all the answers, but I suspect the below plays a big part in not just matters of Bart and the brain, but Bart and the body too. According to this peer-reviewed article:

“The presence of Bartonella-induced psychiatric symptoms should not be surprising. First, psychiatric disorders are brain disorders, and Bartonella is documented as causing many diverse neurologic brain disorders. Second, Bartonella infections are associated with RBCs, which allow small Bartonella bacteria (a fraction of the RBC size) to enter the brain’s vascular system. These Bartonella-infected RBCs probably cause psychiatric morbidity due to brain pathology, as indicated by the fact that some Bartonella patients have neurologic disorders, such as seizures, hemiplegia, ischemic strokes, transverse myelitis, and multiple granulomatous lesions, as well as meningitis and encephalitis.” (Source)

Any part of the body will go on the fritz if it’s vascular matrix waterslides harmful bacteria through its doors.

Lastly, foot problems. I feel comfortable adding this to the “Big 3″ Bart manifestations. Foot pain, arch pain, heel pain, toe joint pain, other foot joint pain, purple feet, discolored feet, weird rashy things on your feet, sores on your feet, pain that goes up the foot and ankle to the shins, calves, or rest of the legs. All of it. Many are misdiagnosed with plantar fasciitis. I have/had many of these too.

Despite these being the Big 3, they rarely come alone. Also many have Bart but have none of the Big 3. It’s a mad, mad world, we live in, eh?

How do we Treat?!

Conventional antibiotics are usually the go-to treatment course for Bart infections. Because it is an intra-cellular bacteria, only intra-cellular antibiotics will work. Despite knowing the kind of antibiotics that work, a multi-drug approach is still needed. These bugs are hard to get rid of and are especially immune to your immune system when hiding within the comforts of your red blood cells. According to one article explaining the rise in Bartonella among veterinarians (go figure), one doctor exclaimed:

“You cannot float humans or horses in enough Doxycycline to kill this bacteria,” said Breitschwerdt. Treatment… requires weeks of multi-antibiotic therapies”. (Source)

Mind you, this is describing those with more acute infections. Those of us who have been lugging around Bart and friends for years are going to require not just weeks, but months and possibly years of treatment. According to several studies, (and if we want to trust Wiki) “Bartonella species are susceptible to a number of standard antibiotics in vitro (in a lab)—macrolides (your Azithromycin, Clarithromycin, Eyrthromycin, etc.) and tetracycline (Doxycycline, Minocycline, Tigecycline – the last one being an IV drug only and a hellish one but incredibly effective one at that, speaking from experience)… Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin (or flouroquinolones), and rifampin; B. henselae is generally resistant to penicillin, amoxicillin, and nafcillin”. My own personal treatment has included oral Cirpro, Rifabutin, and Minocycline as the mainstay of my current Bartonella-based protocol, but these were proceeded last year by intravenous use of Tigecycline, Azithromycin, and Cipro, among others. For CNS infections, IV antibiotics or at the very least, oral antibiotics with proven abilities to cross the blood brain barrier are necessary.

There is a lot of controversy out there about the use of combining several aggressive antibiotics, especially when it comes to flouroquinolones such as Cipro. However, if we are asking me for my personal opinion, they saved my life. I know others who would shout from their rooftops the same. Sure, these treatment methods come with some risk. A good doctor will frequently monitor your CBC and Metabolic panels with routine blood tests while undergoing such therapies. That being said, there are many of us dangerously ill with a plethora of infections. Speaking for myself, I’m not afraid to endure a few side-effects to get my life back.

There are also a number of natural remedies out there. Certain protocols like the Cowden protocol or Byron White formulas exist and many report gradual success with them. No matter the method you feel is right for you, recovery from a deep-rooted Bart infection is a long process and requires patience on the part of the patient.

Finally, as with Lyme disease and all of her hitch-hiking co-infections, “…clinical improvement and the cessation of symptoms do not always signify complete eradication. That is, it may be possible for a patient to relapse due to a significant medical stress to the body or a decrease in immune system capacity.” (Source) But don’t let this get you down. Sing some Beach Boys, sing about Barbara Ann and not Bartonella. Dance a little. All is not lost. People get better. I’ve gotten tremendously better. Most of my symptoms have dissipated. I don’t anticipate I’ll be sharing rash pictures with you again, is what I’m getting at. giphy (6)

We can all toast to that.

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8 comments on “Bah Bah Bah, Bah Bartonella

  1. Todd
    March 18, 2017

    Needed that read. Started antibiotics for bart 3 months ago after having it for 5 months. Feeling better but not where I want to be. U are right, need to keep a good attitude about it.

    Liked by 1 person

  2. Amber
    March 14, 2016

    Thank you so much for this. My doctor and I have suspected I may have bartonella but my test was inconclusive and many of the symptoms overlapped with my co-infections (positive for Lyme, babesia, ebv, mycoplasma pneumoniae), making it hard to be certain. This article has been immensely helpful.

    Like

    • tarathackeray
      March 14, 2016

      I’m so glad, best of luck in your treatment and journey back to health!

      Like

  3. Larisa
    October 29, 2015

    So much of your experience with Lyme and Bart resonates with me… Thank you for informing the public so well about these diseases; people are hearing more about Lyme now, but Bart is a biggie that so many people are still unaware of. Now if only we could get ALL doctors to BELIEVE. Please please do not stop blogging! 🙂

    Liked by 1 person

  4. Joy Cooper
    October 14, 2015

    Given that the level of my ability to articulate thoughts and form coherent sentences equals my level of fatigue, I will simply say WOW!
    Your research and information is stunning.
    Spent the better part of 20 odd, (very odd), years hearing the phrase,”etiology unknown”. I now read your work with interest while the same refrain plays over and over in my mind. – So, THAT’S what that was!
    You are doing a good thing Tara. Not only are you giving information and the power that goes with it, you are validating and bolstering those who now hear, “Damage Done”. Your feeling better has benefits! I pray it continues for you and us.

    Like

    • tarathackeray
      October 15, 2015

      I always love me a comment from Joy. Thank you.

      Like

  5. GMD
    October 13, 2015

    Thanks Tara. So informative. Reminds of some of my treatments when I could afford treatments. When young and hemorrhaging from ulcerative colitis (a presentation of Lyme I have now learned), I was given erythromycin. I had not been allergic to it before. I had a lot of skin reactions, rashes, hives, itching, to erythromycin then, and only thought it was an allergy. Same with a lot of antibiotics after that. It finally came down to only being able to take Cipro. I now am convinced it was the Lyme causing by body to react. I have heard ulcerative colitis patients being given just IV ABX, and never having an episode of UC in their lives again. Yet, conventional medicine still treats UC with usually azulfadine (gave me really bad headches, another reaction of the Lyme I had then) and prednisone (one of my personal poisons given to me for years). This is a marvelous informative post, written with your always excellent talent. I do hope you get into the Lyme treating business when you recover, maybe an RN, or whatever. Work for a Dr. J or someone like him. You would do well. Dr. Harvey told me when I recovered he would like me or someone like me to be available to just talk to patients. I was an engineer making good money, and then Dr. Harvey died in 2011. If I can recover, even though I am older, I would still like to do this. I can spot a Lyme patient a mile away. I have met so many who obviously had Lyme and never had a treatment in their lives. I sent a lot of them to Dr. Harvey. Dr. Harvey asked my why I sent so many Lyme patients to him..I told him I did not like be so very sick, and figured those people didn’t like being sick either. Everyone I sent to Dr. Harvey had Lyme (yes, I know it is a clinical diagnosis, but all their blood work was positive too). Dr. Harvey knew I was Lyme spotter. I could keep a new LLMD well supplied with Lyme patients if I canvas a little. No need for any LLMD to need patients. I found rich ones, poor ones, and all economic statuses in between. Those are long stories which I will not attempt to tell here.

    Liked by 1 person

    • tarathackeray
      October 14, 2015

      Feels great I’m sure to be able to direct someone to a doctor who can make their life better. You are a great example!

      Like

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