I have Lyme. I’d like to not have it anymore. I also just want cake.
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.
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.
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.
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)
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!
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. 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.
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. 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.
We can all toast to that.