Lyme Disease and Bartonella Coinfections
I was recently interviewed on Lyme Basics. Click here to read the full interview.
How do you differentiate between what clinical symptoms are caused by Lyme disease and Bartonella? What are some of the more typical symptoms of a chronic Bartonella infection?
It can be difficult to differentiate between Lyme disease and Bartonellosis based on clinical symptoms alone. There is certainly an overlap of symptoms found in both, such as headaches, fatigue, brain fog and cognitive dysfunction, mood disorders, and joint pain. Bartonella can cause additional signs and symptoms that are more specific for it, but still does not rule out the possibility of another infection or even another disease state.
For instance, Bartonella can cause a linear rash, now known as Bart-tracks, that can have an appearance similar to stretch marks. While this seems to be very specific for Bartonella, there is now some data based on skin biopsies to suggest that Borrelia burgdorferi (the bacteria that causes Lyme disease) can also be found in the same location as Bartonella in the skin. In addition, there are some patients who truly have stretch marks, or striae, due to collagen disorders, and these patients can have some symptoms that overlap with Bartonella.
How do you treat a chronic Bartonella infection?
There are various treatment regimens that have been used in Bartonella infections. There doesn’t seem to be a one size fits all option for all patients. Sometimes herbal protocols can be helpful alone or combined with a variety of other therapeutic interventions, like dietary changes, immune support, efforts to heal the gut, detoxification, and electromagnetic frequency machines.
Sometimes antibiotics are necessary and research suggests that multiple antibiotics are often needed at the same time due to the high rate of resistance that develops in the bartonella organisms.
The case reports that are published by Mozayeni and Breitschwerdt show that Bartonella infection can cause a very broad range of disease manifestations, but what is more problematic is showing the causal relationship between a chronic infection with a Bartonella species and the clinical condition. What are your thoughts about that? And how can physicians in the trenches treating this disease help and collaborate with scientists?
This was a powerful case report that was published linking Bartonella infection with Ehrlers-Danlos Syndrome and Mast Cell Activation Syndrome. The case exemplifies what we already know about Bartonella, that it can exist alter the quality of connective tissue in many parts of the body. Physicians in the trenches often don’t have the time to write papers on their cases but they might have very interesting findings that could help scientists who are studying this condition. I would encourage these physicians to reach out to the ILADS organization and connect with other doctors treating Lyme and tick-borne infections. There may be physicians and scientists out there who could help get the information into publication.
I have learned that antibiotic resistance is not an issue with Lyme disease, however it persists despite being susceptible to the used antibiotic because it creates morphological forms that are able to survive lethal doses of antibiotics.
This is not correct information. Borrelia burgdorferi can absolutely develop antibiotic resistance which can lead to the development of persister bacteria.
Here is a quote from Dr. Horowitz’s publication in 2016, The Use of Dapsone as a Novel “Persister” Drug in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome:
Johns Hopkins researchers in 2015, as well as researchers from Northeastern University (Kim Lewis and colleagues) demonstrated that that Borrelia burgdorferi can form persister cells. Persisters are a small fraction of quiescent bacterial cells that survive lethal antibiotics but can regrow leading to post-treatment relapse. Examples include mycobacterium, syphilis, endocarditis, and biofilm infections.
Does antibiotic resistance play a role in Bartonella infections?
Yes, antibiotic resistance plays a significant role in Bartonella infections. In the April 2019 issue of Antibiotics, research on antibiotic resistance from Johns Hopkins was published in the article “Identification of FDA-Approved Drugs with Activity against Stationary Phase Bartonella henselae.” What they found was that a number of drugs that were not routinely used for Bartonellosis and without previous evidence for antibacterial activity did in fact completely eradicate the stationary phase B. henselae after 3 days in culture. They also found that the drugs currently used to treat Bartonellosis such as rifampin, azithromycin, and ciprofloxacin had poor activity against the stationary phase B. henselae. This is consistent with what we are seeing in clinical practice. Many patients are being treated with conventional antibiotics and not getting better and this is causing other doctors to question the diagnosis of the infection in these patients. These patients can have a chronic infection with Bartonella and yet not respond to treatment.
Many infectious disease doctors think Bartonella is a harmless infection and the reason why Lyme patients have antibodies against Bartonella is because it is a common infection. If antibody-tests are not helpful in all cases what tests are there that can differentiate between an active/chronic or past infection with Bartonella?
There are a number of tests such as PCR and FISH that can be done to help understand whether Bartonella infection is active. Unfortunately, these tests don’t always confirm the diagnosis. A diagnosis of Bartonellosis should still be considered in a patient who is negative on PCR and/or FISH , especially in the setting of clinical signs and symptoms and very elevated antibodies to one or more Bartonella species.
Some physicians say to patients with complex illnesses that they suffer from depression, anxiety, OCD or a range of other psychiatric disorders. From my own experience it can be a symptom of Lyme disease and/or Bartonella infection. How do you differentiate between a classic psychiatric disorder and an infection induced one? And how do you treat it if an infection is the trigger?
These are very complicated questions. Patients with psychiatric manifestations should always be ruled out for underlying systemic medical conditions, including infections and immune dysregulation, first. Conventional medicine, however, often does the opposite. The assumption is that the psychiatric illness is primary and even if there is an underlying medical issue it is unrelated to the psychiatric issue. This does a tremendous disservice to patients and limits their ability to get better.
Having said that, it is not always easy to differentiate between a psychiatric disorder and an infection induced one. All patients with psychiatric issues should, in my opinion, undergo genetic testing to identify their risks for psychiatric illness as well as to identify treatment options that are best for the patient based on their genetic profile. In addition, a full lab panel should be performed to rule out underlying medical conditions that can cause or contribute to psychiatric illness, such as thyroid and/or adrenal dysfunction, vitamin and mineral deficiencies, immunodeficiencies, toxicities such as increased levels of heavy metals, and mast cell activation syndrome, to name a few. A clinical history suggestive of exposure to cats and dogs and/or insect/tick bites should warrant investigation for Bartonella, Lyme and other vector-borne infections.
Since the advancement of laboratory technology, the interest for these more difficult to grow organisms like Bartonella has gotten more interest from scientists, especially those in the field of veterinary medicine. Science doesn’t have all the answers with regards to how Bartonella causes disease and where it resides and evades antibiotics in the host – bone marrow – red blood cells – endothelium – skin. As a treating physician, what are some of the questions on your mind concerning Bartonella that you would like scientific research to answer in the coming decade?
Can we develop better diagnostic tools?
How can we prevent transmission of the organism from animals to humans, from animals to insects and from insects to animals or humans?
What exact treatment regimen will achieve cure in these patients?
VECTOR BORNE DISEASES: BARTONELLA