Bartonella | Frequently Asked Questions
Updated: Mar 19
[BEST VIEWED ON DESKTOP]
Mobile conversion is not well formatted - pdf attached below for those on a cell phone
This disease is incredibly difficult to understand and even more complex to navigate. This list of Frequently Asked Questions is not all inclusive and will be added to and updated accordingly as the research continues to advance and evolve; For now, here is what we currently know. I have done my best to accurately summarize the current literature in a causal format that is not overly scientific. Check back for new updates!
What is Bartonella?
Bartonella are a group of stealth, slow-growing, intracellular bacteria. To date, over 40 species have been identified, 14 of which cause human illness. Bartonella is best known for causing Cat Scratch Disease. This is usually self-limiting or resolves with short-course antibiotics. However, some of these infections progress into something more serious causing systemic disease known as Bartonellosis. The symptoms can manifest acutely or develop much later in life.
What is Bartonellosis?
A chronic, disseminated systemic infection with bartonella is referred to as Bartonellosis. Bartonellosis can cause a plethora of wide-ranging symptoms spanning multiple body systems and can lead to chronic inflammation, immune dysregulation, neuroendocrine dysfunction, chronic pain, nutritional deficiencies, vessel inflammation, neuropathy, autoimmune disease and connective tissue disorders.
What are Bartonella's important bacterial characteristics?
- Bartonella is slow-growing
Bacteria can divide rapidly or slowly, the "replication rate" refers to the amount of time it takes to double it's population.
Bartonella require 24 hours to replicate - This replication occurs within the cells it has infected rather than the blood stream itself
For comparison E.coli can double its population every 20-40 minutes
- Bartonella is a Facultative Intracellular Bacteria: This means it prefers to live inside cells but does not have to
- Bartonella is a Gram-Negative Bacteria
This class of bacteria have great ability to cause human disease and can reach almost all organ systems in the body, especially in immune compromised patients.
They are enclosed in a protective capsule
This capsule prevents white blood cells (immune cells that fight infection) from ingesting the bacteria
Their outer membrane protects against certain antibiotics, like penicillin and allow the bacteria to learn and build resistance
Gram-Negative Bacteria share and acquire genes from that have become resistant and are able to genetically mutate as it learns new threats
When this outer membrane is disrupted, it releases toxic substances (endotoxins) responsible for a Jarisch-Herxheimer Reaction
These endotoxins contribute to the severity of symptoms during infection and treatment
- Chronic Bacteremia develops in 3 phases:
Invasion - Bacteria invade or colonize initial sites of infection which can be local or distant to the site of inoculation
Dissemination - These bacteria overcome host barriers and manipulate our immune response, this allows it to spread from one body site to another
Survival - They adapt to survive in the blood and organs through specialized factors (like adhesins) that prevent detection and immune clearance
- Bartonella performs a 'Coordinated Release': Every 4-8 days this bacteria simultaneously releases bacteria into the blood stream from all infected sites where it can seed new infection, typically in areas of existing or new inflammation.
- Bartonella has evolved to avoid immune detection: It is typically present in low levels and cycles in-and-out of the tissues and blood stream
Which cells are Bartonella known to infect in the human body?
Research has shown Bartonella can infect CD34+ progenitor cells, fibroblasts, monocytes, red blood cells, macrophages, microglial cells, dendritic cells and endothelial cells
Invading these cells is a pathogenic strategy that allows bartonella to manipulate our cellular function but also subvert our immune system. This leads to unrivaled systemic involvement affecting multiple organ systems
What are common syndromes associated with Bartonellosis?
Some of the correlating collateral consequences seen with Bartonellosis include Mast Cell Activation Syndrome, Small Vessel Inflammation, Connective Tissue Abnormalities and collagen disruption (acquired hypermobility similar to hEDS), Autonomic Neuropathy or Dysautonomia (Postural Orthostatic Tachycardia Syndrome), Painful Bladder Syndrome (Interstitial Cystitis like symptoms), Chronic Pain or Complex Pain Syndrome, Neuro-psychiatric Disorders, Peripheral Neuropathies, Intestinal Dysbiosis and Auto-Immune Conditions (ie - Lupus, RA, MS, Celiac, Scleroderma). It is important to note that many bartonella patients exhibit vague autoimmune changes that, often, are not able to fit into one of the well-defined rheumatic categories.
What are Co-Infections?
In the simplest of terms, a co-infection refers to when an organism (like a human or animal) has simultaneous infections by two or more pathogen species. This may be a virus, parasite, fungus or other bacteria. While in the context of tick-borne disease (TBD) we tend to focus on Lyme and it's confections since a tick typically passes more than one pathogen while having a blood meal. However, the medical significance goes well beyond TBD and can occur independent of each other over the course of one's life. This complicates how each disease acts within it's host, the symptomology, disease recognition, as well as the diagnostic process.
Which co-infections are commonly seen with Bartonella?
Bartonella can occur on it's own or as a co-infection. Some common examples of co-infections seen with Bartonella include HHV-6, EBV, CMV, Lyme Disease, Babesia, Ehrlichia, Anaplasma, Mycoplasma and Mycotoxins. Each co-infection needs to be tested for, diagnosed, and treated on its own.
It can often times be the difference between a person achieving remission or failing treatment all together. In those cases, patients tend to exhibit persistent symptoms related to an undiagnosed co-infection rather than a true failure of treatment.
Can you have Bartonellosis without Lyme disease or other co-infections?
Yes, you can be infected with bartonella without Lyme Disease!
Historically, Bartonella has been referred to as a co-infection of Lyme but Bartonella does not need a co-infection to cause serious and debilitating symptoms. An infection with Bartonella can occur independently of other vector-borne tick-borne or zoonotic disease. Anecdotally, physician's clinical experience with Bartonella report it as one of the hardest infections to treat and when seen as a 'co-infection', can be the primary culprit of a patient's most debilitating symptoms
Is it physically painful?
Yes, This disease can cause a myriad of complex symptoms and unrelenting pain, especially in severe cases. It is a painful disease.
What are the symptoms?
Most chronically ill patients will show non-specific or vague 'flu-like' symptoms such as headaches, muscle aches, joint pain, fatigue, difficulty sleeping, feet pain and poor concentration. As the disease progresses, the symptom profile expands which eventually affects multiple body systems. Each patient presents differently, however most will experience neurologic, rheumatic, immunologic and endocrine dysfunction.
Below is a comprehensive chart of symptoms created through the use of multiple publications. For an expanded view, scroll to the bottom of this page.
1. Anderson W. Bartonella like organisms (BLO): consideration, signs and symptoms [online article]. Feb. 17, 2013.
2. Griffith JA. Lyme and co-infection check list [online document]. Neurology Health Center.
4. Breitschwerdt et al.. Bartonella sp. bacteremia in patients with neurological and neurocognitive dysfunction. 2008
5. Singleton KB. The Lyme Disease Solution. Booksurge; 2008.
6. Breitschwerdt et al. Bartonella Associated Cutaneous Lesions in People with Neuropsychiatric Symptoms. Dec 4, 2020
7. Maggi RG etal. Bartonella spp. Bacteremia in high-risk immunocompetent patients. September 1, 2011
8. Johnson et al. Disseminated Cat Scratch Disease in pediatric Patients in Hawaii. May 19, 2020
9. Minnick MF, Battisti JM. Pestilence, persistence and pathogenicity: infection strategies of Bartonella
10. Maman et al. Musculoskeletal Manifestations of Cat Scratch Disease. Clinical Infectious Disease. Dec 15, 2007
Additional Literature and sources referenced:
2. Dr Daniel Kinderlehrer: Recovery from Lyme Disease. 2021
3. Stephen Buhner: Healing Lyme Disease Coinfections, Complementary/Holistic Treatments for Bartonella/Mycoplasma. 2013
4. Galaxy Advance Microbial Diagnostics. Understanding hidden infection: Cat Scratch Disease (Bartonella) 2021
5. Bartonella: new science revives a neglected infection. ILADS Winter 2014 Newsletter.
6 Burrascano JJ. Advanced Topics in Lyme Disease. 16th ed. ILADS
Are there 'Hallmark symptoms' associated with Bartonellosis?
Yes. As you can tell from the chart above, many of these symptoms overlap with multiple other syndromes and disease processes. This is one of the many reasons why chronic bartonella infections are under-recognized. However, there are a few hallmark symptoms that can be a 'red-flag' and indication of Bartonellosis, especially when seen in combination with each other; some of these stand-out hallmark symptoms can include:
Excruciating Feet Pain (in the soles of your feet)
Shin Bone Pain (or deep bone pain along your lower leg)
Skin Lesions or Striations (secondary to collagen disruption) that appear similar to stretch marks (initially bright red, then fading overtime)
Shifting or Migrating Joint Pain (mainly in the medium and large joints) not typically associated with joint swelling
Recurrent Soft Tissue Injuries
New and Progressive Acquired Joint Hypermobility
Neuropsychiatric Shifts (new anxiety, depression, bouts of unexplained rage)
New (seemingly random) Allergic Reactions
Eye Pain and Photosensitivity
'Flu-like Symptoms' (with or without a low-grade fever) that presents in a cyclic fashion, typically after a period of immune suppression or a stressful event (ie- a cold, trauma, surgery, etc).
Why are symptoms variable from person-to-person?
Each individual is different on how their body adapts and responds to a chronic infection with bartonella. In some, symptoms can range from asymptomatic to mild while other's can develop symptoms that are severely debilitating. This is highly dependent on the host-response (person infected), their immune status and complicating co-factors (severe stress, immune suppression, malnutrition, exposure to toxins, concurrent infection with other organisms, etc). There are a plethora of deficiencies, hormonal dysregulations and a variable level of nutritional depletion leading to many secondary issues that further plague Bartonellosis patients.
What is meant by "host response"?
The host-response is a process by which the host (the person or mammal infected) interacts and responds to the pathogen it is encountering. Differences in lifestyle, stress, underlying health status, genetics and nutrition can all impact the host response.
Can symptoms emerge or re-emerge?
Yes, Symptoms may emerge, resolve/improve and re-emerge (seeming cyclic or like a "flare-up"). Typically this occurs after a complicating event or period of immune suppression. A complicating event is defined as severe stress (physical, emotional or mental), malnutrition, exposure to toxins or other illnesses.
Is it okay to use steroids when infected with Bartonella?
The use, function and side effects of steroids are dose-dependent. Steroids can be physiologic (low doses), anti-inflammatory (moderate doses) and immunosuppressive (high doses).
While not absolute, generally, the use of high dose steroids in bartonella patients is not recommended. It can cause further suppression of a patient's already poor immune response and lead to an increase in bacterial growth with progressive systemic and symptomatic decline, acutely likened to "flu-like" features, but with long-term ramifications.
Low-dose or physiologic steroid use is very common in Bartonella treatment protocols. As a consequence of infection-related chronic inflammation and chronic stress, bartonella patients can develop adrenal insufficiency and hormonal imbalances. Supplemental low-dose hydrocortisone is often necessary to help maintain cellular function, regulation of other hormones, blood sugar, blood pressure, energy level and oxidative stress. Most importantly, these lower supplemental doses WILL NOT suppress the immune response, but will actually help enhance patient function and improve treatment outcome.
Which labs are the best for testing for Bartonella?
Galaxy Advanced Microbial Diagnostics serves as the 'Gold Standard' for bartonella testing. This laboratory was founded by Dr Ed Breitschwerdt (an internist and infectious disease veterinarian) and Dr Robert Mozayeni (an internist and human rheumatologist). who are amongst the world’s leading experts on the research, diagnostics, treatment and evolutions of Bartonella. Galaxy utilizes proprietary techniques that help enhance the detection bartonella, determine active infection and account for bartonella's bacterial requirements which help decrease the incidence of false negatives. They offer both human and animal testing.
Other laboratory facilities offering bartonella testing include IgeneX, Armin, MDL and Vibrant America Lab Testing
What is Galaxy Diagnostic's Triple Draw considered the best?
"Testing at a single point in time can result in false negatives simply because the bacteria are not in the blood at the time of patient sampling".
One of Bartonella's defining characteristics is it's ability to simultaneously release new bacteria into the blood stream from infected cells every 4-8 days. During this coordinated cycle, some bacteria leave the cells they have infected and enter the bloodstream unprotected. Within a short window, these bacteria find new homes, typically in places of new inflammation and quickly invade new cells; all of which minimize immune detection.
Galaxy Diagnostics' Triple Draw accounts for this cycle and requires blood to be drawn 3 times - every other day for a week - which increases the likelihood of capturing this release and collecting free-floating bacteria from the blood. Galaxy Diagnostics Triple Draw uses a proprietary BAPGM blood culture to help bartonella thrive outside of a host (ie-on the culture plate), thus enhancing replication. This increases the likelihood of identifying it.
All 3 samples are subjected to PCR, BAPGM Culture and ePCR testing which is much more sensitive and specific than looking at antibodies alone (meaning less false negatives and more true positives, respectively).
Does a negative result rule-out the possibility of a Bartonella infection?
No, a negative does not rule-out the possibility of infection. Chronic Bartonella cases are tremendously difficult to diagnose, especially with traditional antibody methods, like IFA (Immunofluorescence Antibody Assay), antiquated PCR or traditional blood cultures.
What is the difference between IFA, PCR and Blood Cultures testing methods?
1. Traditional IFA (antibody) Testing:
Testing for an antibody response has a high false negative rate, meaning if IFA results are negative, this does not rule out Bartonella. Available testing through conventional labs (like Labcorp or Quest) only look for IgG and IgM antibodies for 2 of the 14 bartonella species capable of causing human illness; B. hensalae (the causative agent of cat scratch disease) and B. quintana. Galaxy Diagnostics is a great resource and specializes in advanced testing for intracellular pathogens. They site a "false negative antibody rate of 83% in chronically infected patients".
Why is this? In chronic Bartonellosis, Bartonella bacteria are rarely freely circulating in the blood stream without protection (remember it primarily lives within our cells and tissues), thus immune response and antibody production is LOW. Bartonella utilize the exact system meant to detect/kill it as it's own personal transit system. This is one of the reasons why diagnosis is so difficult, coining the term "Stealth Pathogen". If the immune system cannot find it then it cannot mount an antibody response against it (leading to a negative IFA test result in chronic presentations).
It is very common for a chronic bartonella patient to have negative antibody results but a positive PCR or Blood Culture. During treatment patients may seroconvert and have a measurable immune response (ie positive IFA antibody testing)
2. Traditional Blood Cultures:
A blood culture tests for the presence of disease-causing pathogens (like bacteria) in your blood. The blood is mixed with a material (culture medium) and placed in an incubator. This is intended to help the bacteria grow if they are present in your blood.
Bartonella require complex nutritional elements and proper temperature conditions in order to grow. Specifically, growth of bartonella species needs to be incubated in fresh media at a temperature of 95 - 98.6 F with 5-10 percent CO2 concentrations and greater than 40 percent humidity for a minimum of 21 days to account for it's slow replication rate.
Traditional blood cultures do not offer such optimal growth conditions and are plated for only 5-7 days. This is not enough time for bartonella to grow and will result in a negative blood culture. A negative blood culture does not mean 'no infection'; In a traditional sense, if the bacteria is in your blood, a negative culture just means the bacteria did not have the specific conditions necessary for it to thrive, grow and be identified.
Galaxy Diagnostics BAPGM cultures offer Bartonella exactly what it needs to thrive, thereby increasing the likelihood of finding it. Even in the best conditions, bartonella are incredibly difficult to grow on blood cultures.
3. PCR Testing:
This method detects bacterial DNA in the blood and tissues of patients. Not all PCR testing is created equal - Conventional PCR lack specific detail in identification, making it less reliable. They are typically performed on a single source blood draw, which increases the likelihood of missing bartonella's cyclic release of bacteria into the bloodstream. Galaxy Diagnostics has the most advanced PCR detection system for bartonellosis/chronic bacteremia and accounts for bartonella's cyclic release by attaining patient blood samples every other day for a week (coined "Triple Draw")
A positive PCR and blood culture confirm active infection.
Which testing methods truly confirm active infection?
Blood Culture with PCR testing
Is there a set protocol to treat Bartonella?
There is no set standard of care or specific protocol (set forth by CDC) for battling Bartonellosis although experts in the area advise combination antibiotics (synthetic, herbal or both) over a long duration are generally necessary. It is very individualized to the host factors, presence of co-infections and severity of pathology present. All underlying derangements, imbalances, chronic inflammation, syndromes and sequelae must also be addressed and the body supported. This is extrapolated from human case-based treatment evidence. When a protocol is referenced it typically has to do with Stephen Buhner (natural herbal therapies) or Dr. Mozayeni (Clarithromycin with Rifamycin). There are no absolutes, multiple therapies exist and each practicing physician tends to have a baseline preference with a tailored approach.
While I recognize there are multiple other alternative therapies to which patients have had success, the focus of my treatment responses are extrapolated from my current treatment plan which is a modified approach combining Buhner and Dr Mozayeni's Protocol.
Are antibiotics alone the answer?
No, antibiotics alone are not the answer.
Treatment consists of complementary and alternative therapies to address all the sequala of chronic illness and Bartonella's disease profile. Patients typically require hormone replacement therapy, aggressive gut health, medications to help quell Mast Cell Activation Syndrome, vitamin/mineral supplementation (for deficiencies and immune support), a multitude of antioxidants, joint support, and herbal therapy to mitigate chemical toxic effects of long term antibiotic (abx) use.
It is quite comprehensive, also addressing underlying co-infections, nutrition, (anti-inflammatory diet which is mainly gluten free, diary free, minimal sugar, organic, no processed foods, no alcohol) and aggressive organ support.
While I recognize there are multiple other alternative therapies to which patients have had success, the focus of my treatment responses are extrapolated from my current treatment plan which is a modified approach combining Buhner and Dr Mozayeni's Protocol.
What is the difference between Rifampin and Rifabutin?
Rifampin and Rifabutin are both part of the antibiotic class called “rifamycins.” In comparison to Rifampin, Rifabutin has a higher potency, is longer acting (has a half-life of 45 hours) and is fat-soluble (allowing it to be well distributed within the intracellular tissue). Because of this, Rifabutin can penetrate areas 20-50% more than Rifampin (especially in the nervous system - brain, spinal fluid and connective tissue) leading to a larger die-off (this is why you hear most people start with rifampin and work up to rifabutin). Herx reactions can be expected around day 8-9. A high fever may be accompanied by the standard variety "flu-like symptoms", increased body pains (arthralgia/myalgias) and skin rash (compared to Rifampin which was associated with low-grade fevers). Because it is longer acting, the herx reactions can take weeks to resolve.
Attached below is a more in-depth handout chart:
Why is Clarithromycin and Hydroxychloroquine often used in combination with Rifabutin?
Rifabutin's potency is amplified when given in combination with Clarithromycin. The plasma concentrations of Rifabutin and it's active metabolite are respectively increased 4 times and 37 times greater than if Rifabutin were administered alone (basically boosting Rifabutin's bacteria killing properties).
Most bartonellosis patients have some aspect of an uncategorized autoimmune and connective tissue disease. The implementation of HCQ (an anti-malarial commonly used in rheumatic disorders) has a dual purpose here -- in the case of Bartonella - 1) It can help mitigate pain and inflammation associated with connective tissue/autoimmune derangements and 2) When given with certain antibiotics, it will enhance that antibiotic's action inside our cells (where bartonella chronically lives). Studies have found that HCQ causes the inside of a cell (specifically the lysosome) to alkalinize - This higher pH increases the bacteria killing potential of antibiotics (potentiates antibiotic’s bactericidal activity intracellularly), especially so with Macrolides (like Clarithromycin) and Rifamycins (like Rifabutin)" .
Essentially, Rifabutin with Clarithromycin, in addition to Hydroxychloroquine increases antibiotic influence and bacterial death.
Is Doxycycline an effective treatment for Bartonellosis?
Doxycycline alone is not an effective treatment to eliminate chronic infections associated with any Bartonella species.
Why is Azithromycin not recommend?
Bartonella have adapted to Azithromycin and are quick to build resistance rendering the antibiotic and others in it's class (ie- macrolides such as Clarithromycin) ineffective.
As stated by Dr Ed Breitschwerdt, "When compared to several other antibiotic classes, azithromycin is not recommended as a first line antibiotic. Once resistance develops, B. henselae isolates are resistant to all macrolides. If azithromycin is used to treat bartonellosis, another antibiotic that maintains high plasma levels should be used concurrently."
What is a Jarisch-Herxheimer Reaction?
A Jarisch–Herxheimer reaction or "herx" is the body's immune response and reaction to harmful substances released during the death of certain pathogens (like Bartonella, Babesia and Lyme disease). It occurs alongside herbal or synthetic antibiotics and other medications that may have antimicrobial properties.
When Bartonella's cellular membrane is disrupted or destroyed by antibiotics, an endotoxin (Lipid A) is released into the blood stream which creates a systemic inflammatory reaction. A 'herx' reaction can be mild or severe and life-threatening. They are generally painful, almost identical to a delayed allergic reaction and likened to "flu-like symptoms" including body pains, aches, fevers, skin rashes, skin pain, headaches, low blood pressure, dizziness, elevated heart rate and severe fatigue.
Onset may occur within 72 hours after starting antibiotics or performing a staged up-titration in antibiotic dosing. The average onset for most bartonella patients is 8-10 days after. Reactions can last days to weeks on end.
Who is Stephen Buhner and what is the 'Buhner Protocol'?
Stephen Harrod Buhner was an expert herbalist and the foremost authority on natural treatment protocols for Lyme, Bartonella, Mycoplasma and many other chronic Vector-Borne Diseases. His work was meticulous with a deep understanding of complex herbal integrations and disease pathophysiology. Buhner clinically tested multiple herbs and authored countless books and publications to educate both medical professionals and patients. He lived his life in service of others. Unfortunately, he passed away recently due to a long fought battle with pulmonary fibrosis, but his work's scientific influence will continue to impact and empower
The Buhner Protocol for Bartonella
Japanese Knotweed, EGCG with quercetin, L-arginine, Cordyceps, Sida Acua, Red Root, Milk Thistle seed, Hawthorne, Rhodiola with Ashwaghanda combination, a combination of isatis/houttuynia/alchornea, pomegranate juice, Vitamin E
Add to Basic Protocol, Based on Symptoms:
CNS/Brain Involvement: Chinese Skullcap, Greater Celandine tincture, Kudzu Root tincture, NAC (N-Acetylcysteine) + Motherwort tincture
With Hypoperfusion of the Brain: Ginkgo tincture
With Neural Pain: Greater Celandine tincture, Kudzo Root tincture
With anxiety: Pasque Flower tincture, Motherwort tincture, Coral Root tincture, Chinese Skullcap tincture
With Extreme Fear: Chinese Skullcap, Vervain tincture
With Sleep Disturbances/Insomnia: Melatonin, Ashwaghanda, Chinese Skullcap, Motherwort tincture
With Severe Fatigue, use the following for 6 months minimum: Eleutherococcus tincture, Rhodiola, Schisandra, Motherwort, Fermented Wheat Germ
With Unproductive Cough: Bidens tincture
With Severe Anemia or RBC lysis: Sida Acuta tincture, NAC, Bidens tincture
With Muscle Wasting or severe Weight Loss: Fermented Wheat Germ, Shiitake Mushroom +/- pure extract of Lentinan
For Detoxification and help with Herxheimer Reactions: Zeolite Liquid
For Breaking up Biofilms: NAC, Greater Celandine, Royal Jelly
This protocol is thoroughly outlined in his book titled 'Healing Lyme Disease Coinfections: Complementary and Holistic Treatments for Bartonella and Mycoplasma". There you can find details on dosing and frequency as well as a comprehensive overview of bartonella infections and disease. I read this book October 2019 and it changed my life.
Is Bartonellosis curable? What is the goal of treatment?
Unfortunately, based on the pathophysiology, it is not currently considered curable. The goal of treatment is remission of clinical symptomology (easing of one's symptoms) with improvement in functional capacity (one's ability to be independent and reliably function). This is achieved by decreasing the bacterial burden with herbal or synthetic antimicrobial treatment strategies, correcting systemic imbalances, addressing underlying co-infections and restoring whole body homeostasis -- Once the symptoms are in remission, the disease can be managed with lifestyle changes that minimize system disruptors (like chronic stress, unhealthy eating habits, poor sleep) and help your immune system stay healthy (by keeping the bacteria in check).
Could IV Glutathione help with treatment?
Yes, it very well can! Here is why - Multiple studies show that any chronic process (resulting in chronic inflammation) overtime depletes your body’s available Glutathione (GSH) stores.
Being the most powerful and abundant antioxidant made within the body, normal levels of glutathione are essential for maintaining health. The highest concentrations of GSH can be found within your liver -- arguably the most important detoxifying organ in the body. Once glutathione is depleted, immune cells lose their ability to fully fight infections; there is increased cell damage, decreased cellular repair and unregulated inflammation.
In the case of chronic disease (and bartonella), our cells eventually get to a place where they are using the GSH faster than they can make it. Essentially, the rate at which free-radicals are generated surpass glutathione production leading to a cascade of inflammation and tissue damage (oxidative stress). As GSH depletion progresses, cells can't keep up with the demand… and the cycle continues.
Although the human body can produce this substance naturally, chronic depletion leads to a functional deficiency. Low GSH levels play a role in the development of neurological disorders, recurrent bacterial infections and have been associated with an increased risk of cancer, diabetes, hepatitis, auto-immune disorders and neurodegenerative diseases (like Parkinson's disease). These same studies also show that replenishing GSH levels can directly strengthen your immune response against bacteria and viruses.
Oral administration of liposomal glutathione and it’s precursors (NAC, P5P, selenium, vitamin C, milk thistle, whey protein, methylated B vitamins, Vitamin E, etc) are available through supplements and food sources. However, these forms require your body’s use of energy to metabolize, transport and absorb the nutrient (which is already in short supply). Bypassing the gut with IV Glutathione infusions provides your cells direct access to exactly what it needs to start efficiently improving levels and decreasing oxidative injury.
How is Bartonella transmitted?
Routes of transmission have traditionally been classified as vector-borne (ie biting insects like sand flies or human lice) or zoonotic (ie animal to human - being bitten or scratched by a cat, typically associated with previous or current flea presence) However new research discovered transmission routes associated with needle stick (direct blood to blood transmission), animal saliva (infectious saliva), pregnancy, blood transfusions and other vectors (spiders, ticks).
What is a Vector-Borne Disease and Zoonosis?
A vector is a living organism or insect (ie mosquito, flea, tick) that can transmit infections (parasites, viruses or bacteria) between animals and humans capable of causing disease (known as Vector-Borne Disease).
Vector-Borne Diseases are human or animal illnesses caused by a parasite, viruses or bacteria that are transmitted by an insect vector.
A Zoonosis is a disease that can be spread from animals to humans. This can be a bacteria, virus or parasite and can spread through direct contact or environmental exposure
The most notable insects in the transmission of bartonella are the cat flea, human louse and sand flies, however, new vectors (such as a spider, horse fly, tick and possibly bed bug) have been identified as potential transmitters. The flea is thought to only pass bartonella from cat-to-cat.
Is there a chance I could transmit Bartonella to my baby during pregnancy?
There is no clear cut 'yes' or 'no' here. We know that infected rodents can transmit Bartonella species through the placenta to their fetus (termed transplacental transmission) and that this occurs naturally and is experimentally repeatable. However, a true understanding of how this relates to humans is not currently known. There is some data suggesting that Bartonella may undergo vertical transmission in humans, but to my knowledge, this has not been definitively proven. It has also brought into question whether transmission is possible through breastfeeding.
In general, 'Vertical Transmission' means that an infection/pathogen uses the intimate nature of pregnancy to transmit disease directly from mother to- an embryo, fetus, during childbirth or to the baby during pregnancy. Vertical Transmission typically occurs when the mother has a pre-existing disease or becomes infected during pregnancy.
During pregnancy, an infection with Bartonellosis has often been associated with, but not causally related to, serious maternal or fetal complications (including miscarriage, fetal death, or premature delivery. This reinforces the need for early detection and treatment of infected pregnant women. That being said, anecdotally, many women who have been diagnosed and successfully achieved remission with appropriate treatment for Bartonella have been able to have healthy babies to term with no obvious onset of clinical illness.
How do I protect myself or my family from this disease?
The best way to protect yourself and your family is to practice consistent flea and tick control (for both animals and humans), address your outdoor environment, use insect repellant and if you are out in nature, consider permethrin treated clothing. It is most important to avoid or prevent insect (or vector) transmission.
On average 40% of cats are asymptomatic carriers of Bartonella. If you are bitten or scratched by a cat (whether it is domestic or feral, has fleas or not), immediately wash the wound out thoroughly with soap and water. If you have chlorhexidine this would also be beneficial. After which, immediately seek medical care for antibiotic therapy. My Bartonella specialist typically prescribes 1 month of minocycline and ciprofloxacin for cat bites. This will cover for Pasteurella but also addresses possible Bartonella. Unfortunately, this combination is not standard practice at the ER. Most of the time Augmentin is prescribed which does not cover for Bartonella alone.
Do your best to avoid animal bites and scratches or rough housing that could result in either. Be cautious of other animals temperament. If you have a cat, keep them indoors. If you have a barn cat, make sure to maintain flea and tick preventative.
Does this mean I need to give away my cat?
It is a great question and a hard one many families are faced with. There is no 'cut and dry' right or wrong answers here for deciding to rehome or keep your beloved cat. There are however certain factors that could determine which option is most suitable for you and your family.
Our pets are crucial to healing. We invite them into our most vulnerable places of solitude and sorrow. For families who know the love of a pet, they are pertinent to our well-being but like any human-animal relation, do carry inherent risks. Knowing what your variables are and taking actions to minimize those risks is what's important.
While research has shown 40 percent of cats are estimated to be asymptomatic bacteremic carriers, that same research has shown a growing list of vectors that are ubiquitous in the natural environment like fleas, mosquitos, ticks, wood louse spiders, sand fleas, lice etc. In that sense, it is impossible to prevent exposure. It is POSSIBLE to control your in-home variables but impossible to abolish the chance of exposure outside of the home
If your cat is well-tempered, the 'risk to benefit' ratio is low, additionally your cat is providing companionship and emotional support.
That being said, its a COMPLETELY different story if you have an outwardly aggressive cat, especially in a family with chronic illness and immune suppression - in this situation, it is just unsafe. Additionally, if your pet is primarily outdoors, with or without appropriate flea and tick preventative, the risk of exposure will be higher. The bottom-line, when it comes to bartonella, cats are an underlying source for exposure even though they are just another innocent bystander in the evolution of a bacteria.
Ultimately, it’s a matter of personal preference and what you are the most comfortable doing for your family given the dynamics of your specific situation. No matter what, it is a difficult situation that weighs on many people and you owe no one an explanation.
For what it's worth, I would have no issue continuing to have them in my life for reasons stated above. As a DVM, cat owner and patient suffering from bartonellosis (acquired through my practice of small animal medicine), in my honest opinion, I would NOT get rid of any of my animals…bartonella or not.
What other infections can occur from a cat bite?
Other infections: The most common bacteria in a cat's mouth is Pasteurella Multocida. This bacteria is zoonotic and is the primary one targeted after a bite typically occurs. Streptoccoccus and Staphylococcus come in 2nd and 3rd. Bites from a cat are polymicrobial (capable of leaving behind multiple types of bacteria) so antibiotic choice should be the one with most broad spectrum coverage.
What's the preferred antibiotic/treatment approach for a cat bite?
Cat's have complex bacterial flora in their mouth. Their teeth are quite sharp so upon entering the skin, the sharpest point of the tooth leaves deposits of bacteria at the deepest part of the wound. It is more of a deep puncture (while a dog bite might lead to a laceration or large opening). Typically puncture wounds can not be appropriately irrigated because swelling occurs almost immediately and whatever is caught in the deepest tissue is at risk of abscessation and cellulitis. Often times animals have periodontal disease and a part of the tooth can chip off. Pending the location of the wound, x-rays assist in ruling out any presence of a remnant foreign body by the bite. If near a joint or deep toward bone, it will also look for radiographic evidence of joint compromise or bone penetration that would also change the antibiotic choice
Antibiotic alternatives for an acute bite can include tetracycline (like minocycline), fluoroquinolones (ciprofloxacin), and trimethoprim-sulfamethoxazole. Depending on the patient's antibiotic tolerance, minocycline and ciprofloxacin x 30 days is the Bartonella Literate Doctor's "go-to" for cat bite intervention. This will cover for bartonella while addressing the more virulent bacteria (such as Pasteurella). Clindamycin and Doxycycline can be tried but this is not the first go to. [Side note: antibiotics commonly prescribed for soft-tissue infections like cephalexin, clindamycin and erythromycin are poor choices for prophylactic treatment in cat bites, the etiology is the difference].
You can also expect being offered a prophy Tetanus booster for possible clostridium tetani exposure
Where can I get my animals tested?
You can get your animals tested by a Veterinarian through IDEXX or submit samples directly to Galaxy Diagnostics. In Veterinary Medicine, Galaxy Diagnostics' proprietary testing methods are already employed and available via IDEXX. The same testing difficulties apply for animals as they do for humans. A negative does not rule out infection.
Should I treat my cat if they are positive for Bartonella??
The primary purpose of testing an outwardly healthy cat would be to know if and what species the cat is carrying/able to transmit, especially if you are ill. BUT if the cat is determined to be positive AND is asymptomatic, it is generally NOT recommend to treat
If your cat does test positive, request your veterinarian have a phone consult with Dr Ed Breitschwerdt to discuss specifics, especially if they are asymptomatic. Cats can tolerate a Bartonella infection much better than humans. In fact, they can tolerate multiple different pathogens while remaining asymptomatic. That being said, recent research has shown cats may present with a broad range of inflammatory conditions when infected with bartonella. If this is the case, it may make the argument for treating. In cats, it is generally thought that the side effects of long term antibiotics will do more harm than good with minimal clarity of if bacteria is ever eradicated. It may provide peace of mind but could be costly and may not have the outcome you hope to achieve.
Can chronic Inflammation cause Depression?
Yes, chronic inflammation can lead to pathophysiologic depression.
This type of depression is not situational (ie- loss of career, income, independence, reproductive health, vitality, lifestyle, relations); it is an actual functional and chemical change that results in internal injury caused by inflammation of the host's immune response to the disease itself. There are two important features here - Bartonella infect our endothelial cells which line all of our blood vessels. This is associated with small vessel inflammation. Bartonella also infect Microglial cells of the Nervous System. Essentially these are immune cells of the brain and play an important role in detecting infection, inflammation and clearing cellular debris (like dead/injured neurons).
The Journal of Immunity recently published an article indicating that immune cells of the brain (specifically these microglial cells) play a key role in ‘brain inflammation-induced depression’. The study further determined that increased microglial activity led to an increase in the release of chemicals within the brain that create depression and influence or heighten our perception of pain. This perpetuates our symptoms and neuropsychiatric profile
What are neuropsychiatric symptoms of Bartonellosis?
Neuropsychiatric symptoms of Bartonella may manifest as depression, anxiety, suicidal ideation, hallucinations (auditory and sensory), dissociation, derealization, depersonalization, irritability, cognitive and memory issues, panic attacks, sleep disorders, sound sensitivity, seizures, psychosis, bipolar disorder and episodes of rage.
In Children, they may present with oppositional defiance disorder, ADD with or without hyperactivity, autism spectrum disorders, learning problems and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) which can resemble severe OCD or an eating disorder
What are the best forms of Magnesium for Nervous System Inflammation?
Magnesium L-Threonate is the ONLY form of magnesium that specifically crosses the brain’s protective barrier and is necessary for optimal nervous system health.
It has been shown to:
Calm Nerve Inflammation
Increase Brain Plasticity (brain's ability to change, grow and adapt neural networks)
Support Neurons (functional units in the CNS)
Stimulate the formation of new brain cells (via 'brain-derived neurotrophic factor' or BDNF).
Interestingly, studies have also shown it can help restore memory deficits, cognitive ability and executive function associated with chronic pain (which most bartonella patients have), In the context of rifabutin, it is primarily used to help reduce inflammation within the central nervous system. If deficient, it can improve a plethora of neurological symptoms as well.
What is the $500 off code for Radiant Health Saunas?
The $500 off code is 'nvoom12'
Radiant Health Saunas only sells direct to consumer. They are considered one of the best and safest FAR IR saunas amongst Bartonella doctors.
The company is located in Canada and Texas and owned by Randy Gomm.
There are multiple, almost identical knock-offs at lower price points - be careful
Check back soon for more updates
What are Binders?
What are Biofilms?
What are Biofilm Busters?
Are FAR Infrared Saunas helpful with detoxing?
What are the top 3 FAR IR Sauna's recommended by LLMD's?
How does Bartonella injure the connective tissue?
What is hEDS? Can hypermobility be acquired?
What is an Autonomic Neuropathy or Dysautonomia?
Is Bartonella contagious from human to human?