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» LymeNet Flash » Questions and Discussion » Medical Questions » Bartonella Information Thread (Page 1)

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Author Topic: Bartonella Information Thread
FuzzySlippers
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Apologies if this has been done before. I thought I'd start a Bartonella information thread. I'll be adding to this as I am able. I hope others will post resources and info that they come across as well.

Fuzzy

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FuzzySlippers
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Even though I posted this information quite awhile ago, I'm posting it again to be included here.

I got these from an LLMD and thought they might be helpful to some. These symptom check-lists do not necessarily list all of the known symptoms associated with Bartonella and Babesia.


Bartonella/Babesia Symptom Questionnaire


Bartonellosis

Common symptoms of bartonellosis include:

___Fatigue (often with agitation, unlike Lyme disease, which is more exhaustion)

___Low grade fevers, especially morning and/or late afternoon, often associated with feelings of "coming down with the flu or a virus"

___Sweats, often morning or late afternoon (sometimes at night) - often described as "thick" or "sticky" in nature

___Headaches, especially frontal (often confused with sinus) or on top of head

___Eye symptoms including episodes of blurred vision, red eyes, dry eyes

___Ringing in the ears (tinnitus) and sometimes hearing problems (decreased or even increased sensitivity - so-called hyperacusis)

___Sore throats (recurring)

___Swollen glands, especially neck and under arms

___Anxiety and worry attacks; others perceive as "very anxious"

___Episodes of confusion and disorientation that are usually transient (and very scary); often can be seizure-like in nature

___Poor sleep (especially difficulty falling asleep); poor sleep quality

___Joint pain and stiffness (often both Left and Right sides as opposed to Lyme which is often on one side only with pain and stiffness that changes locations)

___Muscle pains especially the calves; may be twitching and cramping also

___Foot pain, more in the morning involving the heels or soles of the feet (sometimes misdiagnosed as plantar fasciitis)

___Nerve irritation symptoms which can be described as burning, vibrating, numb, shooting, etc.

___Tremors and/or muscle twitching

___Heart palpitations and strange chest pains

___Episodes of breathlessness

___Strange rashes recurring on the body often, red stretch marks, and peculiar tender lumps and nodules along the sides of the legs or arms, spider veins

___Gastrointestinal symptoms, abdominal pain and acid reflux

___Shin bone pain and tenderness

Bartonella is a bacterium that causes illness, the most commonly known of which is a disease called "Cat Scratch Fever." Thousands of known cases of Bartonella occur in the U.S. each Year, with the vast majority of known cases due to bites from fleas that infest cats or infected dogs (may also occur directly from bites and scratches from infected dogs or cats). Bartonella can also be transmitted by ticks that transmit Lyme Disease. In fact, in a study published recently, deer ticks from New Jersey had a higher prevalence of Bartonella organisms than of Lyme organisms.

It is unclear whether the organism that we see transmitted along with Lyme disease is actually a Bartonella species (such as B. henselae or B. quintana) or is "Bartonella-Like Organism" (BLO) that is yet to be fully identified. While BLO has features similar to organisms in the Bartonella family, it also has features slimiar to the Mycoplasma and the Francisella (causes tularemia) families.

_________________


Babesiosis

As with other co-infections, there is a lot of overlap of symptoms between Lyme disease and Babesiosis. An accumulation of the following signs and symptoms probably warrant testing and/or treatment of Babesiosis:

___Chills

___Fatigue and often excessive sleepiness

___High fever at onset of illness

___Night sweats that are often drenching and profuse

___Severe muscle pains, especially the large muscles of the legs (quads, buttocks, etc.)

___Neurological symptoms often described as "dizzy, tipsy, and spaciness," similar to a sensation of "floating" or "walking off the top of a mountain onto a cloud"

___Depression

___Episodes of breathlessness, "air hunger", and/or cough

___Decreased appetite and/or nausea

___Spleen and/or liver enlargement

___Abnormal labs (low white blood count, low platelet counts, mild elevation of liver enzymes, and elevated sed rate)

___Headaches (migraine-like, persistent, and especially involving the back of the head and upper neck areas)

___Joint pain (more common with Lyme and Bartonella)

___anxiety/panic (more common with Bartonella)

___Lymph gland swelling (more common with Bartonella and Lyme)

[ 20. May 2008, 12:49 PM: Message edited by: FuzzySlippers ]

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FuzzySlippers
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This is an excellent article on Bartonella from the American Society for Microbiology. While the title of this scientific article is "Bartonella (Rochalimaea) Quitana Infections," other forms of Bartonella are discussed as well.

It's a good article!

http://cmr.asm.org/cgi/reprint/9/3/273.pdf

Fuzzy

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FuzzySlippers
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Some Bartonella Rash photos from the Lyme Disease Association:

http://www.lymediseaseassociation.org/PhotoAlbum_RashBart.html

Fuzzy

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FuzzySlippers
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"Bartonella: A Clinician's Viewpoint." Link to video of talk by Dr. B.


rtsp://ldarm.webcastcenter.com/lda/lda_burrascano2005.rm


Fuzzy

p.s. Sorry I couldn't get the link copy as a live link so you'll have to paste it into a new window. Unless someone else can post the live link.

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tosho
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up

--------------------
[Bb WB igm+] [B.henselae PCR+] [Chlamydia pneum.igm+igg+] [EBV igm-igg+]

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AlisonP
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Two very good articles with photos by Dr S in issues of Public Health Alert.


http://publichealthalert.org/pdfnew/2008_05.pdf

http://publichealthalert.org/pdfnew/2007_08.pdf

[Smile]

Alison

[ 06-12-2012, 12:03 PM: Message edited by: Lymetoo ]

--------------------
 -

The obscure we see eventually. The completely obvious, it seems, takes longer. --- Edward R. Murrow

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Keebler
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FuzzySlippers
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Another good article on Bartonella. Probably been posted somewhere before, but I couldn't find it. SO here it is.

"Factors Associated With The Rapid Emergence of Zoonotic Bartonella Infections," published in 2005.

http://tinyurl.com/4ncgwh

It's a PDF file, by the way, 28 pages long.

Fuzzy

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FuzzySlippers
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From a post by LymeToo, here are some more Bartonella symptoms. Thanks, Lymetoo!

Primary credit for authorship of the list below should be given to Tincup (I think).


BARTONELLA SYMPTOMS

GENERAL: Fatigue, Restlessness, Combative behavior, Myalgias, Malaise, Liver and/or Spleen
involvement, Abdominal pain, Infectious Mononucleosis-like Syndrome, Granulomatous Hepatitis

BRAIN: Encephalopathy may occur 1-6 weeks after the initial infection and is fairly common in patients
with Bartonella. Note: Approximately 50 percent of patients who develop Encephalopathy can be affected
by seizures (from focal to generalized, and from brief and self-limited to status epilepticus). Headaches,
Cognitive Dysfunction, and CNS Lesions may be evident.

RASH AND LYMPHADENITIS: Erythematous papules (red splotches or slightly raised red spots) may
develop. Such papules occasionally occur on the lower limbs but are more common on the upper limbs, the
head, and neck. The papules may appear on the skin or mucous membranes. Bartonella may also cause
subcutaneous nodules, with some bone involvement possible. The nodules may show some
hyperpigmentation, be tender, fester, and/or be enlarged or swollen, but not always.

EYES: Conjunctivitis, Bartonella Neuroretinitis, Loss of Vision, Flame Shaped Hemorrhages, Branch
Retinal Artery Occlusion with Vision Loss, Cotton Wool Exudates, Parinaud's Oculoglandular Syndrome,
and Papilledema.
BONES AND MUSCLES: Osteomyelitis, Myositis, Osteolytic Lesions (softening of bone), Myelitis,
Radiculitis, Transverse Myelitis, Arthritis, Chronic Demyelinating Polyneuropathy.

HEART: Endocarditis, Cardiomegaly.
Possible lab findings: The following may show up during standard testing:
Thrombocytopenia, pancytopenia, anemia, elevated serum alkaline phosphatase level, elevated bilirubin, abnormal liver enzymes.
X-ray of the bone may show areas of lysis or poorly-defined areas of cortical destruction with periosteal
reaction. Cardiomegaly may show up on a chest X-Ray.

Biopsies of lymph nodes reveal pathology often indistinguishable from sarcoidosis. Reports of biopsies
strongly suggestive of lymphoma do occur.
Tests occasionally show an enlarged liver with multiple hypodense areas scattered throughout the
parenchyma.


Fuzzy

[ 19. May 2008, 03:34 PM: Message edited by: FuzzySlippers ]

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NorthernLyme1
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There is a good Bartonella Information thread at http://canlyme.com/ including this very thorough Powerpoint presentation by Bruno Chmole from the University of California at Davis:

http://faculty.vetmed.ucdavis.edu/Faculty/bbchomel/WHO_Zoonoses/PDF/bartonellalecture.pdf

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FuzzySlippers
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Bartonella


BARTONELLA-LIKE ORGANISMS
by Joseph Burrascano


It has been said that Bartonella is the most common of all tick-borne pathogens. Indeed, there seems to be a fairly distinct clinical syndrome when this type of organism is present in the chronic Lyme patient. However, several aspects of this infection seem to indicate that this tick-associated strain of Bartonella is different from that described as "cat scratch disease". For example, in patients who fit the clinical picture, standard Bartonella blood testing is commonly non-reactive. Furthermore, the usual Bartonella medications do not work for this- they suppress the symptoms but do not permanently clear them. For these reasons I like to refer to this as a "Bartonella-like organism" (BLO), rather than assume it is a more common species.

Indicators of BLO infection include symptoms involving the central nervous system that are out of proportion to the other systemic symptoms of chronic Lyme. There seems to be an increased irritability to the CMS, with agitation, anxiety, insomnia, and even seizures, plus symptoms of encephalitis, such as cognitive deficits and confusion. Other key symptoms may include gastritis, lower abdominal pain (mesenteric adenitis), sore soles, especially in the AM, tender subcutaneous nodules along the extremities, and red rashes. These rashes may have the appearance of red streaks like stretch marks that do not follow skin planes, spider veins, or red papular eruptions. Lymph nodes may be enlarged and the throat can be sore.

Because standard Bartonella testing, either by serology or PCR, may not pick up this BLO, the blood test is very insensitive. Therefore, the diagnosis is a clinical one, based on the above points. Also, suspect infection with BLO in extensively treated Lyme patients who still are encephalitic, and who never had been treated with a significant course of specific treatment.

The drug of choice to treat BLO is levofloxacin (Levaquin). Levofloxacin is usually never used for Lyme or Babesia, so many patients who have tick-borne diseases, and who have been treated for them but remain ill, may in fact be infected with BLO. Treatment consist of 500 mg daily (may be adjusted based on body weight) for at least one month. Treat for three months or longer in the more ill patient. It has been suggested that levofloxacin may be more effective in treating this infection if a proton pump inhibitor is added in standard doses.

Another subtlety is that certain antibiotic combinations seem to inhibit the action of levofloxacin, while others seem to be neutral. I advise against combining Levaquin with an erythromycin-like drug, as clinically such patients do poorly. On the other hand, combinations with cephalosporins, penicillins and tetracyclines are okay. Alternatives to levofloxacin include rifampin, gentamicin and possibly streptomycin.

Levofloxacin is generally well tolerated, with almost no stomach upset. Very rarely, it can cause confusion and insomnia- this is usually temporary, and may be relieved by lowering the dose. There is, however, one side effect that would require it to be stopped- it may cause a painful tendonitis, usually of the largest tendons. If this happens, then the levofloxacin must be stopped or tendon rupture may occur. Unfortunately, levofloxacin and drugs in this family cannot be given to those under the age of 18, so other alternatives, such as azithromycin and/or rifampin, are used in children.

Incidentally, animal studies show that Bartonella may be transmitted across the placenta. No human studies have been done.

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FuzzySlippers
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Article from The Doctor's Doctor on Bartonella.


http://www.thedoctorsdoctor.com/diseases/bartonella.htm#tx

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FuzzySlippers
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Article from Medscape

http://www.medscape.com/viewarticle/562276


Here's the Abstract:

Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistant Depression?

Posted 09/13/2007

James L. Schaller, MD, MAR; Glenn A. Burkland, DMD; P.J. Langhoff
Author Information
Abstract
Introduction

Bartonella is an emerging infection found in cities, suburbs, and rural locations. Routine national labs offer testing for only 2 species, but at least 9 have been discovered as human infections within the last 15 years. Some authors discuss Bartonella cases having atypical presentations, with serious morbidity considered uncharacteristic of more routine Bartonella infections. Some atypical findings include distortion of vision, abdominal pain, severe liver and spleen tissue abnormalities, thrombocytopenic purpura, bone infection, arthritis, abscesses, heart tissue and heart valve problems. While some articles discuss Bartonella as a cause of neurologic illnesses, psychiatric illnesses have received limited attention. Case reports usually do not focus on psychiatric symptoms and typically only as incidental comorbid findings. In this article, we discuss patients exhibiting new-onset agitation, panic attacks, and treatment-resistant depression, all of which may be attributed to Bartonella.
Methods

Three patients receiving care in an outpatient clinical setting developed acute onset personality changes and agitation, depression, and panic attacks. They were retrospectively examined for evidence of Bartonella infections. The medical and psychiatric treatment progress of each patient was tracked until both were significantly resolved and the Bartonella was cured.
Results

The patients generally seemed to require higher dosing of antidepressants, benzodiazepines, or antipsychotics in order to function normally. Doses were reduced following antibiotic treatment and as the presumed signs of Bartonella infection remitted. All patients improved significantly following treatment and returned to their previously healthy or near-normal baseline mental health status.
Discussion

New Bartonella species are emerging as human infections. Most do not have antibody or polymerase chain reaction (PCR) diagnostic testing at this time. Manual differential examinations are of unknown utility, due to many factors such as low numbers of infected red blood cells, the small size of the infecting bacteria, uncertainty of current techniques in viewing such small bacteria, and limited experience. As an emerging infection, it is unknown whether Bartonella occurrence in humans worldwide is rare or common, without further information from epidemiology, microbiology, pathology, and treatment outcomes research.
Conclusion

Three patients presented with acute psychiatric disorders associated with Bartonella-like signs and symptoms. Each had clear exposure to ticks or fleas and presented with physical symptoms consistent with Bartonella, eg, an enlarged lymph node near an Ixodes tick bite and bacillary angiomatosis found only in Bartonella infections. Laboratory findings and the overall general course of the illnesses seemed consistent with Bartonella infection. The authors are not reporting that these patients offer certain proof of Bartonella infection, but we hope to raise the possibility that patients infected with Bartonella can have a variety of mental health symptoms. Since Bartonella can clearly cause neurologic disorders, we feel the presence of psychiatric disorders is a reasonable expectation.

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FuzzySlippers
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Infection. 2007 Apr;35(2):107-9.

Chronic Vasculitis and Polyneuropathy due to Infection with Bartonella henselae.
Stockmeyer B, Schoerner C, Frangou P, Moriabadi T, Heuss D, Harrer T.

Dept. of Medicine III, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany, [email protected]

Bartonella henselae, the causative agent of cat scratch disease and bacillary angiomatosis, is associated with an expanding spectrum of diseases. Here, we report on a 40-year-old patient suffering from chronic recurrent painful ulcers of the toes, distal axonal sensomotor polyneuropathy and Raynaud's phenomenon. Biopsy of the sural nerve demonstrated an axonal neuropathy with a neurogenic muscular atrophy. Treatment with high dose corticosteroids had no beneficial effect. A biopsy taken from a recurring ulcer 7 years after the beginning of the disease revealed superficial ulcerated hyperkeratosis with subepithelial proliferation of small vessels compatible with a diagnosis of verruca peruana, however, without detection of microorganism. Serologic analysis revealed an elevated IFT titer of 1:1,024 against B. henselae. Treatment with erythromycin induced healing of the ulcer, remission of the vasculitis and the polyneuropathy, and a decline of the IFT titer.

This case illustrates that B. henselae infection should be considered in patients with vasculitis and polyneuropathic syndromes.

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FuzzySlippers
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http://www.cdc.gov/NCIDOD/eid/vol12no03/05-0931.htm



Synopsis
Bartonella Spp. in Pets and Effect on Human Health

Bruno B. Chomel,*Comments Henri-Jean Boulouis, Soichi Maruyama, and Edward B. Breitschwerdt
*University of California School of Veterinary Medicine, Davis, California, USA; Microbiologie-Immunologie, Ecole Nationale Vtrinaire d'Alfort, Maisons-Alfort, France; Nihon University, Kanagawa, Japan; and North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA


Among the many mammals infected with Bartonella spp., pets represent a large reservoir for human infection because most Bartonella spp. infecting them are zoonotic. Cats are the main reservoir for Bartonella henselae, B. clarridgeiae, and B. koehlerae. Dogs can be infected with B. vinsonii subsp. berkhoffii, B. henselae, B. clarridgeiae, B. washoensis, B. elizabethae, and B. quintana. The role of dogs as an important reservoir of Bartonella spp. is less clear than for cats because domestic dogs are more likely to be accidental hosts, at least in nontropical regions. Nevertheless, dogs are excellent sentinels for human infections because a similar disease spectrum develops in dogs. Transmission of B. henselae by cat fleas is better understood, although new potential vectors (ticks and biting flies) have been identified. We review current knowledge on the etiologic agents, clinical features, and epidemiologic characteristics of these emerging zoonoses.

Bartonella spp. are fastidious, hemotropic, gram-negative bacteria that are mainly transmitted by vectors. Among the 11 species or subspecies known or suspected to be pathogenic for humans, 6 have been isolated from pet dogs and cats (Table 1). Domestic cats are the principal reservoir for Bartonella henselae, the main agent of cat-scratch disease (CSD); B. clarridgeiae, which has been suspected in a few cases of CSD; and B. koehlerae, recently reported as the cause of human endocarditis (1,4). Domestic dogs could be one of the reservoirs for B. vinsonii subsp. berkhoffii (reported as B. v. berkhoffii thereafter) because as it can cause prolonged bacteremia in this species (5,6). Dogs can also be infected with B. henselae, B. clarridgeiae, B. washoensis, and B. elizabethae (2). Recently, 2 cases of endocarditis caused by B. quintana were diagnosed (P. Kelly et al., unpub. data). As with human disease, the clinical spectrum of Bartonella infection in dogs is expanding (2). Fleas play a major role in the transmission of feline Bartonella (7), but other potential vectors, such as ticks and biting flies have been recently identified to harbor Bartonella DNA, including B. henselae (8,9). This article provides an update on the etiologic agents, new clinical features, and evolving epidemiologic characteristics of these emerging zoonoses. We will not discuss the diagnosis, treatment, and prevention of Bartonella infections, as several recent review articles have been written on this subject (1,2,10).

[See above link for remainder of article]

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FuzzySlippers
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From the Los Angeles County West Vector & Vector-Borne Disease District (Including a photo of a bartonella lesion on the skin):


http://www.lawestvector.org/bartonella.htm


Bartonella

There is now evidence that ticks may be a significant transmitter of the Bartonella infection to humans. A study in California showed that a minimum of 2.3% of a pool of 1253 Ixodes pacificus ticks tested positive for Bartonella. Additionally, it appears that the Dermacentor species of ticks are also capable of transmitting the Bartonella bacteria.

Early symptoms of Bartonella include a red, crusted, elevated skin lesion where the bacteria enters its host (which can mimic the Lyme disease enlarging rash), followed by flu-like symptoms of fever, muscle and joint aches/pains, nausea, vomiting, and chills. Also, enlargement of the lymph nodes around the ears is often present. More serious symptoms include encephalitis, which can result in headaches, dementia, seizures, coma, inflammation of the heart, abdominal pain, bone lesions, and loss of vision. Studies also indicate that some Lyme disease patients are also infected with Bartonella. Treatment with multiple antibiotics is becoming more common in these situations.

The genus Bartonella, a group of small, weakly-staining, gram-negative bacteria, includes two species currently of human medical importance in the United States. These are B. henselae and B. quintana, .

[click on link for remainder of text]

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Clarissa
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Important Bartonella Article:
http://www.publichealthalert.org/Articles/jamesschaller/ignore%20bartonella%20and%20die.html

--------------------
Clarissa

Because I knew you:
I have been changed for good.

 -

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northstar
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Good grief, someone had better tell
IDSA guideline writers.

They swear there is no evidence that
bart is transmitted by ticks.

N/

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FuzzySlippers
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bump for anyone who might be interested
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Boomerang
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Great info!! Thanks to all.
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mojo
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Thanks for this very informative thread.
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mojo
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bump
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djf2005
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i personally believe bartonella or blo is the biggest reason some of us are so sick and stay sick. its very hard to kill. good luck everyone. thanks for this thread, its informative

derek

--------------------
"Experience is not what happens to you; it is what you do with what happens to you."

[email protected]

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ByronSBell 2007
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over 90% of lyme infected patients have bartonella, just a fun fact....
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djf2005
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not very fun at all [Smile]

whered that stat come from?

how r u making out byron? any progress yet?

--------------------
"Experience is not what happens to you; it is what you do with what happens to you."

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FuzzySlippers
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http://www.co.washoe.nv.us/health/ehs/vector/bartonella.html

Bartonella - Epidemiology of an Emerging Pathogen

This study was initiated to determine the source of infection in a human case of endocarditis (inflammation of the heart) with an unknown cause that occurred in Washoe County. The causative organism was later identified as a previously unknown bacterium and was named Bartonella washoensis. Several other members in the genus Bartonella are known to cause human disease. Among them are Oroya fever (South America), trench fever and cat scratch disease.

The Vector-Borne Diseases Program staff collaborated with researchers from the Centers for Disease Control and Prevention (CDC) in Fort Collins to identify the most likely animal source of the Bartonella infection in the human case. As rodents are often hosts for Bartonella species, blood samples were collected from a variety of rodents throughout the Truckee Meadows area. The samples were cultured to isolate Bartonella organisms. Using genetic sequencing techniques, it was then possible to compare the relatedness of the rodent bacterial isolates with those from the patient. Two of the isolates were found to be 100% genetic matches.*

The rodent species identified is the California ground squirrel (Spermophilus beecheyi), which is common in Washoe County. This squirrel also happens to be the primary host species for the plague bacterium (Yersinia pestis) in Nevada that is transmitted primarily through the bite of infected fleas found on the squirrel. The next step in the Bartonella investigation will be to attempt to identify the possible mode of transmission between squirrels and humans and will focus on the flea common to the squirrels (Oropsylla montana).

* Kosoy, M., Murray, M., Gilmore Jr., R.D, Bai, Y., and Gage, K.L. 2003. Bartonella Strains from Ground Squirrels Are Identical to Bartonella washoensis Isolated from a Human Patient. Journal of Clinical Microbiology. 41:645-650.

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http://www.ncbi.nlm.nih.gov/pubmed/11559306?dopt=Abstract


Concurrent infection of the central nervous system by Borrelia burgdorferi and Bartonella henselae: evidence for a novel tick-borne disease complex.

Eskow E, Rao RV, Mordechai E.

Hunterdon Medical Center, Flemington, NJ, USA.

OBJECTIVES: To investigate Bartonella henselae as a potential human tick-borne pathogen and to evaluate its role as a coinfecting agent of the central nervous system in the presence of neuroborreliosis.

DESIGN: Case report study.

SETTING: A primary health care center in Flemington, NJ, and the Department of Research and Development at Medical Diagnostic Laboratories LLC in Mt Laurel, NJ.

SUBJECTS: Two male patients (aged 14 and 36 years) and 2 female patients (aged 15 and 30 years, respectively) with a history of tick bites and Lyme disease.

MAIN OUTCOME MEASURES: Laboratory and diagnostic findings before and after antimicrobial therapy.

RESULTS: Patients residing in a Lyme-endemic area of New Jersey with ongoing symptoms attributed to chronic Lyme disease were evaluated for possible coinfection with Bartonella species. Elevated levels of B henselae-specific antibodies were found in these patients using the immunofluorescent assay. Bartonella henselae-specific DNA was detected in their blood. None of these patients exhibited the clinical characteristics of cat-scratch disease. Findings of cerebrospinal fluid analysis revealed the presence of both B henselae- and Borrelia burgdorferi-specific DNA. Bartonella henselae-specific DNA was also detected in live deer ticks obtained from the households of 2 of these patients.

CONCLUSIONS: Our data implicate B henselae as a potential human tick-borne pathogen. Patients with a history of neuroborreliosis who have incomplete resolution of symptoms should be evaluated for B henselae infection.

Publication Types:

* Case Reports


PMID: 11559306 [PubMed - indexed for MEDLINE]

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http://www.medscape.com/viewarticle/537749


From Emerging Infectious Diseases
Rodent-Associated Bartonella Febrile Illness, Southwestern United States

Posted 07/10/2006

Jonathan Iralu; Ying Bai; Larry Crook; Bruce Tempest; Gary Simpson; Taylor McKenzie; Frederick Koster
Author Information
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Assess clinically focused product information on Medscape.


Abstract and Introduction

Abstract

Serum specimens from 114 patients hospitalized with a febrile illness were tested with an indirect immunofluorescence assay (IFA) using Bartonella antigens prepared from 6 species of sigmodontine rodents and 3 known human Bartonella pathogens: B. henselae, B. quintana, and B. elizabethae. Acute- and convalescent-phase serum samples from 5 of these patients showed seroconversion with an IFA titer ≥512 to rodent-associated Bartonella antigens. The highest titer was against antigen derived from the white-throated woodrat (Neotoma albigula), although this rodent is not necessarily implicated as the source of infection. Three of the 5 who seroconverted showed no cross-reaction to the 3 Bartonella human pathogens. Common clinical characteristics were fever, chills, myalgias, leukopenia, thrombocytopenia, and transaminasemia. Although antibodies to Bartonella are cross-reactive, high-titer seroconversions to rodent-associated Bartonella antigens in adults with common clinical characteristics should stimulate the search for additional Bartonella human pathogens.
Introduction

The discovery of hantavirus pulmonary syndrome and its high death rate in the southwestern United States resulted in greater vigilance in evaluating patients with acute febrile illness, particularly those with thrombocytopenia.[1] Clinicians soon became aware of substantial numbers of hospitalized patients with a severe flulike prodrome and thrombocytopenia. In spite of conventional culture and serologic analysis for known pathogens and diseases, including hantaviruses, plague, tularemia, relapsing fever, spotted fever, murine typhus, and Q fever, no diagnosis could be made. To assist physicians in identifying treatable pathogens, we submitted serum to reference laboratories for diagnostic seroassays directed at known pathogens and organisms not previously associated with human disease. A concept of the role of rodent-associated bartonellae as a cause of unexplained febrile illness in the western United States has been recently developed (M. Kosoy, pers. comm.). We considered the possibility that some cases in our study were caused by Bartonella species.

Among at least 20 known species and subspecies of Bartonella, 5 have been identified as causes of human disease in North America.[2,3] B. henselae causes cat-scratch disease with regional lymphadenitis and occasionally hepatosplenic disease in the immunocompetent host, and bacillary angiomatosis, cerebritis, or peliosis hepatis in the immunocompromised host.[4-6] Louseborne B. quintana causes trench fever, aseptic meningitis, bacteremia, endocarditis, or bacillary angiomatosis.[4,7-9] Recently isolated cases of infection with B. elizabethae,[10] B. vinsonii subsp. arupensis,[11] and B. washoensis[12] suggest that the spectrum of Bartonella infections may continue to expand.

Many mammals, including numerous species of rodents, are commensally infected with Bartonella species in North America.[12-15] We sought serologic evidence for human bartonellae infection in serious febrile illnesses in the Four Corners region, using diverse Bartonella antigens in an indirect immunofluorescence assay (IFA).[13] We report 7 years' cumulative experience in diagnostic referrals, including 5 cases showing seroconversion, and 4 cases with a single high titer, to Bartonella antigens derived from strains isolated from rodents, particularly the white-throated woodrat (Neotoma albigula) captured in New Mexico.

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http://www.cdc.gov/EID/content/13/12/1948.htm


Volume 13, Number 12-December 2007
Dispatch


Bartonella DNA in Dog Saliva


Ashlee W. Duncan,* Ricardo G. Maggi,* and Edward B. Breitschwerdt* Comments to Author
*North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA

Suggested citation for this article

Abstract
Bartonella species, transmitted by arthropods or animal bites and scratches, are emerging pathogens in human and veterinary medicine. PCR and DNA sequencing were used to test oral swabs collected from dogs. Results indicated the presence of 4 Bartonella species: B. bovis, B. henselae, B. quintana, and B. vinsonii subspecies berkhoffii.

Bartonella species are being recognized as increasingly important bacterial pathogens in veterinary and human medicine. These organisms can be transmitted by an arthropod vector or alternatively by animal scratches or bites (1). Among the 11 species or subspecies known or suspected to be pathogenic in humans, 8 have been detected in or isolated from pet dogs or cats, thereby highlighting the zoonotic potential of these bacteria (2). In general, cats are implicated in the transmission of Bartonella henselae, typically resulting in cat-scratch disease; however, there have also been sporadic reports of Bartonella transmission by dogs (3-5). When B. henselae prevalence was evaluated in a population of 52 dogs, 4 dogs were seroreactive at reciprocal titers of 64 or 128, and Bartonella-positive PCR results were found in 3 of 52 blood samples, 5 of 9 oral swabs, and 5 of 9 nail clippings (5). Based on these reports and the recent recognition of B. henselae and B. vinsonii subspecies berkhoffii bacteremia in veterinarians and veterinary technicians who experience frequent cat and dog scratches and bites (6), we speculated that Bartonella species may be present in the saliva of dogs. The purpose of this study was to determine whether Bartonella DNA could be detected in oral swabs collected from dogs.
The Study

As part of an ongoing study from November 2004 to December 2006 to investigate the prevalence of Anaplasma, Bartonella, and Ehrlichia infections in healthy golden retrievers and golden retrievers with lymphoma, a buccal swab was collected using a sterile cotton applicator. The swab was placed against the inside surface of the dog's cheek. Saliva and tissue were collected by rolling the swab firmly against the cheek. Subsequently, the swab was placed into a sterile, no additive, Vacutainer (Becton Dickinson, Franklin Lakes, NJ, USA) serum tube and allowed to air dry for 10 to 15 minutes at room temperature before the tube was recapped.

Cells on the air-dried swab were resuspended in 500 μL of QuickExtract DNA Extraction Solution (EPICENTRE Biotechnologies, Madison, WI, USA), according to the manufacturer's instructions. Total DNA was isolated using 200 μL of the QuickExtract resuspension, which was extracted through a QIAamp DNA Blood Mini-Kit (QIAGEN, Inc., Valencia, CA, USA) according to the manufacturer's instructions. Similarly, total DNA was extracted from 200 μL of EDTA-anticoagulated whole blood using the QIAamp DNA Blood Mini-Kit.

Oral swabs and blood samples (n = 44 each) were screened for the presence of Bartonella by 2 previously described PCR methods (7). The first PCR targeted a fragment of the 16S-23S intergenic transcribed spacer (ITS) region; samples that were PCR positive for Bartonella DNA by the ITS primers were subsequently analyzed by a second PCR targeting the heme-binding protein gene, Pap31. Positive and negative controls were used in all processing steps, including DNA extraction. PCR amplicons were sequenced to identify species (Davis Sequencing, Davis, CA, USA). Sequence analysis and alignment with GenBank sequences were performed (AlignX, Vector NTI Suite 6.0, InforMax, Inc., Frederick, MD, USA). Additionally, serum samples were analyzed for IgG antibodies to B. henselae and B. vinsonii (berkhoffii) using an indirect immunofluorescence assay (IFA), as described previously (8). Reciprocal titers >64 were considered seroreactive.

Of the 44 dogs surveyed, oral swabs collected from 5 (11.4%) dogs were PCR-positive for Bartonella DNA. Sequencing indicated that 5 different Bartonella species or subtypes were present: B. bovis, B. henselae, B. quintana, and B. vinsonii subsp. berkhoffii types I and II (Table). PCR amplification and sequencing of blood samples from these 5 dogs showed B. henselae and B. vinsonii (berkhoffii) DNA in 2 dogs (Table). None of these 5 dogs was seroreactive to B. henselae or B. vinsonii (berkhoffii) antigens. Contamination was not detected in any of the negative control samples at any stage of processing or at any time during the study. As this work was part of an ongoing study of golden retrievers with and without lymphoma, dogs 1 and 2 had lymphoma; the remaining 3 dogs were clinically healthy (Table).
Conclusions

These results demonstrate the presence of Bartonella DNA in oral swabs obtained from dogs. Notably, 3 Bartonella species and 2 B. vinsonii (berkhoffii) types were found in dog saliva. B. bovis, formerly referred to as B. weissii, was initially isolated from the blood of cats (9). Subsequently, this organism was isolated from the blood of cows in the United States, Europe, and Africa (10-12). To our knowledge, this is only the second known report of the detection of B. bovis DNA in a sample obtained from a dog (13). All 5 dogs in this study lacked serologic evidence of Bartonella infection, a finding which has been previously reported in bacteremic dogs and humans (6,13,14).

Previous studies have shown that targeting multiple Bartonella genes provides molecular evidence of coinfection with more than 1 Bartonella species or strain type (6,7,13). In the current work, the inability to confirm the ITS PCR results with a second PCR target has been previously reported by our laboratory (6,13,14) and likely reflects differences in PCR sensitivity, interference or inhibition of the PCR reaction by oral bacteria that are present in greater numbers than the Bartonella, or the lack of a known heme-binding protein gene in various Bartonella species, such as B. bovis. The limit of detection (LOD) of Bartonella ITS PCR is 2 copies/reaction, while the LOD of Pap31 assay is 10 copies/reaction. Further, although B. henselae has a detectable Pap31 protein (Table), several researchers in our laboratory have successfully isolated B. henselae strains that lack a PCR-detectable heme-binding protein (unpub. data). Upon recognition of the discordance between ITS and Pap31, additional genes such as 16S, gltA, and rpoB were targeted; however, these analyses were negative for Bartonella and resulted in nonspecific bacterial amplification. Because inhibition of ITS PCR was suspected due the presence of other oral bacteria, Bartonella-negative DNA extracts from oral swabs were spiked with B. henselae DNA at 1.5, 2.5, 5, and 10 (0.002 pg/μL) copies/reaction. Inhibition was detected at up to 5 copies/reaction, while the 10 copies/reaction sample was consistently amplified by the ITS primers.

These data, in conjunction with previous case reports (3-5), suggest that potentially viable Bartonella organisms may be transmitted to humans after a dog bite. The detection of DNA by PCR does not necessarily indicate the viability of Bartonella organisms. However, due to the extremely slow growth characteristics of Bartonella spp., isolation from the oral cavity does not seem feasible, because of competition with numerous other rapidly growing oral bacterial species. Recently, Bartonella DNA has been amplified from peripheral lymph nodes of healthy dogs (14). B. henselae was also amplified from salivary gland tissues from a dog with saladenitis (15). There are several plausible routes by which a Bartonella sp. could gain entry to the oral cavity. Future studies should determine if the tonsilar lymphoid tissues, salivary glands, or periodontal, gingival, or other oral tissues can serve as sources of Bartonella spp. contamination of canine saliva. As Bartonella infection may represent an occupational risk for veterinary professionals and others with extensive animal contact (6), additional studies should address the risk of transmission from dogs to humans following bite wounds.
Acknowledgments

We acknowledge the assistance of the veterinarians who provided samples and the owners who allowed participation of their dogs in this study.

This research was funded in part by the American Kennel Club-Canine Health Foundation, Bayer Animal Health, and the State of North Carolina.

Dr Duncan recently completed her PhD in epidemiology and biotechnology in the Intracellular Pathogens Laboratory at the College of Veterinary Medicine-North Carolina State University. Her primary research interests include Bartonella species in dogs and humans.

References

1. Boulouis HJ, Chang CC, Henn JB, Kasten RW, Chomel BB. Factors associated with the rapid emergence of zoonotic Bartonella infections. Vet Res. 2005;36:383-410.
2. Chomel BB, Boulouis HJ, Maruyama S, Breitschwerdt EB. Bartonella spp. in pets and effect on human health. Emerg Infect Dis. 2006;12:389-94.
3. Kerkhoff FT, Ossewaarde JM, de Loos WS, Rothova A. Presumed ocular bartonellosis. Br J Ophthalmol. 1999;83:270-5.
4. Keret D, Giladi M, Kletter Y, Wientroub S. Cat-scratch disease osteomyelitis from a dog scratch. J Bone Joint Surg Br. 1998;80:766-7.
5. Tsukahara M, Tsuneoka H, Iino H, Ohno K, Murano I. Bartonella henselae infection from a dog. Lancet. 1998;352:1682.
6. Breitschwerdt EB, Maggi RG, Duncan AW, Nicholson WL, Hegarty BC, Woods CW. Bartonella species in blood of immunocompetent persons with animal and arthropod contact. Emerg Infect Dis. 2007;13:938-41.
7. Diniz PPVP, Maggi RG, Schwartz DS, Cadenas MB, Bradley JM, Hegarty BC, et al. Canine bartonellosis: serological and molecular prevalence in Brazil and evidence of co-infection with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Vet Res. 2007;38:697-710.
8. Solano-Gallego L, Bradley J, Hegarty B, Sigmon B, Breitschwerdt E. Bartonella henselae IgG antibodies are prevalent in dogs from southeastern USA. Vet Res. 2004;35:585-95.
9. Regnery R, Marano N, Jameson P, Marston E, Jones D, Handley S, et al. A fourth Bartonella species, B. weissii species nova, isolated from domestic cats. In: Abstracts of the 15th Meeting of the American Society for Rickettsiology; Captiva Island, Florida; 2000 April 30-May 3; Abstract 4. American Society for Rickettsiology; 2000.
10. Breitschwerdt EB, Sontakke S, Cannedy A, Hancock SI, Bradley JM. Infection with Bartonella weissii and detection of Nanobacterium antigens in a North Carolina beef herd. J Clin Microbiol. 2001;39:879-82.
11. Bermond D, Boulouis HJ, Heller R, Van Laere G, Monteil H, Chomel BB, et al. Bartonella bovis sp. nov. and Bartonella capreoli sp. nov., isolated from European ruminants. Int J Syst Evol Microbiol. 2002;52:383-90.
12. Raoult D, La Scola B, Kelly PJ, Davoust B, Gomez J. Bartonella bovis in cattle in Africa. Vet Microbiol. 2005;105:155-6.
13. Duncan AW, Maggi RG, Breitschwerdt EB. A combined approach for the enhanced detection and isolation of Bartonella species in dog blood samples: pre-enrichment liquid culture followed by PCR and subculture onto agar plates. J Microbiol Methods. 2007;69:273-81.
14. Duncan AW, Birkenheuer AJ, Maggi RG, Breitschwerdt EB. Bartonella DNA detected in the blood and lymph nodes of healthy dogs. In: Abstracts of the 20th Meeting of the American Society for Rickettsiology; Pacific Grove, California; 2006 Sept 2-7; Abstract 110. American Society for Rickettsiology; 2006.
15. Saunders GK, Monroe WE. Systemic granulomatous disease and sialometaplasia in a dog with Bartonella infection. Vet Pathol. 2006;43:391-2.

Table

Table. PCR, DNA sequencing, and serologic results for the 5 dogs positive for Bartonella DNA in oral swabs
Suggested Citation for this Article

Duncan AW, Maggi RG, Breitschwerdt EB. Bartonella DNA in dog saliva. Emerg Infect Dis [serial on the Internet]. 2007 Dec [date cited]. Available from http://www.cdc.gov/EID/content/13/12/1948.htm

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FuzzySlippers
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Cat scratch disease complicated with aseptic meningitis and neuroretinitis.

Braz J Infect Dis. 2008 Apr
Pinto VL Jr, Curi AL, Pinto Ada S, Nunes EP, Teixeira Mde L, Rozental T, Favacho AR, Castro EL, Bia MN.

Evandro Chagas Clinical Research Institute, Fiocruz.

Cat scratch disease (CSD) is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI) assays for B. henselae were positive and the cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.

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FuzzySlippers
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http://www.ncbi.nlm.nih.gov/pubmed/15210978


The louse-borne human pathogen Bartonella quintana is a genomic derivative of the zoonotic agent Bartonella henselae.


Alsmark CM, Frank AC, Karlberg EO, Legault BA, Ardell DH, Canbck B, Eriksson AS, Nslund AK, Handley SA, Huvet M, La Scola B, Holmberg M, Andersson SG.

Department of Molecular Evolution, Evolutionary Biology Center, Uppsala University, and Department of Medical Sciences, Uppsala University Hospital, Sweden.

We present the complete genomes of two human pathogens, Bartonella quintana (1,581,384 bp) and Bartonella henselae (1,931,047 bp). The two pathogens maintain several similarities in being transmitted by insect vectors, using mammalian reservoirs, infecting similar cell types (endothelial cells and erythrocytes) and causing vasculoproliferative changes in immunocompromised hosts. A primary difference between the two pathogens is their reservoir ecology. Whereas B. quintana is a specialist, using only the human as a reservoir, B. henselae is more promiscuous and is frequently isolated from both cats and humans. Genome comparison elucidated a high degree of overall similarity with major differences being B. henselae specific genomic islands coding for filamentous hemagglutinin, and evidence of extensive genome reduction in B. quintana, reminiscent of that found in Rickettsia prowazekii. Both genomes are reduced versions of chromosome I from the highly related pathogen Brucella melitensis. Flanked by two rRNA operons is a segment with similarity to genes located on chromosome II of B. melitensis, suggesting that it was acquired by integration of megareplicon DNA in a common ancestor of the two Bartonella species. Comparisons of the vector-host ecology of these organisms suggest that the utilization of host-restricted vectors is associated with accelerated rates of genome degradation and may explain why human pathogens transmitted by specialist vectors are outnumbered by zoonotic agents, which use vectors of broad host ranges.

PMID: 15210978 [PubMed - indexed for MEDLINE]

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FuzzySlippers
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bump
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Nessa1815
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Thx for the bump - missed this topic previously

--------------------
"~*~My smile hides my bite~*~."

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StephenC
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quote:
Originally posted by FuzzySlippers:
Strange rashes recurring on the body often, red stretch marks, spider veins

My doctor says this is not true. Is there any evidence supporting this for Bartonella?

--------------------
Lingering chronic symptoms: Fatigue, Derealization, Brain fog. Monthly fever with flu-like symptoms that last for weeks.
Lyme WB Bands Positive: 31, 41, 58, 66
HHV6, EBV, CMV, & Mycoplasma IGG positive.
Chronically Low CD4 count.

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FuzzySlippers
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Hi Stephen,

There is evidence in this thread. Have a look at some of the links. There are plenty of pictures of Bart rashes. They are also spoken about in some of the medical articles posted above, again in this thread.

Fuzzy

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http://www.ncbi.nlm.nih.gov/pubmed/18465733

Macular hole following Bartonella henselae neuroretinitis.Donnio A, Jean-Charles A, Merle H.
Service d'Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hopital Pierre Zobda-Quitman, Fort de France Cedex, Martinique - France (French West Indies).

PURPOSE. To report a case of macular hole secondary to Bartonella henselae neuroretinitis. METHODS. Observational case report. An 11 year-old boy presented urgently with a decrease of visual acuity in the left eye. Posterior segment examination revealed neuroretinitis attributed to Bartonella henselae. Treatment was initiated, resulting in the disappearance of symptoms. RESULTS. Follow-up consultations 7 months later showed a further decline in visual acuity secondary to a macular hole. CONCLUSIONS. Cat scratch disease is a rare pathology and is most often considered benign. Serious complications can nonetheless occur, such as neuroretinitis, choroidal nodules, and disciform keratitis. The authors report a case of sequellar macular hole. They found only one previous report of macular hole caused by B henselae, which, contrary to their case, appeared rapidly 12 days after presentation.

PMID: 18465733 [PubMed - in process]

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http://www.cdc.gov/eid/content/14/7/1168.htm

Volume 14, Number 7-July 2008
Letter
Bartonella quintana and Coxiella burnetii as Causes of Endocarditis, India

Nandhakumar Balakrishnan,* Thangam Menon,* Pierre-Edouard Fournier, and Didier Raoult

*University of Madras, Taramani, Chennai, India; and Universite de la Mediterranee, Marseille, France

Suggested citation for this article

To the Editor: In industrialized countries, blood culture is negative for 2.5%-31% of infectious endocarditis cases (1). In developing countries such as South Africa (2), Algeria (3), and Pakistan (4), culture is negative for 48% to 56%. Negative cultures delay diagnosis and treatment, which profoundly affects clinical outcome. Negative blood cultures commonly result from previous administration of antimicrobial drugs, right-sided endocarditis, or fastidious or noncultivable pathogens (1). Our aim was to identify fastidious agents of blood culture-negative endocarditis by serology. Because of recent attention to zoonotic microorganisms as agents of this condition in developing countries (1), we investigated the prevalence of Coxiella burnetii,Bartonella spp., and Brucella melitensis among endocarditis patients in India.

We cultured blood from 111 patients admitted to the Government General Hospital, Chennai, India, from August 2005 through December 2006, with a diagnosis of infectious endocarditis according to the Duke criteria (5).

Informed consent was obtained from all patients. Three blood samples from each patient, collected at hourly intervals, were inoculated into brain-heart infusion broth supplemented with 0.04% sodium polyanethol sulfonate (HiMedia, Mumbai, India). Cultures were incubated at 37C in a 5% CO2 atmosphere for 14 days and checked each day for turbidity. Subcultures were made on 5% sheep blood and MacConkey agar at 37C at 24 hours, 48 hours, and when culture broth appeared turbid.

Blood cultures were negative for 80 (72%) of the 111 patients. Serum from 63 patients was available for serologic testing. Of these patients, 30 were male and 33 were female; age range was 5-65 years and mean age was 25.5 years.

Endocarditis involved the native valve for 60 (95.23%) and a prosthetic valve for 3 (4.76%). The most frequent predisposing factor was rheumatic heart disease, found in 38 (60.31%).

Of the 60 with native valve endocarditis, the involved valve was mitral for most (36, 60.0%), followed by aortic (8, 13.33%), tricuspid (7, 11.66%), and pulmonary (1, 1.66%); 8 (13.33%) had both valvular and nonvalvular endocarditis. Of the 3 patients with prosthetic valve endocarditis, the involved valve was mitral for 2 and aortic for 1.

Serum samples were screened for Bartonella spp. and C. burnetii by microimmunofluorescence (6,7). A diagnosis of endocarditis was based on an immunoglobulin (Ig) G titer >800 to phase I C. burnetii; this titer has a positive predictive value of 98% (6). A diagnosis of Bartonella infection was based on the combination of a positive microimmunofluorescence titer (IgG to B. quintana or B. henselae >200) and a Western blot profile consistent with endocarditis (Cool.

Identification of the causative species was obtained by Western blot after cross-adsorption with either B. henselae or B. quintana antigens (Cool. Antibodies to B. melitensis were detected by agglutination by using the Rose Bengal and Brucella Wright tests (both from BioRad, Hercules, CA, USA). Of the 63 patients, 9 had a positive antibody response against a tested antigen (Table): 1 to phase I C. burnetii and 8 to Bartonella spp. (IgG >200).

Of these, 7 had a 1-fold dilution higher titer to B. quintana than to B. henselae, including 1 with a low-level cross-reaction with C. burnetii, and 1 had identical titers to both. For all 8 patients, Western blot results were consistent with Bartonella endocarditis. For 7, cross-adsorption identified B. quintana as the causative species; for the other, the infecting Bartonella species remained undetermined because adsorption with B. quintana and B. henselae antigens removed all antibodies. Serologic results for B. melitensis were negative for all patients.

B. quintana is mostly associated with human body lice but has also been found in fleas (9). The predisposing factors for B. quintana endocarditis are homelessness, alcoholism, and exposure to body lice (10).

For our patients, the common predisposing factors were poor hygiene and low socioeconomic status, which may expose them to ectoparasites including lice and fleas. In contrast with previous study findings, B. quintana infectious endocarditis developed on preexisting valvular lesions in all patients (10). This finding may reflect a different clinical evolution than in Europe, where studies have suggested that B. quintana infectious endocarditis followed chronic bacteremia in patients who did not have previous valvular defects (10).

In summary, prevalence of negative blood culture among patients with infectious endocarditis was high (72%). The most commonly associated risk factor was rheumatic heart disease (Table). C. burnetii and Bartonella spp. were responsible for 8% of all infectious endocarditis cases and 14% of blood culture-negative cases. No case of infectious endocarditis caused by B. melitensis was identified.

Our preliminary study suggests that zoonotic agents, especially Bartonella spp., are prevalent causative organisms of blood culture-negative endocarditis in India. We recommend serologic screening for antibodies to zoonotic microorganisms as diagnostic tools for this disease in India.

References
Brouqui P, Raoult D. New insight into the diagnosis of fastidious bacterial endocarditis. FEMS Immunol Med Microbiol. 2006;47:1-13. PubMed DOI
Koegelenberg CF, Doubell AF, Orth H, Reuter H. Infective endocarditis in the Western Cape Province of South Africa: a three-year prospective study. QJM. 2003;96:217-25. PubMed DOI
Benslimani A, Fenollar F, Lepidi H, Raoult D. Bacterial zoonoses and infective endocarditis, Algeria. Emerg Infect Dis. 2005;11:216-24.
Tariq M, Alam M, Munir G, Khan MA, Smego RA Jr. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis. 2004;8:163-70. PubMed DOI
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633-8. PubMed DOI
Dupont HT, Thirion X, Raoult D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol. 1994;1:189-96.
Fournier PE, Mainardi JL, Raoult D. Value of microimmunofluorescence for diagnosis and follow-up of Bartonella endocarditis. Clin Diagn Lab Immunol. 2002;9:795-801. PubMed DOI
Houpikian P, Raoult D. Western immunoblotting for Bartonella endocarditis. Clin Diagn Lab Immunol. 2003;10:95-102. PubMed DOI
Marie JL, Fournier PE, Rolain JM, Briolant S, Davoust B, Raoult D. Molecular detection of Bartonella quintana, B. elizabethae, B. koehlerae, B. doshiae, B. taylorii, and Rickettsia felis in rodent fleas collected in Kabul, Afghanistan. Am J Trop Med Hyg. 2006;74:436-9.
Fournier PE, Lelievre H, Eykyn SJ, Mainardi JL, Marrie TJ, Bruneel F, et al. Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine (Baltimore). 2001;80:245-51. PubMed DOI
Table
Table. Clinical findings and causative agent for 9 patients with blood culture-negative endocarditis, India, August 2005-December 2006

Suggested Citation for this Article
Balakrishnan N, Menon T, Fournier P-E, Raoult D. Bartonella quintana and Coxiella burnetii as causes of endocarditis, India [letter]. Emerg Infect Dis [serial on the Internet]. 2008 Jul [date cited]. Available from http://www.cdc.gov/EID/content/14/7/1168.htm
DOI: 10.3201/eid1407.071374

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FuzzySlippers
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http://www.ncbi.nlm.nih.gov:80/pubmed/10028274

Bartonella alsatica sp. nov., a new Bartonella species isolated from the blood of wild rabbits.

Heller R, Kubina M, Mariet P, Riegel P, Delacour G, Dehio C, Lamarque F, Kasten R, Boulouis HJ, Monteil H, Chomel B, Pimont Y.
Institut de Bactriologie de la Facult de Mdecine, Universit Louis-Pasteur, Hpitaux Universitaires de Strasbourg, France. [email protected]

Bartonella species are considered as emerging human pathogens, with at least six different species pathogenic or possibly pathogenic for humans. However, little is known about Bartonella distribution, species polymorphism and pathogenicity in mammalian species. The objective of this work was to determine the presence, the frequency and the distribution of Bartonella species in wild rabbits (Oryctolagus cuniculus) caught in warrens in Alsace, France. Humans may come into contact with wild rabbits when hunting, especially when they are picked up with bare hands and at time of evisceration. Of 30 blood samples collected and cultured from wild rabbits, nine (30%) were positive for organisms morphologically similar to Bartonella spp. The bacteria appeared as small, fastidious, aerobic, oxidase-negative, Gram-negative rods which could be localized within erythrocytes. Their biochemical properties were similar to those of the genus Bartonella. The sequence of the 16S rRNA gene obtained from the rabbit isolates was highly related to the sequences of the different Bartonella species (97.8-99.3% similarity). The high DNA hybridization rate (81-90% similarity) between the three strains isolated from rabbit blood confirmed that they belong to the same bacterial species. Hybridization values, obtained with the nuclease-TCA method, when testing type strains of recognized Bartonella species (9-14% similarity), support the creation of a new species for the rabbit isolates. The name Bartonella alsatica is proposed for these strains isolated from the blood of wild rabbits. The type strain is IBS 382T (= CIP 105477T).

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FuzzySlippers
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Here is a link to a good slide show. This was posted on CanLyme awhile ago.

Has some info on clinical manifestations, epidemiology, history, etc.

http://www.tropical.umn.edu/TTM/Cases/talks/Bartonella_files/frame.htm#slide0001.htm

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http://www.cdc.gov/ncidod/EiD/vol10no7/03-0896.htm


Bartonella spp. DNA Associated with Biting Flies from California

Crystal Y. Chung,* Rickie W. Kasten,* Sandra M. Paff,* Brian A. Van Horn,* Muriel Vayssier-Taussat, Henri-Jean Boulouis, and Bruno B. Chomel*Comments
*University of California, Davis, California, USA; and Unit Mixte de Recherche, Ecole Nationale Veterinaire d'Alfort, Maisons-Alfort, France

Suggested citation for this article: Chung CY, Kasten RW, Paff SM, Van Horn BA, Vayssier-Taussat M, Boulouis H-J, et al. Bartonella spp. DNA associated with biting flies from California. Emerg Infect Dis. [serial online] 2004 Jul [date cited]. Available from: http://www.cdc.gov/ncidod/EID/vol10no7/03-0896.htm

Bartonella DNA was investigated in 104 horn flies (Haematobia spp.), 60 stable flies (Stomoxys spp.), 11 deer flies (Chrysops spp.), and 11 horse flies (Tabanus spp.) collected on cattle in California. Partial sequencing indicated B. bovis DNA in the horn fly pool and B. henselae type M DNA in one stable fly.

Bartonella spp. are vector-borne bacteria associated with numerous emerging infections in humans and animals (1). Four Bartonella species have been isolated from wild and domestic ruminants. B. schoenbuchensis and B. capreoli were recovered from wild roe deer (Capreolus capreolus) (2,3) in Europe, whereas B. bovis (formerly B. weissii) was recovered from domestic cattle in the United States and Europe (3-5). Strains similar to B. bovis and B. capreoli were also isolated from mule deer (Odocoileus hemionus) and elk (Cervus elaphus) from California (3,4). Recently, B. chomelii was recovered from bacteremic cows in France (6). A high prevalence of infection with various Bartonella species has been reported in domestic and wild ruminants in North America and Europe (2-4). Of the herds investigated in California, 95% of beef cattle and 17% of dairy cattle were bacteremic for B. bovis and 90% of the mule deer were bacteremic for Bartonella spp. (4). The main vector of these ruminant-infecting Bartonella spp. has not been identified.

The role of ticks as potential vectors for Bartonella in cattle was investigated (7,8). In Europe, >70% of 121 Ixodes ricinus ticks collected from roe deer had 16S rRNA gene sequences for Bartonella or other closely related species (7). In California, Bartonella DNA was detected in approximately 19% of 151 questing adult I. pacificus ticks (8), but the direct role of ticks in Bartonella transmission among ruminants has never been established. In a search for an efficient Bartonella vector, which could explain such high prevalence of infection in wild and domestic ruminants, we tested biting flies for Bartonella spp. DNA to establish the potential role of biting flies as vectors of Bartonella in cattle.

. . . .

Conclusions

This identification of Bartonella DNA is the first associated with horn and stable flies and the first identification of B. henselae from a biting fly. It is also the first report of identification of Bartonella DNA from flies from North America. This finding demonstrates, as for ticks, that Bartonella DNA is present in various biting insects.

We found a very low percentage of Bartonella DNA-positive flies, in contrast to the very high prevalence (57 [88%] of 65 observed in Hippoboscidae adult flies (Lipoptena cervi and Hippobosca equina) collected from domestic cattle and wild roe deer in France (H.J. Boulouis, pers. comm.).

This low prevalence may be related to the fact that different fly species were tested but more likely could be associated with a low level of Bartonella bacteremia in our herds. In a previous study, only 17% of cows in a dairy herd were bacteremic (4), and prevalence was even lower in another dairy herd from Tulare, in the central valley of California (B.B. Chomel et al., unpub. data). A follow-up for this study would be to collect blood from herds at the University of California, Davis, and establish the status of Bartonella bacteremia.

Future research should include collecting flies in different locations and herds in which high levels of bacteremia were previously detected. Inhibitory factors were unlikely to be associated with such a low prevalence because spiked controls were systematically detected.

Identification of B. henselae DNA in a stable fly indicates the wide range of blood-sucking arthropods that can harbor this human pathogen. The partial gltA sequence was identical to that for B. henselae type Marseille, the most common type found in cats and humans in California (11). Fleas have been shown to be an efficient vector of B. henselae (12-14).

More recently, B. henselae DNA was identified in adult questing I. pacificus ticks from California and from I. ricinus ticks collected on humans in Italy (8,15). The role of ticks as potential vectors of B. henselae in humans has also been suggested (16-18).

Since Bartonella are likely to be present in biting flies, investigating the potential of biting flies as either mechanical or biologic vectors of Bartonella in cattle and possibly humans should be pursued.

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StephenC
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quote:
Originally posted by FuzzySlippers:
Hi Stephen,

There is evidence in this thread. Have a look at some of the links. There are plenty of pictures of Bart rashes. They are also spoken about in some of the medical articles posted above, again in this thread.

Fuzzy

How does anyone know the stretch marks are vein patterns are bartonella? I haven't been able to find any studies. Not even a loose correlation between those who test positive for Bartonella and those who have stretch marks - and that's not evidence.

--------------------
Lingering chronic symptoms: Fatigue, Derealization, Brain fog. Monthly fever with flu-like symptoms that last for weeks.
Lyme WB Bands Positive: 31, 41, 58, 66
HHV6, EBV, CMV, & Mycoplasma IGG positive.
Chronically Low CD4 count.

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FuzzySlippers
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Hi Stephen,

Try searching PubMed database for articles. I don't know what kind of proof you're looking for. If you require summaries of pathology testing done on skin samples, for example, which would correlate with Bartonellosis -- have you tried searching the Dermatological medical articles?

Other than the published medical articles I've posted here, I'm afraid I can't offer more. I'm just not feeling well enough to look further right now.

I came across this link to a slide show from Dr. B.

www.hopetoheallyme.com/Documents/Reston-2005.ppt


Just as many of the researchers whose articles are posted in this thread refer to skin rashes, Dr. B also speaks of the "stretch mark" rashes in the above link. Perhaps you can contact him or one of the other ILADS docs to try and get the information you are requiring.

Just my own personal experience . . . I've had three separate LLMD's diagnose me with Bart through blood testing and correlating clinical examination -- skin rashes, including the long stretch mark rashes shown in this thread.

I hope you find what you need.

Fuzzy

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kam
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My processing and vision skills are not doing well this am.

I need help finding the article about bartonella in proverty like settings.

I see a doctor today for workmen's comp.

I worked at a low level prison when I got sick.

We had 2 yards shut down after I got sick due to the feral cats and rashes and the men were treated with abx.

I will be leaving at 10:00 am today and would like to take the article with me but can't seem to find it.

WE had several teachers come down sick. One was dx with fibro brought on by stress. The other who came down sick 2 weeks before I did was dx with valley fever and then cfs.

There were others too but can't recall what they were dx with.

WE all came down sick in SEpt/oct 2001

Thanks for your help.

My email address is [email protected]

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kam
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Thanks to whoever posted the pics too. First time I learned why I had stretch marks on my stomach when I first came down sick.

I thought at the time it was very strange. They reminded me of when I was pregnant, but my baby days were over.

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Alv
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StephenC yes there is proof...Buy his book and you will see.Run the test that he mentioned on the book.

http://www.personalconsultcart.com/index.cfm?action=ViewDetails&ItemID=25

[ 03-24-2009, 09:32 PM: Message edited by: Alv ]

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hshbmom
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Here is Dr. Martin Fried's presentation about Bartonella & other infections that cause pathological stretch marks.


See the last one in this list of presentations.


http://lymediseaseassociation.org/Videos_Philadelphia_Medical_Conference.html

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FuzzySlippers
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Bartonella Research Publications:

http://www.cvm.ncsu.edu/six_pro/documents/Bartonellapublications.pdf

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FuzzySlippers
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Article from The News Observer on Bartonella,

http://www.newsobserver.com/news/story/1333377.html

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FuzzySlippers
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http://www.physorg.com/news147626526.html


Researcher Links 'Silent Epidemic' to Hidden Pathogen
December 4th, 2008 in General Science / Biology

(PhysOrg.com) -- A North Carolina State University researcher has discovered that certain tick-borne bacteria may be responsible for some chronic and debilitating neurological illnesses in humans, particularly among people with substantial animal contact or arthropod exposure.

Dr. Edward Breitschwerdt, professor of internal medicine at NC State's College of Veterinary Medicine and adjunct professor of medicine at Duke University, studied the bacteria Bartonella to determine how long these bacteria induce active infection in humans. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a strain of Bartonella that can be carried in a cat's blood for months to years.

Cat scratch disease was thought to be a self-limiting, or "one-time" infection; however, Breitschwerdt's previous work discovered cases of children and adults with chronic Bartonella infections - from strains of the bacteria that are found in cats (B. henselae) and dogs (B. vinsonii subsp. berkhoffii).

In a study published in the September volume of the Journal of Clinical Microbiology, Breitschwerdt and colleagues from the Duke University Medical Center and the Centers for Disease Control and Prevention in Atlanta were able to detect one or more strains of Bartonella in blood samples from six patients suffering from a broad spectrum of neurological and neurocognitive abnormalities, including chronic migraines, seizures, memory loss, disorientation and weakness.

All of the patients in the study had both frequent tick exposure and significant animal exposure - some were veterinarians, others had grown up on farms or had occupations that kept them outdoors - and all of them suffered from chronic, debilitating neurological problems.

The patients were treated with antibiotics, and three of them saw marked improvement. In the other cases, improvements were minimal or short-term.

Breitschwerdt believes that his research offers hope - perhaps the identification of a specific infectious cause of chronic neurological disease and another potential avenue of treatment - for what could be a significant segment of the population.

"Bartonella has been described by some scientists as a 'stealth pathogen,'" he says. "Our research could lead to the elimination of what may be a silent and currently unrecognized epidemic among humans."

Provided by North Carolina State University

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FuzzySlippers
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http://www.sciencedaily.com/releases/2008/11/081123222844.htm

Scientists Discover 21st Century Plague

ScienceDaily (Nov. 24, 2008) -- Bacteria that can cause serious heart disease in humans are being spread by rat fleas, sparking concern that the infections could become a bigger problem in humans. Research published in the December issue of the Journal of Medical Microbiology suggests that brown rats, the biggest and most common rats in Europe, may now be carrying the bacteria.

Since the early 1990s, more than 20 species of Bartonella bacteria have been discovered. They are considered to be emerging zoonotic pathogens, because they can cause serious illness in humans worldwide from heart disease to infection of the spleen and nervous system.

"A new species called Bartonella rochalimae was recently discovered in a patient with an enlarged spleen who had travelled to South America," said Professor Chao-Chin Chang from the National Chung Hsing University in Taiwan. "This event raised concern that it could be a newly emerged zoonotic pathogen. Therefore, we decided to investigate further to understand if rodents living close to human environment could carry this bacteria."

Scientists have found that rodents carry several pathogenic species of Bartonella, such as B. elizabethae, which can cause endocarditis and B. grahamii, which was found to cause neuroretinitis in humans. Although scientists are unsure about the main route of transmission, these infections are most likely to be spread by fleas. Ctenophthalmus nobilis, a flea that lives on bank voles, was shown to transmit different species of Bartonella bacteria. These pathogens have also been found in fleas that live on gerbils, cotton rats and brown rats.

"We analysed bacteria found in Rattus norvegicus in Taiwan. The brown rat is also the most common rat in Europe," said Professor Chang. "By analysing the DNA of the bacteria, we discovered a strain that is most closely related to B. rochalimae, which has been isolated recently from a human infection in the United States".

The researchers took samples from 58 rodents, including 53 brown rats, 2 mice (Mus musculus) and 3 black rats (Rattus rattus). 6 of the rodents were found to be carrying Bartonella bacteria; 5 of these were brown rats. Four of the rodents were carrying B. elizabethae, which can cause heart disease in humans, and one of the black rats was found to be harbouring B. tribocorum. However, the scientists noticed one strain that had not been identified in rodents previously. The strain was finally shown to be close to B. rochalimae.

"Because of the small sample size used in this study, we cannot say for sure that the common brown rat is spreading B. rochalimae," said Professor Chang. "However, several different Bartonella bacteria are surely transmitted by rodents. These results raise concerns about the existence of other reservoirs and vectors for this emerging infection. This certainly warrants further investigation."

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FuzzySlippers
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Discovery Of New Bartonella Species That Infects Humans
07 Jan 2009

Researchers at North Carolina State University and the Centers for Disease Control and Prevention have produced the first link between a species of bacteria most commonly found in sheep and human illness.

Dr. Edward Breitschwerdt, professor of internal medicine at NC State's College of Veterinary Medicine, and NC State colleague Dr. Ricardo Maggi isolated the bacterium Bartonella melophagi from samples of human blood.

B. melophagi is such a newly discovered member of the genus Bartonella it is considered a "Candidatus" species, meaning that its name has yet to be formally accepted. In nature, sheep are the most likely hosts for B. melophagi and transmission among sheep is thought to occur via a wingless fly known as a ked. The route(s) of transmission to humans is unknown.

Their results are published in the January edition of Emerging Infectious Diseases.

The blood samples Breitschwerdt and Maggi tested came from previously healthy women who were suffering from symptoms including muscle fatigue and weakness. One of the patients had been diagnosed with pericarditis, an inflammation of the membrane surrounding the heart. B. melophagi was present in blood samples from both women; Bartonella henselae, a strain of the bacterium which has been associated with human neurological illnesses and fatigue, was isolated from one of the samples.

The research marks the first time that this particular strain of Bartonella has been cultured from human blood and associated with human illness.

"Over the past decade, there has been a rapid expansion in the number of Bartonella species that are documented human pathogens," Breitschwerdt says. "From this preliminary data, it looks as though we may be able to add another species to that list."

"A small number of Bartonella in the bloodstream can cause infection, and this fact, coupled with the large variety of transmission routes by which people can become infected, make the diagnosis, treatment and prevention of the illnesses caused by this bacteria a real challenge," Maggi adds. "I think it's critical that we discover more about how this bacteria infects people, and how Bartonella infection relates to the subsequent development of progressive illnesses in humans."

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lauirel
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bump

--------------------
Never doubt that a small group of thoughtful committed citizens can change the world; indeed, its the only thing that ever has.

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FuzzySlippers
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This info came from Tincup:

Lyme tests miss 75-90 percent of the people infected (Hopkins/ILADS). Bartonella tests miss 50 - 75 percent of those infected (Tufts).


http://www.ncbi.nlm.nih.gov/pubmed/19141385?dopt=Abstract


1: Am J Clin Pathol. 2009 Feb;131(2):250-6.
Related Articles, Links
Click here to read
Evaluation of immunohistochemistry in identifying Bartonella henselae in cat-scratch disease.

Caponetti GC, Pantanowitz L, Marconi S, Havens JM, Lamps LW, Otis CN.

Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.

Cat-scratch disease (CSD) is largely due to infection with Bartonella henselae. Microbiologic detection is difficult, and molecular testing is not readily available. A monoclonal antibody (mAB) to B henselae has become commercially available. We evaluated the usefulness of immunohistochemical analysis (IHC) for diagnosing CSD on surgical specimens and compared these results with polymerase chain reaction (PCR) detection and serologic testing for B henselae. We studied 24 formalin-fixed, paraffin-embedded (FFPE) cases of lymphadenitis with histologic and/or clinical suspicion of CSD. Control cases included 14 cases of lymphadenopathy other than CSD. FFPE tissue sections were evaluated with an mAB to B henselae, Steiner silver stain (SSS), and PCR that targeted B henselae and Bartonella quintana. Positive cases were as follows: SSS, 11 (46%); PCR, 9 (38%); and IHC, 6 (25%). Only 2 cases (8%) were positive for all 3 studies. All control cases were negative for IHC and PCR. The diagnostic sensitivity of these 3 tests is low for CSD. SSS seems to be the most sensitive test but is the least specific. PCR is more sensitive than IHC and may, therefore, serve as a helpful second-line test on all IHC- cases.

Publication Types:

* Evaluation Studies


PMID: 19141385 [PubMed - indexed for MEDLINE]

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lauirel
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Someone had sent me a pm with some questions about the skin manifestations of Bart. Out of the fourty or so that Dr. James Schaller illustrates and describes in his book, my son and I seem to have had 37 of them.

To answer this person's question more specifically in reference to the purple river stretch marks and vessels....

The purple river strecth marks my son has, are the kind of stretch marks that occur where normally they do not. His are located along his lower back and hips, and occured without any signifigant growth to his body. The purple river strecth marks for those with Bartonella, tend to go against the structural lines of normal skin, although some do not. The more purple they are, they more active they are perceived and are commonly referred to as striations, but they really do look like stretch marks to me.

In both the child and adult, you will find stretch marks where there really shouldn't be any, such as the mid arm on the outer part, the antecubital, along the back, the backs of the knees, and the peripheral arm pit margins.

Yes, with Bart you will also commonly encounter new vessels appearing under the skin. Vessels, resembling chains of broken tiny capillaries, spider veins, or varicose veins. Bartonella secretes VEGF in which stimulates vessel growth. You can find these anywhere, and usually they seem to progress where you start out with one or two areas, easily explained with aging, and then you continue to get them.

You may see these in common areas where the ones we acquire through aging appear, but you will also find them in the unusual as well. Such as the inside of the mid arm, along the stomach, and the lateral margins of your feet, esp. around the ankles and clustered in the arches. These can appear as little capillaries or veins. Someone mentioned green vasculature, and I am not sure where the source for the information was, but I don't recall that being discussed by Dr. James Schaller, but there were fourty or so he covered.

Hope this helps with your son.

Lauirel

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UnexpectedIlls
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Great information... I have dark purple stretch marks behind my knees and on my inner thigh that go up indstead of across like the ones from gaining weight in pregnancy... SO I can see my pregnancy stretch marks which are silvery and then ones going up and down which are purple... I also have them on my inner arms going from my armpit almost down to my elbow... they were VERY purple last year and have been getting dimmer to a light pink and some silvery.

I also have the purple ones at the top of my thigh running down. I can see the silvery ones from pregnancy and then these purple ones which have gotten lighter but are still dark and wider than the pregnancy ones.

At my next doc appt, she is doing that VEGF test. Before I got pregnant, hence before I was EVER sick... I had a small kitten off the street... I gave it a home and it gave me hundreds of flee bites all over. This is when all the madness started... SEVERE anxiety that kept me in the hosue.. I even had to drop out of college. I then became pregnant and the rest is history, I have been sick ever sicne with BAD neuro symptoms that have left me bedridden since my daughter was born 2 years ago.


Here is the million dollar question.....

WHAT is the best treatment for Bartonella??

I have been on

Doxy (1 month)
Tetracycline (2 months)
Zith (6 months)
Septra
Bicillin (could only do a month and a half)
Omnicef (short course)
Mepron
Mino while doing the MP for 6 months
Rifampin (short course)

Now I am off all ABX and doing herbs, and other things...

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FuzzySlippers
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Lauirel, you did a fabulous job explaining those Bart skin rashes. Thank you!

Just thought I'd add that another skin manifestation that is seen with Bartonella is a skin condition called Livedo Reticularis. Click on the photo on this link to see a close-up.

http://www.mayoclinic.com/health/livedo-reticularis/AN01622

In the medical literature, one will frequently see this skin condition attributed to Lupus or other conditions. Rarely, have I seen it attributed to Bartonella in the literature I've managed to read. This is unfortunate because Bartonella can be a chief cause of Livedo Ret. in many patients (according to what's been shared with me by LLMD's).

I've got Livedo Ret. as one of my many Bart symptoms. My lacy-web-type rash has larger patterns. The lace pattern has a larger empty center and it is not as dense and concentrated as in the photo above. Also, most of the time the lacy-web-looking rash is red or pink and usually doesn't turn the angry purple that is seen above.

The rash appears on the entire trunk of my body (the front), the entire length of my arms and legs.

Sometimes astute doctors who see this in patients will also look for symptoms of vasculitis, which can Bartonella can also cause (See, the PubMed article posted above on Bartonella causing vasculitis/polyneuropathy). The vasculitis can sometimes accompany the Livedo Reticularis.

Yet another skin manifestation that can appear from Bartonella is Raynaud's Disease (or Phenomenon). Lyme doctors have also shared with me that they also see Raynaud's with other tick borne infections. By the way, Raynaud's can also be caused by non-tick borne infection sources as well. I've read that it can be a side effect from certain medications.

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17127.htm


Shandy, I saw a list somewhere containing information on the combination antibiotic approach that is used for treating Bart when it's present with Lyme and other Co-infections.

I'm not confident I'll be able to find it again (I didn't save it). But I'll try!

Fuzzy

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Alv
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Perfect description-this is exactly what I needed .I knew it was bart and My son had done the VEFG and was high since last year ..but I was curious in what you see in your son .

All I wanted to know how would you perscribe it in every little detail and ACTUALLY that is WHAT me and my son had all along and that is where all neurosymtoms started.

[ 03-24-2009, 09:31 PM: Message edited by: Alv ]

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lauirel
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Very interesting link FuzzySlippers! I have some questions and a couple of observations concerning my experience with Livedo Reticularisor LR.

First a description of myself. If you all are familar with Dr. J.S. then you will also be familar with the skin manifestation of Bartonella called the stacked clams. This was the very first noticable sign for me. I would like to describe my skin for those unfamilar.

I noticed one day a strange type of skin discoloration on my legs. At this point it was in sporadic areas just on my thighs. White spots surronded by light pink borders, or just lighter spots surrounded by normal skin. When i would get cold, these areas would become even more noticable. Because of the hypopigmentation I saw, I wondered if I had acquired a fungal infection. I made an appointment with a dermatologist, a prominent, reknowned tri-state duck. He diagnosed me with a skin fungal infection.

Over time, my stacked clams spread to encompass my entire thighs, stopping at my knees. They then progressed to Livedo Reticularis. I couldn't find the term for it for the life of me, and Thank you FuzzySlippers for doing that for me. What timing. [Smile] I also acquired it across my entire back and the outside of my upper arms.

My question is prior to you developing the Livedo Reticularis, did you noticed what I described, in your skin as well? The stacked clams?

I was also wondering whether on your link you posted whether you had clicked on the other links related to the disease? One was the antiphospolipid syndrome? This is something I experienced because of my Lyme and how it affected by immune system.

As far as treatments we did, they seemed to help me more than my son. [Frown]

We did:

6 months, Rifampin, Isonazid
4 months, co-trimoxazole
4 months, Doxy
3 months, pulsed Zith
4 months, Metronidiazole in stages

A a whole slew of herbals to synergize with. I can't find the list, but when I do, I will post.

We also used oils with Bay Laurel as Bay is supposed to help with bartonella. I picked that up here from a poster I can't remember her name either. i claim lyme alzheimers.....lol I keep wanting to say Jeannie or something like that.

Warning, got a hell of a candida fight from it even with pre and probiotics.

And yes, we did these all at the same time. Don't ask me about our liver enzymes. [Frown] But it did really help me. my purple rivers went away, but my sons did not. We still struggle.

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bears1985
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Lauriel - I can sympathize because I have the same symptoms. I am on IV EDTA and IV Zithromax at the moment. I herxed rather badly and only been on it for one week. I understand that Dr's are wanting to test for elevated VEGF, but like my Dr said...if the pathogen is killed...the VEGF goes away and isnt relevant. Of all the misunderstandings, I dont understand why these striations and stretch marks dont go away. My doctor may try IV Gentamicin. I will let you know if anything works and please let me know. If any others are having luck, espicially with the stretch marks and striations, please let me know. Thanks.
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lauirel
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Hi Bears1985.

When I posted my last post on this subject, I really was at a point where I was going to throw my hands up in the air. We have been battling Bart for well over a year. Ironically, since that last post, something has happened.

My son, in which did not seem to be helped with the antibiotics as much as I, has recently had a change. He was going shirtless yesterday and is quite unusual considering his embarrassment over these purple rivers. Being stealth, I sneaked glances trying to get a good visual and became a raving lunitic.

It seems his purple rivers are dissappearing, not just fading. We have been rotating the things recommeded for over a year. We had that period of antibiotics, and then continued the rotational stuff for Lyme, Babesia, and Bartonella. We also did a rotation of antivirals just recently due to everyone coming down with the flu and also to correlate with my Candida fight. Our rotations overlap and often include many targets at once. We also continually treat for fungal and candida issues by natural means. And we have been supplementing our detoxification pathways and are also pretty fanatic on detoxification period. Out of all this, there were only three new rotations I added. One was Mangosteen, one was Pau de Arco, and the other a topical ozonated olive oil directly to the purple rivers.

I have no idea if what we recently added has had an effect or whether it was the continual rotation of the naturals we used and over time has lead to this improvement. From what I know of Bart, I wouldn't think it was anything recent, but maybe it was the tipping factor.

Timing is kinda funny as I was just about to go back to the drawing board. I have never stopped treating all three at anytime, we have just changed our rotationals after a period of time and combinations. We use the same things over and over again, I just switch them up every couple of months.

My son's protocol isn't any different than my own. Because he is in school, it was hard to get the mid day thing so it made it difficult for me to gauge his progress or lack there of. So by putting myself on the same protocol, it made it easier for me to pick the rotationals and combinations and correlate his reactions to my own.

I know the detail is lacking but I didn't write it down, I just went on our symptoms and reactions. Now I wish I had. I have a headache from hell right now, but I do have a basic protocol that I used as my base and worked and added from there. I gleaned it from another Lymie in which cured himself, his wife, and his two dogs. I will try to write it down later and post if anyone is interested.

I am not claiming cure, but we have had an improvement of late. Please keep good thoughts going for my son. He has been through the teenage ringer with Lyme and company added to it and then losing our home on top of everything. I sure hope this means we are getting somewhere. Time will tell.

Many regards to all....Lauirel

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CD57
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Lauriel, it would be great it you could post your detailed treatment. I think you may be onto something and rotating these meds and herbs may work . Someone on another forum was talking about pulsed quinolone (a month?) followed by high dose HH capsule (like 15 per day), and then switching back and forth between those.
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Julie F.
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Lauriel,
I, too, would like to read a more about your treatment. When you're feeling up to posting it, of course.

I've got bart screaming through my body right now. This really and truly stinks!

Thanks,
Julie

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FuzzySlippers
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Journal of Clinical Microbiology, September 2008, p. 2856-2861, Vol. 46, No. 9

American Society for Microbiology. All Rights Reserved.


Bartonella sp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction

E. B. Breitschwerdt,1* R. G. Maggi,1 W. L. Nicholson,2 N. A. Cherry,1 and C. W. Woods3

Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina,1 Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia,2 Duke University Medical Center, Durham, North Carolina3

Received 1 May 2008/ Returned for modification 16 June 2008/ Accepted 10 July 2008



We detected infection with a Bartonella species (B. henselae or B. vinsonii subsp. berkhoffii) in blood samples from six immunocompetent patients who presented with a chronic neurological or neurocognitive syndrome including seizures, ataxia, memory loss, and/or tremors. Each of these patients had substantial animal contact or recent arthropod exposure as a potential risk factor for Bartonella infection. Additional studies should be performed to clarify the potential role of Bartonella spp. as a cause of chronic neurological and neurocognitive dysfunction.

[click on link for remainder of article]

http://jcm.asm.org/cgi/content/full/46/9/2856

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FuzzySlippers
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Ok, well, I'm not too thrilled with the cautious manner this author used in opining, but here is what the IDSA said about the study in the previous link immediately above.

At least the article below seems to advise docs to remember the possibility of Bartonella.

Fuzzy


http://news.idsociety.org/idsa/issues/2008-10-01/2.html#Bartonella


Bartonella Bacteremia and Neurological Symptoms
Khalil Ghanem, MD

A case series published in the September issue of the Journal of Clinical Microbiology suggests an association between chronic neurological symptoms and Bartonella species bacteremia in patients with documented animal or arthropod exposures.

The authors report six cases of immunocompetent patients who presented with a myriad of subacute to chronic neurological symptoms (including seizures, paralysis, headaches, fatigue, memory loss, and visual disturbances) and who were found to have bacteremia with Bartonella henslea and/or Bartonella vinsonii subspecies berkhoffii. All six patients reported clear exposures to cats (mostly scratches or bites), arthropods, farms, or farm animals. The duration of neurological symptoms lasted from one month to five years. In most of these cases, treatment of the infection led to subjective improvement of the neurological symptoms.

In addition to serological testing, the investigators used broth enrichment methods coupled with molecular diagnostics to document infection. These methods are not routinely available in clinical laboratories.

The association noted in this paper is interesting but far from definitive. Given that infectious diseases clinicians are often asked to evaluate patients with neurological symptoms of unclear etiology, the possibility of Bartonella infection can be entertained when evaluating patients with clear animal or arthropod exposures. (Breitschwerdt et al., J Clin Microb. 2008:46; 2856-2861.)

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FuzzySlippers
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This might have some useful info to use as a launching pad for further research.

I don't agree with some of what's been written here -- the self-limiting nature of Bartonella, that chronicity occurs only in HIV infected patients, nor the poor sanitation/hygiene remarks relating to trench fever. Bartonella Quintana (Trench Fever) has been seen plenty as a co-infection with Lyme Disease, regardless of hygiene and HIV status.

I'm sure many of you will not agree with the remarks in this article about the rarity of some of the strains as well as the stated rarity of some of the symptoms/complications seen with those strains.

Nevertheless, I'm posting this in case it might help people who are interested in researching.

http://www.patient.co.uk/showdoc/40000346/


Bartonellosis

Bartonella are Gram-negative bacteria and are facultative intracellular parasites.

* They are found in various vertebrates, rodents and their flea vectors, and are associated with an increasing range of diseases. Transmission is generally considered to be by arthropod vectors.
* Three species of the genus Bartonella are known to be important causes of human disease, although other species are increasingly being recognised as important.1 The range of infection varies from mild lymphadenopathy seen in cat scratch disease, to life-threatening systemic disease in immunocompromised patients.2
Infections caused by Bartonella species include:
o Cat-scratch disease: B. henselae - Bacillary angiomatosis is a disseminated form of B. henselae infection, found most commonly in HIV-positive patients
o Oroya fever/verruga peruana: B. bacilliformis
o Trench fever: B. quintana; louse-borne, variable fever with persisting severe shin and other bone pain
* Endocarditis is sometimes associated with Bartonella infection (including B. henselae, B. quintana, B. elizabethae). Homelessness and alcoholism are risk factors for B. henselae endocarditis.
* Bartonella encephalopathies are rare in patients with normal immunity but may occur in HIV-positive patients, especially with B. henselae and B. quintana infection. Features include meningoencephalitis, encephalopathy and neuropsychiatric disorders.
* B. henselae osteomyelitis and hepatitis have been reported.

Cat Scratch Disease

See Cat Scratch Disease article.
Trench Fever

Synonyms: Shinbone fever, 5-day fever, Wolhynia fever, Quintana fever, His-Werner disease.

* Epidemiology:
o It is caused by B. quintana (formerly Rochalimaea or Rickettsia quintana.)
o Urban trench fever is now seen in alcoholics and the homeless.
o Poor sanitation and lack of personal hygiene strongly correlate with transmission by the body louse Pediculus humanus.
* Presentation:
o Fever develops after an incubation period of a few days to a month. Usually, several episodes of fever develop and each episode lasts about 5 days.
o Other symptoms include joint and muscle aches, headache, dizziness, and pain behind the eyes. Some patients have diffuse symptoms without fever.
o May cause culture-negative endocarditis.
o On examination there are injected conjunctivae, nystagmus, hepatosplenomegaly, lymphadenopathy, a maculopapular rash and tender muscles and joints.
* Differential Diagnosis:
o Other causes of fever, headache, focal neurology and lymphadenopathy, e.g. CMV, HIV seroconversion. Other causes of culture-negative endocarditis include Legionellosis, Q Fever and slow-growing streptococci.
* Investigations:
o Serology testing is the most cost-effective method to confirm the diagnosis.
o Culture for Bartonella may be useful in patients who have other manifestations of either B henselae or B quintana infection (e.g. fever of unknown origin, neuroretinitis, encephalitis, culture-negative endocarditis). Fresh media is required to increase the chance of isolating the organism.
* Management:
o Doxycycline is given for at least two weeks and a longer course when the liver or other organs are involved. Chloramphenicol may be used in severe cases.3
* Complications:
o Persistent bacteraemia with B. henselae may develop in people with AIDS.
* Prognosis:
o Usually self-limiting. Trench fever reinfection may recur within 3-6 months, because antibodies do not give full protection.
o Bartonella endocarditis: the recommended treatment is doxycycline for 6 weeks, with gentamicin for 2 weeks.3 Surgical resection of heart valves is usually required. Mortality rate of bartonella endocarditis is 30%.

Bacillary Angiomatosis and Peliosis Hepatitis

* Both B. quintana and B. henselae are associated with these conditions.
* Bacillary angiomatosis was initially described in people infected with HIV infection.
* Symptoms depend on the anatomical site involved and may include fever, tender lymphadenopathy, and skin lesions. Cystic hepatitis (peliosis) often occurs in bacillary angiomatosis.
* Homeless persons and alcoholics typically develop B. quintana endocarditis.
* Presentation:
o Lesions are often dark purple and resemble Kaposi's sarcoma.
o There may be enlargement of the liver, lymph nodes, or spleen if infected.
* Investigations:
o Patients should have HIV antibodies and CD4 lymphocyte counts checked.
o Usually causes anaemia and elevated serum alkaline phosphatase.
* Management:
o Effective antibiotics include erythromycin, doxycycline, azithromycin, clarithromycin, or a fluoroquinolone.
o Doxycycline combined with rifampin is effective for patients with severe disease.3
* Prognosis:
o Untreated patients have a high mortality.
o Immunocompromised patients with bacillary angiomatosis or peliosis hepatitis respond well to antibiotics.
o Relapses are common.

Oroya Fever and Verruga Peruana

Synonym: Carrion disease

* Epidemiology:
o B. bacilliformis is common in the Peruvian Andes and transmission is limited to elevations of 1000-3000 meters because of the habitat of the sand fly vector.
* Presentation:
o Bacteraemia of Oroya fever begins 3-12 weeks after a sand fly bite.
o May be mild where endemic (Andean Peru, Ecuador, Colombia, Chile, Bolivia, and Guatemala) but may be severe in newly infected patients, with profound haemolytic anemia, which is often fatal if untreated.
o Severe illness causes fever, headache, dyspnoea, mental state changes, and seizures.
o Weeks or months later, untreated survivors develop verruga peruana lesions (angiomatous skin lesions), which begin as small nodules and then grow. They then form vascular lesions, which ulcerate, bleed, and then heal by fibrosis over several months.
* Differential Diagnosis:
o Other serious causes of fever in a patient who has returned from a developing country include dengue fever, malaria, tuberculosis and babesiosis.
* Investigations:
o Haemolytic anaemia, thrombocytopenia and abnormal liver function tests.
o Serology testing is the most cost-effective method to confirm the diagnosis.
* Management:
o Both chloramphenicol or doxycycline are effective and need to be given for at least one week. Chloramphenicol is usually reserved for severe cases.3
* Prognosis:
o Untreated patients have a 95% mortality rate.
o Persistent bacteraemia may occur in survivors.

Other Associations

* B. elizabethae is a rare cause of endocarditis.
* B. washoensis is associated with cardiac disease (ground squirrel host).
* B. vinsonii (subspecies arupensis) causes fever and neurological symptoms.
* B. grahamii associated with neuroretinitis, as is B. henselae.

Document references

1. Edwards B; Bartonellosis; eMedicine, March 2006
2. Anderson BE, Neuman MA; Bartonella spp. as emerging human pathogens.; Clin Microbiol Rev. 1997 Apr;10(2):203-19. [abstract]
3. Rolain JM et al; Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004 Jun;48(6):1921-33.

Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. EMIS 2009.
DocID: 1354
Document Version: 22
DocRef: bgp346
Last Updated: 30 Oct 2007
Review Date: 29 Oct 2009

[ 02-20-2009, 05:44 PM: Message edited by: FuzzySlippers ]

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FuzzySlippers
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http://www.natvetlab.com/PDF/catownerbrochure.pdf

"Human Bartonella Diseases:

Bartonella, transmitted from cats, can cause 22 human diseases and cat scratch disease is only the "tip of the iceberg."

[click on link for listing of some of those 22 human diseases and also more info in general]

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FuzzySlippers
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http://jmm.sgmjournals.org/cgi/content/full/56/1/133


J Med Microbiol 56 (2007), 133-135; DOI: 10.1099/jmm.0.46649-0
2007 Society for General Microbiology
ISSN 1473-5644

Case Report


Bone marrow and skin granulomatosis in a patient with Bartonella infection


Yoav Keynan1, Evgeny Yakirevitch2, Tali Shusterman3, Erella Alter-Migdal1, Boaz Avidor4, Gabriel Weber1 and Michael Giladi4

1 Department of Internal Medicine, Infectious Disease Unit, Carmel Hospital, Haifa, Israel

2 Department of Pathology, Carmel Hospital, Haifa, Israel

3 Hematology Unit, Carmel Hospital, Haifa, Israel

4 Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Tel Aviv Medical Center, Tel Aviv, Israel

Correspondence
Yoav Keynan
[email protected]

Received 27 March 2006
Accepted 12 September 2006

This report describes a case of granulomatous inflammation, involving the bone marrow and skin, due to Bartonella infection in an immunocompetent patient. The clinical presentation included prolonged fever, pancytopenia, rash and hepatitis. Bartonella infection should thus be added to the growing list of entities that produce marrow granulomas and fever.

[click on link for remainder of article]

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FuzzySlippers
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I'd forgotten about this until I saw tosho's recent post on another thread. This is from Doc B's Guidelines. This section lists co-infection symptoms.

I'm including it here as a basis of comparison for Lyme, Bart and other Co-Infections.

Thanks, Tosho!

CLASSIC LYME (Bb infection)-

Gradual onset of initial (viral-like) symptoms- this often makes it difficult to pinpoint when the infection
began.

Multisystem- almost always, in disseminated stages, involves more than one part or system (i.e. joint
pain plus cognitive dysfunction).

Migratory- first a knee will hurt, then over time this may lessen and the elbow or shoulder acts up, and
later the joints calm down but headaches worsen.

Stiff joints and loud joint crepitus, especially the neck (``Lyme shrug'').

Headaches are often nuchal and associated with stiff, painful and crepitant neck.

Afternoon fevers, often unnoticed- most Lyme patients have subnormal temperatures in the AM but rise
to 99+ by early to mid-afternoon. No obvious sweats.

Tiredness and limited stamina- often is a strong need to rest or even nap in the afternoon, especially
when the flushed face and elevated temperature appears.

4-week cycles- Bb activity, and thus symptoms, wax and wane in a cycle that repeats roughly every
four weeks. This cycle, if clear, can guide your treatments.

Slow response to treatment, with an initial symptom flare in most (``Herxheimer-like reaction'') then
improvement over weeks, punctuated by the monthly symptom flares. Likewise, if treatment is ended
too soon, an initial period of well-being will gradually, over a few weeks, be replaced by a return of
symptoms.

EM rash in 25% to 50%


BARTONELLA & ''BARTONELLA-LIKE ORGANISMS''-

Gradual onset of initial illness.

CNS symptoms are out of proportion to the musculoskeletal ones- if a patient has no or minimal joint
complaints but is severely encephalopathic (see below), then think of Bartonella/BLO.

Obvious signs of CNS irritability can include muscle twitches, tremors, insomnia, seizures, agitation,
anxiety, severe mood swings, outbursts and antisocial behavior.

GI involvement may present as gastritis or abdominal pain (mesenteric adenitis).

Sore soles, especially in the morning.

Tender sub-cutaneous nodules along the extremities, especially outer thigh, shins, and occasionally
along the triceps.

Occasional lymphadenopathy.

Morning fevers, usually around 99. Occasionally light sweats are noted.

Elevated vascular endothelial growth factor (VEGF) occurs in a minority, but the degree of elevation
correlates with activity of the infection and may be used to monitor treatment.

Rapid response to treatment changes- often symptoms improve within days after antibiotics are begun,
but relapses occur also within days if medication is withdrawn early.

May have papular or linear red rashes (like stretch marks that do not always follow skin planes),
especially in those with GI involvement.


BABESIA SPECIES-

Rapid onset of initial illness, often with sudden onset of high fever, severe headaches, sweats and
fatigue, thus it is easy to know when infection began.

Obvious sweats, usually at night, but can be day sweats as well.

Air hunger, need to sigh and take a deep breath; dry cough without apparent reason.

Headaches can be severe - dull, global (involves the whole head, described like the head is in a vise).

Fatigue is prominent, does not clear with rest, and is made worse with exercise.

Mental dullness and slowing of reactions and responses.

Dizziness- more like a tippy feeling, and not vertigo or purely orthostasis.

Symptoms cycle rapidly, with flares every four to six days.

Hypercoaguable states are often associated with Babesia infections.

Rarely, splenomegaly

Very severe Lyme Disease can be a clue to Babesia infection, as it will make Lyme symptoms worse
and Lyme treatments less effective.


EHRLICHIA/ANAPLASMA-

Rapid onset of initial illness with fever, headache, prostration.

Headaches are sharp, knife-like, and often behind the eyes.

Muscle pain, not joint pain, and can be mild or severe.

Low WBC count, elevated liver enzymes, and (rarely) inclusions seen in the WBCs.

Rarely see diffuse vasculitic rash, including palms and soles (less than 10%).

Rapid response to treatment.


DNA VIRUSES (HHV-6, EBV, CMV)

Persistent fatigue, made worse with exercise.

Sore throat, lymphadenopathy, and other viral-like complaints.

May see elevated liver enzymes and low WBC counts.

Autonomic dysfunction.

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FuzzySlippers
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bump
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aMomWithHope
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Alv, Lauriel, and others:

I would love to read more about the herbs you used to combat Bart--and Lyme and Babs if used-- and the method in which you used them, i.e., continued with antibiotics--which ones?

Did you rotate the herbs? Antibiotics? Rotation schedule?

Thanks!

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FuzzySlippers
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http://www.uvaldeleadernews.com/articles/2008/11/17/news/news1.txt

Thanks to Lymetoo for posting this article. I'm adding it to this thread.


Medical research benefits local veterinarian suffering from MS

by Margaret Palermo - Staff writer

What if you were struggling with a neuromuscular disease that left you pretty much unable to walk or work and kept getting worse, even with treatment?

And then, through an incredible series of coincidences, a diagnosis of a degenerative neuromuscular disease meets up with a bacterium that shows up on a blood test and suddenly your life is handed back to you?

A year ago, local veterinarian John Barnes was facing the possibility of spending the rest of his life in a wheelchair as his body degenerated. He was unable to walk with more than a shuffling pace and found it difficult to work.

It started one day in December of 2004, he said. I was the only one in the house and I woke up about 2 or 3 in the morning with fever and vomiting and thought I had food poisoning, he said. A thermometer pegged his fever at 103, though he said he thought it might have gone higher.

I took a shower and I felt like an octopus on the land, he said describing the weakness accompanying his sudden-onset illness. I felt like I had no bones.

And from that point on, things only got worse. I was a jogger and had been for years, he said. I was jogging and noticed when I went around the third lap of the track, my left leg started to trip a little bit. The next week or two, it was the second lap. I knew I had a problem in one of my neck discs. I thought it was related to that.

He talked to friends who were doctors and they told him he probably had some kind of virus and he should get over it in a couple of months.

But the problem didn't go away. It just kept getting worse. My neurology friends said we better do some testing on you and find out, he said. An MRI and spinal taps were done. It was a fairly clear-cut picture that I had MS.

Treatments for multiple sclerosis were started. We started the typical MS protocol which is interferon shots, said Barnes. With the interferon, he was having relapses about every six months, something typical with MS. Interferon, he explained, is a maintenance drug for MS, but not a cure.

Then in July 2005, he was talking to a friend who is a world-class veterinary internist at Texas A&M University at College Station about an oncology case they shared. Barnes said his friend was unaware of his medical condition.

She asked how I was doing. I said you know how it is with MS. You have your good days and your bad days, he said. I started talking to her about it and I made the comment to her that I'm not balking at the diagnosis of MS, but I'm exposed to so many weird things, I would like to know that's all I have.

He said his friend agreed with him and said his timing was perfect because she had a friend who was doing a study. She gave Barnes an e-mail address for Dr. E.B. Breitschwerdt, co-director of the Vector-Borne Disease Laboratory at the North Carolina State University College of Veterinary Medicine in Raleigh, N.C.

Breitschwerdt has been working with something called polymerase chain reaction, or PCR, testing which can be used to detect and diagnose bacteria by looking for genes or portions of genes in a patient's sample.

The advantage of PCR testing is that it can be used to amplify any gene that had been identified, speeding up the identification process.

Breitschwerdt also called Barnes' timing perfect and agreed to use him in his study. He drew Bartonella out of my blood, said Barnes, explaining that other types of tests can show that you've been exposed to Bartonella, but not that you currently have the bacteria still active in your body.

Typically, Bartonella is self-limiting, he said. When he drew it out of me the first time, he was working with a Duke University infectious disease guy. Dr. (C.W.) Woods was not excited about me being positive, but said he would test me again in a couple of months. He tested again and it was there again.

Barnes said they wanted to test the second sample to find out what species of Bartonella it was since there are at least a dozen different species of the bacteria. Then they lost my sample and a bunch of other samples. I was with my neurologist and they were doing some IV-IG therapy and I was undergoing that.

Barnes said the next round of testing his blood for Bartonella had to wait until he finished the IV-IG treatments. Another couple of months go by and they take another sample again and, sure enough, I'm positive again, he said.

This was about April 2007 that Dr. Breitschwerdt saw that my sample was positive, said Barnes. He said the sample turned out to be Bartonella henselae-San Antonio strain. I said great, what do we do? He said we still don't know.

Barnes also has a cardiologist, Dr. Jamil Bitar. I was talking to him about it and he said I should talk to his brother Camil Bitar, who is an infectious disease expert in Louisiana, said Barnes. Dr. Woods is not sure, but he's thinking about an antibiotic protocol.

Barnes talked about the protocol with Dr. Camil Bitar, explaining that it included taking two antibiotics, one of which could have a bad effect on the liver. We started by the month to see how my liver was doing, he said. I asked him how long should I be on it and Dr. Bitar said until you're well.

That was the first time anyone had ever told me this might make me well and he said absolutely, said Barnes. I was excited about that part of it, that this could reverse some of my clinical signs. Dr. Bitar agreed that I should stay on the drug as long as I could handle it. I just finished in August 2008.

Barnes said he saw changes in himself from the first month, however. The first month, I could see a change in, believe it or not, the color of my toes, he said. He said his toes had been gray, but regained their normal color.

My fatigue slowly got better, he said. In September of this year, after he had already finished the antibiotic regimen, he discovered he could bring his right leg up past his knee without having to lift it with his hand. By October he could move his legs as if he were jogging. He shared news of his progress with Dr. John Shudde. Dr. Shudde said 'Simple pleasures are, indeed, the best!' said Barnes.

What Dr. Camil Bitar says, and I agree, is that Bartonella was the trigger for my MS, he said. They don't know what triggers MS. He and I would both agree that I should not go so far as to say I don't have MS. Since they don't know what causes MS is, it's hard to say what's going on.

I think what we have is Bartonella-induced MS. I thank God every day that I'm getting better. I told myself if I don't get any better, if I can't jog again, at least I'm doing better in other things.

The potential for helping others with strange illnesses that could be related to Bartonella is obvious. What's so exciting to me about this is that we don't know how many people are being undiagnosed or misdiagnosed, said Barnes. At this point, he said, there is no way to know how many problems could be the result of Bartonella.

With diagnostic tests getting better, it is now possible to treat the actual disease rather than just treating symptoms. Dr. Breitschwerdt told me about the dean of a veterinary school who came down with neurologic signs and his 12-year-old daughter had fatigue. They were tested and they found Bartonella in his spinal fluid and in the girls' blood and in their dog's mouth. They are being treated and doing well, said Barnes.

Of the six research subjects, including Barnes, that Breitschwerdt used in his study, two were veterinarians who reported frequent bites from cats, dogs, pocket pets and other animals, one reported a severe scratch from a cat, one had frequent arthropod exposure and had been bitten by a pig and pecked frequently by various fowl, another owned a horse farm and had frequent arthropod exposure and cat scratches and the sixth was a teenager who developed sever debilitating migraine headaches after a tick was removed from his ankle.

The most exciting thing about Ed's work is the hope which will be instilled in so many, said Barnes.

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FuzzySlippers
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Thanks to LymeCFIDSMCS for posting this. I'm including it in this thread.


http://www.sciencedaily.com/releases/2005/12/051215081728.htm


New Study Identifies Louse-borne Diseases That Ravaged Napoleon's Army

ScienceDaily (Dec. 15, 2005) -- Using dental pulp extracted from the teeth of soldiers who died during Napoleon's disastrous retreat through Russia in 1812, a new study finds DNA evidence that epidemic typhus and trench fever ran rampant among the French Grand Army. The study, published in the Jan. 1 issue of The Journal of Infectious Diseases, now available online, identifies the specific species of louse-borne pathogens that were a major cause of death among the remains of the retreating army.

Napoleon marched into Russia in the summer of 1812 with a half-million soldiers. Only a few thousand staggered out again, victims of war, weather, and disease. Twenty-five thousand arrived in Vilnius that winter, but only 3,000 lived to continue the retreat. The dead were buried in mass graves.

Construction work in 2001 unearthed one such grave, containing between 2,000 and 3,000 corpses. Didier Raoult, MD, PhD, from the Universit de la Mditerrane in Marseille, France, and colleagues identified body segments of five lice in a forensic excavation of two kilograms of earth containing fragments of bone and remnants of clothing. Three of the lice carried DNA from Bartonella quintana, which causes the disease commonly known as trench fever, which afflicted many soldiers in World War I.

The team analyzed dental pulp from 72 teeth, taken from the remains of 35 soldiers. Dental pulp from seven soldiers contained DNA from B. quintana, and pulp from three soldiers contained DNA from Rickettsia prowazakii, which causes epidemic typhus. Testing for other organisms gave negative results, and other appropriate controls were negative.

In all, 29 percent of the soldiers tested had evidence of either R. prowazkii or B. quintana infection, suggesting that louse-born diseases such as typhus and trench fever may have been a major factor contributing to Napoleon's retreat from Russia. The authors conclude that searching for DNA of infectious agents in dental pulp may become an important tool for investigating the history of communicable diseases.

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FuzzySlippers
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Hope this link isn't a duplicate here. My eyes have gone all blurry this morning. lol


http://www.sciencedaily.com/releases/2008/11/081123222844.htm


21st Century Plague? Rat Fleas Spread Heart-damaging Bacteria


Brown rats may now be carrying bacteria that can cause serious heart disease in humans. Rat fleas can spread the disease.

ScienceDaily (Nov. 24, 2008) -- Bacteria that can cause serious heart disease in humans are being spread by rat fleas, sparking concern that the infections could become a bigger problem in humans. Research published in the December issue of the Journal of Medical Microbiology suggests that brown rats, the biggest and most common rats in Europe, may now be carrying the bacteria.

Since the early 1990s, more than 20 species of Bartonella bacteria have been discovered. They are considered to be emerging zoonotic pathogens, because they can cause serious illness in humans worldwide from heart disease to infection of the spleen and nervous system.

"A new species called Bartonella rochalimae was recently discovered in a patient with an enlarged spleen who had travelled to South America," said Professor Chao-Chin Chang from the National Chung Hsing University in Taiwan. "This event raised concern that it could be a newly emerged zoonotic pathogen. Therefore, we decided to investigate further to understand if rodents living close to human environment could carry this bacteria."

Scientists have found that rodents carry several pathogenic species of Bartonella, such as B. elizabethae, which can cause endocarditis and B. grahamii, which was found to cause neuroretinitis in humans. Although scientists are unsure about the main route of transmission, these infections are most likely to be spread by fleas. Ctenophthalmus nobilis, a flea that lives on bank voles, was shown to transmit different species of Bartonella bacteria. These pathogens have also been found in fleas that live on gerbils, cotton rats and brown rats.

"We analysed bacteria found in Rattus norvegicus in Taiwan. The brown rat is also the most common rat in Europe," said Professor Chang. "By analysing the DNA of the bacteria, we discovered a strain that is most closely related to B. rochalimae, which has been isolated recently from a human infection in the United States".

The researchers took samples from 58 rodents, including 53 brown rats, 2 mice (Mus musculus) and 3 black rats (Rattus rattus). 6 of the rodents were found to be carrying Bartonella bacteria; 5 of these were brown rats. Four of the rodents were carrying B. elizabethae, which can cause heart disease in humans, and one of the black rats was found to be harbouring B. tribocorum. However, the scientists noticed one strain that had not been identified in rodents previously. The strain was finally shown to be close to B. rochalimae.

"Because of the small sample size used in this study, we cannot say for sure that the common brown rat is spreading B. rochalimae," said Professor Chang. "However, several different Bartonella bacteria are surely transmitted by rodents. These results raise concerns about the existence of other reservoirs and vectors for this emerging infection. This certainly warrants further investigation."

Journal reference:

1. Jen-Wei Lin et al. Isolation of Bartonella species from rodents in Taiwan including a strain closely related to 'Bartonella rochalimae' from Rattus norvegicus. Journal of Medical Microbiology, 2008; 57 (12): 1496 DOI: 10.1099/jmm.0.2008/004671-0

Adapted from materials provided by Society for General Microbiology, via AlphaGalileo.

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CD57
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Is there any way to sticky this list at the top?

Fuzzy, who gave you the symptom list?

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