posted
My daughter tested positive for Bartonella with a low IgG titer 1:128.
Of course over the holiday's we are having trouble reaching llmd and pcp sees us in early January.
I saw Dr. B's 25 minute speech on Bartonella and was excited to hear that if my daughter is treated for this she may feel better. She currently is on Ketek and I gather she should be on a course of Levaquin.
Any other suggestions or links?
She also has a low Kappa Lambda Ratio makes me worried. PCP's nurse says it means inflammation.
By the way she has been treated for about 4 years with all the usually Lyme and Babesia meds both oral and IV.
kelmo
Frequent Contributor (1K+ posts)
Member # 8797
posted
I ordered that DVD, as well, and called my LLMD right away. My daughter has bart with a 1:640 ANA. She tested positive for two strains.
We have been in zithromyacin and rifampin for a year. Her doc doesn't want to rock the boat since she has been having slow progress.
I know, fast progress would be better, but her gut was reamed out and we are working on healing that.
Ketek is good, stick with that as long as you can. I understand it's hard on the liver, but what isn't? My LLMD likes Ketek. He says Dr. B likes it, as well.
That Bartonella DVD is a couple of years old. I think Leviquan is hard on tendons.
That's my opinion. Sorry your daughter is ill. I know how it robs our children.
Have a wonderful Christmas.
Posts: 2903 | From AZ | Registered: Feb 2006
| IP: Logged |
I also had low IgG titers to Bart and tried Levaquin. Within three days my calves were aching terribly; I knew from here it was my tendons. It took 7 days to clear.
Am working on Mg loading to try it again as mentioned in the questions section in that speech you referenced.
So if Rxed Levaquin make sure your daughter doesn't have this problem as the damage can become permanent.
As for inflammation, I found that Allergy Research Group's "Inflamed" basically knocked my headaches almost out entirely. I take 2 caps tid on an empty stomach.
Good luck, I hope her symptoms are relieved with Bart treatment,
Tim
Posts: 52 | From California | Registered: Aug 2005
| IP: Logged |
Marnie
Frequent Contributor (5K+ posts)
Member # 773
posted
Sam,
For what it's worth, here are my bartonella files (most are old, so not all links may still work):
Serum Magnesium in Cats Critically ill humans and dogs commonly have abnormal serum magnesium concentration (Mg). A study of 57 cats in intensive care found that abnormal Mg was associated with increased morbidity and mortality.
Hypermagnesemia was seen in cats with azotemia or thoracic neoplasia and pleural effusion.
While hypomagnesemia was more common,
it was not associated with any specific category of disease. In some cases, low Mg was seen during hospitalization, perhaps from reduced dietary intake, administration of fluids low in magnesium, or effects of medications.
Hypomagnesemia could contribute to patient mortality byaffecting cardiac or other functions. Reference: Whitney. Adv Sm An Med Surg 16(9): 1, 2003.
Cat-scratch Disease Causing Status Epilepticus in Children
Lupin Ap4A hydrolase has particularly high sequence identity with the Ap4A hydrolase encoded by ialA, one of two genes associated with the ability of Bartonella bacilliformis to invade and survive as a parasite of human erythrocytes [4].
Cat-scratch disease is an infection at the site of a cat scratch caused by the bacterium Bartonella henselae.
After a person is scratched by a cat infected with Bartonella henselae, the bacteria tend to infect the walls of the blood vessels. The cat usually shows no signs of illness.
Symptoms Within 3 to 10 days of getting a minor scratch, the person usually develops a red, crusted blister up to 21/2 inches in diameter. Rarely, a blister containing pus (pustule) appears. Lymph nodes in the area swell, become firm, and are tender when touched.
Later, they fill with pus and may drain through the skin. The person may feel ill, have a lack of appetite, and have a fever or headache. About 10 percent of the infected people have other symptoms, such as eye problems, which cause visual changes, or brain swelling, which causes a headache or stupor.
In almost all infected people, the skin clears up and the swelling in the lymph nodes disappears within 2 to 5 months. Recovery is complete. A severe form of cat-scratch disease can occur in people with AIDS.
Diagnosis and Treatment The diagnosis of cat-scratch disease seems likely if a person has swollen lymph nodes for more than 3 weeks after being scratched by a cat. In uncertain cases, a blood sample may be tested for antibodies to Bartonella henselae.
Treatment consists of applying heat and taking pain relievers. A fluid-filled lymph node that is painful can usually be drained with a needle to alleviate the pain. Antibiotics may be given to help eradicate the bacteria, especially in people with AIDS.
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.
Signs In Humans: Cat scratch fever was first recognized in people in 1931. Cases occur worldwide.
The disease is most frequently associated with the bite or scratch of a kitten under six month of age. Children and young adults 2-24 years of age and veterinarians make up 80-90% of the human cases.
Most cases occur in the fall and winter months. People who have been scratched or bitten first develop one or more pustules (pimples) at the site of the wound. One to four weeks later, nearby lymph nodes become swollen and tender. These are usually the lymph nodes at the armpit. Mysteriously, patients with no known exposure to cats will occasionally develop the disease.
Fever, headache and fatigue are common. Some people develop a concurrent tonsillitis and neck pain. It is rare for more serious signs to develop in healthy people and most recover without treatment over a three-week period. However, when a person's health is not good or the immune system that protects the body is compromised, a series of much more serious diseases can occur.
The symptoms of this atypical bartonellosis are highly variable and can be fatal. Often these are people who have undergone organ transplants, chemotherapy or have AIDS. One of these unusual forms called bacillary angiomatosis in which blood-filled cysts appear on the skin.
A second is called Parinaud's oculolandular syndrome. When it affects the liver and spleen it is called peliosis hepatitis or splenic peliosis. It sometimes affects the linings of the heart (endocarditis) and other times the eye (retinitis) and optic nerve. It can also affect the lungs and brain.
Ophthalmic manifestations of Bartonellosis may occur in up to 13% of patients with systemic cat-scratch disease and includes:
� Parinaud's oculoglandular syndrome: granulomatous conjunctivitis with associated preauricular lymphadenopathy
� Neuroretinitis
� Focal chorioretinitis
After resolution of the disease, final outcome can include residual visual field defect, decreased contrast sensitivity and visual acuity, and sectoral disc pallor on exam.
Classically, a macular star of lipid exudates is seen as subretinal fluid is resorbed (see Figure 7 for a classic macular star). Indeed, most cases of unilateral macular star with optic disc swelling is related to ocular bartonellosis, as is the case with this patient's (however, a differential diagnosis is offered below). Eventually, the macular exudates also resolve.
OCULAR SIGNS � granulomatous conjunctivitis with preauricular lymphadenopathy (in cases of Parinaud's oculoglandular syndrome--POGS) � systemic lymphadenopathy � optic nerve edema � subretinal fluid, exudates, or a macular star � focal chorioretinitis � enlarged blind spot on visual field testing � positive skin test or serum titer for Bartonella H. SYMPTOMS � systemic symptoms of disease may resemble a flu-like illness (malaise/weakness, low-grade fever, headache, and joint or muscle pains) � patients may also notice enlarged regional lymph nodes in the axillae, groin, neck, or head � decreased/blurry vision, usually in one eye � red eye (in patients with POGS) � patients may notice decreased visual field
� Within 3-10 days, a small skin lesion may appear. Twenty-five to 60% of patients report a macule, papule, pustule, and/or vesicle. � In 1-2 weeks, edema and tenderness manifest in regional lymph nodes that drain the area of exposure. � Atypical presentation (5-10% incidence) may include the following: o Parinaud oculoglandular syndrome, characterized by conjunctival granuloma with suppurative preauricular adenitis o Encephalopathy o Erythema nodosum o Thrombocytopenic purpura o Arthritis o Synovitis o Pneumonia Physical: � Among patients with this disease, 50% have involvement of a single node, 30% have involvement of nodes in multiple sites, and 20% have involvement of several nodes in the same region. In 80% of cases, the lymphadenopathy ranges from 1-5 cm. While the majority of lesions regress over 2-6 months, they may last for as long as 2 years. Suppuration is seen in about 10% of cases. Cellulitis is rare.
� Typical features
Chronic tender lymphadenopathy (49%) o Fever (38-41�C) lasting 1-7 days (32%) o Malaise or fatigue (30%) o Anorexia, emesis, weight loss (15%) o Headache (14%) o Splenomegaly (11%) o Pharyngitis (8%) o Transient truncal maculopapular rash (5%) � Atypical features (16%) o Conjunctival granuloma with conjunctivitis and preauricular adenopathy (6%) o CNS, including encephalopathy/encephalitis with seizures, combative behavior, extreme lethargy, or coma (2%) o Cranial/peripheral nerve involvement, including facial nerve paresis, myelitis, neuroretinitis, polyneuritis, radiculitis, optic neuritis with transient blindness o Thrombocytopenic purpura o Osteitis/osteomyelitis (0.3%) o Hepatomegaly/hepatosplenomegaly with hepatic granulomata (0.3%) o Skin symptoms, including erythema nodosum, erythema marginatum, erythema multiforme o Pulmonary disease (0.2%)
Typical: Within 3 to 10 days after a minor scratch, a cutaneous lesion develops at the site in 60 to 90% of patients. The typical primary lesion is an erythematous, crusted papule (rarely, a pustule), 2 to 6 mm in diameter. Regional lymphadenopathy develops within 2 wk, usually unilaterally and in relation to the scratch site (ie, affecting axillary, epitrochlear, submandibular, cervical, or inguinal nodes).
The nodes are initially firm and tender, later becoming fluctuant, and may drain with fistula formation. Fever (in 32 to 60% of patients), malaise (in 29%), headache (in 13%), and anorexia (in 14%) may accompany the lymphadenopathy (in 100%).
Atypical: Unusual manifestations occur in 5 to 14% of patients: Parinaud's oculoglandular syndrome (conjunctivitis associated with palpable preauricular nodes) is seen in 6%; neurologic manifestations (encephalopathy, seizures, neuroretinitis, myelitis, paraplegia, cerebral arteritis) in 2%; and hepatosplenic granulomatous disease.
Other rare manifestations include erythema nodosum, osteolytic lesions, and thrombocytopenic purpura. A severe form has been reported in several patients with AIDS. The skin lesion and lymphadenopathy subside spontaneously within 2 to 5 mo.
The first sign of cat-scratch disease may be a small blister at the site of a scratch or bite 3-10 days after injury. The blister (which sometimes contains pus) often looks like an insect bite and is usually found on the hands, arms, or head.
Within two weeks of the blister's appearance, lymph nodes near the site of injury become swollen. Often the infected person develops a fever or experiences fatigue or headaches. The symptoms usually disappear within a month, although the lymph nodes may remain swollen for several months. Hepatitis, pneumonia, and other dangerous complications can arise, but the likelihood of cat-scratch disease posing a serious threat to health is very small.
AIDS patients and other immunocompromised people face the greatest risk of dangerous complications. Occasionally, the symptoms of cat-scratch disease take the form of what is called Parinaud's oculoglandular syndrome. In such cases, a small sore develops on the palpebral conjunctiva (the membrane lining the inner eyelid), and is often accompanied by conjunctivitis (inflammation of the membrane) and swollen lymph nodes in front of the ear.
Researchers suspect that the first step in the development of Parinaud's oculoglandular syndrome occurs when Bartonella henselae bacteria pass from a cat's saliva to its fur during grooming. Rubbing one's eyes after handling the cat then transmits the bacteria to the conjunctiva.
Clinical Signs: Cats typically do not show signs of sickness when they are infected with Bartonella henselae. People who contract the bacteria through a bite wound or scratch develop an erythematous papule at the site of the wound. In three to 10 days, lymphadenopathy may develop.
People with the disease may also experience fever, anorexia, malaise, headache, myalgia, arthralgia, nausea, and skin eruptions. Most cases of cat scratch disease are self-limiting, but may take several months to resolve. Symptoms:
Cats typically do not show signs of sickness when they are infected with Bartonella henselae. People who contract the bacteria through a bite or a scratch develop a raised, reddened area at the site of the wound.
Three to 10 days later, their lymph nodes may become very tender and swollen. Those afflicted with the illness may develop a mild fever, lose weight, develop red, raised bumps on their skin, and experience flu-like symptoms such as headaches, pain in the muscles and joints, and nausea. Most cases of cat scratch disease will resolve spontaneously; however, this can take several months.
The symptoms of CSD vary greatly among people who acquire the disease. The most common symptoms are fever lasting seven to fifty-six days, abdominal pain, and lesions.
Lesions are usually found above lymph nodes near the site of the scratch. This occurs since B. henselae in many cases causes lymphadenopathy which is disease of the lymph nodes.8 Lesions have also been found on the liver and spleen of infected patients.9 In atypical cases B. henselae causes endocaritis which is vegetation of bacteria on the surface of the endocardium or in the endocardium itself.10
A wide variety of antibiotics are used to kill B. henselae.
(In culture B. henselae is susceptible to many antibiotics.11
Aminoglycosides are considered to be bactericidal while beta-lactams are clearly ineffective.3 In vivo B. henselae is much more difficult to kill which could be do to its intracellular growth. )
Cat scratch disease is a disease caused by bacteria that are often carried by cats, especially kittens.
About a week after being scratched or bitten, your child may have these symptoms: � 1 or more bumps at the site of a cat scratch or bite � tiredness � poor appetite � headache � fever. One to 4 weeks later, the bacteria travel to nearby lymph nodes, usually in the armpit, groin or neck. The lymph nodes become large lumps that are usually painful and may get red. These large lymph nodes that are the most typical feature of cat scratch disease.
ost of the time the body's defense system can clear up the infection without any treatment.
Your child will be tired and have a loss of appetite usually for less than 1 week. The swollen lymph glands will usually start to get smaller in 2 months, but may not return to normal size for several months.
About 1 in 50 people with cat scratch disease will have symptoms that affect the nervous system. Symptoms may include seizures, numbness and tingling, loss of muscle strength or problems with the eyes.
These symptoms get completely better with time.
Rarely a lymph node will form a tract to the skin and drain pus. Gradually the large lumps will decrease in size. On other rare occasions, the bacteria can spread to other parts of the body.
Systemic symptoms. Skin pustules ("inoculation" pustules) occur 3-10 days after the injury at the sight of the scratch or bite. Regional tender lymphadenopathy, most commonly of the head and neck, can persist for 2-4 months. Fever, malaise, fatigue, headache, and sore throat are also common. Rash occurs frequently and can appear as maculopapular, petechial, or erythema multiforme or nodosum. Hepatosplenomegaly can occur as well as osteolytic lesions. Neurologic symptoms. Neurologic symptoms are relatively uncommon, but, if present, usually occur 3-8 weeks after animal contact. A mild aseptic meningitis is the more typical manifestation with mild lymphocytic pleocytosis and slightly elevated protein. Rarely, life-threatening encephalitis and seizures have been reported. Radiculitis, myelitis, cognitive deficits, and (rare) cranial neuropathy may also occur. Neurologic imaging. MRI in patients with cat-scratch disease is often normal, but findings may also be consistent with cerebral edema and, rarely, as in our patient, multifocal white matter lesions can be seen. Ocular findings. Approximately 50% of the time, ocular symptoms are bilateral, and can include all of the following. � Follicular conjunctivitis (5% of patients) � Regional lymphadenopathy � Serous retinal detachment � Retinitis � Branch retinal artery occlusion
Neuro-ophthalmologic manifestations. Neuroretinitis is the most common neuro-ophthalmologic finding seen with Bartonella infection. It generally occurs 1-2 weeks after symptom onset and is usually unilateral.
Optic disc swelling can also be seen, and patients experience a loss of visual acuity. Flame-shaped hemorrhages may be present, as well as macular star, which represents serous exudates secondary to vascular congestion around the macula. In addition, CN III and VII palsies, nystagmus, and homonymous field defects have been reported.
In a small (N = 18) retrospective study of patients with neuroretinitis or Leber's idiopathic stellate neuroretinitis, 64% of the 14 patients tested had elevated IgM or IgG for B henselae, suggesting current or past infection.
Ticks Have Potential To Transmit Cat Scratch Disease
WASHINGTON, DC - April 12, 2001 -- Cat scratch disease may no longer be the appropriate name for the malady caused by the bacterium Bartonella henselae. Researchers at the University of California, Davis, have discovered evidence of the organism in ticks, suggesting that the arthropod has the potential to transmit the disease.
They report their results in the April 2001 issue of the Journal of Clinical Microbiology. NaN
"We cannot say for certain that ticks are vectors of these diseases, but at the least we can say they carry Bartonella DNA and could be potential vectors," says Dr. Bruno Chomel, Professor of Zoonoses at UC Davis and one of the investigators on the study.
Working on the hypothesis that ticks may serve as a transmission vector for Bartonella bacteria, Dr. Chomel and his associates tested Ixodes pacificus ticks from the coastal range area of California (which includes the San Francisco area) for the presence of Bartonella DNA. "We found that almost 20% of the ticks were positive, a percentage that's even higher than for known tick-borne diseases like Borrelia burgdorferi (the cause of Lyme disease) or ehrlichia," says Dr. Chomel.
One species of the bacteria, Bartonella quintana, has long been known to cause trench fever in humans, but it has only been in the last decade or so that B. henselae was identified as the cause of cat scratch disease.
More recently, two other species, B. washoensis and B. vinsonii subspecies berkhoffii have been found to cause disease in humans. All four were among the Bartonella bacteria found in the ticks.
Cat scratch disease is a relatively mild disease in humans, generally consisting of a low-grade fever and swollen lymph nodes, but in patients with compromised immune systems it can lead to a potentially fatal disease known as bacillary angiomatosis.
Several years ago, it was discovered that fleas could transmit B. henselae and in fact they were the primary mode of transmission between cats, says Dr. Chomel.
But dogs also appeared to carry the infection, and studies suggested that fleas were not a common transmission method for canines.
Additional findings of B. henselae in cows, where fleas are not common, further supported the theory of a different vector, such as ticks. "Some earlier work in Europe had tested ticks for a variety of bacteria and did find evidence of Bartonella, " says Dr. Chomel. "But they looked at ticks that had already fed on blood. We were looking to see if the DNA of Bartonella was present in the ticks before they fed on large mammals."
And it was, meaning the ticks could not have acquired the infection from cats, dogs or cows. There are two possible hypotheses on the ultimate source of the bacteria, says Dr. Chomel.
The first is that the tick acquired the infection during an earlier stage in its life cycle, as a larva or nymph, by feeding on a smaller mammal (such as a rat) or even a lizard. The second is the possibility of vertical transmission. An infected female could have had the bacteria in her ovaries and passed it on to her offspring.
More research is necessary to understand the origin of the infection in these ticks. One method might be to test those animals that are common food sources for larvae and nymphs. "Can we find them in lizards? Can we find them in rodents?" asks Dr. Chomel.
As to whether ticks can transmit these diseases to humans, Dr. Chomel is cautious in his conclusions. "We have no clear experimental demonstration of ticks being able to transmit the infection to humans," he says. The next step is to see if transmission is possible in animal models.
He does point to evidence, though, that suggests it's possible. A paper published in the early 1990s found two cases of cat scratch disease where the only known risk factor was a tick bite. Reports on cat scratch disease before the identification of Bartonella henselae as the cause describe cases that did not appear to be caused by a cat scratch. It is estimated that these non-traditional modes of infection may account for up to 5 percent of all cases of the disease.
The Journal of Clinical Microbiology is a publication of the American Society for Microbiology. The American Society for Microbiology is the largest single life science society, composed of over 42,000 scientists, teachers, physicians, and health professionals.
Its mission is to promote research and training in the microbiological sciences and to assist communication between scientists, policymakers, and the public to improve health, economic well being, and the environment.
Jill E.
Frequent Contributor (1K+ posts)
Member # 9121
posted
I'll be starting Rifampin for it soon - hoping my liver will be able to tolerate it. Was on Levaquin briefly, am still recovering from Achilles Tendon problems in both legs so I'm not going back on quinolones.
Jill
-------------------- If laughter is the best medicine, why hasn't stand-up comedy cured me? Posts: 1773 | From San Diego | Registered: Apr 2006
| IP: Logged |
savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
I was on levaquin for several months to treat bart, but found that Ketek and septra worked the best for me.
Posts: 1603 | From ny | Registered: Aug 2006
| IP: Logged |
kelmo
Frequent Contributor (1K+ posts)
Member # 8797
posted
My daughter has been on zith for one year, rifampin added in June. Her liver tests have continued to be low/normal. She drinks a pretty good detox tea, foot detox patches, over a gallon of water and sweats in a sauna several times a week.
She was making progress until we had to change a psyche medication. She is still thrown off by that, so all symptoms are flaring.
There are several medications that are good for bartonella. There are also several strains of bartonella, and they seem to be regionalized. So, the cat-scratch fever symptoms don't always apply.
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic