https://www.ncbi.nlm.nih.gov/pubmed/31374162/

2019 Jul;28(7):957-963. doi: 10.17219/acem/94159.

Tick-borne pathogens Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii and Rickettsia spp. may trigger endocarditis.

Abstract

BACKGROUND:

Infections caused by tick-borne pathogens such as Bartonella spp., Borrelia burgdorferi s.l., Coxiella burnetii and Rickettsia spp. are capable of causing serious lesions of the mitral and aortic valves, leading to a need for valve replacement.

OBJECTIVES:

The aim of the study was to determine whether such cases are sporadic or frequent. An additional goal was to establish effective diagnostic methods to detect these infections.

MATERIAL AND METHODS:

The study involved 148 patients undergoing valve replacement. Blood samples were drawn for serological testing. Samples of the removed mitral and aortic valves were tested with PCR and immunohistochemical staining.

RESULTS:

Specific antibodies to

  • Bartonella spp. were detected in 47 patients (31.7%) and in 1 of the healthy controls (1%) (p < 0.05)
  • B. burgdorferi spirochetes were found in 18 of the patients (12.2%) and in 6 blood donors from the control group (5.8%) (p < 0.1)
  • Rickettsia spp. were detected in 12 (8.1%) 
  • C. burnetii phase I and II antigens in the serum of 1 patient. All the participants in the control group were seronegative to C. burnetii and Rickettsia spp. antigens.
  • PCR tests for detection of Bartonella spp., B. burgdorferi s.l., C. burnetii and Rickettsia spp. DNA in the valve samples were all negative.

Inflammation foci with mononuclear lymphoid cells in the aortic and mitral valves were seen in sections stained with hematoxiline and eozine. In sections dyed using the indirect immunofluorescence method with hyperimmune sera, Bartonella spp. and Rickettsia spp. were found.

CONCLUSIONS:

The results obtained indicate that laboratory diagnostics for patients with heart disorders should be expanded to include tests detecting tick-borne zoonoses such as bartonelloses, Lyme borreliosis, rickettsioses and Q fever.

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**Comment**

This article shows that tick borne pathogens are common with patients needing heart valve replacements. Unfortunately, testing still isn’t accurate. Finding antibodies, authorities would argue, doesn’t mean a person has symptoms; however, this issue desperately needs further research as finding antibodies does indicate the presence of pathogens.

A point to be made about the low percentage of those testing positive for Lyme might be due to the fact they only tested one strain: Borrelia burgdorferi sensu lato.  There are 300 strains worldwide and 100 in the U.S. (and counting).

Bartonella is similar in the fact that a recent article pointed out that a 14-year-old boy with PANS caused by Bartonella henselae infection was NOT seropositive. Only one of the three blood samples tested positive before culturing and only two tested positive after culturing. A single blood draw might have missed confirming a diagnosis of bartonellosis.

How many doctors are going to hunt these infections to ground? How many have the time and doggedness it requires to find them? It’s far more likely they will take the results from a singular test, close the book, and move onto the next patient.

We desperately need accurate tests that pick up ALL the pathogens.