In order to come up with the best strategy it’s first important to know thy enemy.
http://townsendletter.com/July2015/bartonellosis0715_3.html Fifteen species of gram-negative aerobic Bartonella are known to infect humans; however Dr. Ricardo Maggi’s statement is quite telling, “This case reinforces the hypothesis that any Bartonella species can cause human infection.”
http://www.medicinenet.com/script/main/art.asp?articlekey=5848 History records one strain, Bartonella quintana, as causing Trench Fever, a major problem in the military that often resembled typhoid and influenza; however, urban trench fever still occurs in the homeless, alcoholics, and in injection drug users. The unusual rickettsial organism multiplies in the gut of the body louse and is spread by rubbing infected louse feces into dry skin or eyes. http://www.nejm.org/doi/full/10.1056/NEJM199901213400303 Among the homeless in France, B. quintana infections presented with nonspecific symptoms or no symptoms. It has also been found responsible for a disease called bacillary angiomatosis (purple lesions on or under the skin, subcutaneous tissue, bone, or other organs) in people infected with HIV and the immunocompromised and for infection of the heart and great vessels (endocarditis) with bloodstream infection (B. henselae can do this as well & importantly can cause subacute endocarditis – infection of heart valves, which is often negative upon culturing). Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His’ disease, His-Werner disease, Werner-His disease. Symptoms of Trench Fever: Fever that comes and goes in a 5-day cycle, headache, pain behind the eyes, pain in the shin bones, general body aches, classic rash – pink-red patches and small bumps that appear and disappear, usually on the chest, as the fever comes and goes.
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702008000200013 Another strain, B. henselae causes Cat Scratch disease, has caused aseptic meningitis (often viruses that cause inflammation of the lining of the brain), neuroretinitis (inflammation of the retina and optic nerve), and regional lymphadenopathy (swollen lymph node(s) in one local area) in one patient. Others have had vision problems, headaches, resistant neurological deficits, and seizures. Bacillary peliosis causes vascular lesions in the liver and spleen.
While swollen lymph nodes (lymphadenitis) is considered a hallmark symptom, this study https://www.ncbi.nlm.nih.gov/pubmed/26551620, looking at 100 cases of confirmed B. henselae infection found that nearly half lacked the typical abscesses only identifiable by microscopy but rather mimicked other reactive (acute or chronic) infectious lymphademopathies.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835656/#__ffn_sectitle Here a 6 year old had fevers up to 101, a dry cough, intermittent periumbilical abdominal pain, and night sweats. Misdiagnosed with a urinary tract infection, only to return to the ER with persistent fevers and cough. She was sent home after a chest radiograph showed perihilar peribronchial thickening and was told she had atypical pneumonia. Back to the ER she went with persistent fevers. Upon hospital admittance tests discovered an echogenic liver and enlarged spleen with lesions as well as a positive Bartonella henselae titer. Previously a kitten had scratched her on her chest.
https://www.lymediseaseassociation.org/index.php/about-lyme/other-tick-borne-diseases/bartonellosis Ticks that transmit Bartonella include Ixodes Scapularis (also called the blacklegged tick or deer tick) and Ixodes Pacificus (western black legged tick), both of which also transmit Lyme disease. More than one co-infection can be transmitted from the same tick bite. A paper by Martin Fried and Aswine Bal, both MD’s, https://www.lymediseaseassociation.org/images/NewDirectory/Studies-Papers/Fried_Bartonella-2002.pdf, found it to cause heartburn, abdominal pain, skin rash, gastritis (inflammation of the stomach lining) and duodentis (inflammation of 1st portion of the small intestine) in children and adolescents, as well as mesenteric adenitis (inflammation in abdominal lymph nodes).
Bartonella has an affinity for endothelial cells, red blood cells, microglial cells, macrophages, and CD34 progenitor cells hindering nutrient, oxygen, and antibiotic delivery to tissues. This causes fatigue, pain, and cognitive and mood issues. They hide in red blood cells to evade the immune system and utilize hemin, and can cause persistent infection, with some species actually deforming red blood cells. Some remain in the cells for the life of the cell while others kill the cell outright. Every 3-6 days there is a new infection wave.
Various strains have been found in eye fluid, the heart (myocarditis and endocarditis), and cysts, and can infect by nearly anything puncturing the skin and exchanging bodily fluids – including needles. Evidence also suggests congenital transmission.
https://wwwnc.cdc.gov/eid/article/22/3/15-0269_article This article identified 6 species in patients with chronic, subjective symptoms who were bitten by ticks. While three strains were B. henselae (Cat scratch fever), 3 were associated with animal infections (B. doshiae, B. schoenbuchensis, and B. tribocorum). They also found hemangioendothelioma (vascular tumors) in 2 case patients. The authors stated that Bartonella spp. may be the cause of unclear and undiagnosed chronic illness in humans previously bitten by ticks.
https://www.youtube.com/watch?v=g5g_PVSIA_0 Approx. 3 min
Dr. Ed Breitschwerdt, professor of internal medicine at North Carolina State University, discusses recent research into the Bartonella bacteria. Animals and humans can both become infected with the bacteria from insect bites. It may be possible for an infected mother to pass the bacteria to her unborn child in utero, the professor has found. To download a transcript of the complete 25-minute interview in PDF format, visit http://ncsu.edu/project/nsaudiovideo/…
https://www.youtube.com/watch?v=Sz9e-is-UuY Approx. 4.30 min
Published on Oct 15, 2014
Dr. Breitschwerdt talked about Bartonella at the NorVect conference 2014. This is an excerpt of his presentation: Bartonellosis: A One Health Approach to An Emerging Infectious Disease.
https://www.youtube.com/watch?v=2s2o_oPGYM8 Approx. 12.30 min
Published on Oct 14, 2015
Dr. Mozayeni talks about Bartonella as one of the major co-infections of Lyme disease. It’s more prevalent than Lyme, as there are many more ways to contract the disease (eg. flees, cats). In a study, that Dr. Breitschwerdt and Mozayeni published in The Journal of Emerging Diseases, about 60% of Lyme patients tested positive for Bartonella. Dr. Mozayeni also talks about the importance of looking at Biofilm when treating Lyme, Bartonella etc. as biofilm can harbor many of these microbes and be the cause of many symptoms.
Symptoms are largely associated with where the blood flow is compromised. The reason many have pain in the soles of their feet is due to inflammation caused by microvascular trauma. It has been known to cause cysts around dental roots leading to chronic and hard to diagnose head and face pain as well as root canals. This microvascular trauma is also to blame for brain issues causing psychological issues such as anxiety, anger, and suicidal thoughts, since the small vessel disease affects executive function. A cog is literally caught in the wheel. As neurotransmitters become depleted due to overstimulation, depression rears its ugly head. A vicious cycle ensues.
Due to the cyclical nature of Bartonella and that it exists in very low amounts in human blood, blood tests are unreliable. It also has a long division time between 22-24 hours and requires a special growth environment. There is a Triple Draw through Galaxy which collects blood over 8 days to maximize the test, stating a 90% reduction in false negatives.
http://townsendletter.com/July2015/bartonellosis0715_3.html
Mode of Transmission: Arthropod vectors including fleas and flea feces, biting flies such as sand flies and horn flies, the human body louse, mosquitoes, and ticks; through bites and scratches of reservoir hosts; and potentially from needles and syringes in the drug addicted. Needle stick transmission to veterinarians has been reported. There is documentation that cats have received it through blood transfusion. 3.2% of blood donors in Brazil were found to carry Bartonella in their blood. Bartonella DNA has been found in dust mites. Those with arthropod exposure have an increased risk, as well as those working and living with pets that have arthropod exposure. 28% of veterinarians tested positively for Bartonella compared with 0% of controls. About half of all cats may be infected with Bartonella – as high as 80% in feral cats and near 40% of domestic cats. In various studies dogs have close to a 50% rate as well. Evidence now suggests it may be transmitted congenitally from mother to child – potentially leading to birth defects.
https://madisonarealymesupportgroup.com/2011/09/25/the-bartonella-checklist-copyrighted-2011-james-schaller-md-version-11/
Print out this checklist and complete it. If you have symptoms, discuss with your doctor.
If you find a doctor willing to be properly educated on tick borne illness, please give them this link: https://madisonarealymesupportgroup.com/2017/06/20/help-doctors-get-educated-on-lyme-and-tick-borne-illness/
Bartonella Treatment: This is for educational purposes only. Please discuss treatment options with your health care practitioner.
The predominant antimicrobial drugs for Bartonella are intracellular; however, while reducing symptoms there are relapses. According to IDSA, the best drugs are erythromycin and doxycycline with clarithromycin or azithromycin as alternatives. A combination therapy of doxy and rifampin is preferred for those with CNS involvement and those with repeated relapses may need indefinite treatment.
Also, due to the nature of the organism some have responded miraculously to blood thinners such as heparin or Lovenox – or other agents that reduce clot formation, including alkalinizers such as apple cider vinegar, vegetables and vitamin C. Reducing the stickiness of the blood by taking fish oil or a low-dose baby aspirin also may help. Boluoke, lumbrokinase, serrapeptase, Wobenzym, and InflaQuell may also help.
The following have been found to be helpful:
doxycycline
erythromycin
rifampin
doxy with rifampin
doxy with gentamycin
gentamicin and ceftriazone with or without doxy, chloramphenicol, ciprofloxacin, or streptomycin
azithromycin or doxy combined with rifampin, clarithromycin, or a fluoroquinolone
http://www.treatlyme.net/treat-lyme-book/kills-bartonella-a-brief-guide
According to Dr. Ross one needs to correct sleep, decrease inflammation, improve the immune system, correct hormonal imbalances, provide nutrients, and remove yeast in order to beat Bartonella. He also feels it is best to use antibiotic combinations as do Drs. Horowitz and Jemsek. Ross has three tiers, with tier 1 working 90% of the time, tier 2 at about 80%, and tier 3 (herbs) working 70% of the time or less (Dr. Horowitz has found this to be true of herbs as well).
**UPDATE 2022**
Dr. Ross’s Bartonella treatment update includes information about:
- fluconazole (Diflucan) or itraconazole (Sporonax) to kill persisters and growing bartonella
- liposomal Cinnamon, Clove and Oregano Oil to kill bartonella persisters which is better than oregano oil alone
- lumbrokinase to treat Bartonella-fibrin nests.
Tier 1: Rifampin 300 mg 2 pills 1 time a day with one of the following:
Minocycline 100mg 1 pill 2 times a day
bactrim DS 1 pill 2 times a day or
azithromycin 500mg 1 pill per day
Doxycycline 100mg 1 or 2 times a day can be substituted for the mino but rifampin decreases doxy levels in the blood. Clarithromycin 500mg 1 pill 2 times a day can be substituted for azith but rifampin also decreases clarith blood levels.
Levofloxacin 500mg 1 pill 2 times a day or ciprofloxacin 500mg 1 pill 2 times a day with one of the following:
minocycline 100mg 1 pill 2 times a day,
doxycycline 100mg 1 to 2 pills 2 times a day, or
bactrim DS 1 pill 2 times a day
Clarith and azith are not used with flouroquinolones because they may cause heart rhythm problems.
Clarithromycin 500mg 1 pill 2 times a day and Bactrim DS 1 pill 2 times a day
Tier 2: Clarithromycin 500mg 1 pill two times a day, or
Azithromycin 500mg 1 pill two times a day
Combine these with a tetracycline:
doxycycline 100mg 1 or two pills 2 times a day,
minocycline 100mg 1 pill 2 times a day, or
tetracycline 500mg 1 pill 3 times a day
Tier 3: Start Houttuynia at 5 drops 2 times a day and increase daily by 1 drop per dose till at 30 drops 2 times a day. Take Sida Acuta concurrently at 1/4tsp 2 times a day and after 1 week if tolerating, increase to 1/2 tsp 3 times a day.
According to Ross, treatment requires 4-6 months with an exception of levofloxacin which usually requires 1-3 months. Treat until most symptoms are resolved. His experience is that 95% recover from Bartonella when using the immune supports and either tier one or two.
*Long-term tendon damage and ruptures, retinal detachment, and other symptoms have been connected with fluoroquinolones – resulting in fluoroquinolone toxicity syndrome – or being “floxed,” however, one of the most experienced LLMD’s in Wisconsin has noted that he has used these drugs for over 30 years without this ever happening. The fluoroquinolones are made with fluoride and go deep into muscle tissue, which is what makes them so effective. Often, the best usage is using a fluoroquinolone that paves the way for other antibiotics to do their jobs better.
http://www.lymebook.com/antibiotic-treatment-for-babesia-bartonella-ehrlichia-co-infections
Dr. Singleton also reports that in his experience tendonitis is rare, but if it happens – stop – until symptoms are resolved and then restart in a few days at a lower dose. He also suggests putting the patient on 600-1,000mg of magnesium for a few weeks prior to treatment with a fluoroquinolone to prepare tendons and muscles and to continue taking through treatment, separating it by three or more hours. And, as always, drink plenty of water to help the body detox.
*Many react strongly to Rifampin, perhaps due to a rapid metabolism of sterol hormones, which causes severe symptoms with low adrenals and low cortisol. In the very ill, Dr. Mozanyeni starts with herbal antimicrobials and assists the adrenals until the patient is able to tolerate antibiotics. When the antibiotic regimen is finished he puts them back on more natural antimicrobials if treatment is needed long term.
http://townsendletter.com/July2015/bartonellosis0715_3.html
Dr. Mozanyeni uses clarithromcin or azithromycin, later adding rifampin with clarithromycin. If a patient is on meds that impact rifampin, he may then use Mycobutin. He has not found the need to use IV therapies except in cases where patients can not take pills. He has noted that antibiotics used for Lyme may push Bartonella further into cells making treatment more challenging.
While the current drugs for treating bartonellosis, include rifampin, erythromycin, azithromycin, doxycycline, and ciprofloxacin, they had very low minimal inhibitory concentration (MIC) against growing B. henselae, they had relatively poor activity against stationary phase B. henselae, except aminoglycosides
Recent research has shown many other things have higher activity than current Bartonella treatments: https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/
The identified top drug candidates include:
- pyrvinium pamoate
- daptomycin
- methylene blue
- zole drugs (clotrimazole, miconazole, sulconazole, econazole, oxiconazole, butoconazole, bifonazole)
- aminoglycosides (gentamicin and streptomycin, amikacin, kanamycin)
- amifostine (Ethyol)
- antiviral Lopinavir/ritonavir
- colistin
- nitroxoline
- nitrofurantoin
- verteporfin
- pentamidine
- berberine
- aprepitant
- olsalazine
- clinafloxacin
- clofoctol
Pyrvinium pamoate, daptomycin, methylene blue, clotrimazole, and gentamicin and streptomycin at their respective maximum drug concentration in serum (Cmax) had the capacity to completely eradicate stationary phase B. henselae after 3-day drug exposure in subculture studies.
The identified FDA-approved agents with activity against stationary phase B. henselae should facilitate development of more effective treatments for persistent Bartonella infections.
**Personal experiment**
As my husband and I have always relapsed with Bartonella symptoms and have always responded to and herxed from the combined usage of rifampin and clarithromycin, I decided to try Berberine when I developed severe lower back pain out of the blue. I tried numerous combinations but after further reading about MIC levels, I decided upon 500mg three times a day to keep it in the blood stream. I’m happy to report I herxed immediately and later had the direct response of diminished pain. Time will tell but Berberine appears to help substantially. Please see: https://draxe.com/nutrition/berberine/, https://articles.mercola.com/sites/articles/archive/2015/06/22/berberine-benefits.aspx
Alternative Treatments:
allicin, sulforaphane, Sida acuta, Isatis, Houttuynia, Alchornea cordifolia, Japanese knotweed, EGCG, hawthorn, cordyceps, L-arginine, Cryptolepis, Samento, A-BART, Curcumin, quercetin, astaxanthin, Xymogen, AngiNOX, L-arginine, Profusia Plus, Salvia miltiorrhiza, Vinpocetine, Cratoxy, Ginkgo biloba
http://buhnerhealinglyme.com
Master Herbalist, Stephen Buhner’s Bartonella protocol – research is ongoing, but this is the most up to date. The following herbs are to be taken for 30 days. If the symptoms come back when the protocol is stopped the dosage was probably not high enough – so the protocol should be modified and continued until the blood cell infection is gone. He recommends Woodland Essence for all the tinctures. Remember – herb dosages are extremely individual.
Sida acuta tincture – 1/4tsp 3Xday
Hawthorn tincture, same
Japanese knotweed, same (or 2 capsules 3Xday from Green Dragon Botanicals)
EGCG (green tea extract) 400mg/day – approximately 4 cups of green tea
Houttuynia 1 Tbs daily (Yu Xing Cao – 1st Chinese Herbs, powder – use Lyme code at checkout for 10% off)
L-arginine 5000 mg daily in divided doses Milk Thistle seed, standardized, 1200 mg daily
PLEASE NOTE: If you have active herpes, chicken pox, or shingles DO NOT USE L-arginine.
Madison Area Lyme Support Group 