Archive for the ‘Bartonella’ Category

Bartonella, Retinitis & BRAO in 13 Year Old Boy

https://pubmed.ncbi.nlm.nih.gov/32435719/

Branch retinal artery occlusion secondary to Bartonella henselae infection in a 13 year-old

Affiliation

Free PMC article

Abstract

Purpose: To summarize the case of a 13 year-old boy diagnosed with a BRAO (branches of retinal vein become blocked) secondary to B. henselae infection.

Observations: The patient presented with a sudden, unilateral, and painless scotoma (interruption in the visual field or blind spot). Fundoscopic findings and multimodal imaging were consistent with a BRAO with associated areas of intraretinal whitening along the involved artery. Upon further questioning, the patient reported having 15 cats at home. Antibodies were positive for B. henselae. The patient was treated with oral doxycycline 100 mg twice daily for 2 months with complete resolution of the retinal findings and the scotoma.

Conclusions and importance: B. henselae should be considered as a potential cause of retinitis and BRAO, even in pediatric-aged patients.

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For more:  https://madisonarealymesupportgroup.com/2019/08/10/multimodal-imaging-of-two-unconventional-cases-of-bartonella-neuroretinitis/

https://madisonarealymesupportgroup.com/2017/07/21/bartonella-and-neuroretinitis/

https://madisonarealymesupportgroup.com/2018/05/10/bartonella-neuroretinitis-not-atypical/

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

https://madisonarealymesupportgroup.com/2019/07/28/treatment-strategies-for-neuroretinitis-due-to-bartonella-current-options-emerging-therapies/

https://madisonarealymesupportgroup.com/2020/11/01/understanding-bartonella-symptoms-testing-and-treatment/

https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

Family’s Reoccurring Strep – & Pet Cat

https://www.washingtonpost.com/health/medical-mysteries/this-familys-repeated-strep-throat-infections-frustrated-their-doctors/2020/05/22/

This family’s repeated strep throat infections frustrated their doctors

By  Sandra G. Boodman

May 23, 2020

When Dan Levitis, his wife, Iris, and their three young children trooped into a Madison, Wis., urgent care clinic around 8 a.m. on New Year’s Day 2018, the staff didn’t seem surprised to see them. The family had sought treatment several times in the previous two months for recurrent strep throat infections.

They had taken multiple rounds of drugs, professionally deep cleaned their home and replaced contaminated toothbrushes, but none of it worked for long. Inevitably, the infection came roaring back.  (See link for article)

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**Comment**

A very intriguing case.  Important excerpts:

Levitis called his mother, a retired pediatrician who had practiced in suburban Maryland, for advice. She told him about a family she had seen who kept getting strep until they got rid of their pet cat.

While a report from the American Veterinary Medical Association states that doctors sometimes blame pets for recurrent strep throat infections, “evidence doesn’t support this.”

To the surprise of the vet school faculty, group A strep was found in the cat’s throat; it appeared to match the strain of strep collected during Levitis’s most recent throat culture.

This case shows that clinical doctors often know things medical associations don’t!

The family went on vacation, (all treated with antibiotics) and their house was professionally cleaned for the second time, while the asymptomatic cat was also given antibiotics and disinfectant spray for his fur, which finally put a stop to the endless strep infections.

Due to the denial of most of the doctors and their corresponding unwillingness to swab the cat’s throat, this case almost went unsolved.  Food for thought, and another reminder to be willing to fight for answers.

For more:  https://madisonarealymesupportgroup.com/2019/01/29/woman-links-lyme-disease-diagnosis-to-pet-cat-sleeping-in-bed/

https://madisonarealymesupportgroup.com/2019/05/28/woman-wakes-up-with-black-eye-swollen-face-after-cat-scratch-that-left-her-on-iv-drip-for-four-days/

https://madisonarealymesupportgroup.com/2020/07/14/woman-killed-from-lethal-bacteria-after-cat-licked-her/

https://madisonarealymesupportgroup.com/2019/06/28/cat-scratch-disease-vet-suffers-extreme-fatigue-for-a-decade-after-catching-rare-severe-case-of-bartonella-infection-that-isnt-rare/

These articles are just the tip of the ice-berg.  I hope this makes it crystal clear that Bartonella is NOT RARE!

Bartonella Induced Persistent Mechanical Hypersensitivity in Mice Observed (Which Means Pain For Us)

https://pubmed.ncbi.nlm.nih.gov/33146308/

Bartonella henselae infection induces a persistent mechanical hypersensitivity in mice

. 2020 Oct 30;62:e79

doi: 10.1590/S1678-9946202062079.eCollection 2020.

Free PMC article

Abstract

Bartonella spp. are re-emerging and neglected bacterial pathogens. The natural reservoirs for several species of this genus are domestic animals such as cats and dogs, the most common pets in the USA and Brazil. Some cat studies suggest that the infection is more prevalent in tropical and poverty-stricken areas. These bacteria were associated with a wide spectrum of clinical manifestations:

  • fever of unknown origin
  • endocarditis
  • angiomatosis
  • chronic lymphadenopathy
  • hepatitis
  • fatigue
  • paresthesia and pain

Our group has already demonstrated that B. henselae -infected sickle cell disease mice present with hyperalgesia. We hypothesized that even immunocompetent mice infected by B. henselae would show an increased and persistent mechanical sensitivity. Five ten-week old male BALB/c mice were intraperitoneally inoculated with a 30 µL of suspension containing 10 4 CFU/mL of B. henselae, while five others were inoculated with an equal volume of saline solution. Four days after bacterial inoculation, the mechanical paw withdrawal threshold was measured using von Frey filaments in all animals, for five consecutive days.

The infected animals showed hypersensitivity to mechanical stimuli for five consecutive days. The present study has demonstrated that B. henselae infection induces persistent mechanical hypersensitivity, a signal consistent with pain.

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For more:  https://madisonarealymesupportgroup.com/2020/11/01/understanding-bartonella-symptoms-testing-and-treatment/

https://madisonarealymesupportgroup.com/category/bartonella-treatment/  Symptom checklist & treatments within link

A Flea’s Knees: A Unique Presentation of Cat Scratch Disease

https://pubmed.ncbi.nlm.nih.gov/33129648/

The flea’s knees: A unique presentation of cat scratch disease

Abstract

A 4-year-old girl presented to the emergency department with right leg pain and associated limp for one day. There was no trauma or injury; she had no fever or recent illness. Her exam was notable for tenderness and swelling to the right knee, most prominent in the popliteal region. Initial laboratory testing was unremarkable except for a mildly elevated C-reactive protein. She had normal radiographs of the right lower extremity. A soft tissue ultrasound demonstrated popliteal lymphadenopathy, a rare finding in children. Reassessment of the patient revealed cat flea bites to the leg, which prompted concern for Bartonella henselae infection causing Cat-scratch Disease (CSD). The patient was treated empirically with Azithromycin and her Bartonella titers returned two days later consistent with active infection. This is a rare clinical report describing popliteal lymphadenitis and lower extremity arthropathy caused by Bartonella henselae infection secondary to cat flea bites.

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**Comment**

I can only fathom the thousands of similar cases that have gone undiagnosed.

For more:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

Understanding Bartonella: Symptoms, Testing, and Treatment

https://rawlsmd.com/health-articles/understanding-bartonella?

Understanding Bartonella: Symptoms, Testing, and Treatment

Understanding Bartonella: Symptoms, Testing, and Treatment

by Dr. Bill Rawls
Last Updated 10/27/2020

Bartonella bacteria are gram-negative, meaning they have a double cell wall that’s like a protective capsule that prevents the immune system’s white blood cells from ingesting them. They are slow growing, come in different shapes, and are very difficult to isolate in the lab. They can live inside cells and in isolated locations in the body, protected from the immune system and antibiotics.

Inside an average medical textbook, you will find references to three conditions caused by different strains of bartonella: cat scratch fever (Bartonella henselae), trench fever (Bartonella quintana), and Carrion’s disease (Bartonella bacilliformis). But research over the past 20 years has shown that bartonella is quite a bit more complex. Though some people develop acute symptoms associated with the classic bartonella infections, many people with symptoms of chronic illness who are found to harbor bartonella species have no memory of acute illness.

There are actually many species of bartonella that are widespread in all mammal populations, including whales and dolphins. More than a dozen species have been isolated that can infect humans, hence the broader-named category called bartonella-like organisms (BLO).

Bartonella is typically spread by biting insects (fleas, ticks, mosquitoes, sandflies, lice, chiggers, biting flies, scabies, mites, and even louse-eating spiders), but it can also be transmitted by contaminated bites (of animals), scratches (cat scratch), and ingestion.

Infection by any bartonella species is called Bartonellosis. Let’s examine some of the strains that impact human health.

Bartonella henselae

The most common bartonella strain (as far as anyone knows) is Bartonella henselae. It is the cause of cat scratch fever.

Classically, a scratch from a cat carrying B. henselae develops into a rash, followed about 3 to 10 days after the scratch by symptoms that include low-grade fever, headache, sore throat, and conjunctivitis. Swollen lymph nodes are typical and take weeks to months to subside. In most cases, symptoms are not generally debilitating and resolve without treatment.

Concept of homeless animals - young Stray cat on the street.

Classic cat scratch fever is common, with more than 20,000 cases reported in the U.S. each year. About a third of domestic cats are carriers, along with their fleas. Of course, cats are commonly bitten by ticks, and B. henselae is readily transmitted along with other tick-borne microbes.

When Bartonellosis with B. henselae is caused by an insect bite (ticks, fleas, mosquitoes, etc.), the symptom complex is less well defined and highly variable. Most cases are not reported, and the actual incidence of B. henselae infection may be 10 to 100 times or even a 1,000 times greater than that reported for classic cat scratch fever.

Beyond cats, dogs and other mammals — including humans — also carry B. henselae. Different studies of human populations around the world have shown that the carrier rate for B. henselae in asymptomatic individuals is anywhere from 10% to 30%.

But in certain circumstances, B. henselae may pose serious risks to your health. Emerging insights, like those reported in the journal Cancer Research, suggest B. henselae may be implicated in the development of inflammatory breast cancer (IBC), an aggressive form of breast cancer.

It may be that bartonella facilitates the dispersal of breast tumor cells through the lymphatic system and initiates an acute, cellular inflammatory response, leading to a state of chronic inflammation in patients with IBC. Although more research is needed to determine B. henselae’s contributions to IBC in humans, this preliminary information underscores the importance of understanding how bartonella species may be connected to other health conditions.

Bartonella quintana

Another common species of bartonella, Bartonella quintana is the cause of trench fever. The name comes from the trenches of WWI, where soldiers lived in desperate and debilitating conditions and the spread of Bartonellosis by B. quintana was rampant.

B. quintana, spread by body lice, causes severe fever, headache, muscle aches, leg and back pain, skin rashes, conjunctivitis, and, rarely, heart failure. Today, it’s common in homeless people, again, transmitted by body lice. About 10% to 20% of homeless populations in the U.S. harbor chronic infection with B. quintana. (Estimates suggest that the number of homeless people may be as high as 3.5 million.)

B. quintana can be transmitted directly by the bite of a louse as well as by infected bodies of dead lice scratched into abraded skin. The bacteria becomes tightly interwoven into the feces of the louse, which also is a transmission vector. Louse feces-bound bartonella is infectious for more than a year and can be inhaled or ingested with dust particles. B. quintana has also been found in cats, dogs, monkeys, gerbils, and rats, and it can be transmitted by other insect vectors.

What Bartonella Does to the Body

After entering the body (by whatever means), bartonella infects specialized white blood cells called CD 34+. These blood cells are precursors for cells that line blood vessels and other tissues (endothelial cells).

The microbe enters the cell and creates a cyst around itself (called a vacuole) to gain protection. It also turns off the ability of the cell to self-destruct. Chemical messengers stimulated by bartonella microbes cause more CD 34+ cells to congregate. These messengers simultaneously suppress other key parts of the immune response.

CD 34+ migrate throughout the body and replace damaged endothelial cells. This places bartonella exactly where it wants to be. Once established inside blood vessels, bartonella starts scavenging red blood cells as a nutrient source.

split image. bartonella on left, red blood cells on right

While all of this sounds highly threatening, B. henselae or B. quintana are actually not highly virulent microbes. If the person’s immune system is healthy, the cells of the immune system quickly gain the upper hand, and the microbe is dispatched within a couple of weeks. After a brief low-grade illness, the person is back to full health. Because the illness is rarely debilitating, a doctor and the healthcare system are generally not involved, and a formal diagnosis is never made.

If immune function is not up to par, however, chronic, low-grade infection can occur. It’s insidious The person has mild illness initially but then never gets completely better. The degree of debility is variable and dependent on immune status. It is possible (even common) to have chronic infection without having noticeable symptoms.

Bartonella gains protection from the immune system by invading cells that line blood vessels. Symptoms are mostly related to damage caused to small blood vessels (small vessel disease). Types of symptoms are related to the organs involved. Typical organs that can be affected include:

  • Liver
  • Spleen
  • Bone marrow
  • Eyes
  • Skin
  • Vascular system, including the heart

Stealth Characteristics of Bartonella

With only one known exception (see “The Exception” section, below), bartonella bacteria meet all the characteristics of stealth, low-virulence microbes, opportunistic pathogens with the advantage of persistence to gain a foothold in the body instead of relying on an aggressive attack. The characteristics of stealth microbes are as follows:

  • Widely prevalent in the natural world
  • Ancient host-vector relationship with multiple hosts and vectors
  • Initial infection is generally mild
  • Slow growing
  • Occurs in low concentrations in the body (even in very symptomatic individuals)
  • Associated with chronic infection in immunocompromised hosts
  • Symptoms of chronic infection are very nonspecific and similar to other low-virulence microbes
  • Have the ability to live and thrive inside cells in the body, shielded from the immune system
  • Both difficult to diagnose and difficult to eradicate, low-virulence microbes are very covert

Like other stealth microbes, bartonella is not much of a threat by itself. Virulence is additive, however; coinfection with multiple low-virulence microbes like bartonella and borrelia (the primary bacteria responsible for Lyme disease) can result in significant chronic illness. Bartonella occurs as a coinfection in at least 25% of Lyme disease cases.

Symptoms of Chronic Bartonella Infection

Symptoms of bartonella infection are highly variable, and some people who have it might not experience any signs of illness. The spectrum of symptoms widely overlaps with other low-virulence microbes and may include:

  • Skin rash at the site of initial infection
  • Low-grade fever (100℉ – 102℉)
  • Swollen lymph nodes near the initial infection site are hallmarks of initial infection; lymph nodes can be filled with pus and drain in severe cases.
  • Severe fatigue
  • Muscle pain
  • Body aches
  • Abdominal pain
  • Loose stools, constipation, or impaired general intestinal function
  • Eye infection (conjunctivitis)
  • Liver and spleen enlargement in acute or chronic infection
  • Relapsing low-grade fever
  • Chronic eye problems, including blurred vision, photophobia, and eye irritation
  • Bartonella commonly infects bone marrow with resulting bone pain; the most common location is the shin bone.
  • Pain in the soles of feet upon waking in the morning. This is associated with trauma to blood vessels in the soles of the feet with walking and is a classic bartonella symptom.
  • Ankle and knee pain on one or both sides
  • Anemia can occur from bartonella scavenging nutrients from red blood cells.
  • Small vessel disease, affecting the brain and nervous system
  • Headaches
  • Depression and rage
  • Anxiety
  • Neurological symptoms like poor balance, brain fog, decreased cognition, memory impairment, insomnia, and restlessness
  • Poor stress tolerance
  • Demineralization of teeth and jaw, causing chronic face and neck pain
  • Transient tooth pain
  • Chronic bartonella infections are associated with higher rates of root canals (due to compromise of small vessels supplying the tooth).
  • Small vessel disease can affect the function of the autonomic nervous system (sympathetic and parasympathetic systems), resulting in postural orthostatic tachycardia syndrome (POTS).
  • Vascular system issues such as infection of cells lining the heart (endocarditis), leading to chest pain, shortness of breath, palpitations, and, in some cases, damage to heart valves
  • Respiratory symptoms, including unexplained cough
  • Urogenital problems like irritable bladder, kidney disease, pelvic pain, and infertility
  • Bartonella may be passed during pregnancy and between partners.
  • Severely immunocompromised individuals (mainly AIDS patients) can develop cranberry-like skin lesions from the proliferation of infected blood vessels under the skin.

With such an expansive list of symptoms that intersects with other microbes and health conditions, an average doctor isn’t going to consider bartonella. They would likely chalk it up to aging and offer only prescriptions to control the symptoms, nothing more.

A Word About Other Bartonella Species

Research over the past 20 years has revealed bartonella species other than B. henselaeand B. quintana. New ones are added to the list every year. A partial list includes B. clarridgeiae, B. elizabethae, B. vinsonii, B. berkhoffi, B. grahamii, and B. washoensis.

All but one bartonella species cause similar symptom profiles as the two better-known bartonella species and are somewhat interchangeable. In other words, other species of bartonella can cause cat scratch fever or trench fever. All bartonella species infect mammals via biting insect vectors. Ticks are known to transmit several different species of bartonella.

Bartonella is so prevalent that most people will cross paths with some form of it during a lifetime (but in most cases never know it).

But there is one exception: Bartonella bacilliformis, which causes Carrion’s disease. It is a highly virulent microbe that only occurs in the Andes regions of Peru, Ecuador, and Colombia.

A bite from a sandfly transmits B. bacilliformis, causing a high fever (called Oroya fever). This is accompanied by severe anemia from the destruction of red blood cells, severe enlargement of the spleen and liver, bleeding into lymph nodes, and destruction of blood vessels. Mortality is 40% without treatment.

Bartonella bacilliformis is an exception compared to other species of bartonella, but fortunately, it holds to the rule that higher-virulence microbes tend to be uncommon or rare.

How to Diagnose Bartonella

Doctor explaining diagnosis during a video conference with patient at midnight. Physician giving consultation to sick patient from hospital office during virtual examination, screen, medicine, appointment.

Like Lyme disease and other stealth microbes, bartonella is notoriously difficult to diagnose. Testing is species-specific and generally only looks for the most common species of bartonella. Because concentrations of the organism in the body are so low, it can be hard to find. The following are tests and methods to help gain some more information.

Indirect Fluorescence Assay (IFA)

IFA tests for antibodies (IgG and IgM) to bartonella. IFA is not very sensitive because antibodies levels tend to be low. Fry Laboratories (Scottsdale, Az) offers both IFA and standard PCA.

Polymerase Chain Reaction (PCR)

Standard PCR detects bartonella DNA in a blood sample. Because concentrations of the microbe are very low with chronic infection, this test is unreliable. However, Galaxy Diagnostics (based in Research Triangle, NC) performs an amplified version of PCR called ePCR that is more reliable.

The presence of bartonella in blood is amplified with special culture media and then tested with PCR. The test takes 2 to 4 weeks to perform and tests for all known forms of bartonella. Additionally, Armin Labs (Augsburg, Germany) offers several testing methods, including PCR and IFA tests.

IGeneX

This test uses an amplified version of PCR and immunofluorescence testing (FISH), together for improved accuracy of testing for multiple species of bartonella. FISH testing is unique in that it evaluates for bartonella RNA, as opposed to relying on an immune response from the host. The primary drawbacks to testing with IGeneX are high expense and lack of coverage by insurance.

As a general rule of thumb, positive testing can help direct therapy, but a negative test does not rule out the presence of bartonella. The expense of testing must be weighed against money directed at comprehensive therapy. As with other low-virulent microbes, sometimes it’s best just to assume that it is there and develop a comprehensive recovery protocol that addresses it.

Conventional Medical Solutions

As a general rule, two antibiotics at one time are superior to one for bartonella infection, most commonly doxycycline and rifampin for 2 to 4 weeks. Individuals with serious or debilitating symptoms, such as those consistent with endocarditis, should be evaluated by a healthcare provider and should receive antibiotic therapy. Note that some people with chronic bartonella infection do respond to conventional antibiotic therapy, too.

Antibiotic-resistant bartonella is common, and because the microbes are slow growing, occur in low concentrations in the body, and concentrate in areas where antibiotics do not penetrate, nonresponders are common. Many people who do respond relapse later.

Natural Solutions for Bartonella

The best alternative solution to overcoming a bartonella infection is supporting the natural healing potential of the body. That calls for minimizing exposure to the modern-day factors that disrupt immune function and allow low- virulence microbes like bartonella to flourish, including artificially created food products, petrochemicals and other toxins, artificial sources of radiation, and constant daily stress . In fact, avoiding these factors as much as possible is an essential step for controlling the present epidemic of all chronic diseases like Lyme disease, fibromyalgia, fatigue syndromes, and autoimmune diseases.

image split into three. Cryptolepis, black walnut, and japanese knotweed

Natural herbal therapy offers a good alternative for chronic bartonella infection. Herbs reduce inflammation, restore normal immune function, and suppress a wide range of stealth microbes. Here are some top choices to get you started.

green Cryptolepis

Cryptolepis

Traditionally used to treat malaria in Africa, cryptolepis demonstrates systemic antibacterial properties and antiprotozoal properties. The herb is anti-inflammatory and provides antimicrobial activity, and new research in bioRxiv suggests it might defend against B. henselae as well.

Suggested dosage: Cryptolepis is available as a powder, tea, capsule, or tincture, so the dose varies depending on the preparation.

Side effects: It tends to be well tolerated in most people.

Black Walnut with green leaves

Black Walnut (Juglans nigra)

Native to North America, black walnut trees may be found in your own yard. Integrative healthcare professionals have long used black walnut anecdotally to combat intestinal parasites, however, the same research mentioned above indicates it may combat bartonella. In addition to antiparasitic and antibacterial properties, black walnut also demonstrates antioxidant and anti-inflammatory qualities.

Suggested dosage: Black walnut usually is found in tinctures and dried powders. The dose will likely depend upon the preparation and the professional expertise of your healthcare provider. Standard doses may range from 250 mg to 500 mg, two to three times daily.

Side effects: Because there is some potential for toxicity with black walnut, it is best used in conjunction with other herbs and for a shorter duration, like a couple of weeks to a couple of months at a time.

Japanese Knotweed with white flower blooms

Japanese Knotweed (Polygonum cuspidatum)

Japanese knotweed with resveratrol has been used for centuries in traditional Asian medicine, and it’s a potent antioxidant with antimicrobial and anti-inflammatory properties. Japanese Knotweed may eradicate various phases of bartonella bacteria, according to the bioRxiv study.

Suggested dosage: 200-800 mg Japanese knotweed (standardized to 50% trans-resveratrol), two to three times daily

Side effects: They’re rare, with low potential for toxicity. Caution is advised if you’re also taking anticoagulants, because resveratrol has blood-thinning properties. Avoid it during pregnancy.

Bartonella Reactions to Treatment

Bartonella has a very low potential to cause Herxheimer reactions. The outer coat from dead bacteria is much less reactive than most other bacteria involved with Lyme disease. The bacteria does not form biofilms, but it can form vacuoles that are similar in the liver. Generally, vacuoles are broken down by the body when healing occurs.

The Bottom Line

Chronic bartonella infections may require a combination of conventional and natural therapies. Therefore, it’s important to have a knowledgeable healthcare provider involved in your care to determine an appropriate treatment strategy for you. Treatments that include natural protocols to suppress microbes along and immune enhancement are the building blocks of a successful recovery.

Finally, remember to optimize immune health by prioritizing sleep, eliminating refined carbohydrates and processed foods from your diet, incorporating detoxification strategies to assist with toxin removal, and adding exercise as tolerated. Be patient, and you’ll begin to see your health gradually get better.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

REFERENCES
1. Breitschwerdt EB. Bartonellosis: one health perspective for an emerging infectious disease. ILAR J. 2014;55(1):46-58. doi: 10.1093/ilar/ilu015
2. Eschow, Rao, Mordechai, Concurrent Infection of the Central Nervous System by Borrelia burgdorferi and Bartonella henselae, Evidence for a Novel Tick-borne Disease Complex, Arch Neurol, 2001, 58 (9), p. 1357-1363 – http://archneur.jamanetwork.com/article.aspx?articleid=780359
3. Walter Berghoff, Chronic Lyme Disease and Co-infections: Differential Diagnosis, Open Neurol J, 2012, 6: p. 158-178 – http://www.cdc.gov/bartonella/
4. Forsgren, Scott, Interview with B. Robert Mozeyeni, MD: Unraveling the Mystery of Bartonellosis, Townsend Letter, July 2015 – http://www.townsendletter.com/July2015/bartonellosis0715.html
5. Mascarelli, Maggi, Hopkins, Mozayeni, Trull, Bradley, Hogarty, and Breitschwerdt, Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse spider bites, Parasites & Vectors, 2013, 6:98
6. Edward Bealmear Breitswerdt, DMV, Bartonellosis: One Health Perspective for an Emerging Infectious Disease, ILAR Journal, 2014, 55(1), p. 46-58 – http://ilarjournal.oxfordjournals.org/content/55/1/46.full
7. Buhner S H, Healing Lyme Disease Coinfections, Healing Arts Press, Copyright 20138. Jawetz, Melnick, Adelberg, Medical Microbiology, 24th edition, Lange/McGraw-Hill, 20079. Beers, Berkhoff, ed, The Merck Manual of Diagnosis and Therapy, 17th edition, Merck & Co, 1999
8. SV Fernandez, L Aburto, R Maggi, EB Breitschwerdt and M Cristofanilli
Cancer Res December 15 2012 (72) (24 Supplement) P3-10-03; doi: 10.1158/0008-5472.SABCS12-P3-10-03
9. Xiao Ma, Jacob Leone, Sunjya Schweig, Ying Zhang. bioRxiv 2020.08.19.256768; doi: 10.1101/2020.08.19.256768
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**Comment**
A few things:
  1. Bartonella has caused other psychological issues besides rage and anxiety:  https://madisonarealymesupportgroup.com/2019/03/21/bartonella-sudden-onset-adolescent-schizophrenia-a-case-study/
  2. Immunocompetent people can have Bartonella:  https://madisonarealymesupportgroup.com/2020/08/12/bartonella-american-academy-of-pediatrics/
  3. For far too long we’ve been told only people with severely compromised immune systems get Bartonella and that a healthy immune system will wipe it out:  https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/
  4. Personally, I’ve used every single herb listed within this article.  I have found the combination of rifampin and clarithromycin to be THE most effective treatment for Bartonella.  After years of treatment both my husband and I have been able to maintain with Berberine:  https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/, https://madisonarealymesupportgroup.com/2020/07/16/benefits-of-berberine-against-chronic-disease/, https://madisonarealymesupportgroup.com/2019/04/05/study-shows-berberine-induces-cell-death-in-leukemia/
  5. Some are saying Disulfiram may have action also on Bartonella.  It also reduces inflammation:  https://madisonarealymesupportgroup.com/2020/10/01/study-shows-dsm-works-for-lyme-reduces-inflammatory-markers-antibody-titers/