Archive for the ‘Bartonella’ Category

Bartonella Rochalimae and Canine Heart Infections

https://news.ncsu.edu/2020/07/bartonella-rochalimae/

Bartonella rochalimae and Canine Heart Infections

Cute Dog
Image by Chen Vision, licensed under CC BY-NC 2.0

In a recently published paper, NC State researchers looked at 18 dogs infected with a strain of the bacteria Bartonella called Bartonella rochalimae. They documented the health effects of the bacteria, which included infectious endocarditis – an inflammation of the heart’s inner lining and valves – as well as more general chronic illness. The work is further evidence of the connection between B. rochalimae and both endocarditis and chronic health effects in dogs and may have implications for human health. Lead author Ed Breitschwerdt, Melanie S. Steele Distinguished Professor of Internal Medicine and Bartonella expert, sat down with The Abstract to answer some questions about the new findings.

The Abstract (TA): It looks as though the dogs in the study show evidence that this particular strain is associated not just with infectious endocarditis (IE), but also with the persistent health problems we see with infections from more common Bartonella (B. henselae, etc) species?

Breitschwerdt: That is correct. The association with endocarditis was very recent as well. So this manuscript provides further support for this species as a pathogen in dogs and humans.

Bartonella is now a well-recognized cause of what was historically culture-negative endocarditis; that is, patients (dogs and humans) with echocardiographic evidence of endocarditis and no bacterial growth using conventional blood cultures.

TA: How many strains of Bartonella have been identified to date? How is B. rochalimae different from other strains of Bartonella? Do different types of fleas or insect vectors carry particular strains, is it geography-based, or is it just luck of the draw?

Breitschwerdt: We are currently at around 40 named Bartonella species or subspecies, 10 of which have caused IE in a dog or human. Unfortunately, we have very little information in veterinary or human medicine regarding potential differences in how we should be most effectively diagnosing and treating specific Bartonella species or subspecies. Thus, most diagnostic and treatment considerations are based upon experiences with the most common Bartonella species (Bartonella henselae) that infect dogs and humans.

The genus Bartonella is unique among vector borne pathogens in the context of the wide spectrum of arthropod vectors that are known or suspected to transmit these bacteria. Yes, there are definitive geographical localizations, such as Bartonella bacilliformis, transmitted by a specific sandfly species in the mountainous Andes in Peru and Ecuador.

Alternatively, Bartonella henselae is transmitted to cats by a specific flea species throughout much of the world. Rodents and small mammals are frequently infected with specific Bartonella species in specific geographic locations by an evolutionarily adapted flea species that tends to selectively infest specific hosts or a narrow host range.

Most recently bats, infected by bat flies, have become another important reservoir for newly discovered Bartonella species. Importantly, a bat-associated Bartonella species (Candidatus Bartonella mayotenensis) was first identified as a cause of culture-negative endocarditis in a patient at the Mayo Clinic by amplification and sequencing of the bacterial DNA from the patient’s heart valve. It was several years later when bats were found to be reservoirs for this new species.

TA: Are there strains of Bartonella that aren’t associated with what we think of when we think of bartonellosis: the mimicking of chronic diseases like multiple sclerosis, migraines, seizures, etc?

Breitschwerdt: The diagnosis of infection with a Bartonella species remains challenging despite improvements in microbiological isolation and DNA detection methodologies. A polymerase chain reaction (PCR) primer set used in our laboratory to detect other Bartonella species with a high degree of sensitivity did not find B. rochalimae DNA. This is only one of many examples of the need for more comprehensive (sensitive and specific) diagnostic tests that will clarify the role of Bartonella species in patients with migraines and seizures. We continue to work on improvements in diagnostic testing modalities, while attempting to clarify the role of Bartonella species in a spectrum of chronic diseases.

TA: Does this particular strain really “like” the aortic valve, or is that true of Bartonella generally?

Breitschwerdt: In both dogs and humans, approximately 75% of Bartonella IE cases involve the aortic valve. The remaining 20-25% involve the mitral valve or both the mitral and aortic valves. Thus it is clear that all Bartonella species to date have a predilection to localize to the aortic valve.

TA: How prevalent is IE in dogs? Is it always fatal?

Breitschwerdt: IE is a relatively uncommon disease. Depending upon the study, Bartonella can be the cause of over 1/3 of IE cases in dogs, which is remarkable as we did not know this genus infected dogs until 1993, when the first case of IE bartonellosis was documented at NC State’s College of Veterinary Medicine. That is the first case of bartonellosis in a dog worldwide.

TA: Is this something that veterinarians should be taking into consideration when treating dogs with infectious endocarditis? Would it change the treatment regimen in terms of type or dosage of antibiotics?

Breitschwerdt: Yes, there are special antibiotic selection considerations when Bartonella is the suspected or confirmed cause of endocarditis. Not a good infection to have or an easy infection to treat.

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**Comment**

Again, we owe Dr. Breitschwerdt a world of gratitude for his work with Bartonella.  He has single-handedly studied and brought forth research on this elusive organism that can make life miserable.

For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

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/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

https://madisonarealymesupportgroup.com/2020/02/26/zoonotic-diseases-why-we-are-so-interested-in-bats-bartonella-mycoplasma-coronavirus/

https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/

https://www.envita.com/lyme-disease/bartonella-a-chronic-lyme-disease-coinfection-is-more-causing-chronic-fatigue-problems

Woman Killed From Lethal Bacteria After Cat Licked Her

https://www.news.com.au/lifestyle/home/pets/woman-killed-from-lethal-bacteria-after-cat-licked-her/news-story/

Woman killed from lethal bacteria after cat licked her

A grandmother spent nine days in a coma before dying after her pet cat licked her, prompting a warning to other owners from doctors.

JULY 6, 20207:06PM

Doctors are warning people about the dangers of cat saliva after a woman died from her pet licking her.

Infectious disease specialists say they are seeing at least one person a week in Melbourne hospitals because of the lethal bacteria in cat saliva.

They warn it can cause devastating complications such as heart failure and even blindness.

One Melbourne family has been left heartbroken after they found their 80-year-old grandmother unresponsive in bed with her cat Minty curled up beside her.

While the family want to stay anonymous, they wanted to warn others about the dangers of keeping cats, especially for vulnerable people. (See link for article)

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**Comment**

Key Quote:  

“It is a big deal and it is emerging more and more now as an unrecognised cause of heart valve infection, which is obviously fatal if untreated,” Prof Grayson told the newspaper.

The article mentions pasteurella, which can cause meningitis, and bartonella, which causes “cat scratch disease”.

Bartonella is a common coinfection with Lyme disease and is a very persistent infection.  For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/ There is a checklist you can print and fill out in this link.

Excerpt:

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.

If my husband and I have symptoms they are caused by Bartonella, not Lyme.

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/2019/03/24/cat-scratch-disease-caused-teens-schizophrenia-like-symptoms-report-says/

 

 

 

 

Bartonella Neuroretinitis

https://pubmed.ncbi.nlm.nih.gov/32546517/

. 2020 Jun 16;practneurol-2020-002586.

doi: 10.1136/practneurol-2020-002586.Online ahead of print.

Bartonella Neuroretinitis (Cat-Scratch Disease)

Abstract

We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic disc oedema and a macular star. A low-positive initial serological test for Bartonella henselae does not exclude cat-scratch disease if there is high clinical suspicion, and repeat testing is recommended to look for titre rise.

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**Comment**

A negative test does not exclude Bartonella either.

For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

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/2019/09/07/keep-an-eye-out-for-bartonella/

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

https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

Case of Cerebral Vasculitis Due to Neurobartonellosis

https://nn.neurology.org/content/7/5/e791

A case of cerebral vasculitis due to neurobartonellosis

Meryim Poursheykhi, Farhan Mithani, Tanu Garg, Christian Cajavilca, Siraya Jaijakul, Steve Fung, Richard Klucznik, Rajan Gadhia

We report a case of a 60-year-old right-handed woman with hypertension, hyperlipidemia, and hypothyroidism who presented with a three-week history of:

  • recurrent thunderclap headaches 
  • photophobia (aversion to light)
  • phonophobi (aversion to sound)
  • nausea
  • vomiting

She reported one brief episode of:

  • slurred speech
  • expressive aphasia (inability to understand and formulate language)
  • right facial droop
  • right hemiparesis suggestive of a TIA

Family history was remarkable for primary angiitis of the CNS (PACNS) in the mother. Neurologic examination was unremarkable. CT of the head was negative; CT angiography (CTA) of the head and neck suggested fibromuscular dysplasia in bilateral cervical internal carotid arteries and distal right vertebral artery. MRI of the brain showed no correlating abnormalities. A digital subtraction angiography (DSA) revealed multivessel intracranial medium and large vessel narrowing and fusiform dilatations, suggestive of reversible cerebral vasoconstriction syndrome (RCVS) vs vasculitis. Subsequent MR intracranial vessel wall imaging (IVWI) showed multifocal concentric vessel wall thickening and enhancement consistent with vasculitis (figure). Transcranial Doppler showed no evidence of elevated intracranial velocities. CSF studies were unremarkable with an opening pressure of 10 cm H2O, 2 white blood cells (normal 0–5/mm3), 2 red blood cells (normal 0–1/mm3), 58 mg/dL glucose (normal 40–70, serum glucose 87), 41 mg/dL protein (normal 15–45), normal Q-albumin ratio, normal IgG synthetic rate, and IgG index. Serum inflammatory and infectious studies had been negative thus far. Empiric high-dose IV steroids lead to complete symptom resolution.

Final infectious workup revealed strongly positive serum Bartonella IgM titer of 1:256 and negative IgG, consistent with her reported cat exposure.

She was started on an outpatient two-week course of doxycycline, rifampin, and oral steroids. Four weeks later, repeat vessel wall MRI and Bartonella serologies (IgM titer 1:80) showed improvement.

Figure
FigureVessel imaging

(A) Angiogram of the left internal carotid artery showing multifocal narrowing and fusiform dilatations (arrows) pretreatment. (B) Intracranial vessel wall MRI showing multifocal concentric vessel wall thickening and enhancement (arrows) pretreatment. (C) Intracranial vessel wall MRI showing reduction in vessel wall enhancement (arrows) posttreatment. (D) Magnetic resonance angiography (MRA) head showing multifocal stenoses (arrows) pretreatment. (E) MRA head showing improvement of stenoses (arrows) posttreatment.

Discussion

We present an individual with symptoms initially concerning for RCVS vs vasculitis who was subsequently found to have secondary CNS vasculitis due to cat-scratch disease (CSD). To our knowledge, this is the first adult case of Bartonella henselae-associated CNS vasculitis, particularly without encephalopathy as the presenting symptom.

CSD typically presents with self-limited regional lymphadenopathy and fever.1 Neurologic complications are rare, occurring in 2% of cases with encephalopathy as the most common manifestation.2 Neuroretinitis, seizures, coma, myelopathies, and cranial and peripheral nerve involvement have also been reported. CNS vasculitis associated with CSD, however, has only been reported in 2 pediatric cases which presented with strokes.3,4

Diagnostically, identifying primary and secondary CNS vasculitis can be challenging both clinically and radiographically. No specific studies in serum or CSF are available for the diagnosis of CNS vasculitis. As in neurobartonellosis, CSF may be unremarkable or reveal nonspecific mild lymphocytic pleocytosis. Cerebral vasculopathies can present with similar luminal patterns, and therefore, imaging modalities such as DSA, magnetic resonance angiography (MRA), and CTA provide nonspecific results leading to difficulties identifying and differentiating between common etiologies of intracranial disease including vasospasm, atherosclerosis, and inflammation. Although DSA remains the gold standard for vessel imaging, it is an invasive study that provides information limited to the vessel lumen. Conversely, IVWI allows direct visualization of the vessel wall by subtracting the signal of blood in the vessel lumen and has shown to improve diagnostic specificity.5 In CNS vasculitis, IVWI shows multifocal concentric vessel wall enhancement and thickening as seen in our patient. In RCVS, vessel wall thickening may be present but with minimal or no enhancement.5

At this time, there is no clear evidence-based treatment regimen or duration for neurologic manifestations of CSD including CNS vasculitis.1 We recommend concomitant treatment of the infection with antibiotics and secondary vasculitis with high-dose steroids. Our patient received a 2-week combination of doxycycline 100 mg and rifampin 300 mg twice daily per current expert opinion.6 In addition, we initiated 5 days of high-dose IV steroids, followed by a 1-week oral steroid taper. To avoid recurrent invasive testing, we repeated IVWI 4 weeks later for treatment monitoring and found significant reduction in vessel wall enhancement (figure).

Our case reiterates the importance of ruling out rare causes of CNS vasculitis including assessing animal exposure before diagnosing PACNS. Detection of the etiology of vasculitis is essential to guide treatment and for prognostication. Noninvasive imaging such as an IVWI provides valuable diagnostic information and can be useful in assessing the treatment response over time by minimizing the need for repeat invasive DSA.

Study funding

No targeted funding reported.

Disclosure

M. Poursheykhi, F. Mithani, T. Garg, C. Cajavilca, S. Jaijakul, S. Fung, R. Klucznik, and R. Gadhia report no disclosures. Go to Neurology.org/NN for full disclosures.

Acknowledgment

The authors thank Dr. Gadhia for his mentorship.

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**Comment**

Since Bartonella is a vascular disease, it follows that it will cause vasculitis pretty much anywhere in the body.  https://madisonarealymesupportgroup.com/2020/01/05/bartonella-endocarditis-masquerading-as-systemic-vasculitis-with-rapidly-progressive-glomerulonephritis/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

It also creates tumors, many neurological manifestations including PANS and other mental health issues.

The concern with their treatment is it wasn’t long enough and she could relapse, which is common.  Bartonella, in my opinion, is as bad if not worse than Lyme disease and together it’s a one, two punch – you are out.

Marna Ericson’s work has demonstrated it to survive right along side a PICC line with antibiotics being pumped directly into the body:  https://madisonarealymesupportgroup.com/2019/02/27/advanced-imaging-found-bartonella-around-pic-line/  The subject is her son who has chronic bartonellosis.

 

 

 

Kills Bartonella: A Brief Guide

https://www.treatlyme.net/guide/kills-bartonella-a-brief-guide

Kills Bartonella: A Brief Guide – Dr. Marty Ross

updated 6/24/20

“New experiments show effective Bartonella treatments must do more than kill growing germ forms – they should also kill hibernating persister forms of Bartonella and include agents to remove biofilms.”   Marty Ross MD

Recent research published in 2019 and early 2020 is changing the approach I take to treat Bartonella. Previous research showed Bartonella has rapidly growing germ forms – thus the antibiotics I recommended in the past treated growing forms only. New research shows that Bartonella also has non-growing forms called persisters. Think of a persister as a hibernating form of the germ that ignores most antibiotics and immune system attacks. In addition, this new research shows that Bartonella can form protective sugar-slime coverings called biofilms. These biofilms can block the immune system and antibiotics from reaching Bartonella. This new research is based on petri dish laboratory experiments.

In this updated article I review the best treatment approaches to eradicate Bartonella based on my clinical experience and this new science. (See link for article)

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**Comment**

In my experience Bartonella is as bad or worse than Lyme.  It is what both my husband and I struggle with when we relapse.  Unlike Dr. Ross, our doctor HAS had good results with A-Bart from Byron White for Bartonella maintanance.  For US it has been Berberine that has kept us at bay.  We take 500 mg 3X/day with good success.  Berberine is a wonderful herb and does 1,000 different things.  For more:  https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/

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