Welcome. My name is Dr. Jody Greenfield and I am Board Certified in Internal Medicine. I formerly taught medical students as well as Internal Medicine residents in training. I currently see patients with general medical problems and I also have an interest in patients with chronic and complex medical problems as well as tick-borne diseases. I enjoy explaining complex medical problems in simple terms.
Today I am going to talk about signs and symptoms of chronic Bartonella infection. What is Bartonella? For the microbiologists out there, Bartonella is a small gram-negative intracellular organism. Where does Bartonella come from? Bartonella can be transmitted via ticks, fleas, sandflies, or even lice. There are different species of Bartonella, and we don't know if some may cause clinical disease in people, and a test does not exist for all types of Bartonella.
Most of us doctors and health care professionals are familiar with acute Bartonella infection. This can occur in people with a normal immune system. One can get Bartonella infection from a cat or dog bite or cat scratch — so this is also known as Cat Scratch Disease (CSD) or Cat Scratch Fever. In patients who are immunocompromised, such as AIDS patients, Bartonella can cause other problems. In someone with recent cat scratch disease, a patient can get swollen lymph nodes. Someone can even potentially get endocarditis from Bartonella infection (an infection of the valves of the heart). These Bartonella infections are generally more well recognized than chronic Bartonella infections.
Someone can actually have a Bartonella infection but may not even have any symptoms. However, it is becoming more recognized that patients can have a chronic Bartonella infection. If you have many of these symptoms, it would be a good idea to bring it to the attention of your treating licensed health care professional. If you are a health care professional and you see a patient with many of these symptoms, it would be a good idea to include Bartonella on your list of possible causes.
Chronic Bartonella can affect different organ systems such as the skin, the GI tract, cardiac, the musculoskeletal system, and the nervous system. In the skin, it has been observed that people with Bartonella can have red lines which look like "striae" that are not caused by weight gain and do not follow the skin folds. Another dermatological symptom is adult acne in a patient who never had acne before. In some patients one may notice an increase in blood vessels such as "spider veins." Chronic Bartonella infection can also cause swollen lymph nodes. Some GI symptoms include gastroesophageal reflux, abdominal pain, diarrhea, or constipation. One can even get liver function test abnormalities. Palpitations have been associated with Bartonella infections. People can develop blurry vision or light sensitivity.
Sometimes these Bartonella infections can mimic other diseases. Some patients with Lyme disease can have similar symptoms to Bartonella. However, frequently in patients who have Bartonella, their neurological symptoms are typically more pronounced. Some neurological symptoms include headaches, brain fog, insomnia, memory loss, nerve pain, numbness, tingling, and muscle twitches. In patients with seizure-like activity and no other obvious cause (like sudden high fever, head trauma, abnormal EEG), Bartonella is a diagnosis to consider. There can be psychological symptoms such as anxiety, depression, irritability, or even rage. Musculoskeletal symptoms can include shin pain, bone pain, or multiple joint pains. Some patients with Bartonella, when awaking in the morning and starting to walk, have pain in the soles of their feet. Of course, the symptoms I mentioned could have other causes in addition to, or instead of, Bartonella, but Bartonella is something to keep in mind on the list of possibilities.
There are different types of tests that can be done when looking for Bartonella infection. Unfortunately, testing is not 100% accurate — one can still get false positives or false negatives. Some tests include a blood test called VEGF which may be elevated in active Bartonella infection. Other tests include a blood test for IFA — IgM and IgG. There are Bartonella PCR tests to look for the Bartonella DNA. One can also do a tissue biopsy to directly look for the Bartonella organisms. I don't recommend everyone gets a tissue biopsy, however if you are going for a medical procedure already where they can send an additional sample to the lab, it is something for your treating health care professional to consider if you are having many of these symptoms.
Those are some potential signs and symptoms of Bartonella infection. As there are many possibilities, it is a good idea to see your licensed health care professional to consider including Bartonella as a potential diagnosis if you have some of these problems. Kindly read the disclaimer section in the Blog posts. Thank you, and may you have good health.