Bartonella: Not a tick-borne disease or Lyme coinfection

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Bartonella false positives are common

In chronic Lyme groups, patients are often misled into believing they have multiple fake diagnoses, not just “chronic Lyme”. Quite commonly, patients desperate for an explanation to their symptoms are wrongly diagnosed with Bartonella.

Bartonella is a genus of bacteria, and the most common species transmitted to humans in North America is called Bartonella henselae. As discussed in more detail below, Bartonella henselae causes cat-scratch disease, which clears up on its own in most cases and results in lifelong immunity.

The CDC debunks some common myths about Bartonella:

  • There is currently no convincing evidence that ticks can transmit Bartonella infection to humans.
  • Unfortunately there is a great deal of misinformation regarding multiple tickborne infections (called coinfections) on the internet. The possibility of having several tickborne infections at once or having pathogens such as Bartonella that have not been shown to be tickborne, is extremely unlikely.

Since Lyme bacteria (Borrelia burgdorferi) is only spread by black legged (Ixodes) ticks and Bartonella is not a tick-borne infection, Bartonella is not a coinfection of Lyme disease. Unfortunately, false claims of multiple coinfections are made by quacks and their patients. Usually, the quacks and hopeful patients are well-meaning but simply wrong.

In a 2013 survey by quackery propaganda group LymeDisease.org, 54% of respondents claiming to have chronic Lyme disease—itself an unrecognized diagnosis— also claimed to have a Bartonella coinfection. As detailed in our post on tick-borne infections in the United States, the survey results defy reality.

But what about positive tests?

Confusion may be caused by inappropriate use of testing. Many people produce antibodies to Bartonella bacteria, but this does not mean that Bartonella is causing symptoms. In a study of Italian children, 62% had antibodies to Bartonella but no evidence of cat-scratch disease. Another study found 30% of Germans produce antibodies to Bartonella.

In addition, CDC scientists have called into question certain PCR (DNA) tests that have not been validated. The scientists criticized one paper by fringe researchers Edward Breitschwerdt, Ricardo Maggi, Bobak Robert Mozayeni, Elizabeth Pultorak, Barbara Hegarty, Julie Bradley, and Maria Correa, as containing “serious flaws in content and underlying message.”

The Breitschwerdt paper inexplicably claimed many subjects tested positive for Bartonella DNA by PCR and yet did not test positive for Bartonella antibodies. Since a Bartonella infection typically provokes an immune response, the scientists questioned the contradictory and implausible results.

Breitschwerdt, Maggi, and Mozayeni are executives in the for-profit company Galaxy Diagnostics, which sells expensive testing for Bartonella and tick-borne diseases. They stand to profit from disease mongering about Bartonella and other infections they sell tests for.

Breitschwerdt and Maggi are employees of the College of Veterinary Medicine at North Carolina State University. French infectious disease specialist Dr. Didier Raoult was exasperated by Bartonella testing performed at NC State, and he cited a Breitschwerdt paper in a complaint:

Some patients whose test results are negative in my laboratory were tested at the College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA (3) and received positive results (using a technique that I have not been able to reproduce). Now one of my patients is arguing and menacing because I do not confirm his infection by Bartonella spp.

Mozayeni, a medical doctor, was elected president of the pseudoscience group ILADS. Mozayeni and Breitschwerdt were listed as speakers at an ILADS conference. In 2010, the Healthcare Protection Agency of UK issued scathing conclusions about guidelines issued by ILADS:

  • The ILADS guidelines are not evidence-based and are poorly constructed.
  • Application of the ILADS guidelines’ poorly defined case definitions will result in a very high risk of misdiagnosis.
  • Use of ILADS guidelines’ vague treatment recommendations, including prolonged use of antibiotics, has potentially serious consequences.
  • Patients misdiagnosed with Lyme disease risk losing opportunities for diagnosis and treatment of other conditions. They also risk serious physical, psychological social and financial adverse events.

Mozayeni runs Translational Medicine Group and Bethesda Hyperbaric Oxygen Therapy, which are located in Bethesda, Maryland. The subjects of the Breitschwerdt paper were patients examined and selected by Mozayeni.

Doctors are very concerned about patients who have been diagnosed with false Bartonella infections because the patients may receive unnecessary treatments and delay treatment for a real conditions. Ultimately, a positive test is not necessarily meaningful. Because of the confusion surrounding testing, the CDC advises:

It is important for all abnormal test results to be interpreted with your health care provider in the context of your medical history.

LymeScience recommends against patronizing the following labs: Galaxy Diagnostics, IgeneX, DNA Connexions, ArminLabs, and others listed on our Red Flags of Chronic Lyme Quackery page.

Fake Bartonella photos flood the Internet

Cat-scratch disease is caused by infection with bacteria called Bartonella henselae. According to the CDC, typical symptoms include:

  • Low-grade fever may be present
  • Enlarged, tender lymph nodes that develop 1–3 weeks after exposure
  • A papule or pustule at the inoculation site

This is a photo of real papules caused by Cat-scratch disease:

Two Bartonella papules
Cat-scratch disease lesions or papules one week after inoculation (Source: Mazur-Melewska-et-al, copyright CC By 4.0)

In chronic Lyme groups, dubious photos of rashes are commonly presented as evidence of Bartonella infection. In reality, these photos are typically stretch marks, a common skin condition also called Striae distensae. According to Medscape:

Approximately 90% of pregnant women, 70% of adolescent females, and 40% of adolescent males (many of whom participate in sports) have stretch marks.

Below is a photo of typical stretch marks:

Stretch marks
Stretch marks from a 13 year old boy (source: Wikimedia Commons)

As shown below, a search for “rash bartonella” on Google Images returns several photos that are likely stretch marks and not skin manifestations of Bartonella. The top hit is from the pseudoscience organization LymeDisease.org.

No reputable science organization features photos like this of Bartonella. One of the images is just a mislabeled version of the Wikimedia stretch marks image.

Dermatologists reassure the public

Upon discovery, stretch marks can seem concerning to parents and teenagers. Fortunately, scientists in the Department of Dermatology at Johns Hopkins University studied the issue in 2018 by reviewing cases of stretch marks of teenage boys, specifically in the lower back.

Regarding the studied stretch marks, the scientists found:

  • Stretch marks have nothing to do with bacterial infection, including Bartonella or Lyme disease.
  • Stretch marks are associated with rapid growth spurt, tall stature, and family history of stretch marks.
  • Stretch marks are not related to chronic medical conditions or anabolic steroid use.
  • Further medical testing is unnecessary.
  • Unsubstantiated information spread by Lyme-oriented web sites (such as lymedisease.org, lymeactionnetwork.org, and lymeneteurope.org) may cause unnecessary concerns from parents.

The American Academy of Dermatology has more information on why stretch marks appear and how to get rid of them.

What is real Bartonella?

Several Bartonella species are known to infect humans. Bartonella henselae causes cat-scratch disease because the bacteria is transmitted to humans from a scratch of a cat. The human body louse (lice) transmits Bartonella quintana to humans, causing Trench fever. 

The National Organization for Rare Disorders states that Trench fever “is commonly found in homeless, alcoholic, and poverty-stricken populations where poor sanitation and poor hygiene often occurs.”

cat scratching
Cats cause Bartonella henselae infection, not ticks!

Bartonella treatments

Cat-Scratch Disease treatments

Most cases of cat-scratch disease go away on their own, so antibiotics are typically not recommended. Instead, guidelines recommend analgesics and careful monitoring. Though there is little data to support specific antibiotic treatment of cat-scratch disease in patients with functioning immune systems, antibiotics (e.g. a 4 day course) are sometimes used in complicated cases.

A very small subset of patients, such as the immunocompromised, may develop worse symptoms and require special treatment. For example, cat-scratch disease and other Bartonella infections can be more serious in HIV/AIDS patients or those receiving immunosuppressant drugs. Bartonella has also been recognized as a cause of endocarditis, a severe manifestation.

According to infectious disease specialist Dr. Katarzyna Mazur-Melewska and colleagues:

One episode of cat-scratch disease confers lifelong immunity to all patients.

Other Bartonella species treatments

For Trench fever and serious complications of Bartonella, the CDC recommends consulting with an infectious disease expert and treating with antibiotics.

Conclusion

Given the known characteristics of Bartonella, the claims of chronic tick-borne Bartonella infections are simply not supported by science. A real Bartonella infection bears little resemblance to how it is portrayed in non-science-based forums online.

Despite claims by chronic Lyme activists of numerous chronic tick-borne coinfections, a 2014 scientific review concluded:

The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses.

In other words, the diagnoses of chronic coinfections that chronic Lyme advocates have received are likely misdiagnoses.

Resources

Cat-scratch Disease/Bartonella in Children

Kidshealth.org: Cat Scratch Disease

Childrens Hospital of Philadelphia: Cat Scratch Disease in Children