Bartonella and Cat Scratch Disease

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Joel (snowathlete) continues his series on zoonotic pathogens with an introduction to Bartonelliosis


Photo by girlstyle

Bartonella is a zoonotic that frequently infects humans causing diseases termed Bartonelliosis. Probably the most commonly known is cat scratch disease (CSD) which, you guessed it, you catch from cats (especially cute kittens). Cat scratch disease is caused by two species of Bartonella: B. henselae and B. clarridgeiae. But more than a dozen species of Bartonella can cause diseases in humans including B. bacilliformis which causes Carrion’s disease, and B. quintana which causes trench fever. It is not uncommon for people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to test positive for Bartonella.

Now I have to be honest, I find it hard to take the name ‘cat scratch disease’ seriously. Sure, trench fever sounds pretty rough going, and Carrion’s disease sounds even worse until you realize it was named after Mr Carrion, not decaying flesh, but ‘cat scratch disease’…Seriously?

I thought chronic fatigue syndrome (CFS) was bad. I mean, it sounds so mild, doesn't it? And people get scratched by cats all the time and nothing bad befalls them…Well, often it seems that it is mild, but not always. In addition, there is some evidence that other forms of Bartonellosis are most severe.

Bartonella is an intracellular, rod-shaped bacterium and possesses whip-like flagella. They are Gram-negative, which means that they have a cell wall which is hard to penetrate (it doesn't absorb the dye when a Gram staining protocol is performed) and this means they are more resilient to attack from the immune system or antibiotic treatments. B. henselae for instance, is resistant to penicillin and nafcillin.


TRANSMISSION

Let’s start by looking at how you can get it. As I mentioned already, cats are one of the reservoirs of CSD and humans are often infected via a scratch or bite. Cat fleas are also thought to be a possible route of transmission [1, 2].

Rodents are also reservoirs for the pathogen and ticks have been shown to carry Bartonella as well [3]. Many people infected with other tick-borne infections such as Borrelia or Rickettsia also have Bartonella. Nonetheless, transmission from ticks has not been conclusively proven and some research argues against it [4].

Other species of Bartonella can be transmitted by vectors such as flies in the case of Carrion’s disease and body lice as in the case of trench fever. Transmission of some species of Bartonella from dogs to humans is also thought, by some, to be a possibility, but this is not widely accepted yet.


HOW COMMON?

Infection usually occurs in childhood and is often mild and self-limiting. However, in some cases - especially in those with weakened immune systems - treatment may be required.

In a study in San Francisco, 41 percent of cats were found to be infected with B. henselae [5]. As this was a snap-shot of infection in these cats, and other species of Bartonella were not looked for, it seems reasonable to assume that over the life of a cat, the infection rate of Bartonella may be higher still.


SPECIES

There are many species of Bartonella. B. henselae is the most commonly known and studied, but other species are not well studied and most cannot be tested in mainstream labs. Many are better understood in reference to animals, not just cats but dogs too, and these species may be more damaging to humans than the species that cause CSD [6].


CO-INFECTIONS

If you were infected via a cat or a cat flea, then it is not uncommon to be infected with toxoplama at the same time. If you got it from a tick then there are a multitude of other infections that you may have received in the deal, including Borrelia (you can read about that here), Babesia, Rickettsia or Ehrlichia. All of these co-infections complicate the picture, making it harder to diagnose and treat, and reducing your chance of recovery. There is evidence suggesting that a concurrent infection with both Bartonella and Borrelia may result in a disease complex which is able to infect and damage the nervous system [7].


SYMPTOMS


Bartonella (Image by AJC1)

In CSD the first signs of infection are papules or pastules at the site of injury, and later swelling of the lymph nodes sometimes occurs near the site of infection. Fever and fatigue, malaise, headache, chills, backache, insomnia, and less commonly weight loss, arthritis, rashes and sore throat may also occur. You may also get marks on the skin that look like – and are often misdiagnosed as - stretch marks.

In more extreme cases you may suffer from encephalopathy (brain dysfunction), neuroretinitis (eye infection) and impaired vision, osteomyelitis (bone infection) or Parinaud oculoglandular syndrome (a granulomatous conjunctivitis) and cardiomyopathy.

As it is thought that some people may be infected with other species of Bartonella that cause non-CSD Bartonellosis, it is possible that symptoms could be different in these cases, and it is also possible to carry the infection (perhaps with resulting immune suppression?) but be asymptomatic.

Can these symptoms be mistaken for ME/CFS? Maybe. It is not uncommon for people diagnosed with ME/CFS to test positive for Bartonella infection and because of the symptom overlap people often suffer with Bartonella for a long time before they are diagnosed with it and treated. It is most likely that it is an opportunistic infection, but there has not been sufficient research carried out to rule it out as a possible cause.


EFFECT ON IMMUNE SYSTEM

Bartonella invade erythrocytes (red blood cells) and also inhabit the endothelium (the cells forming the interior layer of blood vessels).

There is some evidence that Bartonella hits the immune system, with one paper suggesting that a Bartonella species – B. bacilliformis - is immunosuppressive, and resembles AIDS [8].


DIAGNOSIS AND TESTING

It is often hard to diagnose, especially if you weren't injured by a cat or your symptoms occurred sometime after such an event. Some experts believe it is routinely misdiagnosed as another illness. A PCR blood test for the two strains which cause CSD is widely available, but tests for other species are not easy to find. A lymph node biopsy may be performed if you have swollen lymph nodes and an enlarged spleen may be an aid to clinical diagnosis.


TREATMENT

Often, Bartonella infection appears to be non-serious and will resolve without treatment, but in established cases where the immune system does not deal with the infection, antibiotics are prescribed and the antibiotic chosen depends on the strains found to cause the infection.

Doxycycline is often used for the species which cause CSD, as is Azithromycin (the treatment of choice in pregnant women), clarithromycin, rifampin, trimethoprim-sulfamethoxazole, or ciprofloxacin may also be given. And there are a multitude of others, depending on the strain and (just as important) who your doctor is.


WHAT HAS THIS TO DO WITH ME/CFS?

As already pointed out, there is symptom overlap between the two diseases, some people diagnosed with ME/CFS subsequently test positive for Bartonella, and there are many strains that are not well-known. There is plenty of scope for Bartonella to be a factor in ME/CFS, most likely as a co-infection, but there is also some scope for it to be linked with the pathogenesis of the disease.

The surprising thing is that there has been little published research exploring possible links, which unfortunately means a lot of the evidence for a link is anecdotal. Not insignificant, just not necessarily reliable.

One piece of research shows that some people diagnosed with CFS were found to be positive for various species of Bartonella that they tested for [9] though the proportion of patients in the study with CFS was not large and some of the data in the study is not presented in a way that makes drawing conclusions straightforward.

The only published paper that I could find which looked specifically at ME/CFS and Bartonella was by Komaroff almost 20 years ago [10], which concluded that infection with the henselae strain of Bartonella was unlikely to be the cause of ME/CFS. Welcome, for sure, but hardly sufficient to rule out Bartonella altogether.

Some doctors do test for it, De Meirleir for one certainly tests for it. Others, such as Lerner, Montoya and Cheney, believe that heart problems are common in ME/CFS patients, which may suggest a link to Bartonella as some species are known to cause heart problems, particularly those species which infect dogs.

Are any of these doctors (or anyone else), looking closely at it?

Although there is only one published peer-reviewed paper on Bartonella in ME/CFS, that doesn't mean that people haven't looked. It just means that they didn't find anything worth reporting. But with a lot still unknown about Bartonella species, it is by no means ruled out yet, so we shouldn't be surprised if we hear more about it in the future. In the meantime, as with other zoonotic infections that may present with similar symptomology to ME/CFS (Borrelia, Staphylococcus, Giardia lamblia, etc.), it is well worth being tested for them if you haven't been already, as ME/CFS is of course supposed to be a diagnosis of exclusion.

Joel was diagnosed with ME/CFS in 2009 but struggled with the illness for some time prior to this. He loves to write, and hopes to regain enough health to return to the career he loved and have his work published.​

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REFERENCES

1. Higgins JA, et al. 1996. Acquisition of the cat scratch disease agent Bartonella henselae by cat fleas (Siphonapteraulicidae). http://www.ncbi.nlm.nih.gov/pubmed/8667399
2. Foil L, et al. 1998. Experimental infection of domestic cats with Bartonella henselae by inoculation of Ctenocephalides felis. http://www.ncbi.nlm.nih.gov/pubmed/9775583
3. Martin E Aldelson, et al. 2004. Prevalence of Borrelia burgdorferi, Bartonella spp., Babesia microti, and Anaplasma phagocytophila in Ixodes scapularis Ticks Collected in Northern New Jersey. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC427842/
4. Telford SR III, et al. 2010. Bartonella spp. transmission by ticks not established. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322007/
5. Koehler JE, et al. 1994. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. http://www.ncbi.nlm.nih.gov/pubmed/8301768/
6. Edward B, et al. 2010. Bartonellosis: an emerging infectious disease of zoonotic importance to animals and human beings. http://onlinelibrary.wiley.com/doi/10.1111/j.1476-4431.2009.00496.x/abstract
7. Eskow E, et al. 2001. Concurrent infection of the central nervous system by Borrelia burgdorferi and Bartonella henselae: evidence for a novel tick-borne disease complex. http://www.ncbi.nlm.nih.gov/pubmed/11559306
8. Eduado Ticona, et al. 2009. The pathophysiology of the acute phase of human bartonellosis resembles AIDS. http://www.medical-hypotheses.com/article/S0306-9877(09)00470-8/abstract
9. Maggie RG, et al. 2012. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358077/
10. Komaroff, et al. 1994. Persistent infection with Bartonella (Rochalimaea) henselae or Afipia felis is unlikely to be a cause of chronic fatigue syndrome.

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snowathlete,

Thank you sooo much for this great post! I've been curious about Bartonella for a long time. I was positive for Cat Scratch Disease a couple years after the onset of my chronic illness. Still had the fresh scratch on my arm when I was tested. The infectious disease doctor told me that adults who had not been around cats during their childhood generally got much worse symptoms when infected. I was @ 25 at the time and had just adopted my first-ever cat. A stray, of course. I was actually pretty sick with it, although it was tough to tell what was CSD and what was ME/CFS. One thing I remember is that I was so sore to the touch that it hurt a LOT to take a shower.

I suspect that the CSD was not treated, although I was clearly immune compromised when I got it.

Another interesting twist: I recently took six months of doxycycline for an unrelated infection. During that time, my 33-year sore throat and golf ball glands disappeared. I'd always suspected the sore throat was chronic EBV, but now I'm wondering if it was more likely Bart? Wish I knew more; it seems like the response to doxy is meaningful.

Anyway, thank you thank you for this. I'm going to print it out and take it to my doctor next week.

Loads of good wishes!

 

snowathlete,

Thank you sooo much for this great post! I've been curious about Bartonella for a long time. I was positive for Cat Scratch Disease a couple years after the onset of my chronic illness. Still had the fresh scratch on my arm when I was tested. The infectious disease doctor told me that adults who had not been around cats during their childhood generally got much worse symptoms when infected. I was @ 25 at the time and had just adopted my first-ever cat. A stray, of course. I was actually pretty sick with it, although it was tough to tell what was CSD and what was ME/CFS. One thing I remember is that I was so sore to the touch that it hurt a LOT to take a shower.

I suspect that the CSD was not treated, although I was clearly immune compromised when I got it.

Another interesting twist: I recently took six months of doxycycline for an unrelated infection. During that time, my 33-year sore throat and golf ball glands disappeared. I'd always suspected the sore throat was chronic EBV, but now I'm wondering if it was more likely Bart? Wish I knew more; it seems like the response to doxy is meaningful.

Anyway, thank you thank you for this. I'm going to print it out and take it to my doctor next week.

Loads of good wishes!

Thanks Creekee, so glad that you found it useful.
I just (yesterday) got diagnosed with probable Bartonelliosis as well as Borreliosis (Lyme). Because of my foggy brain, when I write these articles, within a few days I forget it all, so I just read it as if someone else had writen it. I was particularly struck by this line "There is evidence suggesting that a concurrent infection with both Bartonella and Borrelia may result in a disease complex which is able to infect and damage the nervous system [7]."
I'm going to go and check out that reference...

Really interestng to hear of your improvement on doxy. I had a chronic sore throat for a year or two leading up to getting full-blown ME, then it disappeared. I met my wife a couple of years before I got ill, and she had two cats, that had both been strays. One moved with her when we got married, it died two years ago after I came down with ME. Coincidence? Maybe... Maybe not.

 

Cute kitten

 

Would complete blood count show some abnormalities if we were infected with Bartonella, or would it be possible to have it and have all results within normal range?

 

Would complete blood count show some abnormalities if we were infected with Bartonella, or would it be possible to have it and have all results within normal range?

Hi Tally,

I'm no expert, but my full blood count stuff on the NHS came back normal, and here I am being told I have bartonella now.

 

Stephen Buhner, author of Healing Lyme, has a new book out devoted specifically to Bartonella. He also has some information on his website including a protocol using herbs:
http://buhnerhealinglyme.com/herbs/lyme-with-bartonella/

 

In 2009 I was totally bedridden and tested positive for bartonella. Today still not recovered but no more sign of bartonella. I think it is an opportunistic infection that reappears when your immune system is down with ME. In other cases it is a co-infection of Lyme.

 

Would complete blood count show some abnormalities if we were infected with Bartonella, or would it be possible to have it and have all results within normal range?

My CBC was normal. And I also tested highly positive for Bartonella.

 

Does anyone know if Bartonella can impact your CD57 count?

 

Does anyone know if Bartonella can impact your CD57 count?

I don't know specifically, though having just been diagnosed with probably Lyme and Bartonella, my count is normal:
CD57+/CD3- absolute count – 239 (60-360)

Mind you, I read that it is normally low in Lyme patients, but mine isn't...so who knows?

 

I don't know specifically, though having just been diagnosed with probably Lyme and Bartonella, my count is normal:
CD57+/CD3- absolute count – 239 (60-360)

Mind you, I read that it is normally low in Lyme patients, but mine isn't...so who knows?

According to Buhner, people with Lyme generally have low CD57 which is partially why he recommends cat's claw. However, Ema said her CD57 wasn't low even though she had Lyme. There are conflicting studies on whether or not people with Lyme actually have low CD57. This is a rebuttal to a study that claims to refute the notion of decreased CD57 in Lyme patients:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772377/
Natural Killer Cells in Chronic Lyme Disease
We appreciate the interest of Marques et al. in the assessment of immune parameters in Lyme disease. The conclusions of their report appear to differ from the findings of our study of CD3− CD57+natural killer (NK) cells in patients with persistent symptoms of tick-borne illness. Further scrutiny reveals that their analysis employed questionable patient selection criteria and unproven testing and ultimately lacked the power to detect the differences observed in our study.The two reports have little in common. Our study examined 73 patients with a female/male ratio of 1.6:1, consistent with the gender distribution of patients with chronic Lyme disease. Using a flow cytometry test system with an established normal range and well-defined coefficient of variation, we found that the CD3− C57+ NK subset appears to be a useful immunologic marker in patients with persistent Lyme disease symptoms compared to either normal subjects or 32 disease controls. Importantly, factors that appeared to influence the CD57 NK levels were the predominant type of Lyme symptom and response to antibiotic treatment on serial sampling
In contrast, Marques et al. analyzed nine patients with “post-Lyme disease syndrome,” a newly described and unvetted diagnostic entity defined by testing that is biased against women. These nine patients were selected with a female/male ratio of 2:1 and compared to nine predominantly male controls and 12 patients with unknown serologic test results who had “recovered” from poorly characterized symptoms of Lyme disease. With this small sample size, an excessive discrepancy of 100 cells/μl (corresponding to 2.5 to 5.0 standard deviations in our patient population) would be necessary to detect a significant difference in the NK cell counts. Thus, the study had insufficient power to conclude that there was no difference among these small and poorly matched patient groups. The authors also failed to correlate NK cell numbers with patient symptomatology and/or antibiotic therapy, and serial sampling was not performed.
In terms of NK testing, Marques et al. failed to establish a normal range for the CD3− CD57+ subset, and they did not report the coefficient of variation of their flow cytometry testing. Thus, the test system itself has no documented consistency or relation to either population norms or other diseases. The scatter plot suggests that the authors were examining a heterogeneous group of patients, making statistical analysis meaningless in this small patient sample.
In summary, Marques et al. have provided questionable data about the CD3− CD57+ NK subset in an underpowered analysis of a heterogeneous group of patients, and their data are insufficient to reach a meaningful conclusion. As noted in our larger population-based study, which was supported by more recent immunologic evaluation the CD3− C57+ NK subset appears to be a useful immunologic marker in patients with persistent Lyme disease symptoms.

 

Soluble CD14 is supposed to be high in Lyme too, but mine is low.

You seem to get different levels with different strains though (even the three main strains known to cause Lyme) so that may be another factor that influences these things, on top of disease stage, duration, gender, co-infections! I'm pleased I have KDM who has seen a lot of people and a lot of results, I'd be stuck without that I think.

 

Soluble CD14 is supposed to be high in Lyme too, but mine is low.

You seem to get different levels with different strains though (even the three main strains known to cause Lyme) so that may be another factor that influences these things, on top of disease stage, duration, gender, co-infections! I'm pleased I have KDM who has seen a lot of people and a lot of results, I'd be stuck without that I think.

You are very lucky!

Interesting that different strains result in different levels. Which makes me wonder about Bart having some effect. I know many of those with Lyme have been treated without seeing their CD57 correspond in any obvious way. I.e. when they felt better, their number stayed the same or went down. I think there's some general consensus that the number will eventually come up in a well-treated Lyme patient.

I'm currently negative for Lyme by Western Blot and PCR, but my CD57 has dropped from 71 a year ago to 40 last month. "Expected" range on that is 60-360 but most Lyme pros I've heard talk about it feel the number should be over 200 for a person to be healthy, On the other hand, I know several sick with Lyme who have numbers well over 200 during their infection. Maybe it's a very slow downward trend once you're infected. Maybe mine has been slowly sliding for 33 years. Really wish I could find a good LLMD. Currently seeing Dr. Fry, but it's hard to get his attention on anything other than his special cootie.

Thanks for sharing your KDM story, snowathlete. It's really inspiring to get to watch someone get the tests they need from someone who can actually make sense of them. Will be watching your treatment very nosily!

 

Thanks for this article... this is one area Im still looking at and a doctor thinks I could have (but I havent been tested for Bartonella..just waiting for my lyme disease results which I should of had back before now).

 

Thank you Joel, for such an interesting article...again!

Now that you have been diagnosed with the infection, have you been put on an antibiotic regimen? Did they test for it for specific reasons? My doctor never suggested to check for it here in NY although I have many cognitive issues. I will ask him about it now. It seems to me that because of our dysfunctioned immune system, we are not able to properly fight any type of invasion. This is probably why many of us have such high titers of viral in our body and why we might harbor these opportunistic infections.

 

Thanks taniaaust1, Nielk.

Yes going to be starting 8 week course of oral antibiotics. Then he wants to see me again and assess how it is going.
I think KDM tests most of his patients for these things (a wide range of zoonotics and other pathogens) that can cause the same symptoms, because if they are the real cause of the symptoms then you can treat and maybe get better, and if co-infections then you can treat them, and I guess, also maybe get better (even if not cured). For me that is important, to find out if you have these things and test for them.

 

I'm sorry, but I can't concentrate on this story because that kitten is so cute. Cute little germy runt!

You can get tested for Bartonella here: http://labsmd.com/tests.php?view=search_results
and
here: http://www.privatemdlabs.com/lab_tests.php?view=search_results

 

KDM is looking into Bartonella very closely. He gets people tested for a lot of species, unknown to be pathogenic in humans. A publication would be on it's way. In his 12th web seminar, which will be available in English in two weeks, he is talking about 32 species and the one found in his patients is usually not Cat Scratch Disease (Hensalae).

What I miss in this article above are mental issues. Bartonella would be responsible for psychiatric illness like depression, anxiety, tics and more severe psychosis or schizophrenia, but there is little published about this. So one would not know. KDM is also looking into this. With treatment at first these symptoms can get very bad but then they get better. A Dutch psychiatrist who researches the role of infections in psychopathology is also looking into this. A lot of people with ME/CFS suffer from (mild) psychiatric symptoms. If they are more severe they are more likely diagnosed with a psychiatric disease. But when you look at family members different diagnosis may be in one family.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100128/

 

I tested positive for lyme, bartonella quintana and bartonella henselae in the past. Now I am negative for all of them. My blood count have always been normal. And my CD57 went up with antibiotic treatment. Now it is normal, but I am still symptomatic, so I go by symptoms. Btw: I am the one who had severe neuropsychiatric symptoms, mainly depression and anxiety, so I think the connection with bartonella is true....