PATHOGEN

Chronic bartonellosis may be caused by Bartonella bacteria, of which several dozen species are known. An interesting feature of these bacteria is that their natural reservoir hosts typically do not develop illness, even when the organism is present in high concentrations.

Transmission may occur via vectors such as fleas, ticks, lice, and other blood-sucking arthropods that feed multiple times during their life cycle. Infection may also occur through animal scratches or bites (primarily cats and dogs), and through contaminated needles.

Researchers believe the risk of developing disease is higher when humans become infected with a species for which they are not the natural host.

Here is a non exhaustive list of the most important species capable of causing a human disease:

Species – Natural Reservoir

• Quintana – Human

• Henselae – Cat

• Vinsonii – Dog

• Elizabethae – Rat

• Koehlerae – Cat

SYMPTOMS

Symptoms are often non-specific and may differ substantially from the acute form of the disease. The acute presentation is most characteristically associated with fever and enlarged lymph nodes.

In approximately 95% of cases, the acute form is self-limiting and resolves without pharmacological treatment. However, about 5% of individuals may develop a chronic condition.

A significant portion of symptoms results from small-vessel (capillary) inflammation caused by Bartonella. Consequently, various organs may be affected, particularly the nervous system. Clinical manifestations depend on whether the motor (movement coordination, muscle tremor), sensory (neuropathy, nerve pain), or autonomic nervous system (dysautonomia, organ hypofunction) is involved.

When the central nervous system is affected, neuropsychiatric manifestations are common.

Collagen structures may also become targets of Bartonella, in which case degenerative disc disease and dermatological manifestations are frequently observed.

If the most characteristic (though not necessarily most common) symptoms must be named, they include:

• Plantar (sole) pain

• Burning sensation in the extremities

• Bone pain

• Lymph node enlargement

• Striae not related to growth

TESTING AND DIAGNOSIS

Diagnostic evaluation is complicated by the fact that a significant portion of the population—estimated in some studies at 50–60%—has been exposed to Bartonella, with many individuals remaining asymptomatic.

Direct detection methods (microscopy, PCR) may yield false-positive results. Similarly, serological assays assessing humoral immune response (Western Blot, ELISA, ELISpot) may show positivity in asymptomatic individuals (maintenance infection).

Conversely, a negative result with any method does not exclude infection or disease.

For example, the concentration of Bartonella henselae in feline blood may be up to one million times higher than in humans, yet cats typically do not develop clinical disease.

Therefore, the key is not merely detecting the pathogen, but assessing disruption of the homeostatic balance between the bacterium and the immune system.

Three important diagnostic parameters include:

1. Symptom assessment and correlation with Bartonella-associated physiological alterations, while excluding alternative diagnoses.
2. Species identification to evaluate potential zoonotic (animal-origin) infection.
3. Immune response measurement, primarily humoral (antibody-based, e.g., Western Blot) and possibly cellular (ELISpot), using tests calibrated for chronic presentation. Considering the Bartonella life cycle, this may indicate active replication.
4. Direct detection tests, aiming to detect the actual pathogen from blood or tissue. Culture PCR and FISH (Fluorescent In-Situ Hybridization) with probe specific to 23S rRNA have proven to be the most sensitive tests in this category.

An important advantage of immune response monitoring is the ability to evaluate therapeutic effectiveness and determine optimal treatment duration.

Available testing options in accredited laboratories include:

• ELISA test – approximately 5% sensitivity

• ELISpot test – approximately 20% sensitivity

• Western Blot (U.S. laboratories) – approximately 90% sensitivity (available via Rare Diseases Labs Europe)

Among Bartonella specialists, it is common practice to evaluate panel testing (direct detection combined with immune response measurement), particularly when clinical suspicion is high but a given test result is negative.

THERAPEUTIC OPTIONS

In chronic cases, treatment duration typically ranges from 6–24 months.

Just as disease development appears to depend on individual host-response factors not yet fully defined by research, recovery also varies significantly—there is no universal therapy.

Specialists in this field often consider the following options (listed from milder to more complex approaches). It is generally recommended to begin with less aggressive therapy and reassess effectiveness before escalating treatment.

Buhner Herbal Protocol

Widely available online, this plant-based protocol is frequently assembled by herbal companies under this name.

Main components include:

• Japanese Knotweed

• Sida Acuta

• Houttuynia

Dr. Mozayeni – Basic Protocol

Combination of:

• Clarithromycin

• Allicin

Dr. Shikhman – Basic Protocol

Combination of:

• Azithromycin

• Plaquenil

In cases of unsuccessful response, Dr. Shikhman reportedly transitions to the same main protocol used by Dr. Mozayeni.

Dr. Mozayeni – Main Protocol

Combination of:

• Clarithromycin

• Rifampin or Rifabutin

REFERENCES

https://en.wikipedia.org/wiki/Bartonella
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88941/
https://www.galaxydx.com/what-is-bartonellosis/#
https://academic.oup.com/cid/article/38/1/145/355826
https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.977
https://youtu.be/rYi4z1cFVcQ