Bartonellahenselae is the causative agent of the notorious cat-scratch fever, endocarditis, and several other serious diseases in humans. Look no further than Lyme-disease co-infection Bartonella, bacteria that live within cells, for its source.
Bartonella are transmitted by fleas, body lice, and ticks – often accompanied by Lyme disease. The infection can be carried by flies in Peru’s Andes Mountains, Colombia, and Ecuador while human body lice carriers are found throughout the world. The European sheep tick is a known carrier while 5 different species of Bartonella have been detected in nearly 20 percent of I. Pacificus ticks collected throughout California.
Wide Range of Bartonellosis Symptoms co-infection of Chronic Lyme Disease
Lyme disease Co-Infection Bartonellosis symptoms can present as a mild infection or produce serious symptoms that affect the whole body. Early signs of the infection may include fever, fatigue, headache, reduced appetite, or an unusual streaked rash. The infection is also known to produce swollen glands around the head, neck, and arms. Another significant indicator of Bartonellosis is a disproportionate onset ofneurologic symptoms compared to those of other systemic Lyme disease symptoms. Bartonellosis patients may also suffer with gastritis, lower abdominal pain, sore soles, and tender subcutaneous nodules along the extremities. Enlarged lymph nodes are often accompanied by a sore throat. As the infection advances, more symptoms are likely to surface, including:
• Bacillary angiomatosis and peliosis hepatitis
• Carrión’s disease (includes both Oroya fever and verrugaperuana)
• Cat scratch fever
• Chronic fatigue syndrome
• Endocarditis – inflammation of the heart valves
• Erythema nodosum – inflammation of fat cells under the skin
• Recurrent bacteremia — bacteria in the blood
• Uveitis – eye inflammation
• Thrombocytopenic purpura – low blood platelet
Patients with Neurological Symptoms Susceptible to Seizuresfrom Chronic Lyme Disease
Encephalopathy, a brain disorder or disease is often realized among Bartonella patients. In fact, up to 50 percent of patients who develop Encephalopathy can be affected by seizures ranging from focal to generalized, and from brief and self-limited to status epilepticus. Additionally, sufferers of this Lyme disease co-infection may experience symptoms that include headaches, cognitive dysfunction, and even CNS lesions.
The Life Cycle and Spread of Bartonella
Bartonellatypically dwell within a preferred host animal without causing significant disease. For example, cats often carry B. henselae and B. clarridgeiae strains while wild rats harbor B. doshiae, B. grahamii, B. taylorii, and B. tribocorum.
Household pets, as well as ticks, fleas, sand flies, and body lice are common carriers of Bartonella. In humans, IV drug users who share syringes can pass on the Lyme disease co-infection, as well.
Once the infection reaches the bloodstream, it uses its tail-like flagellum to seek out red blood cells. At which point, it burrows directly into them. Once inside, it replicates by releasing a molecule which helps to produce more bacteria.
The Immune System is Criticalfor Long-term Bartonella Treatment
A patient’s immune system has the greatest impact on the impact of infection. Those who are infected with Bartonella but have an otherwise healthy immune system may experience only a short-lived and mild experience, whereas those who are immunocompromised may have high numbers of bacteria that persist in the blood and tissues, causing multiple ongoing symptoms.
Those who contract Lyme disease Complex are almost always going to be immunocompromised because of the sheer number of infections their immune systems must deal with simultaneously.
Envita prefers not to waste the time necessary to test for the infections, rather, we quickly identify the patients’ immune status and work efficiently to restore it to optimal functionality by integrating the best treatments from around the world – the foundation of all effective Lyme disease treatment.
Diagnosis Errors: False Negatives in Immuno-compromised Patients in Chronic Lyme Disease Bartonella
There are aspects of Lyme disease testing that allow medical personnel to identify Bartonella organisms through immunohistochemical staining. By and large, however, this diagnosis method is typically reserved for those with angiomatosis.
The DNA of various Bartonella species may also be amplified by PCR in blood, spinal fluid and tissue. Considering the cross-reactivity of antibody tests, PCR may very well be the most reliable method to identify such infection. And, while it is possible to do a culture of the organisms, they are generally slow-growing in the lab, limiting its usefulness as a method of diagnosis. It should be noted that false negative serological results may occur among the immunocompromised – a characterization that suits virtually all who suffer with Lyme disease symptoms.
Complications in Treatment
One difficulty that comes with Lyme disease treatment, in particular as it relates to Bartonellosis, has to do with the effect of antibiotics – they tend to slow down the bacteria’s reproduction, but typically do not kill the infection.Another challenge comes from the disease’s location as Bartonella is often sequestered inside the erythrocytes, or red blood cells, making them harder to deal with. This,combined with an already weakened immune system further complicates treatment. On top of this, Lyme disease patients often simultaneously face borreliosis, candida, HHV-6 and/or are dealing with other toxins such as heavy metals to further complicate matters.
BartonellaCharacteristics Allowing for Immune Evasion
The makeup Bartonellalipopolysaccaride (LPS) includes Lipid A as well as long-chain fatty acids that allow the bacteria to evade the immune system. Data have shown Bartonella’s surface molecules go unrecognized by TLR-4 on dendritic cells and macrophages – a recipe for persistent infection. Moreover, B. henselae avoids lysosomal fusion and acidification once the bacteria invade endothelial cells and macrophages. Precisely how local bacterial control is lost in immunocompromised subjects remains unclear, but is an area of great significance for those facing Lyme disease treatment.
Bacterial Persistence: Pro- and Anti-Inflammatory Response
Clincal and in vitro studies implicated a Th1 immune response to Bartonella infection. The old Bartonella skin test required an injection of suppurative material derived from the lymph nodes of catch scratch disease patients. Results were considered positive if a large erythematous area developed on the skin within two days. This delayed-type hypersensitivity reaction is mediated through the Th1 immune response.
In other Lyme disease testing, a Th1 response was also supported through in vitro studies among mice with splenocytes who showed an increase in the production of Th1 cytokines in response to B. henselea. Elevated IL-8 demonstrates the role of innate immunity in response to the same B. henselea.
The role of cytokines in acute and chronic Bartonella infection was considered in various other studies. Immune competent subjects with CSD suffering acute infections revealed upregulation of proinflammatory and anti-inflammatory cytokines. On the other hand, low CD4 counts have been associated with elevated IL-10 levels during times of acute Bartonella infection.
Lyme disease testing must consider effects on the immunocompromised as most patients fit this category. In such circumstance, Bartonellosistypically revolves around the establishment of bacterial stimulated angiogenesis. Unfortunately, understanding the details regarding Bartonella species has been greatly delayed for lack of a useful animal model.
As it is clear that response as it pertains to a competent immune system involves Th1 and innate immunity (macrophages) we may conclude that HIV-positive patients (as well as others who are immunodeficient in these areas including Lyme disease symptoms sufferers) would find it extremely challenging to limit this infection in such a manner. That being said, we cannot say definitively that this is the method by which HIV aids the spread of Bartonella.
What we do know is that intraerythrocytic persistence is characteristic of infections within immune-competent hosts. Endothelial and periendothelial persistence leading to vasoproliferation is a characteristic exhibited among the immunocompromised.
Angiogenesis in Bartonella Complications Co-infection of Lyme Disease
The most common disease resultant of B. buintana and B. henselae infections is angiomatosis, particularly in those with cell-mediated immunodeficiency resultant of HIV or posttransplant patients on immunosuppressive therapy. Manifestations of antiomatosisinclude its characteristic vasoproliferative lesion, bacillary angiomatosis, and others due to both direct and indirect effects on endothelial cells.
Additional issues with these strains are sustained as the infections persist inlocalized areas, reproducing within collagen tissue. This results in an antiapoptic state in the endolthelial cells, resultant of effector protein excretion – ultimately causing cell proliferation.
Extensive Lyme disease testing relating to its co-infections has shown that Bartonella may also play a significant role in the development of bacillary angiomatosis, as elevated levels have been detected in both animal and human studies. However, this is not the case among immune-competent subjects with CSD who experience an increase in leukocyte rolling and adhesion causing an environment of significant inflammation.
Envita Medical Centers Leader in Chronic Lyme Disease Treatment
To learn more about these infection and related symptoms of fatigue, chronic fatigue syndrome and fibromyalgia like symptoms contact Envita medical Centers leader in Chronic disease solutions.
REF:
Clinical and Development Immunology. 2012; 2012: 612809.
Published online 2011 November 17
Hornef MW, Wick MJ, Rhen M, Normark S. Bacterial strategies for overcoming host innate and adaptive immune responses. Nature Immunology. 2002;3(11):1033–1040. [PubMed]
Huarcaya E, Best I, Rodriguez-Tafur J, et al. Cytokines and T-cell lymphocytes count in patients in the acute and chronic phases of Bartonellabacilliformis infection in an endemic area in Peru: a pilot study. Revista do Instituto de Medicina Tropical de Sao Paulo. 2011;53(3):149–154. [PubMed]
Matera G, Liberto MC, Quirino A, et al. Bartonellaquintana lipopolysaccharide effects on leukocytes, CXC chemokines and apoptosis: a study on the human whole blood and a rat model. International Immunopharmacology. 2003;3(6):853–864. [PubMed]
Zähringer U, Lindner B, Knirel YA, et al. Structure and biological activity of the short-chain lipopolysaccharide from Bartonellahenselae ATCC 49882T. Journal of Biological Chemistry. 2004;279(20):21046–21054.
Popa C, Abdollahi-Roodsaz S, Joosten LAB, et al. Bartonellaquintana lipopolysaccharide is a natural antagonist of toll-like receptor 4. Infection and Immunity. 2007;75(10):4831–4837.
Matera G, Liberto MC, Joosten LAB, et al. The janus face of Bartonellaquintana recognition by toll-like receptors (TLRs): a review. European Cytokine Network. 2008;19(3):113–118.
Kyme PA, Haas A, Schaller M, Peschel A, Iredell J, Kempf VAJ. Unusual trafficking pattern of Bartonellahenselae-containing vacuoles in macrophages and endothelial cells.Cellular Microbiology. 2005;7(7):1019–1034.
Vermi W, Facchetti F, Riboldi E, et al. Role of dendritic cell-derived CXCL13 in the pathogenesis of Bartonellahenselae B-rich granuloma. Blood. 2006;107(2):454–462
Resto-Ruiz S, Burgess A, Anderson BE. The role of the host immune response in pathogenesis of Bartonellahenselae.DNA and Cell Biology. 2003;22(6):431–440.
McCord AM, Resto-Ruiz SI, Anderson BE. Autocrine role for interleukin-8 in Bartonellahenselae-induced angiogenesis.Infection and Immunity. 2006;74(9):5185–5190.
Papadopoulos NG, Gourgiotis D, Bossios A, Fretzayas A, Moustaki M, Karpathios T. Circulating cytokines in patients with cat scratch disease. Clinical Infectious Diseases. 2001;33(6):e54–e56.
Glynn P, Coakley R, Kilgallen I, Murphy N, O’Neill S. Circulating interleukin 6 and interleukin 10 in community acquired pneumonia. Thorax. 1999;54(1):51–55. 27. Musso T, Badolato R, Ravarino D, et al. Interaction of Bartonellahenselae with the murine macrophage cell line J774: infection and proinflammatory response. Infection and Immunity. 2001;69(10):5974–5980.
Minnick MF, Battisti JM. Pestilence, persistence and pathogenicity: infection strategies of Bartonella. Future Microbiology. 2009;4(6):743–758.
Chiaraviglio L, Duong S, Brown DA, Birtles RJ, Kirby JE. An immunocompromised murine model of chronic Bartonella infection.American Journal of Pathology. 2010;176(6):2753–2763.
Santos R, Cardoso O, Rodrigues P, et al. Bacillary angiomatosis by Bartonellaquintana in an HIV-infected patient.Journal of the American Academy of Dermatology. 2000;42(2, part 1):299–301.
Schmid MC, Scheidegger F, Dehio M, et al. A translocated bacterial protein protects vascular endothelial cells from apoptosis. PLoS Pathogens. 2006;2(11):p. e115.
Chang CC, Chen YJ, Tseng CS, et al. A comparative study of the interaction of Bartonellahenselae strains with human endothelial cells. Veterinary Microbiology. 2011;149(1-2):147–156.
Lymedisease.org
Pediatric Infect Dis J. 2012 Feb 1.
Adelson ME et al. J ClinMicrobiol.2004; 42:2799-2801.
Hammoud K et al. eMedicine.com. 2008.
Rolain JM et al. Antimicrobial Agents Chemother. 2004 Jun;48(6):1921-33.
Bartonella are transmitted by fleas, body lice, and ticks – often accompanied by Lyme disease. The infection can be carried by flies in Peru’s Andes Mountains, Colombia, and Ecuador while human body lice carriers are found throughout the world. The European sheep tick is a known carrier while 5 different species of Bartonella have been detected in nearly 20 percent of I. Pacificus ticks collected throughout California.
Wide Range of Bartonellosis Symptoms co-infection of Chronic Lyme Disease
Lyme disease Co-Infection Bartonellosis symptoms can present as a mild infection or produce serious symptoms that affect the whole body. Early signs of the infection may include fever, fatigue, headache, reduced appetite, or an unusual streaked rash. The infection is also known to produce swollen glands around the head, neck, and arms. Another significant indicator of Bartonellosis is a disproportionate onset ofneurologic symptoms compared to those of other systemic Lyme disease symptoms. Bartonellosis patients may also suffer with gastritis, lower abdominal pain, sore soles, and tender subcutaneous nodules along the extremities. Enlarged lymph nodes are often accompanied by a sore throat. As the infection advances, more symptoms are likely to surface, including:
• Bacillary angiomatosis and peliosis hepatitis
• Carrión’s disease (includes both Oroya fever and verrugaperuana)
• Cat scratch fever
• Chronic fatigue syndrome
• Endocarditis – inflammation of the heart valves
• Erythema nodosum – inflammation of fat cells under the skin
• Recurrent bacteremia — bacteria in the blood
• Uveitis – eye inflammation
• Thrombocytopenic purpura – low blood platelet
Patients with Neurological Symptoms Susceptible to Seizuresfrom Chronic Lyme Disease
Encephalopathy, a brain disorder or disease is often realized among Bartonella patients. In fact, up to 50 percent of patients who develop Encephalopathy can be affected by seizures ranging from focal to generalized, and from brief and self-limited to status epilepticus. Additionally, sufferers of this Lyme disease co-infection may experience symptoms that include headaches, cognitive dysfunction, and even CNS lesions.
The Life Cycle and Spread of Bartonella
Bartonellatypically dwell within a preferred host animal without causing significant disease. For example, cats often carry B. henselae and B. clarridgeiae strains while wild rats harbor B. doshiae, B. grahamii, B. taylorii, and B. tribocorum.
Household pets, as well as ticks, fleas, sand flies, and body lice are common carriers of Bartonella. In humans, IV drug users who share syringes can pass on the Lyme disease co-infection, as well.
Once the infection reaches the bloodstream, it uses its tail-like flagellum to seek out red blood cells. At which point, it burrows directly into them. Once inside, it replicates by releasing a molecule which helps to produce more bacteria.
The Immune System is Criticalfor Long-term Bartonella Treatment
A patient’s immune system has the greatest impact on the impact of infection. Those who are infected with Bartonella but have an otherwise healthy immune system may experience only a short-lived and mild experience, whereas those who are immunocompromised may have high numbers of bacteria that persist in the blood and tissues, causing multiple ongoing symptoms.
Those who contract Lyme disease Complex are almost always going to be immunocompromised because of the sheer number of infections their immune systems must deal with simultaneously.
Envita prefers not to waste the time necessary to test for the infections, rather, we quickly identify the patients’ immune status and work efficiently to restore it to optimal functionality by integrating the best treatments from around the world – the foundation of all effective Lyme disease treatment.
Diagnosis Errors: False Negatives in Immuno-compromised Patients in Chronic Lyme Disease Bartonella
There are aspects of Lyme disease testing that allow medical personnel to identify Bartonella organisms through immunohistochemical staining. By and large, however, this diagnosis method is typically reserved for those with angiomatosis.
The DNA of various Bartonella species may also be amplified by PCR in blood, spinal fluid and tissue. Considering the cross-reactivity of antibody tests, PCR may very well be the most reliable method to identify such infection. And, while it is possible to do a culture of the organisms, they are generally slow-growing in the lab, limiting its usefulness as a method of diagnosis. It should be noted that false negative serological results may occur among the immunocompromised – a characterization that suits virtually all who suffer with Lyme disease symptoms.
Complications in Treatment
One difficulty that comes with Lyme disease treatment, in particular as it relates to Bartonellosis, has to do with the effect of antibiotics – they tend to slow down the bacteria’s reproduction, but typically do not kill the infection.Another challenge comes from the disease’s location as Bartonella is often sequestered inside the erythrocytes, or red blood cells, making them harder to deal with. This,combined with an already weakened immune system further complicates treatment. On top of this, Lyme disease patients often simultaneously face borreliosis, candida, HHV-6 and/or are dealing with other toxins such as heavy metals to further complicate matters.
BartonellaCharacteristics Allowing for Immune Evasion
The makeup Bartonellalipopolysaccaride (LPS) includes Lipid A as well as long-chain fatty acids that allow the bacteria to evade the immune system. Data have shown Bartonella’s surface molecules go unrecognized by TLR-4 on dendritic cells and macrophages – a recipe for persistent infection. Moreover, B. henselae avoids lysosomal fusion and acidification once the bacteria invade endothelial cells and macrophages. Precisely how local bacterial control is lost in immunocompromised subjects remains unclear, but is an area of great significance for those facing Lyme disease treatment.
Bacterial Persistence: Pro- and Anti-Inflammatory Response
Clincal and in vitro studies implicated a Th1 immune response to Bartonella infection. The old Bartonella skin test required an injection of suppurative material derived from the lymph nodes of catch scratch disease patients. Results were considered positive if a large erythematous area developed on the skin within two days. This delayed-type hypersensitivity reaction is mediated through the Th1 immune response.
In other Lyme disease testing, a Th1 response was also supported through in vitro studies among mice with splenocytes who showed an increase in the production of Th1 cytokines in response to B. henselea. Elevated IL-8 demonstrates the role of innate immunity in response to the same B. henselea.
The role of cytokines in acute and chronic Bartonella infection was considered in various other studies. Immune competent subjects with CSD suffering acute infections revealed upregulation of proinflammatory and anti-inflammatory cytokines. On the other hand, low CD4 counts have been associated with elevated IL-10 levels during times of acute Bartonella infection.
Lyme disease testing must consider effects on the immunocompromised as most patients fit this category. In such circumstance, Bartonellosistypically revolves around the establishment of bacterial stimulated angiogenesis. Unfortunately, understanding the details regarding Bartonella species has been greatly delayed for lack of a useful animal model.
As it is clear that response as it pertains to a competent immune system involves Th1 and innate immunity (macrophages) we may conclude that HIV-positive patients (as well as others who are immunodeficient in these areas including Lyme disease symptoms sufferers) would find it extremely challenging to limit this infection in such a manner. That being said, we cannot say definitively that this is the method by which HIV aids the spread of Bartonella.
What we do know is that intraerythrocytic persistence is characteristic of infections within immune-competent hosts. Endothelial and periendothelial persistence leading to vasoproliferation is a characteristic exhibited among the immunocompromised.
Angiogenesis in Bartonella Complications Co-infection of Lyme Disease
The most common disease resultant of B. buintana and B. henselae infections is angiomatosis, particularly in those with cell-mediated immunodeficiency resultant of HIV or posttransplant patients on immunosuppressive therapy. Manifestations of antiomatosisinclude its characteristic vasoproliferative lesion, bacillary angiomatosis, and others due to both direct and indirect effects on endothelial cells.
Additional issues with these strains are sustained as the infections persist inlocalized areas, reproducing within collagen tissue. This results in an antiapoptic state in the endolthelial cells, resultant of effector protein excretion – ultimately causing cell proliferation.
Extensive Lyme disease testing relating to its co-infections has shown that Bartonella may also play a significant role in the development of bacillary angiomatosis, as elevated levels have been detected in both animal and human studies. However, this is not the case among immune-competent subjects with CSD who experience an increase in leukocyte rolling and adhesion causing an environment of significant inflammation.
Envita Medical Centers Leader in Chronic Lyme Disease Treatment
To learn more about these infection and related symptoms of fatigue, chronic fatigue syndrome and fibromyalgia like symptoms contact Envita medical Centers leader in Chronic disease solutions.
REF:
Clinical and Development Immunology. 2012; 2012: 612809.
Published online 2011 November 17
Hornef MW, Wick MJ, Rhen M, Normark S. Bacterial strategies for overcoming host innate and adaptive immune responses. Nature Immunology. 2002;3(11):1033–1040. [PubMed]
Huarcaya E, Best I, Rodriguez-Tafur J, et al. Cytokines and T-cell lymphocytes count in patients in the acute and chronic phases of Bartonellabacilliformis infection in an endemic area in Peru: a pilot study. Revista do Instituto de Medicina Tropical de Sao Paulo. 2011;53(3):149–154. [PubMed]
Matera G, Liberto MC, Quirino A, et al. Bartonellaquintana lipopolysaccharide effects on leukocytes, CXC chemokines and apoptosis: a study on the human whole blood and a rat model. International Immunopharmacology. 2003;3(6):853–864. [PubMed]
Zähringer U, Lindner B, Knirel YA, et al. Structure and biological activity of the short-chain lipopolysaccharide from Bartonellahenselae ATCC 49882T. Journal of Biological Chemistry. 2004;279(20):21046–21054.
Popa C, Abdollahi-Roodsaz S, Joosten LAB, et al. Bartonellaquintana lipopolysaccharide is a natural antagonist of toll-like receptor 4. Infection and Immunity. 2007;75(10):4831–4837.
Matera G, Liberto MC, Joosten LAB, et al. The janus face of Bartonellaquintana recognition by toll-like receptors (TLRs): a review. European Cytokine Network. 2008;19(3):113–118.
Kyme PA, Haas A, Schaller M, Peschel A, Iredell J, Kempf VAJ. Unusual trafficking pattern of Bartonellahenselae-containing vacuoles in macrophages and endothelial cells.Cellular Microbiology. 2005;7(7):1019–1034.
Vermi W, Facchetti F, Riboldi E, et al. Role of dendritic cell-derived CXCL13 in the pathogenesis of Bartonellahenselae B-rich granuloma. Blood. 2006;107(2):454–462
Resto-Ruiz S, Burgess A, Anderson BE. The role of the host immune response in pathogenesis of Bartonellahenselae.DNA and Cell Biology. 2003;22(6):431–440.
McCord AM, Resto-Ruiz SI, Anderson BE. Autocrine role for interleukin-8 in Bartonellahenselae-induced angiogenesis.Infection and Immunity. 2006;74(9):5185–5190.
Papadopoulos NG, Gourgiotis D, Bossios A, Fretzayas A, Moustaki M, Karpathios T. Circulating cytokines in patients with cat scratch disease. Clinical Infectious Diseases. 2001;33(6):e54–e56.
Glynn P, Coakley R, Kilgallen I, Murphy N, O’Neill S. Circulating interleukin 6 and interleukin 10 in community acquired pneumonia. Thorax. 1999;54(1):51–55. 27. Musso T, Badolato R, Ravarino D, et al. Interaction of Bartonellahenselae with the murine macrophage cell line J774: infection and proinflammatory response. Infection and Immunity. 2001;69(10):5974–5980.
Minnick MF, Battisti JM. Pestilence, persistence and pathogenicity: infection strategies of Bartonella. Future Microbiology. 2009;4(6):743–758.
Chiaraviglio L, Duong S, Brown DA, Birtles RJ, Kirby JE. An immunocompromised murine model of chronic Bartonella infection.American Journal of Pathology. 2010;176(6):2753–2763.
Santos R, Cardoso O, Rodrigues P, et al. Bacillary angiomatosis by Bartonellaquintana in an HIV-infected patient.Journal of the American Academy of Dermatology. 2000;42(2, part 1):299–301.
Schmid MC, Scheidegger F, Dehio M, et al. A translocated bacterial protein protects vascular endothelial cells from apoptosis. PLoS Pathogens. 2006;2(11):p. e115.
Chang CC, Chen YJ, Tseng CS, et al. A comparative study of the interaction of Bartonellahenselae strains with human endothelial cells. Veterinary Microbiology. 2011;149(1-2):147–156.
Lymedisease.org
Pediatric Infect Dis J. 2012 Feb 1.
Adelson ME et al. J ClinMicrobiol.2004; 42:2799-2801.
Hammoud K et al. eMedicine.com. 2008.
Rolain JM et al. Antimicrobial Agents Chemother. 2004 Jun;48(6):1921-33.