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Bartonella: Considerations, Signs, and Symptoms

by Wayne Anderson, ND

Disclaimer: Given the fact that Borrelia and the co-infections all have the same mechanisms of action there is significant symptom overlap. These symptom pictures are meant to be used as templates that will vary given the individual patient’s comorbidities, strengths and weaknesses.

About Bartonella

Differentiating Bartonella from Babesia is like comparing shades of gray. They have many of the same symptoms with different intensities.

The main difference between the two is that Bartonella will be more painful. It likes the joints and periarticular areas. The pain migrates, affecting different joints at different times. It is usually unilateral and gets mistaken for arthritis in its intensity.

Key to note for Bartonella is sensations of pain in the soles of the feet. Headaches are a defining symptom of Bartonella, as Babesia usually has more head pressure. Bartonella is not as smart as Babesia, it stays more superficial, affecting skin, and mucous membranes. The skin can have sores like acne, stria, subcutaneous nodules. The skin can have weird sensations like crawling (formication), burning, or other types of neuropathy.

The Bartonella patient will have low-grade sore throat and gastritis. Bartonella lives in the liver and spleen. It can cause mildly elevated liver enzymes and lymph node swelling. It can cause all the same cognitive, memory, and mood problems as Babesia, but not as extreme. When Bartonella and Babesia come together, these symptoms are additive, making for a very impaired patient. Bartonella patients are more hot, and can have low grade fevers, as Babesia patients tend to chill.

It can have acute and/or chronic patterns and is remarkably common in patients with chronic neurological symptoms, especially when dominated by pain.

Common Symptoms of Bartonella

  • Fatigue-like illness, but “Wired-Tired” (often mistaken for CFIDS).
  • All forms of headache: migraine, tension, cluster, mixed type.
  • Joint pains, extremities, large and small (knee, shoulders, hands, etc).
  • Pain will be wandering, joint to joint, switching side to side, and seldom bilateral.
  • Can settle in previously injured joints, making them worse and more chronic.
  • Can swell a joint (especially the knee and fingers).
  • Can be mistaken for fibromyalgia.
  • More likely to affect surface membranes, causing skin problems, striae, nodular lumps under the skin, etc. (Probably involved in Morgellons Disease)
  • Gastritis (In the absence of H. pylori must be the next diagnostic consideration).
  • Since it settles in the liver, it will compromise liver function, episodically elevating liver enzymes. When liver enzymes are mildly elevated (5-20 on ALT and/or AST) without an explanation, think Bartonella.
  • Lymphadenopathy, often neck but can be in any node depending on individual structure compromise.
  • Settles in the spleen, often subtle splenomegaly.

Chronic Bartonella Symptoms Organized by Organ Systems:

Pain/Joint Pain
  • Joint pain in knees can be large or small joints.
  • Usually wandering, unilateral, can be swollen and seldom hot.
  • Often periarticular.
  • Minor joint trauma takes longer than normal to heal.
Head
  • Headaches can be severe.
  • Ice pick, in and around eyes.
  • Migraine
  • Unlike Babesia, which has more pressure, Bartonella would be described as “weird sensations.”
  • Same cognitive, memory, and emotional symptoms as Babesia but milder, not as disabling.

These encephalopathic symptom differences between Babesia and Bartonella are an attempt at distinguishing between subtle shades of gray.

Lymphatic System
  • Mild splenomegaly.
  • Boggy lymphadenopathy is seldom hard but often painful.
  • Worse cervical chains, popliteal fossa, and thoracic duct.
  • Vague tightness of chest.
  • Puffy supraclavicular, left over right.
  • Painful chest wall, mid to upper sternum.
Eyes
  • Conjunctivitis.
  • Pain in and around eyes.
  • Intermittent blurred vision.
Throat
  • Mild sore throat, worse with stress, upon waking, Feels like “just about to get sore throat.
Gastrointestinal
  • Gastritis.
  • Dysmotility.
  • Worse esophagus.
  • Occasional difficulty swallowing.
Liver/Gallbladder
  • Mild hepatomegaly.
  • Mildly elevated liver enzymes.
  • Gallbladder dysfunction.
  • GERD.
  • Right Upper Quadrant (RUQ) pain.
Skin
  • Rashes, papular, stria, abdominal and upper legs, acne, crusty scalp.
  • Subcutaneous nodules can be tender.
  • Crawling, burning, multiple sensations.
Feet
  • Sensitive, painful soles, worse getting out of bed and standing, usually bilateral.
  • Painful bones of the feet, foot, and ankle can both be painful, but unlike the soles, they are usually unilateral.

Possible Physical Exam Findings:

  • Lymph node swelling.
  • Striae: abdomen, upper legs.
  • Papulovesicular rash.
  • Fever.
  • Photophobia.
  • Fasciculations.
  • Hepatomegaly.
  • Mild Splenomegaly.
  • Gastritis.
  • Subcutaneous nodules.

Possible Physical Presentations:

  • Can have long dormant stages that are asymptomatic between acute episodes.
  • Can last for weeks to months.
  • Can have a relapsing acute form for months.
  • Like the worst flu I ever had!” Can be mistaken for Mono.
  • Fever, chills, some sweats.
  • Swollen lymph glands, sore throat.
  • Hepatosplenomegaly (can cause mildly elevated liver enzymes).
  • Significant body aches and joint pains.
  • Headache, along with other subclinical encephalopathy symptoms.