Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy

Maluki, Azar Hadi; Breitschwerdt, Edward B.; Bemis, Lynne T.; Greenberg, Rosalie; Mozayeni, B. Robert; Dencklau, Jamie; Ericson, Marna E.

doi:10.1002/ccr3.2939

Cited by 5 publications

(5 citation statements)

References 44 publications

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“…This has particular importance from a public health perspective, considering that Lyme disease has been associated with suicidal ideation [239], where individuals with Lyme borreliosis have higher rates of any mental or affective disorders, suicide attempts, and death by suicide compared to those without Lyme borreliosis [240]. Similarly, bartonellosis has recently been reported to have a high association with neuropsychiatric symptoms, especially in those presenting with Bartonella striae [163,164,241], which were present in two out of three of our patients. The treatment of Lyme disease and its associated co-infections, including Bartonella, using pulsed dapsone combination therapy relieved these resistant neuropsychiatric symptoms that had not been previously controlled with psychiatric medications.…”

Section: Discussionmentioning

confidence: 68%

“…Her symptoms started in 2008 when she was living in the woods in Germany, in a highly endemic area for Lyme disease [163]. She had striae, which developed on her flanks, buttocks, and inner thighs, and had cats growing up, receiving multiple bites and scratches; yet, she had never been diagnosed with Bartonella [164]. Despite increasing fatigue, migratory myalgias, migratory neuropathy, cognitive difficulties, and severe neuropsychiatric symptoms, it took four years for the patient to be diagnosed with chronic Lyme disease, relapsing fever, Babesia duncani, and anaplasmosis, although migratory muscle and joint pain, and especially migratory nerve pain, is a characteristic clinical symptom of chronic Lyme disease [165]; relapsing and remitting night sweats in a young woman is indicative of a possible infection with Babesia spp.…”

Section: Discussionmentioning

confidence: 99%

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Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

Horowitz,

Fallon,

Freeman

2024

Microorganisms

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Three patients with relapsing and remitting borreliosis, babesiosis, and bartonellosis, despite extended anti-infective therapy, were prescribed double-dose dapsone combination therapy (DDDCT) for 8 weeks, followed by one or several two-week courses of pulsed high-dose dapsone combination therapy (HDDCT). We discuss these patients’ cases to illustrate three important variables required for long-term remission. First, diagnosing and treating active co-infections, including Babesia and Bartonella were important. Babesia required rotations of multiple anti-malarial drug combinations and herbal therapies, and Bartonella required one or several 6-day HDDCT pulses to achieve clinical remission. Second, all prior oral, intramuscular (IM), and/or intravenous (IV) antibiotics used for chronic Lyme disease (CLD)/post-treatment Lyme disease syndrome (PTLDS), irrespective of the length of administration, were inferior in efficacy to short-term pulsed biofilm/persister drug combination therapy i.e., dapsone, rifampin, methylene blue, and pyrazinamide, which improved resistant fatigue, pain, headaches, insomnia, and neuropsychiatric symptoms. Lastly, addressing multiple factors on the 16-point multiple systemic infectious disease syndrome (MSIDS) model was important in achieving remission. In conclusion, DDDCT with one or several 6–7-day pulses of HDDCT, while addressing abnormalities on the 16-point MSIDS map, could represent a novel effective clinical and anti-infective strategy in CLD/PTLDS and associated co-infections including Bartonella.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

Horowitz,

Fallon,

Freeman

2024

Microorganisms

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“…Bartonella immunoreactivity has been detected in skin-tissue biopsies in these lesions. 97 Further evidence of Bartonella infection in this patient is the provocation of Jarisch-Herxheimer reactions when she was started on SXT, or the dose of SXT was increased; when SXT was introduced, she experienced an increase in hip pain and was more adamant in her refusal to eat, and SXT has anti-Bartonella activity. 98 Bartonella is a common co-infection of Lyme borreliosis.…”

Section: Discussionmentioning

confidence: 82%

Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study

Kinderlehrer¹

2021

IMCRJ

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The etiology of anorexia nervosa (AN) is multifactorial, and infections may play a contributory and possibly a prominent role. A case is presented which is indicative of a causal association between tick-borne infections and AN. This adolescent female was diagnosed with AN at an eating disorder clinic after excessive food restriction and an irrational fear of weight gain necessitating nasogastric tube feeding. Her history was consistent with systemic infections and she tested serologically positive to Borrelia burgdorferi, Babesia microti, and Mycoplasma pneumoniae; in addition, her clinical presentation was consistent with a Bartonella infection. After treatment with oral and intravenous antimicrobials, she stopped food restriction and no longer had body image concerns. Physicians should be aware of the possibility that tick-borne infections could underly a diagnosis of AN. The role of tick-borne infections in the etiology of AN warrants further study.

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“…In this patient, the cutaneous lesions and neuropsychiatric symptoms resolved with antimicrobial therapy [8]. In 2020, three additional children with neuropsychiatric symptoms and concurrent cutaneous lesions, referred to as "Bartonella tracks", were described [9]. Due to variability in the cutaneous lesions in patients with acute-onset CSD and in those with chronic symptoms and blood stream infections, we propose the more inclusive designation encompassing historical terms (striae and tracks) to describe the overall spectrum of lesions as Bartonella-Associated Cutaneous Lesions (BACL).…”

Section: Introductionmentioning

confidence: 89%

Bartonella Associated Cutaneous Lesions (BACL) in People with Neuropsychiatric Symptoms

et al. 2020

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Bartonella species are globally important emerging pathogens that were not known to infect animals or humans in North America prior to the human immunodeficiency virus (HIV) epidemic. Ongoing improvements in diagnostic testing modalities have allowed for the discovery of Bartonella species (spp.) DNA in blood; cerebrospinal fluid; and the skin of patients with cutaneous lesions, fatigue, myalgia, and neurological symptoms. We describe Bartonella spp. test results for participants reporting neuropsychiatric symptoms, the majority of whom reported the concurrent development of cutaneous lesions. Study participants completed a medical history, a risk factor questionnaire, and provided cutaneous lesion photographs. Bartonella spp. serology and Bartonella alpha proteobacteria enrichment blood culture/PCR were assessed. Within a 14-month period, 33 participants enrolled; 29/33 had serological and/or PCR evidence supporting Bartonella spp. infection, of whom 24 reported concurrent cutaneous lesions since neuropsychiatric symptom onset. We conclude that cutaneous lesions were common among people reporting neuropsychiatric symptoms and Bartonella spp. infection or exposure. Additional studies, using sensitive microbiological and imaging techniques, are needed to determine if, or to what extent, Bartonella spp. might contribute to cutaneous lesions and neuropsychiatric symptoms in patients.

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Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy

Abstract: We demonstrate Bartonella spp are abundant in skin lesions resembling striae distensae. These striae distensae‐like lesions, coincidental with sudden onset of neuropsychiatric symptoms, indicate testing for suspected Bartonella spp. infection.

Cited by 5 publications

References 44 publications

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study

Bartonella Associated Cutaneous Lesions (BACL) in People with Neuropsychiatric Symptoms

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