Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics

Abstract

The diagnostic tests available to identify vector-borne pathogens have major limitations. Clinicians must consider an assortment of often diverse symptoms to decide what pathogen or pathogens to suspect and test for. Even then, there are limitations to the currently available indirect detection methods, such as serology, or direct detection methods such as molecular tests with or without culture enrichment. Bartonella spp., which are considered stealth pathogens, are particularly difficult to detect and diagnose. We present a case report of a patient who experienced a spider bite followed by myalgia, lymphadenopathy, and trouble sleeping. She did not test positive for Bartonella spp. through clinically available testing. Her symptoms progressed and she was told she needed a double hip replacement. Prior to the surgery, her blood was submitted for novel molecular testing, where Bartonella spp. was confirmed, and a spirochete was also detected. Additional testing using novel methods over a period of five years found Bartonella henselae and Borrelia burgdorferi in her blood. This patient’s case is an example of why new diagnostic methods for vector-borne pathogens are urgently needed and why new knowledge of the variable manifestations of Bartonellosis need to be provided to the medical community to inform and heighten their index of suspicion.

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

“…That patient had never received high-dose dapsone combination therapy. Bartonella is a known stealth pathogen that can hide in the intracellular compartment and periodically seed into the bloodstream [159], and its persistence may be underestimated due to the broad range of species and limitations of present diagnostic testing [160]. Case number 2, highlighted here, who is now in remission, had neuropsychiatric symptoms along with classic Bartonella striae.…”

“…The optimal length of time in between pulses to rapidly eradicate persisters has been recently addressed using a methodology where the bactericidal effectiveness of periodic pulse dosing depended primarily on the ratio of durations of the corresponding on and off parts of the pulse [227]. The methodology relies on explicit formulas that make use of easily obtainable data from time-growth and time-kill experiments with a bacterial population exposed to antibiotics [227] and could be conducted for both Borrelia burgdorferi and Bartonella henselae since both have biofilm/persister forms in culture and in vitro [82][83][84]153,158,160,228,229].…”