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The 2nd European Crypto-Infections Conference presented by the Lyme Resource Centre was held September 26 – 27 2020. This event focused on difficult-to-detect tick-borne pathogens implicated in chronic illnesses affecting both people and animals. An hour-long video of Dr. Robert Mozayeni, Galaxy’s medical director, discussing his experience with bartonellosis patients over the past 13 years is now available to the public. The video and a brief description of the content can be seen below:
Dr. Mozayeni discusses various topics related to Bartonella throughout this provider-focused presentation, including biology, disease manifestations, diagnostic approaches, and therapeutic considerations.
- Bartonella species are slow-growing, immune-evasive bacteria that are known or suspected to be transmitted to people and animals by fleas, lice, ticks, and other insect vectors. The acute disease presentation, cat scratch disease caused by Bartonella henselae, is recognized by the medical community. However, chronic Bartonella infection is poorly understood and underdiagnosed because it has non-specific symptoms that often overlap with other complex diseases, like Lyme borreliosis.
- Dr. Mozayeni explains that Bartonella species infect the endothelial cells lining the blood vessels, resulting in biofilms and vascular inflammation in many areas of the body. This causes small vessel disease and leads to a diverse host response across affected individuals. Rather than an infectious disease, chronic Bartonella infection could be considered a “host-response” disease.
- Research over the past 10-15 years has led to a better understanding of some chronic manifestations of bartonellosis, such as neuropsychiatric symptoms and skin lesions. Dr. Mozayeni shares pictures of the skin lesions he has observed in his patient population and how they can change over time. He also highlights a couple of publications focused on neuropsychiatric patients with Bartonella-associated cutaneous lesions:
- Dr. Mozayeni discusses the challenges of diagnosing bartonellosis and the caveats to the various molecular and serology test methods that are currently available. Although bartonellosis can be a clinical diagnosis, laboratory evidence can be helpful in confirming a suspected infection and monitoring treatment. He recommends using both molecular and serology test methods because one method may not work in every case. He illustrates this point with a 2012 publication co-authored by Galaxy scientists showing that IFA serology and PCR on blood or enrichment culture all detected positives that were missed by the other methods.
- The video ends with a discussion of therapeutic recommendations based on his experience and some newer options, like methylene blue, that show promise for certain segments of his patient population but need further research.
Links to more presentations from this event can be found here.
References
Breitschwerdt, E. B. et al. (2019). Bartonella henselae bloodstream infection in a boy with pediatric acute-onset neuropsychiatric syndrome. Journal of Central Nervous System Disease, 11, 1-8. 10.1177/1179573519832014
Maluki, A. et al. (2020). Imaging analysis of Bartonella species in the skin using single-photon and multi-photon (second harmonic generation) laser scanning microscopy. Clinical Case Reports, 8(8), 1564-1570. 10.1002/ccr3.2939
Maggi, R. G. et al (2012). Bartonella spp. Bacteremia and Rheumatic symptoms in Patients from Lyme Disease-endemic Region. Emerging Infectious Diseases, 18 (5), 783-791. 10.3201/eid1805.111366