What are the symptoms of bartonellosis?

Symptoms range from mild to severe, and differ depending on whether the infection is recent — known as an acute infection — or long-standing, known as a chronic infection. A person may also carry the bacteria without showing any signs, or the first symptoms may not appear until months or even years after transmission [2].

I - Acute infection:

Symptoms usually appear 5 to 14 days after transmission. Most commonly: fever, headache, fatigue, loss of appetite, difficulty concentrating, muscle pain, and swollen lymph nodes around the head, neck and arms [15-16].

One sign is particularly suggestive, although not always present: skin lesions of various shapes, sometimes mistaken for stretch marks [3].

Journal of Central Nervous System Disease

Pathogens Journal - 2020

II - Chronic infection:

After the acute phase — or without any initial symptoms — the infection can become long-lasting. The bacterium spreads to the blood vessels, the lymphatic system and various organs.

Symptoms then become very diverse: nervous system disorders, heart conditions such as endocarditis, psychiatric manifestations [4-17-18-19-20-21].

Some are specific to bartonellosis; others are also found in co-infections such as babesiosis or Lyme borreliosis [23-24].

Symptoms specific to bartonellosis

• Rashes or skin lesions (see images above)

• Pain in the soles of the feet, especially with the first steps in the morning

• Pain on the inside of the shins

• Swollen, tender lymph nodes in the neck

• Extreme anger or rage

Symptoms shared with other infections

• General signs — fatigue, weakness, high fever at first, then persistent mild fever

• Memory and concentration — cognitive disorders, “brain fog”

• Mood — depression, anxiety, obsessive disorders, psychosis

• Pain — headaches, muscle and joint pain, sore throat

• Nervous system — epilepsy, excitotoxicity

• Heart — rhythm disorders, chills, endocarditis, chest pain

• Sleep — sleep disorders, insomnia

• Vision and hearing — visual disturbances, eye infections, sensitivity to light and sound

• Digestion and bladder — nausea, constipation, diarrhea, gastritis, irritable bowel syndrome, interstitial cystitis, irritable bladder

• Teeth and gums — toothache with no visible decay, bleeding gums, sensitivity to cold

Sources: [1-2-3-4-14-15-16-17-18-19-20-21-22]

It is possible to have only some of the symptoms.

Step I - Symptom assessment

The diagnosis of bartonellosis relies primarily on clinical examination: symptoms, medical history and physical examination. A thorough medical consultation with a specialist is therefore essential.

Many symptoms are shared with Lyme borreliosis and babesiosis [23-24]. It is not uncommon for some people to have several infections at once [4-5-7-8].

The questionnaire by Dr. Horowitz, a specialist in borreliosis and co-infections, helps assess the likelihood of an infection.

Step II - Microbiological testing

It is important to know that there is not yet any fully reliable blood test. Recent tests are better (see below), but they only serve to support the clinical diagnosis: a negative test does not rule out an infection [15-17].

1. The official tests in Switzerland:

In Switzerland, two tests are used:

• IFA — measures antibodies, i.e. the immune system's response, not the bacterium itself. It misses many infections: one study found a detection rate of only 6% [25]. It generally only recognizes 1 to 2 of the more than 10 Bartonella species present in Switzerland [16].

• PCR — looks directly for the bacterium's DNA and works for all species. However, Bartonella hides inside cells, which makes it difficult to detect in the blood [6-15].

2. Other possible tests:

There are newer, much more sensitive tests that can detect more Bartonella species. They are not recognized for diagnosis in Switzerland: they are performed in laboratories in Belgium, Germany and the USA.

Sources: [26-27-28]

There are no large-scale studies on these tests yet, but they are widely used by specialist physicians who are members of ILADS.

3. Other microbiological analyses:

Bartonella grows mainly in the inner lining of blood vessels. To multiply there, it causes the body to produce a substance called VEGF. A high VEGF level can therefore indicate an active infection [29].