The pain of Bartonella

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The pain of Bartonella

_http://www.newsobserver.com/2010/05/21/492795/the-pain-of-bartonella.html_

(http://www.newsobserver.com/2010/05/21/492795/the-pain-of-bartonella.html)

BY SARAH AVERY - Staff Writer

A bacterial infection typically spread by fleas, lice and biting flies

could be more prevalent than many think, and may have been transmitted from a

mother to her children at birth, scientists from N.C. State University say.

Dr. Breitschwerdt, an infectious disease veterinarian and one of

the world's leading researchers of bacteria called Bartonella, has for the

first time documented evidence that the pathogen may have been passed between

family members.

Although more studies are needed to back up his findings, Breitschwerdt

and colleagues describe the case of a mother and father who began battling

chronic aches, fatigues and other symptoms soon after they were married. When

their twins were born in 1998, the daughter died after nine days from a

heart defect, and the son developed chronic health problems.

Using tissue from the daughter's autopsy and blood from the surviving

family members, Breitschwerdt's team discovered that the entire family was

infected with the same species of Bartonella bacteria, despite having no shared

exposures to flea or lice infestations. Bartonella is known to causes such

illnesses as trench fever and cat scratch disease, and it is increasingly

suspected of triggering a variety of aches and inflammations that doctors

have been unable to diagnose.

" I think we have stumbled across something that is of monumental medical

importance, " said Breitschwerdt, whose findings were published recently in

the Journal of Clinical Microbiology.

Proving the mother-child transmission could be difficult, however. Little

funding is available for such research because the bacteria are still not

considered a major source of human disease.

Dr. Kosoy, who heads the Bartonella laboratory for the Centers for

Disease Control and Prevention in Fort , Colo., said scientists are

only beginning to build evidence that Bartonella infections may be more

common than previously thought.

" Bartonella are circulated around the world in many animals, but there are

different Bartonella species, and the question is how can they be

transmitted to humans? " Kosoy said, noting that most known cases have been

transmitted from biting insects. He said the NCSU findings about the potential

family transmission are compelling but inconclusive.

Dozens of strains

At least 26 strains of Bartonella have been named worldwide, and the list

is growing. The most notorious Bartonella infection is cat scratch disease,

a fever illness passed to humans from flea-infected cats. Fleas are the

primary hosts, and they spread the bacteria in their feces.

Other Bartonella strains spread more serious diseases. Kosoy is studying

how often heart inflammation is caused by a Bartonella that thrives among

rat fleas in Thailand. He has already established that about 25 percent of

unexplained fever illnesses among a group of patients there was caused by

Bartonella .

" This is not limited to cat scratch, " Kosoy said. " That's just the tip of

the iceberg. "

Breitschwerdt said he thinks the bacteria may be the hidden cause behind a

host of chronic symptoms - muscle aches, neurological problems, fatigue,

arthritis - that defy diagnosis.

About two years ago, Breitschwerdt began testing blood samples from a

doctor in land, who was curious whether Bartonella infections might be

causing problems for some of his patients.

" There are lab tests showing inflammation, " but no discernible cause, said

Dr. Mozayeni, a Yale-educated rheumatologist who practices in

Rockville, Md.

Mozayeni contacted Breitschwerdt and his NCSU colleague, Maggi,

who together developed a more sensitive test for Bartonella. Routine blood

tests fail to detect Bartonella because they search for antibodies that the

body is slow to produce.

Instead, Breitschwerdt and Maggi figured out how to cultivate the bacteria

in the laboratory from blood samples of infected people. They founded a

company called Galaxy Diagnostics to handle the laboratory volume.

Of Mozayeni's mystery patients tested at the lab, nearly 20 percent had

Bartonella infections.

" I suspect this is going to be one of the causes of rheumatoid arthritis

and a few other things, but it's too speculative right now to say, " Mozayeni

said.

Human testing

More studies are needed, and Mozayeni has joined Breitschwerdt and Maggi

in the diagnostic company to oversee human testing.

" Certainly, the prevalence of Bartonella infection in people with chronic

illness is higher than I would have ever guessed, but we still don't know

what that means, " Breitschwerdt said.

Among the biggest unknowns is how to treat people who have been infected.

The effectiveness of antibiotics depends on which strain of Bartonella is

at work, and with so many strains, treatments can be hit or miss.

Breitschwerdt said the family in his most recent study declined to comment

about their experience. He said they were having difficulty finding a

doctor.

" It is very difficult to find a physician who wants to see someone with a

chronic illness that is poorly defined, " he said, adding that many such

patients often think they have Lyme disease, a tick-borne bacterial infection

with similar symptoms - and stigma. " With an unexplained illness, it

becomes problematic. "

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