Dr. Kyle Warren
Meghan Feir Walker
Although it's the third most common tick-borne infection, Bartonella often gets overlooked in standard medicine. When a patient tells me they’ve tried to do everything right and test normal for conditions at their doctor’s office, yet they still feel miserable, oftentimes, the missing piece of the puzzle is not only chronic Lyme, but an accompanying co-infection like Bartonella.
Bartonella is a stealth infection that can complicate recovery, amplify symptoms, and make standard protocols less effective. It’s not always obvious, not always found in standard testing, and often overlooked — even by well-meaning doctors. As someone who has walked this journey both personally and professionally, I can tell you: When Bartonella is missed, recovery from Lyme often stalls.
Key takeaways
• Bartonella is the third most common tick-borne infection and can complicate recovery from chronic Lyme.
• Bartonella is a separate infection from Lyme. While it spreads through ticks, it can also spread through vectors like fleas, lice, and animal scratches.
• Symptoms are wide-ranging: Fatigue, neurological changes, mental health problems, skin rashes, swollen lymph nodes, and foot and shin pain are among the most common.
• Bartonella can persist for weeks to years, often cycling or shifting over time.
• Skin signs like red streaks can be a clear sign that it’s a Bartonella infection.
• Because Bartonella can affect multiple systems at once, a functional approach is often necessary.
What is Bartonella?
In 93% of chronic Lyme patients, at least one co-infection is paired with Lyme disease, making life even more of a complicated struggle. And for the record, you don’t have to have Lyme to have a co-infection.
While Lyme disease (Borrelia) is the No. 1 most common tick-borne disease that gets transmitted to humans, and Babesia is the second most common, Bartonella is next in line as the third most common tick co-infection. While it can mimic Lyme disease in certain ways with the symptoms it creates, it’s quite different from how Lyme works. This is why, when you’re fighting Bartonella alone or Bartonella paired with Lyme or other infections, you need to know what adjustments to make in your protocol in order to be successful and heal.
One of the most frustrating things about Bartonella is that when you Google it, you primarily only get information about cat scratch disease (CSD) or “cat scratch fever,” which is a huge oversight. You don’t see information about it being the third most common tick-borne disease that has been rapidly spreading.
Ticks can carry a large menu of diseases, so one tick bite can give you a number of infections. While Lyme can be spread through more than just tick bites, ticks are Lyme’s primary vector. But it’s important to note that Bartonella can be spread through fleas and animal scratches as well, particularly from cats.
While it’s estimated that roughly 15% of cats carry Bartonella, and you can indeed get it through a cat scratch or cat saliva, Bartonella can also be transmitted through ticks, fleas, lice, and other animals’ bites or scratches.
If you were to talk with a veterinarian, you’d discover they know much more than regular doctors about vector-borne diseases like Bartonella and Lyme disease. Lyme, Bartonella, and many of the other common Lyme disease co-infections are familiar territory in the veterinary field. Being around animals every day, their chances of getting infected with Bartonella are much higher.
However, what’s sad is that Lyme disease and co-infections are much more common in humans than doctors realize, and it’s only been spreading, yet they, in general, know so little about these tick-borne diseases. This causes many patients to fall through the cracks of the medical system for years without effective help.
How many species of Bartonella are there?
While there are more than 45 known species of Bartonella, only around seven of those are known to infect humans, including B. henselae, B. bacilliformis, B. quintana, B. vinsonii, B. grahamii, B. elizabethae, and B. koehlerae.
Whenever we suspect a patient may have Bartonella, we routinely test four strains of Bartonella, including Bartonella henselae (the most common and well-known strain), Bartonella quintana, Bartonella vinsonii, and Bartonella elizabethae. In certain patients, more advanced Bartonella testing is available if needed, but I can almost always find Bartonella with my standard testing panel when I suspect it due to symptoms.
Bartonella species, like Lyme species, have been discovered over time, one by one. For many years, we thought these were region-specific strains, but with how consistently animals, birds, and the ticks hitching a ride on these travelers go to other areas, these diseases have rapidly spread.
Why it’s often missed: Testing for Bartonella
As with testing for Lyme disease, Bartonella shares many of the same frustrations. Whether it’s only testing for one species or not testing at all, these tick-borne diseases are often tested using outdated or inadequate testing methods, or they get ignored entirely.
Where regular doctors test for one species of Lyme, Borrelia burgdorferi, we test for 18 species. With Bartonella, the grand majority of doctors never even test for it. It’s just not on their radar as the CDC stresses the cat vector for this disease and misses the larger tick-borne way of transmission. And if a doctor does test for it, at the request of the patient, they are typically only testing Bartonella henselae. We normally run testing for four different species.
I have seen some examples where patients are tested for Lyme, Babesia, Anaplasma, or Ehrlichia, but somehow Bartonella is overlooked.
But it's extremely important to run Bartonella testing when you're testing for tick-borne illnesses because it’s so common.
Bartonella vs. Lyme: What’s the difference?
While both Lyme (Borrelia) and Bartonella are types of bacteria, Bartonella works differently from Lyme.
Both Lyme and Bartonella are complex and can enter into chronic forms, but they have different ways of evading the immune system. Lyme hates oxygen, whereas Bartonella loves it. Lyme likes to form biofilms (protective shields that are difficult to penetrate) to protect itself in between your cells in your joints and nerves, whereas Bartonella is an obligate intracellular bacterium, meaning it lives inside the cells of the lining of your blood vessels (the endothelium) and in your skin (epithelial tissue). This helps it evade your immune system and persist.
How Bartonella and Lyme interact
Unfortunately, when Lyme and Bartonella are paired together, they amplify each other’s devastation in the body. When Lyme is paired with one or more co-infections, it’s like the worst school bullies come together to beat you up. Bartonella can trigger inflammation in small blood vessels and the nervous system, which intensifies the brain fog, neuropathic pain, mood swings, and fatigue that may already be caused by Lyme.
As mentioned earlier, 93% of people with chronic Lyme are also dealing with another co-infection on top of that infection. From other studies, we’ve learned that 80% of people are typically able to defeat Lyme when bitten by an infected tick because their immune system is working well enough. If you have 100 people who get bitten by an infected tick, 80 of them will get better on their own. Out of the 20 who do end up with a chronic infection, 19 of them will wind up with at least one co-infection on top of Lyme.
The vast majority of people who have chronic Lyme have a combination of infections, and it’s the combination of two or three infections together that wreaks enough havoc on your immune system to where you can’t get over it on your own.
Out of the 20 to 25 patients I see each month, I likely see the combination of Lyme and Bartonella 8 to 10 times. The only combination I see more often is the combination of Lyme with Babesia. Of course, it’s common for patients to have more than two infections at once, but the combination of Lyme and Bartonella is the second most common combination I see in my office.
Common symptoms of Bartonella
While both Lyme and Bartonella can cause fatigue, neurological symptoms, and chronic pain, Bartonella has some distinct symptom manifestations.
Bartonella infiltrates the lining of your circulatory system. It loves the epithelial cells, which make up the skin lining, but its favorite tissue is the lining of the blood vessels. This messes up blood flow.
When you have both Lyme and Bartonella working against you, you have Lyme bacteria living and affecting your joints and nerves, and Bartonella living in the blood vessels. This creates major issues with getting proper blood flow to the brain and to the feet and fingers.
Neurological symptoms of Bartonella
The neurological symptoms of Bartonella can be fierce. From anxiety, irritability, and mood swings to brain fog, memory problems, and sensory sensitivity, the range of issues can be expansive, intense, and miserable.
Bartonella has been known by patients to cause a noticeable worsening in their mental health. Sometimes, they were already dealing with anxiety and OCD prior to their infection, and the infection exacerbates their mental health symptoms. Other times, they had no previous issue with anxiety and OCD, yet they started to experience major issues with these conditions after getting infected.
Since Bartonella can greatly affect the nerves, a wide variety of strange sensations can occur. Some patients have felt like they had water spilled on them or Vicks Vapo Rub slathered on random spots on their bodies. Others have felt like hundreds of bugs are crawling under their skin. Many other nerve symptoms can happen as well.
Physical symptoms of Bartonella
Some of the hallmark physical symptoms of Bartonella involve foot, heel, and shin pain. Swollen lymph nodes, fatigue, and migratory muscle and joint pain are also common problems.
As mentioned before, the stretch mark-like rash is also a clear visual representation of Bartonella, but that doesn’t occur in many instances.
Because of Bartonella’s impact on the circulatory system, it’s extremely common for Bartonella patients to experience cardiovascular symptoms. A large number of my patients have gone to the ER with cardio symptoms, often resembling heart attacks, only to have results come back “normal.”
While Babesia is most famous for causing air hunger or shortness of breath, Bartonella can also cause this miserable symptom.
Unfortunately, Lyme and Bartonella are a double hit to your immune and nervous systems. Each infection hits your nerves and joints in two different ways. Lyme directly settles into the joints and nerves and creates inflammation there. Then Bartonella starts to create problems with the blood supply to that area, therefore amplifying the problem. When you're being hit from two different sides, it makes it hard to heal and function.
When a patient presents with foot and shin pain, skin, peripheral neuropathies, neurological, and cardiovascular issues, I immediately suspect Bartonella may be one of the culprits.
What does Bartonella look like?
Besides sheer misery, Bartonella is most notably identified outwardly by the rash that resembles stretch marks (striae) or linear red streaks. However, a Bartonella rash typically appears on the back, sides of the body, or inner arms.
As it is with Lyme, the problem with identifying infections only by the presence of a distinct rash is that, in most cases, these rashes aren’t present.
Bartonella in children
Bartonella can affect anyone, but children often present symptoms a bit differently than teens and adults.
When we see tick-borne illnesses in kids, they typically present as some kind of inflammatory arthritis or behavioral problems. Parents frequently describe their child as having become “a different kid.” Common pediatric patterns include irritability, mood swings, fatigue, recurrent sore throats, learning difficulties, and sleep disturbances.
If you see clear signs of the Bartonella rash, that’s a clear sign to get tested.
Pain symptoms of Bartonella in children
If the child is dealing with pain, they often don’t know how to explain what they are dealing with and might not realize it’s unusual. It’s not uncommon for kids to never mention the pain they’re experiencing. However, you’ll often see these children avoid activity more than usual. They often don't want to do normal activities. That's a key sign you could have a tick-borne illness occurring, including Bartonella.
In general, Lyme affects more knees, and Bartonella affects more feet. However, that’s not always the case, which is why thorough testing is necessary. In kids, leg pain is common with Bartonella infections.
Neurological symptoms of Bartonella in children
The neurological symptoms of Bartonella in kids often seem like behavioral problems and oppositional defiance. They may have problems at school, strange behavioral issues, intense temper tantrums, or anxiety or panic attacks. Sometimes, these extreme temper tantrums in a kid can be a clear sign their nervous system is inflamed.
It can be hard to navigate whether behavioral issues in children are a parenting, growing-up, or health issue, and it often can be a combination. However, the intensity of these issues is often extreme when a health issue is present.
Duration and persistence
While some people have mild Bartonella infections that resolve quickly, others experience long-term illnesses that persist for years until effectively treated.
I’ve had hundreds of patients who have had multiple systems in their bodies affected by long-term Bartonella infections that never resolve on their own. This is why thorough testing and personalized protocols are so important for a person to heal from Bartonella.
When to seek functional support
If you’ve been experiencing troubling symptoms and standard medicine can’t pinpoint the root cause(s), testing for tick-borne illnesses like Bartonella is crucial.
Bartonella is nothing to mess around with. It’s real, it’s complex, and it’s a problem that’s spreading rapidly, affecting the lives of thousands.
While conventional medicine may overlook or minimize co-infections, functional medicine — when applied with Lyme-specific expertise — offers powerful tools to support the body’s ability to heal.
What makes you fast or slow to heal?
If you come into my office and only have one or two infections, it’s likely your progress will be faster than someone who’s fighting five or six infections. Someone fighting multiple infections will almost always be more complicated and slower going than another person with fewer infections. Also, someone who has just developed a chronic infection will usually heal faster than someone who’s had an infection for years.
Being able to track which infections are getting better and which ones aren’t will help us make adjustments after trying a protocol for a few months. Knowing what bugs I’m fighting has been the single biggest factor in helping patients recover.
Take control of your health
Learn more about Bartonella in our second article of this series.
If you’re ready to take control of your health, reach out to our clinic and set up your free consultation with one of our team members. They will go through your history, symptoms, and next steps with you.
Discovering what your body is fighting is the first step in recovering. You can get better from Bartonella, Lyme, and other co-infections!
To learn more about Lyme disease and co-infections, check out our Lyme page and blog.
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