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Do Bartonella Infections Cause Agitation,
Panic Disorder, and Treatment-Resistant Depression?

Below is first clear and complete article on Bartonella and Psychiatry. It has many points and is free with 2 minute registration. Bartonella is seen in as many as 60% of patients with psychiatric symptoms and routinely missed. Article attached below shows:

  1. Shows relapse even after MONTHS of treatment exists, and what is a probably cure.
  2. Shows labs are unreliable
  3. Shows massive different psychiatrist symptoms
  4. 9 species infect humans nor just 1-2.
  5. Infection and/or inflammation with Bartonella causes eccentric dosing that needs careful tailoring.
  6. Almost 90 references
  7. Shows that rashes, lymph nodes and papules are not the only way to treat, even if used here in article.
  8. Dosing is higher then expect and may need to be mixed with other medications
  9. Past articles mention some psychiatric issues: Depression, Dementia, Encephalopathy, Violent behavior, Confusion, Combative behavior and Substance abuse disorders

Selection from Original Article

For the complete article (full text and references) go to: www.medscape.com/viewarticle/562276

Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistant Depression?

James L. Schaller, MD, MAR; Glenn A. Burkland, DMD; P.J. Langhoff

Medscape General Medicine. 2007;9(3):54.



Bartonella is an emerging infection found in cities, suburbs, and rural locations. Routine national labs offer testing for only 2 species, but at least 9 have been discovered as human infections within the last 15 years. Some authors discuss Bartonella cases having atypical presentations, with serious morbidity considered uncharacteristic of more routine Bartonella infections. Some atypical findings include distortion of vision, abdominal pain, severe liver and spleen tissue abnormalities, thrombocytopenic purpura, bone infection, arthritis, abscesses, heart tissue and heart valve problems. While some articles discuss Bartonella as a cause of neurologic illnesses, psychiatric illnesses have received limited attention. Case reports usually do not focus on psychiatric symptoms and typically only as incidental comorbid findings. In this article, we discuss patients exhibiting new-onset agitation, panic attacks, and treatment-resistant depression, all of which may be attributed to Bartonella.


Three patients receiving care in an outpatient clinical setting developed acute onset personality changes and agitation, depression, and panic attacks. They were retrospectively examined for evidence of Bartonella infections. The medical and psychiatric treatment progress of each patient was tracked until both were significantly resolved and the Bartonella was cured.


The patients generally seemed to require higher dosing of antidepressants, benzodiazepines, or antipsychotics in order to function normally. Doses were reduced following antibiotic treatment and as the presumed signs of Bartonella infection remitted. All patients improved significantly following treatment and returned to their previously healthy or near-normal baseline mental health status.


New Bartonella species are emerging as human infections. Most do not have antibody or polymerase chain reaction (PCR) diagnostic testing at this time. Manual differential examinations are of unknown utility, due to many factors such as low numbers of infected red blood cells, the small size of the infecting bacteria, uncertainty of current techniques in viewing such small bacteria, and limited experience. As an emerging infection, it is unknown whether Bartonella occurrence in humans worldwide is rare or common, without further information from epidemiology, microbiology, pathology, and treatment outcomes research.


Three patients presented with acute psychiatric disorders associated with Bartonella-like signs and symptoms. Each had clear exposure to ticks or fleas and presented with physical symptoms consistent with Bartonella, eg, an enlarged lymph node near an Ixodes tick bite and bacillary angiomatosis found only in Bartonella infections. Laboratory findings and the overall general course of the illnesses seemed consistent with Bartonella infection. The authors are not reporting that these patients offer certain proof of Bartonella infection, but we hope to raise the possibility that patients infected with Bartonella can have a variety of mental health symptoms. Since Bartonella can clearly cause neurologic disorders, we feel the presence of psychiatric disorders is a reasonable expectation.


Bartonella is an infection that may cause a rash, enlarged lymph node(s), and malaise and fatigue that resolve over several weeks.[1,2] Many animals and insects carry this infection. Bartonella has multiple vectors and infection sources including fleas, flea feces, cat licks or scratches, ticks, lice, and biting flies.[3-6] Young stray kittens are often able to infect humans due to flea feces on their paws, or through cat scratches, bites, or licks.[7-10]

Bartonella is found in cities, suburbs, and rural locations,[11-14] and is an emerging infection. In recent decades, Bartonella research publications are increasing, but psychiatric disorders were underreported in the soldiers of World War I and World War II. For example, approximately 1 million soldiers in WWI were affected with Bartonella quintana,[15] but medical journals did not report much about its psychiatric manifestations.

In the last 15 years, 9 Bartonella bacteria have been identified that are known to infect humans: B henselae, B elizabethae, B grahamii, B vinsonii subsp. arupensis, B vinsonii subsp. berkhoffii, B grahamii, B washoensis, and, more recently, B koehlerae and B rochalimae.[16-20] Currently, the largest national laboratories offer tests for only 2 species[21-23] (B quintana and B henselae).

Some Bartonella cases have "atypical" presentations with signs or symptoms lasting more than weeks, causing diverse medical problems. For example, Bartonella can cause vision abnormalities, prolonged fever, joint pain, lung inflammation, respiratory disease, and granulomas throughout the body. It can occasionally cause abdominal pain, liver and spleen tissue abnormalities, thrombocytopenic purpura, bone infection, papules or pustules, maculopapular rashes, arthritis, abscesses,[20, 24-30] heart tissue and heart valve problems,[31-37] and neurologic illnesses.[38-42]

Traditionally, cognitive neurology has been related to some psychiatric illnesses. A search of PubMed with "Bartonella" and the search words "depression," "mania," "bipolar," "major depression," "depression," "anxiety," "panic," "panic attack," "psychosis," and "schizophrenia" yielded the limited journal results below:

  • Depression
  • Dementia
  • Encephalopathy
  • Violent behavior
  • Confusion
  • Combative behavior
  • Substance abuse disorders[43-48]

Some articles link Bartonella to substance abuse. Bartonella is repeatedly linked with alcoholism in the presence of substandard living conditions. Intravenous drug users also have an elevated prevalence of antibodies to Bartonella organisms and may be at significant risk of becoming infected.[49-53] The 3 cases described below are consistent with past reports of Bartonella causing psychiatric symptoms, and add further clinical data to these past reports.

Case 1

A 41-year-old male minister was reported by his wife, best friends, and children to have undergone a personality change after a camping trip in North Carolina. After the trip, the patient described a small right-sided "aching" axillary lymph node and reported a "fever." He removed 3 Ixodes deer ticks from his leg and shoulder. Five weeks later, he had an "enlarged and very annoying" right-sided axillary lymph node, "excessive warmth," irritability, severe insomnia, and new-onset eccentric rage. He had new excess sensitivity to slightly annoying smells and sounds. His afternoon temperatures were 98.7-99.9=B0F, which he recorded every 3 days.

The patient tested negative for Lyme disease using the Centers for Disease Control and Prevention (CDC) 2-tier surveillance testing procedure performed at Quest Diagnostics, and yet Bartonella was suspected from his unilateral lymph node symptom and Ixodes attachment. The duration of the lymph node ache was at least 5 weeks, so "atypical" Bartonella was considered in the differential.

The patient was ordered an IgG and IgM B henselae along with other lab testing. The only positive result was an IgM of 1:256. A PCR test for 2 Bartonella species was negative, but positive for B henselae when repeated.

During the next 2 weeks, the patient developed serious agitation, panic attacks, and major depression. His major depression was quantified by the Inventory to Diagnose Depression (IDD) scale.[54-56] His IDD was 39. This is in the moderate to severe range, so he was diagnosed with major depression (MD). He also was found to have excess anxiety with a 29 on the Beck Anxiety Inventory (BAI) scale, using 0-7 as a functional normal range. (Judith Beck, personal communication, 1994).[57-59]

He was so agitated that during arguments with his spouse, he threw objects such as kitchen glasses, a baseball, and a chair into his home's drywall. Previously he was unknown to use insults or to curse at people, and now he did both almost daily. He slept 8-9 hours per day, ate normally, and had normal speech speed and enunciation patterns.

A psychiatrist diagnosed him as having bipolar disorder, despite the fact that he had no genetic history or any previous history of depression or mania. The patient gained 15 pounds in 3 weeks on 1250 mg per day of valproic acid, so he was tried on lithium carbonate, 300 mg at breakfast, lunch and dinner, with 600 mg once in the evening (blood level 1.1 mEq/L). These medications had no clear clinical effect on the patient's agitation, mood extremes, or anhedonia with hopelessness. They were stopped after a minimum of 3-week trials.

A trial of quetiapine at 12.5 mg in the morning, afternoon, and 50 mg at bedtime helped significantly for 3 weeks, but then the drug stopped controlling his agitation and other dysfunctional behaviors. A higher dose of 25 mg of quetiapine in the morning, 25 mg in the afternoon, and 100 mg at bed was successful. The patient surprisingly reported that he felt "good" and "content" on this medication at these doses.

At this point, the patient still had a large tender unilateral lymph node, fatigue, and new papules under his right arm. Various causes of persistent large unilateral lymph nodes with papules were felt to fit a diagnosis of Bartonella .

Based on a consult with an infectious disease physician, the patient was treated with azithromycin 250 mg twice daily and rifampicin 300 mg twice daily with food for 2 weeks. The patient's anxiety increased, and he experienced 5 panic attacks. He became psychiatrically worse: highly reactive, emotionally volatile, and markedly irritable. His quetiapine was increased to 50 mg at breakfast and lunch, and 200 mg once in the evening, with immediate control of his increased morbidity.

After 5 weeks on this dual-antibiotic treatment, the patient began to exhibit sleepiness. His quetiapine dose was reduced to 25 mg at breakfast and 75 mg at bedtime, with no return of agitation or mood lability.

He was still complaining, however, of right-sided axillary lymph node symptoms, so he was treated for another 3 weeks on these antibiotics. A medical literature review of PubMed looking for the ideal dose of antibiotics and duration of treatment for this suspected Bartonella infection offered no uniform results. However, the patient's lymph node complaints ended abruptly following 8 weeks of antibiotics, and so his medications were stopped.

The patient's psychiatric symptoms have significantly improved, and he now remains on escitalopram 5 mg and quetiapine 6.5 mg in the morning and 25 mg qhs. His personality is felt to be 90% of baseline, according to his spouse and closest friend. We suggest this man's psychiatric problems support a Bartonella presentation. Specifically, his symptoms immediately followed a clear Ixodes attachment, a new unilateral and uncomfortable axillary lymph node appeared just after this attachment, new papules formed, and he experienced a new constant "slight fever" feeling, a low-positive Bartonella serology result, conflicting PCR results, and a positive response to 2 antibiotics from medication classes that are believed to be effective in vivo against Bartonella . Further, his emotional improvement occurred nearly simultaneous to his enlarged lymph node normalization.

For the complete article (full text and references) go to: www.medscape.com/viewarticle/562276

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