This disease can manifest in many ways, with facial palsy, with nerve palsies, with many CNS manifestations you wouldn't think of at first. SEIZURES!!! Encephalopathy! Etc! Osteomyelitis, Myositis, Myelitis, Radiculitis, Transverse Myelitis, Arthritis, Chronic Demyelinating Polyneuropathy

TREATMENT is with QUINOLINES_ Levaquin, Cipro!!! QUINOLINES!!!

OkAy, if you are an IV drug user (I'm not, I was a vodka & valium person myself) you are at high risk for: BARTONELLA aka cat scratch disease.

Doctors almost always test ONLY FOR BARTONELLA HENSELAE, the kinds cats are most likely to transmit-

BUT BARTONELLA WAS DISCOVERED TO BE TICK BORNE IN 1999!!!

It is in ticks!!! http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

If you HAVE BEEN or are an IV DRUG USER
THE ODDS ARE YOU WOULD BARTONELLA ELIZABETHAE
NOT Henselae!!!

There are MANY human pathogenic strains- and if you test for ONE and get a negative it does not mean you don't have ANOTHER strain!! The most common test for Bartonella tests ONLY for Bartonella HENSELAE which is NOT THE MOST COMMON KIND. I know, stupid, eh? MDs have to catch up with the reseacrh, it takes time...

See these remarkable statistics!!!

New York: IV Drug Users 46% found with JUST B. elizabethae - 46%!!!!!!!!!!!!!

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum


Sweden: IV Drug Users 39% seropositive for JUST B. elizabethae - 39%!!!

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum


Los Angeles: Homeless People 12.5% to Bartonella elizabethae,
9.5% positive to Bartonella QUINTANA and 3.5% to bartonella Henselae-
a grand total in LOS ANGELES of % positive for SOME Bartonella strain:
thats 25%!!!! 25%!!!!!!!!!!!!!!!!!!!!

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Bartonella quintana, the agent of "trench fever", was found in a 4000 year old human tooth. It is a microbe that has been around a very very very long time!!!!!!! http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Good paper about Bartonella in humans by Bruno Chomel of UC Davis:
http://tech.research.usf.edu/cm/pdf/...nella_AVMA.pdf

BARTONELLA SYMPTOMS

GENERAL: Fatigue, Restlessness, Combative behavior, Myalgias, Malaise, Liver and/or Spleen involvement, Abdominal pain, Infectious Mononucleosis-like Syndrome, Granulomatous Hepatitis

BRAIN: Encephalopathy may occur 1-6 weeks after the initial infection and is fairly common in patients with Bartonella. Note: Approximately 50 percent of patients who develop Encephalopathy can be affected by seizures (from focal to generalized, and from brief and self-limited to status epilepticus). Headaches, Cognitive Dysfunction, and CNS Lesions may be evident.

RASH AND LYMPHADENITIS: Erythematous papules (red splotches or slightly raised red spots) may develop. Such papules occasionally occur on the lower limbs but are more common on the upper limbs, the head, and neck. The papules may appear on the skin or mucous membranes. Bartonella may also cause subcutaneous nodules, with some bone involvement possible. The nodules may show some hyperpigmentation, be tender, fester, and/or be enlarged or swollen, but not always.

EYES: Conjunctivitis, Bartonella Neuroretinitis, Loss of Vision, Flame Shaped Hemorrhages, Branch Retinal Artery Occlusion with Vision Loss, Cotton Wool Exudates, Parinaud’s Oculoglandular Syndrome,and Papilledema.


BONES AND MUSCLES: Osteomyelitis, Myositis, Osteolytic Lesions (softening of bone), Myelitis, Radiculitis, Transverse Myelitis, Arthritis, Chronic Demyelinating Polyneuropathy.

HEART: Endocarditis, Cardiomegaly.

Possible lab findings: The following may show up during standard testing:
Thrombocytopenia, pancytopenia, anemia, elevated serum alkaline phosphatase level, elevated bilirubin, abnormal liver enzymes. X-ray of the bone may show areas of lysis or poorly-defined areas of corticl destruction with periosteal reaction. Cardiomegaly may show up on a chest X-Ray.

Biopsies of lymph nodes reveal pathology often indistinguishable from sarcoidosis. Reports of biopsies strongly suggestive of lymphoma do occur.
Tests occasionally show an enlarged liver with multiple hypodense areas scattered throughout the parenchyma.