Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistan

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Do Bartonella Infections Cause Agitation,

Panic Disorder, and Treatment-Resistant Depression?

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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

 

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Selection from Original Article

For the complete article (full text and references) go to:

_www.medscape.com/viewarticle/562276_

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2276Ó)

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.

Abstract

Introduction

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.

Methods

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.

Results

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.

Discussion

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.

Conclusion

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.

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Introduction

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.

 

 

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2276Ó)