First of all, in the case of such a long-standing and treated possible infection, it would be legitimate to ask how the persistence of the infection was confirmed. Do the symptoms still confirm the ongoing infection?
There is no generally accepted laboratory test for Bartonella. This intracellular parasitic bacterium occurs in many different genotypes, so it is not possible to detect all variants with specific tests. Specific tests, i.e. serological, PCR and other antibody-based tests (e.g. FISH microscopy), have been developed for variants occurring in the USA. Serological tests do not always show results if the pathogen is located inside the cell or in a place that is difficult for the body to reach. There are also a number of uncertified tests whose reliability cannot be substantiated. Neither serology nor PCR testing is suitable for confirming an existing infection, as they can be positive even in the recovered phase of the infection.
Although official US recommendations suggest microscopic examination (after culture, enrichment and concentration) or PCR detection, different strains occur in Europe, so non-specific, direct detection methods (e.g. microscopy) may be preferable. It is important that these tests can detect even low concentrations of the infection, which the body may be able to control without the appearance of symptoms. Thus, the diagnosis requires increased attention from the treating physician.
Secondly, treating Bartonella is challenging even for experienced physicians. A combination of antibiotics and antiparasitic agents is usually considered, but it is important to note that these pathogens multiply inside the cell. Therefore, antibiotics with higher intracellular absorption (e.g. minocycline, ciprofloxacin) may be more effective.
In cases of prolonged conditions associated with Lyme disease and co-infections (e.g. Bartonella), a complex approach is important, not just antibiotics.
A healthy diet, vitamin supplements (e.g. vitamin D, vitamin C, B complex) and probiotics can be a reasonable basis for antibiotic treatment, but it is important to note that supplements alone do not solve the problem of infection. It is important to support the intestinal flora, ensure adequate protein intake, avoid blood sugar fluctuations, reduce lifestyle factors that increase inflammation, and engage in gradual, condition-appropriate exercise. Bartonella hinders the body’s oxygen transport, so outdoor activities can alleviate symptoms.
The utilisation of carbohydrates requires more oxygen, so in addition to consuming moderate, slowly absorbed carbohydrates necessary for the intestinal flora, it may be worthwhile to partially induce ketosis.
I would also emphasise the importance of balancing rest and exercise, as overexertion can worsen symptoms. It is also important that the treatment is reviewed regularly and not automatically continued for years without change.
Overall, the most important factors are a confirmed diagnosis, a structured plan agreed with a doctor, a balanced diet, protection of the intestinal flora, an anti-inflammatory lifestyle and individually tailored exercise.
(C) Lyme Borreliosis Foundation
