Advertisement
1 / 19

CASE HISTORIES: BARTONELLA-LIKE ORGANISMS PowerPoint PPT Presentation


  • 851 Views
  • Uploaded on 18-08-2012
  • Presentation posted in: General

CASE HISTORIES: BARTONELLA-LIKE ORGANISMS. JOSEPH J. BURRASCANO JR., M.D. East End Medical Associates, P.C. East Hampton, NY. BARTONELLA. Is the most common of all tick-borne pathogens Fairly distinct clinical syndrome - PowerPoint PPT Presentation

Download Presentation

CASE HISTORIES: BARTONELLA-LIKE ORGANISMS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Case histories bartonella like organisms l.jpg

CASE HISTORIES:BARTONELLA-LIKE ORGANISMS

JOSEPH J. BURRASCANO JR., M.D.

East End Medical Associates, P.C.

East Hampton, NY

J.J. Burrascano Jr. M.D.


Bartonella l.jpg

BARTONELLA

  • Is the most common of all tick-borne pathogens

  • Fairly distinct clinical syndrome

  • This tick-associated strain of Bartonella appears to be different from that described as “cat scratch disease”

J.J. Burrascano Jr. M.D.


Bartonella like organism blo l.jpg

BARTONELLA-LIKE ORGANISM (“BLO”)

  • Predominantly neurologic disease, and less vascular manifestations.

  • Standard Bartonella blood testing is commonly non-reactive.

  • The usual Bartonella medications do not work for this

  • For these reasons I like to refer to this as a “Bartonella-like organism” (BLO)

  • One day BLO may be identified to be an altogether different organism

J.J. Burrascano Jr. M.D.


Case histories l.jpg

CASE HISTORIES

  • 13 consecutive patients

  • All were PCR + for Bartonella

  • Age 33-75, median 48

  • 4/13 bite, 5/13 EM. None with both

  • 5 males, 8 females

  • Ill before Diagnosis:

    • 60 d (one patient)

    • 2-32 yrs

    • median 10 yrs

J.J. Burrascano Jr. M.D.


Case histories5 l.jpg

CASE HISTORIES

  • Lyme- 12 sero +, 5 PCR + (all were also sero +) One with EM was sero & PCR negative for Lyme!

  • Babes- 9 positive- 3 sero + , 3 PCR +, 3 FISH +, 3 Bowen smear + ( 2 sero & PCR +; one FISH & Bowen +)

  • Ehrl/Anapl- none

  • Others- MF-3; Chl- 2; CMV-2; HHV-6- 1

J.J. Burrascano Jr. M.D.


Indicators of blo l.jpg

INDICATORS OF BLO

  • CNS symptoms out of proportion to the other systemic symptoms of chronic Lyme

  • Increased irritability of the CNS, with agitation, anxiety, insomnia, and even seizures or seizure-like activity

  • Tender subcutaneous nodules along the extremities

  • Sore soles, especially in the AM

J.J. Burrascano Jr. M.D.


Indicators of blo7 l.jpg

INDICATORS OF BLO

  • Gastritis, lower abdominal pain (mesenteric adenitis)

  • Lymph nodes may be enlarged, sometimes with a sore throat

  • Red rashes. These rashes may be red papular eruptions, spider veins, or the appearance of red streaks like stretch marks that do not follow skin planes

J.J. Burrascano Jr. M.D.


Bartonella rashes l.jpg

Bartonella Rashes

Red bumps- may form scabs

J.J. Burrascano Jr. M.D.


Bartonella rashes9 l.jpg

Bartonella Rashes

Linear rashes- look like stretch marks

Photos taken by Dr. Martin Fried, with thanks

to him and to the Lyme Disease Association

J.J. Burrascano Jr. M.D.


More bartonella l.jpg

More Bartonella

Back of legs

J.J. Burrascano Jr. M.D.


Bartonella11 l.jpg

Bartonella

Lower back

J.J. Burrascano Jr. M.D.


Bartonella12 l.jpg

Bartonella

Under the arm

J.J. Burrascano Jr. M.D.


Testing is very insensitive l.jpg

TESTING IS VERY INSENSITIVE

  • Clinically + Bartonella, with + response to treatment: only 20% are + on serology or PCR (80% false negative rate!)

  • Occasionally see elevated VEGF- <20% of clinically suspect cases, but when elevated, can be followed to assess efficacy of treatment

  • Therefore, the diagnosis is a clinical one, based on the above points.

  • Also, suspect infection with BLO in extensively treated Lyme patients who still are encephalitic, and who never had been treated with a significant course of BLO meds

J.J. Burrascano Jr. M.D.


Antibiotic treatment l.jpg

ANTIBIOTIC TREATMENT

  • Best = FQ. Levofloxacin > Cipro; efficacy decreased if co-admin with erythros

  • Cephalosporins- advanced generation best but 8/9 relapsed; Bicillin similar

  • Combination of Rifampin + Biaxin fair

  • Combination of Flagyl + Biaxin fair

  • Worst = erythromycin derivatives, even IV azithromycin

  • Doxycycline not much better (even IV doxy)

J.J. Burrascano Jr. M.D.


Treatment recommendations l.jpg

TREATMENT RECOMMENDATIONS

  • The drug of choice to treat BLO is levofloxacin.

  • Levofloxacin is usually never used for Lyme or Babesia, so many patients who have tick-borne diseases, and who have been treated for them but remain ill, may in fact be infected with BLO.

  • Treatment consist of 500 mg daily (may be adjusted based on body weight) for at least one month.

  • Treat for three months or longer in the more ill patient.

  • It has been suggested that levofloxacin may be more effective in treating this infection if a proton pump inhibitor is added in standard doses.

J.J. Burrascano Jr. M.D.


Treatment recommendations16 l.jpg

TREATMENT RECOMMENDATIONS

  • Another subtlety is that certain antibiotic combinations seem to inhibit the action of levofloxacin, while others seem to be neutral.

  • I advise against using or combining with an erythromycin-like drug, as clinically such patients do poorly

  • Combinations with cephalosporins & penicillins are okay

  • Alternatives to levofloxacin include possibly gentamicin and possibly streptomycin

J.J. Burrascano Jr. M.D.


Side effects fq l.jpg

SIDE EFFECTS FQ

  • Levofloxacin is generally well tolerated, with almost no stomach upset

  • It may cause a painful tendonitis, usually of the largest tendons. 2/15 courses in this series

  • Very rarely, it can cause confusion- this may be relieved by lowering the dose. 0/15

  • Levofloxacin and drugs in this family cannot be given to those under the age of 18, so other alternatives, such as cephalosporins are used in children

J.J. Burrascano Jr. M.D.


Gestational transmission l.jpg

GESTATIONAL TRANSMISSION ?

Animal studies show that Bartonella may be transmitted across the placenta. No human studies have been done.

J.J. Burrascano Jr. M.D.


Thank you l.jpg

THANK YOU !

J.J. Burrascano Jr. M.D.