Possible relapse of Bartonella

the symptoms you mention and mild deviations in the CBC are consistent with bartonella - but of course - there is considerable overlap with other infections and conditions so we cannot be definitive.

neutrophils can be decreased after or during taking abx - due to the neutrophils mopping up the dead/dying bacteria and then dying off themselves - this is recoded in the scientific literature

rifampicin and a macrolide and a tetracycline is used extensively by LLMDs like Dr H - so i think its a common selection for bartonella or bartonella with lyme

be aware that IgG testing or any serologic testing for bartonella is now known to have VERY low sensitivity - perhaps as low as 20% - meaning its likely to give a negative result in 4 out of 5 people who are actually infected.
for info - this test has been withdrawn by the UK NHS in the last 12 month or so - because they eventually acknowledged its not a good test ( the UK NHS is heavily invested in serologic tests - so it would have to be very clear that its a poor test for them to stop using it)

i hope its of some help

hi Bhava

thank you forthe kind words

for info most LLMDs typically use standard doses of antibiotics as defined by the general dosing guidelines for other infections

where there are different dosing options - they tend to use towards the upper end of the dose for lyme and bart etc

you can find that for each drug here
example for azithromycin https://www.drugs.com/dosage/azithromycin.html

i would say 500mg daily is more common for bartonella

minocycline is typically used at 100mg twice a day

rifampicin typically 300mg twice a day also

at these level i would suggest safety labs every 4-6 weeks - CBC, LFT, KFT to help manage the risks

for info rifampicin is also active for Lyme ( most antibiotics are not specific to one species or even genus of bacteria )

i hope it helps

Hi Bhava
my best offerings are as follows

1, i would expect normalising - but what normal for you may not be right in the middle of the common "normal ranges" - results for comparison from well before you started to become ill would be helpful here
often we may be infected long before we notice symptoms - and onset can be very gradual - which is why i say long before
also, red blood cells last around 90 days - so recovery from anaemia after chronic infection could take longer than a few weeks - the whole system can be disturbed and run down - so i would expect longer.

2, serologic tests are not a reliable way to track infection status - many people doctors included misunderstand this - but people with chronic infections may be sero negative or sero positive - and people who have no symptoms may remain seropositive for years.
there is some moderate evidence that certain immune markers are associated with active disease and recovery of these markers could be an indication of recovery
for example CD57+ counts have been used in this way - but only if they are low when chronically ill

3, with most antibiotics its not a matter of just increasing the dose over time - its more that there is an upper limit of what is considered safe - and in fact the target dose for lyme is typically that or close to that.
ie - in Lyme the doses used are typically the highest doses of that drug normally used in other infections
see our previous discussions and dosing info on drugs.com

so ramping up antibiotics, if its done at all is typically more about tolerability
it may be too much for some people to go to full dose of some of these antibiotics right from the off - and so they may start on half that dose for a few weeks - then move to full dose

in general antibiotics are not intended to be gradually titrated upwards.
going beyond standard doses is done occasionally - but doctors doing this will be mindful that they are stepping outside the boundaries for which we have good safety data - and thereby incurring greater risk for the patient - and there would normally need to be an exceptional justification in terms of benefit to the patient to justify this additional risk ( if you are self treating - i would not advise it at all - self medicating while unaware of the risks and boundaries is what commonly causes people t come to harm with pharma drugs).

it is usually safer and more effective to instead add more different but compatible antibiotics in combinations where each is at or below its maximum dose - but due to synergy, together in combination they have increased efficacy.

i hope it helps

most antibiotics can be taken with food - and generally this reduces gastric symptoms like nausea etc - at the doses used for lyme i think this is usually the best plan

most herbs are taken before meals - eg 10 or 20 mins before

most supplements are also taken with food - a few specific ones on an empty stomach - like proteolytic enzymes for biofilms -
i take xylitol on an empty stomach also
in general - unless there is a specific recommendation to do otherwise on the bottle - i would take them all with food - usually just before the meal

ref herx signs / significance
symptoms and reactions are highly individual - some people with lyme diagnosis seem to get little or no signs of herx reactions even from combinations of antibiotics - and others extreme reactions from even tiny doses.
in addition the specific symptoms a person experiences are highly variable
in my case there is v little if any immediate effect from antibiotics - more there is just a general increase in pain, fatigue and sleep disturbance that tends to increase over days or weeks after stating antibiotic and then gradually face again after stopping them.
i think the best you can do is to keep track of your reactions and try to spot patterns while being aware of the risk of over interpretation and confirmation bias.
i would suggest using longer term objective measure as your main evaluation of treatment efficacy
eg - measures of physical activity, hours of sleep etc

i am not sure if we know whether bartonella or lyme causes more damage
both can be life threatening
bartonella seems if anything harder to resolve.
but of course they are not existing in isolation and it may well be that Lyme might need to be present to weaken the host enough for bartonella to become chronic - or visa versa - babesia may well perform a similar function
these interactions of multiple pathogens and host are very much understudied and therefore not well understood - so we have to be careful of applying single pathogen single disease models to them

due to the likely complex interplay between multiple pathogens helping to keep the host ill - and it not being clear if Lyme causes bartonella to stay chronic or visa versa - many LLMD's treat bartonella and lyme concurrently - luckily the drugs to treat bartonella and lyme are usually active for both.
the phases of treatment are then more to do with establishing and managing host tolerability than the microbes themselves

ref testing
serologic (antibody) testing for bartonella has severe limitations - a standard IgG or IgM test is likely under 20% sensitive ( misses 4 out of 5 chronic cases ) so if its negative you really cannot draw any conclusions.
if on the other hand on the slim chance it is positive - the specificity is above 90% so you can have decent confidence its a true positive - this how the asymmetry of sensitivity and specificity works.

PCR of blood is around 30-50% sensitive - so better than serology but still worse than a coin toss chance of getting a positive result if you are chronically infected. so PCR of blood is also v poor - negative results are again meaningless - specificity is however above 99%

PCR of infected tissue - eg a swollen lymph node - is much better - the UK national health service will likely adopt this as a standard - but it is more invasive and therefore rarely performed

after that there are the specialist labs for bartonella - (these tend to be expensive - and accessed via a practitioner)
1, Igenex have a multispecies western blot for bartonella that is serology - but uses many antigens from multiple species to get a higher sensitivity - this is probably above 50% sensitive

2, Galaxy diagnostics have a triple draw digital droplet PCR that is first cultured to maximise the chances of detecting bartonella - they have published a validation study that shows its around 50% sensitivity - but in reality the test likely performs much better than this. The scientist who founded the lab are highly respected researchers in the field with decades of published work on bartonella to their name and they are v careful not to over claim.

3, T-Labs is another advanced lab in the USA - they have a bartonella immuno-fluorescence based test that should also be highly sensitive

finally, i am not quite at the stage of doing it right now, but, due to the lack of useful bartonella tests priced below aroudn $1000 - i am considering setting up a UK based lab that performs thin blood smear testing via microscopy that can be used as a direct method (not reliant on antibodies) to detect bartonella and babesia species.
this is a WHO approved test method for detecting blood born pathogens.
i used this method to definitively diagnose my own bartonella infection.(see link in my signature)
T-Lab also offers this type of test and uses it for both diagnosis and treatment progress tracking - but its a labour intensive test and requires the operators to be highly trained (rather than an automated machine that spits out the results) - so its rarely used today - despite the advantages.
this test can also detect other disease markers like platelet activation and platelet aggregation, amyloid and fibrin deposits and red blood cell morphology changes ( all common in chronic Lyme patients and can give indications of treatment progress)

i would be wary of using a subjective measure of how one feels as a measure of progress

those kind of measures are highly variable from day to day and week to week based on mood, diet, sleep, the weather etc etc

when progress is typically slow and incremental with ups and downs along the way - this type of measure becomes unreliable

instead i use a combination of objective measures that i can measure track consistently over time - and plot these on a graph so i can see trends - results of treatment trials etc
for me these are
-hrs of good sleep i had the previous night
-how much exercise i was able to do that day
-how many tasks of 15mins or more i was able to do that day
-how long my daily walk took to complete

this are repeatable objective measures of my ability to function normally in the world - and are much less susceptible to fluctuation due to mood, weather etc

using such measures, if your scores go up you can be sure you are improving - no matter how gradually

if its of interest i have written about how to do this before in other threads - eg the recent one with Palermo

ref CBC etc be aware the although in the long term after treatment i would expect the CBC to normalise after successful treatment - antibiotics do cause abnormal CBC's while you are taking them - so this may not be such a useful measure during treatment
also - after successful treatment normalise might mean to normalise to to something like normal for you before getting ill - not necessarily normal in the sense of the tests normal range - so the best comparison is a result long before you became ill.

i hope its of some help