After 37 years treating Lyme disease, I’ve learned that some of the most disabling symptoms patients experience don’t come from Lyme at all—they come from Bartonella, a coinfection that produces neuropsychiatric manifestations, burning pain, and vascular symptoms that standard Lyme treatment doesn’t address.
Bartonella is transmitted by the same ticks that carry Lyme disease, and studies suggest 30-40% of Lyme patients test positive for Bartonella coinfection. Yet it’s frequently missed, misdiagnosed as psychiatric illness, or dismissed when testing comes back negative—despite the fact that Bartonella serology is notoriously unreliable.
When Bartonella goes unrecognized, patients are told their anxiety is stress, their rage is a personality disorder, and their burning foot pain is neuropathy of unknown cause. Treatment focuses on managing symptoms rather than addressing the underlying infection. Months or years pass before anyone considers Bartonella—and by then, the infection has become entrenched.
What Is Bartonella?
Bartonella is a bacterial infection transmitted by ticks, fleas, and potentially other vectors. Multiple Bartonella species can infect humans, with Bartonella henselae and Bartonella quintana being most common in tick-borne illness. The bacteria invade endothelial cells lining blood vessels, causing vascular inflammation and a wide range of symptoms affecting the nervous system, skin, eyes, and other organs.
Unlike Lyme disease, which produces characteristic patterns like migratory joint pain and erythema migrans rash, Bartonella symptoms are often neuropsychiatric and vascular—making it easy to miss when clinicians aren’t looking for it.
Bartonella Symptoms in Lyme Disease Patients
Bartonella produces a distinct symptom profile that differs from Lyme disease alone. The most characteristic presentations include neuropsychiatric symptoms, burning pain, and vascular manifestations.
Neuropsychiatric symptoms are among the most debilitating Bartonella manifestations. Patients experience sudden-onset anxiety or panic attacks, rage episodes or emotional outbursts disproportionate to triggers, intrusive thoughts or obsessive patterns, mood swings and emotional lability, depersonalization or feeling detached from reality, and brain fog or cognitive dysfunction.
These symptoms often appear suddenly in previously stable individuals, leading to psychiatric diagnosis without investigation of infectious causes. When antibiotics targeting Bartonella are started, neuropsychiatric symptoms frequently improve—confirming that the problem was infection, not primary mental illness.
Burning pain is another hallmark of Bartonella. Patients describe burning sensations in the feet (especially the soles), tingling or electric shock sensations, pain disproportionate to physical findings, symptoms that worsen at night, and hypersensitivity to touch or pressure.
This pain pattern differs from typical Lyme neuropathy, which tends to be more numbing than burning. The burning quality and foot predominance are characteristic of Bartonella vascular involvement affecting small nerve fibers.
Vascular and skin manifestations reflect Bartonella’s tendency to invade blood vessel linings. Patients may develop stretch marks (striae) appearing without weight gain or pregnancy, red or purple skin streaks, subcutaneous nodules, papular rashes, or visible blood vessel changes.
The stretch marks associated with Bartonella often appear on the back, thighs, or abdomen in locations unusual for typical striae, and may occur in males or non-pregnant females—clues that vascular inflammation rather than mechanical stretching is the cause.
Why Bartonella Is Missed
Bartonella testing is unreliable. Serology has poor sensitivity, missing many infections. PCR testing requires proper timing and specimen handling. Blood culture is rarely positive in chronic infections. Many patients with clear clinical Bartonella symptoms test negative on all available assays.
This creates a diagnostic dilemma. Clinicians who rely on test results miss Bartonella infections. Those who treat based on clinical presentation face resistance from insurance companies and colleagues who demand laboratory confirmation.
The reality is that Bartonella is often diagnosed and treated presumptively based on symptom patterns—neuropsychiatric symptoms plus burning foot pain in a Lyme patient strongly suggests Bartonella regardless of serology.
Bartonella and Psychiatric Misdiagnosis
The neuropsychiatric symptoms of Bartonella are frequently misdiagnosed as primary psychiatric illness. Patients presenting with sudden anxiety, rage, or intrusive thoughts are given diagnoses of panic disorder, bipolar disorder, or obsessive-compulsive disorder without consideration of infectious causes.
Psychiatric medications may provide partial symptom relief but don’t address the underlying infection. When Bartonella is finally recognized and treated with appropriate antibiotics, many patients experience resolution of symptoms that psychiatry alone never achieved.
This pattern—psychiatric symptoms improving with antibiotic treatment—confirms that infection was driving the neuropsychiatric manifestations, not primary brain disease or psychological factors.
Treatment Challenges
Bartonella is difficult to treat. The bacteria hide inside cells and blood vessels, protected from many antibiotics that don’t penetrate intracellularly. Standard doxycycline for Lyme disease may not adequately address Bartonella, requiring different antibiotic combinations or extended treatment duration.
Common Bartonella treatment regimens include azithromycin plus rifampin, fluoroquinolones, or combination therapy targeting intracellular bacteria. Treatment duration varies but often extends months rather than weeks, particularly when diagnosis was delayed.
Herxheimer reactions during Bartonella treatment can be severe, with temporary worsening of neuropsychiatric symptoms, pain, and fatigue as bacteria die off. Managing these reactions while continuing effective therapy requires clinical experience and individualized approaches.
Clinical Takeaways
Bartonella is a common Lyme disease coinfection affecting 30-40% of patients, producing neuropsychiatric symptoms, burning pain, and vascular manifestations distinct from Lyme disease alone. Testing is unreliable with poor sensitivity across serology, PCR, and culture methods, making clinical diagnosis based on characteristic symptom patterns essential. Neuropsychiatric symptoms including sudden-onset anxiety, rage episodes, and intrusive thoughts are frequently misdiagnosed as primary psychiatric illness when they actually reflect Bartonella infection. Treatment requires intracellular antibiotics beyond standard Lyme protocols, often extending months rather than weeks, with significant Herxheimer reactions common during therapy.
Frequently Asked Questions
What are the most common Bartonella symptoms?
Neuropsychiatric symptoms (anxiety, rage, intrusive thoughts), burning foot pain, stretch marks without weight gain, and vascular manifestations are most characteristic of Bartonella infection.
Can Bartonella cause psychiatric symptoms?
Yes. Bartonella commonly produces anxiety, panic attacks, rage episodes, mood swings, and intrusive thoughts that are frequently misdiagnosed as primary psychiatric illness.
How is Bartonella diagnosed?
Testing is unreliable. Clinical diagnosis based on characteristic symptoms—neuropsychiatric manifestations, burning pain, stretch marks—guides treatment when laboratory confirmation is negative or unavailable.
Does Bartonella respond to Lyme disease antibiotics?
Not always. Bartonella requires intracellular antibiotics like azithromycin, rifampin, or fluoroquinolones. Standard doxycycline for Lyme may not adequately treat Bartonella coinfection.
Can you have Bartonella without Lyme disease?
Yes, though many patients with tick-borne Bartonella also have Lyme disease. Bartonella can be transmitted by ticks, fleas, and other vectors independently of Borrelia burgdorferi.
References
- Maggi RG, et al. Bartonella spp. bacteremia in high-risk immunocompetent patients. Diagn Microbiol Infect Dis. 2011;71(4):430-437.
- Breitschwerdt EB, et al. Bartonella species bacteremia in patients with neurological and neurocognitive dysfunction. J Clin Microbiol. 2008;46(9):2856-2861.
- Schaller JL, Burkland GA, Langhoff PJ. Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistant Depression? MedGenMed. 2007;9(3):54.
Bartonella species cause several human diseases, most famously “cat scratch fever.” While traditionally associated with flea bites and cat scratches, Bartonella has been found in ticks—including black-legged ticks that transmit Lyme.
Key symptoms:
Streak-like rash (in some patients)
Swollen lymph nodes
Neuropsychiatric symptoms — anxiety, irritability, rage
Fatigue, headaches, fever
Why it’s missed: Testing is unreliable, and many physicians don’t consider tick-borne Bartonella. Psychiatric symptoms may be attributed to stress or mental illness rather than infection.
Related Reading
Bartonella Symptoms
- Bartonella Associated Psychiatric Symptoms
- Additional Bartonella posts (you’ll add these later as you identify them)
