BAL Spotlights Series
In this wide-ranging conversation, Dana Parish talks with eminent veterinarian Dr. Edward Breitschwerdt about Bartonella infections, the diseases and symptoms presentations in humans, how the bacteria are transmitted, and how doctors often miss Bartonellosis as the root causes in sudden onset of psychosis, frightening behavioral changes, and inexplicable physical deterioration in humans. Note: This transcribed podcast has been edited for clarity.
Dana Parish: Welcome to the Ticktective Podcast, a program of the Bay Area Lyme Foundation, where our mission is to make Lyme disease easy to diagnose and simple to cure. I’m your guest host today, Dana Parish. I’m the co-author of the book Chronic, and I’m on the advisory board of Bay Area Lyme Foundation. This program offers insightful interviews with clinicians, scientists, patients, and other interesting people. We’re a nonprofit foundation based in Silicon Valley, and thanks to a generous grant that covers a hundred percent of our overhead, all your donations go directly to our research and our prevention programs. For more information about Lyme disease, please visit us at us at bayarealyme.org.
Hi, I’m Dana Parish, and I’m so honored to be the guest host today for the Ticktective Podcast on behalf of Bay Area Lyme Foundation, of which I am a very proud advisory board member, and we are thrilled to welcome Dr. Ed Breitschwerdt today. He is the Melanie S. Steele, Professor of Medicine and Infectious Diseases at North Carolina State University College of Veterinary Medicine. He is also an adjunct professor of medicine at Duke University Medical Center. And we could read a bio for you that goes on forever because you are so incredibly distinguished. You’re the world’s leading expert, in many people’s opinions on, Bartonella, which is one of the main reasons that we’ve been brought together to talk here today. Thank you so much for agreeing to do this podcast and for being such an incredible ally and champion for this cause and this community and such a diligent, brilliant researcher and personally a friend. I really appreciate you, Ed. Thank you for being here. How did you get into this? A world of Bartonella?
Dr. Edward Breitschwerdt: I became a member of the American Society of Rickettsiology as a veterinary internist trying to understand Rickettsia. I was welcomed by members of the organization and a Rickettsiologist at CDC, Dr. Russ Regnery, at one of the national meetings, presented an abstract. That abstract was to tell us as an audience that they had finally found the organism that caused cat scratch disease. And that organism was a Bartonella that became Bartonella henselae, a bacteria. The thing I always liked about Dr. Regnery is he was a very basic microbiologist and Rickettsiologist, and I was a clinician trying to understand the basic concepts of these bacteria and the diseases they cause. So, the next morning we actually ended up having breakfast at the same table when I asked him how difficult Bartonella was to isolate, and he said: ‘If I could find three feral cats in Raleigh, I could come up with at least one and probably two isolates,’ which really says anybody that is very kind, very benevolent and out there feeding and getting scratched by feral cats, really needs to be careful. So, we knew that fact 30 years ago, when Bartonella henselae was first (discovered). So, the initial research in our laboratory focused on Bartonella and cats.
Dana Parish: As you and I were talking a little earlier today, I was one of those kids sitting on my front porch feeding the neighborhood cats and probably getting infected with Bartonella multiple times and not realizing it. And I had a lot of weird little things when I was a kid. And I had a period where I had ticks and I had to get my adenoids out, (and) my tonsils. I was the kid who always had stuff. So, you’re saying that, and it’s really making me think! I’m glad you’re saying this, and I’m going to call my mom after this and tell her that she shouldn’t have let me play with all those cats. She should have called you!
Dr. Edward Breitschwerdt: Well, don’t blame your mom because when you were growing up, we didn’t know Bartonella existed on the North American continent.
Dana Parish: Ah, okay. I hear you. It’s a good thing though to say, because I have lots of friends with kids and we all love animals, of course. And it’s important to say this because I’m so concerned about the amount of Bartonella that’s being spread from animals—and from bugs of course—but just innocently with no awareness. So, it’s good to bring awareness to it.
Dr. Edward Breitschwerdt: We clearly are as well, certainly within the veterinary profession. And the thing that anybody listening should know is that the current knowledge on Bartonella transmission from a cat to a human means that the cat has to have fleas and it has to contaminate its nail bed, like a hypodermic needle, or its saliva, and then the Bartonella is actually transmitted. So, the pathogenesis of this disease is that the flea finds a feral cat somewhere, it gets a blood meal, it takes up the Bartonella, and then it produces large numbers of Bartonella in its intestinal tract, which end up in the feces. Then the cat—in the process of grooming—contaminates either the mouth or the nails so that it’s likely that both bite and scratch transmission occur. But scratch transmission is the one that occurs most frequently. So, the take home message is there’s tons of very good, very safe products to keep fleas off animals. And as I say to veterinarians when I lecture, it’s more important to eliminate flea infestations today than it ever has been in the history of veterinary medicine.
Dana Parish: I totally understand and can appreciate that so much. It’s so diabolical when you describe how it transmits. Cats step in the litter box, or they’re grooming themselves. And you know, also, my friends who have cats let them walk all over the dining room table. I look at all that so differently now in light of this knowledge about Bartonella.
Dr. Edward Breitschwerdt: I do as well. As a veterinarian, one of the concerns I have in regard to Bartonella as zoonoses—or the transmission from an animal to the human—is that we as humans have changed our behavior in regard to cats and dogs. And we’ve done that in a very short period of time. When I grew up on a farm, cats were never allowed in the house, and dogs would only come in during the winter when there was two feet or three feet of snow outside. But as you just alluded to, that’s totally different than what exists today where many people who have pets, they’re inside all the time, or they’re in the bedroom or on the sofa, or on mother’s lap.
Dana Parish: Do dogs carry Bartonella? We talked a little about cats, but do dogs carry Bartonella as frequently? And what is the prevalence, do you think? I don’t know if the data’s all been borne out, but what do you think?
Dr. Edward Breitschwerdt: It’s very clear that fleas and cats have co-evolved very effectively with Bartonella. We know from published studies that cats buried with pharaohs in Egyptian tombs 4,000 years ago still had Bartonella DNA in their tooth bed. And that tells us that this has been going on for a very long time. The cats that were sitting on the lap of the Pharaoh had had fleas at some point in time, because they had Bartonella in their blood. The prevalence in cats varies. So, if you’re in Iceland and there’s no fleas, the Bartonella seroprevalence is almost zero. If you’re in North Carolina and you look at feral cats, infection prevalence can be as high as 80%, where we can demonstrate the organism in the cat’s blood. Any part of the United States that has a tremendously high flea density is going to have a very high prevalence of Bartonella in their cat population, unless the cats are kept indoors and they never get fleas, or the owners use products that keep them from becoming flea infested.
Dana Parish: When I was living in San Diego, the flea situation, there was like nothing I have ever seen. I would just walk down the street and get bitten in the middle of the street. I spoke to the local ecologist who said: ‘Oh, yeah, nothing ever dies here.’ I’ll never forget, he just said: ‘It’s just the weather. You know, it’s why you love it here. And that’s why it’s also going to be really, really difficult.’ They have all kinds of mites and weird things that I don’t recognize from my many years in New York City. It’s really crazy. And now I’m really careful with my dog, Lucy because even in spite of all my best efforts, she still would get fleas and we’re constantly bathing her. And I was getting bitten a lot. And I definitely am very concerned about that. And also, for her wellbeing.
Dr. Edward Breitschwerdt: It reminds me of a particular case in which a young lady from Australia likely became infected by visiting San Francisco. (She was) staying in a hostel and got so many flea bites on her legs that she developed a cellulitis and was hospitalized. She ended up back in Australia and subsequently developed a very unusual vascular proliferative tumor (epithelioid hemangioendothelioma or EHE). Because Bartonella species have been associated with vasoproliferative tumors in animals and humans, we got involved in testing her for Bartonella, and (we) proved that she was infected with Bartonella henselae.
Dana Parish: Is she okay? Did she get a good outcome?
Dr. Edward Breitschwerdt: Years later, she’s doing a lot better than she would’ve been if they didn’t know she had Bartonella.
Dana Parish: That’s incredible. I didn’t know about that. I have heard you talk about prevalence. There’s a study about the homeless population in San Francisco with a very high rate of Bartonella. Can we talk a little bit about that? I also, wonder if it plays a role (in homelessness) because Bartonella causes so many neuropsychiatric conditions, and sometimes I wonder what was the chicken or the egg. I mean, what do you think?
Dr. Edward Breitschwerdt: So, you’re absolutely right that Bartonella was discovered in the indigent homeless or HIV infected populations in San Francisco. In regard to North America—and I made this comment earlier—prior to 1990, we did not know that a cat, dog, horse human, or any other animal on the North American continent was infected with, or potentially carrying a Bartonella in its blood, or (that it was) being transmitted by fleas, lice or any other vector. The way Bartonella was discovered about two or three years before Russ Regnery said Bartonella henselae caused cat scratch disease was through the fact that immunosuppressed individuals, i.e., people with AIDS, develop very unusual vascular proliferative tumors. That’s one of the reasons that we’ve looked at a vascular tumor in dogs called a hemangiosarcoma. We’ve also looked at a vascular tumor in humans, which relates to the young lady I mentioned in Australia.
Dana Parish: And where was that in her body?
Dr. Edward Breitschwerdt: The tumor was in her liver? Its scientific name is the Epitheloid hemangioendothelioma. And again, we don’t know for sure that Bartonella caused the tumor, but at least in Australia, England, and the United States, we’ve identified people who the physicians and the pathologists histologically diagnosed that cancer and microbiologically, we documented that they had Bartonella in association with the cancer. So, it was because of AIDS and the associated immunodeficiency that Bartonella infected individuals developed vascular proliferative lesions that were either on the skin or in the liver. If they’re on the skin, they’re called bacillary angiomatosis. If they’re in the liver, it’s called peliosis hepatis. But the real important aspect of that history is that at that point (in time), nobody could culture Bartonella. So, David Relman (physician and microbiologist) at Stanford, in California, used DNA techniques to detect and describe the bacteria. The fact that these people were immunosuppressed, there were so many Bartonella growing in their vasoproliferative tumor tissues, Relman and colleagues could separate out the Bartonella DNA from the host DNA, successfully sequence the bacterial DNA and say that it was either the old Trench Fever agent Bartonella quintana, or a new bacteria that nobody had ever “seen before.” At that time, no matching sequence had been deposited in GenBank (National Institute of Health, an internationally available database that annotates and stores DNA sequences). With further genetic characterization, the bacteria was named Bartonella henselae. Today, there are over 40 Bartonella species, not strains, but specific species that have been accepted by the microbiologists in the world classification of bacteria.
Dana Parish: And how many infect humans?
Dr. Edward Breitschwerdt: The current number is 18.
Dana Parish: It went up from when we wrote (our book) and we interviewed you for the book, it was lower, it was 14. That’s really interesting.
Dr. Edward Breitschwerdt: And that’s an important point because the concern (about) Bartonella and, in my opinion, (it) is one of the most important medical ‘one health’ problems that we need to work on (together) physicians, veterinarians, ecologists, vector biologists, to figure out what’s going on that we did not know about before the AIDS epidemic lead to the rediscovery of this genus. I say this because, 1) Bartonella species are transmitted by far more vectors than most of our tick-transmitted diseases or even our mosquito-transmitted diseases. And 2) these bacteria have a very broad number and types of reservoir hosts in nature. So, there’s Bartonella in bats, there’s Bartonella in rats, there’s Bartonella in the ground squirrels that you have in California. There’s Bartonella that have co-evolved with dogs, that have co-evolved with coyotes and foxes, there’s Bartonella in gray squirrels and Bartonella in my cows on my farm.
Dana Parish: Do we have to worry about ingesting meat?
Dr. Edward Breitschwerdt: I don’t think so. Based on anything we know currently, I don’t think anything that would end up in a meat product or any other food product would be a means of transmission.
Dana Parish: How about kissing your dog? We know it’s in cat saliva, right? It’s probably in dog saliva.
Dr. Edward Breitschwerdt: I would say that if one of my children or my grandmother was immunosuppressed due to having (let’s say) rheumatoid arthritis and she’s taking immunosuppressive drugs, I would just tell her to be a little bit cautious in regard to too much kissing and contact with saliva. And if the dog had fleas on it, I would tell her to get rid of the fleas and no kissing of the dog until there were no fleas in the house. At this point, we clearly don’t want to scare anybody, but also, there’s more we don’t know about this genus of bacteria than we do know. Until we know more about when and how various Bartonella species are transmitted we just have to be a little cautious.
Dana Parish: What about dog scratches? We talk a lot about cat scratches, but people get scratched by dogs too. Is that a concern?
Dr. Edward Breitschwerdt: So, there are a couple of cases of dog bite transmission in the literature. There are cases that were just published out of Brazil last year on ferret (and Guinea pig) transmission. The ferret was a bite, and the Guinea pig was a scratch. Following transmission of Bartonella henselae from these pets, both people developed neuroretinitis. Neuroretinitis is a classic (indication) for ophthalmologists to consider Bartonella henselae infection in the differential diagnosis. There are other infections that cause neuroretinitis. I’m not an ophthalmologist on the veterinary side and clearly not on the human side, but Bartonella is probably the most prevalent organism that causes neuroretinitis in humans.
Dana Parish: And yet it’s so largely under-recognized in medicine. I had a super bad case that caused heart failure, and everybody missed it until I saw a specialist, obviously Dr. (Steven) Phillips, but I couldn’t get a diagnosis.
Dr. Edward Breitschwerdt: What happened in human medicine is (that) after Dr. Regnery made the association between Bartonella and cat scratch disease that (finding) was solidified by a lot of studies throughout the world. There may be another Bartonella in cats that’s called Bartonella clarridgeiae that could cause a cat scratch disease presentation. But the vast majority of cat scratch disease cases are caused by Bartonella henselae. The human medical literature prior to knowing what was really causing cat scratch disease indicated that it was a self-limiting disease: i.e., physicians could treat it with antibiotics, but it didn’t seem to make much difference in the course of illness. In most instances people immunologically eliminate the infection. So, cat scratch disease, I should clarify, is three things: A scratch, a fever—because it’s been called cat scratch fever–and developing a big lymph node. Typically, if you get a scratch on your hand, your axillary lymph node will enlarge, but sometimes you can get scratch on your hand and multiple lymph nodes in your body, including those in your groin, will get enlarged. And again, that’s well established in the medical literature.
Dr. Edward Breitschwerdt (continued): Historically, the next important thing that happened with Bartonella, after we figured out: 1) it’s here, and 2) it causes these vascular, proliferative lesions if you’re immunosuppressed—and 3) it’s the cause of cat scratch disease—was the association with what’s called culture-negative endocarditis (infection of the valves in the heart). Bartonella is difficult to isolate, and difficult to culture from the blood of sick individuals. Despite the methods that have been developed over the last 30 years, including those in our laboratory, our ability to culture Bartonella is still extremely difficult compared to most bacteria that we (know) cause endocarditis. And so, within a year—and the year was 1993—researchers found Bartonella quintana, which is transmitted by the human body lice in San Francisco and other areas of the world where there are indigent people who are infested with the human body louse, Bartonella elizabethae which is a rat associated Bartonella and Bartonella henselae that we have discussed in detail
Dr. Edward Breitschwerdt (continued): Somehow Bartonella elizabethae managed to get out of a rat, get into a human and cause endocarditis. And then Bartonella henselae became the third one all reported within a year of culture negative endocarditis. I think the current count is that there’s nine Bartonella species that have caused endocarditis in humans, including Bartonella mayotimonensis named for the Mayo Clinic and senensis for the French group in Marseilles that characterized it. And it’s in bats. So, somehow this Bartonella made the jump from a bat to a human resulting in localization and endocarditis. I would say by the end of the 1990s, we knew that Bartonella could cause enlarged lymph nodes in conjunction with or independent of cat scratch disease and we knew it could cause endocarditis and we knew it was more likely to cause recognizable disease if you were immunosuppressed.
Dana Parish: Even though Bartonella has been found in ticks for some reason it’s controversial to make the leap to saying that ticks are transmitting it. I got a tick bite right here (pointing to her body) and this lymph node was like a golf ball. I went to the ER. It was so big that my internist said it had to be scanned. And my ENT at NYU—at the time I was in New York—said I had to come back every three months to make sure it wasn’t getting worse. And I actually had four other glands surrounding it that were smaller, but this was so big and so palpable that it caused alarm. So, this notion that it can’t be spread by ticks to me is weird because it was such a direct correlation for me. But I’ve also heard about spider bites and perhaps you could just run through the list of vectors other than cats and dogs and fleas that can possibly spread this disease.
Dr. Edward Breitschwerdt: Clearly, we know that lice can (spread Bartonella) and the human body louse (can), we know that fleas can amongst rodents, amongst cats, amongst dogs. We know that sand flies can transmit Bartonella bacilliformis in Peru, and particularly in the Peruvian mountains. And that particular Bartonella has a very colorful history that goes back hundreds of years, in as much as it causes a very severe hemolytic anemia. And it also causes another vascular proliferative lesion. So, it’s called Verruca peruana. And it looks just like bacillary angiomatosis in an AIDS patient. So, probably after endocarditis—and I’ll come back to the vectors in just a second—the next big area of Bartonella research and emphasis was actually associated with trying to understand: ‘Gee, here’s a bacteria that can make blood vessels proliferate and can make tumor-like lesions.’ And if you treat the Bartonella, the lesions go away. So, that became a major focus and remains a major focus of some laboratories in and around the world.
Dr. Edward Breitschwerdt (continued): So, going back to the vectors, we clearly know lice, sand flies, fleas, keds, (which are wingless flies) transmit Bartonella to deer and to sheep; biting flies—if you go to a stable you will see those flies, i.e., the horse flies that are biting the horses. They transmit (Bartonella) to cattle and likely to horses. And we’ve reported, as you alluded to a family with neurologic symptoms in Kentucky, that the mother did an excellent job of documenting everything and took pictures of the spiders, took pictures of the bites on her children. They lived in an apartment at that point in time and it flooded. They got an infiltration of these little rolly pollies or woodlice that if you pick up a board in North Carolina, anywhere I think you can see them. And there is a spider that’s called a Woodlouse Hunter Spider. And these spiders came into the flooded apartment where the woodlice had proliferated. But the important part was we got the Bartonella henselae out of the mother by DNA sequencing out of one of the two sons. The sickest son that she had called me about, we could prove he had antibodies, but we couldn’t find the organism. And I think it’s because they had him on high levels of IVIG at that point in time. And a year and a half later, after they had moved out of the apartment, the father actually went back and kept turning over sticks and logs and anything he could find, and he sent us rolly pollies and sent us Woodlouse Hunter Spiders and Patricia Mascarelli a post-doc in the lab was able to prove that we had the same Bartonella henselae strain in the wood lice, the Woodlouse Hunter Spiders, and the two people that we could amplify and sequence in from their blood. So, we don’t know for sure, and this is where the controversy over tick transmission is: nobody will accept tick transmission until it’s done in the laboratory with Bartonella henselae. And there’s a couple of those studies that are in progress and we’ll just have to hold tight and see what the results actually are.
Dana Parish: I didn’t know you when I had my tick bite.
Dr. Edward Breitschwerdt: Yes. We would’ve liked to have had that tick because if you know what you developed is classic cat scratch disease and with a tick bite disease. And we’ve actually seen that in a dog that presented to our college with a tick in its ear and a big lymph node in its neck. And what was very interesting about that dog is the differences in the cytology. It went from being a reactive lymph node—they were doing aspiration cytology—to being a granuloma lymph node to being an aspirate by the third attending veterinarian where it looked like it was a cancer. And that didn’t make any sense because all this occurred within a seven-to-10-day period. And then when it was referred to us, it actually had a slightly different cytological appearance that looked like a giant cell tumor.
Dr. Edward Breitschwerdt (continued): Bartonella causes giant cell tumors in children that the diagnosis is cat scratch disease. Now, unfortunately, I had read enough that we tested that dog for Bartonella, and we proved that it had Bartonella, actually not henselae but Bartonella vinsonii which was the first Bartonella that anybody in the world found in the dog. And that was our lab because we were doing a lot of Bartonella work and we studied a dog with culture-negative endocarditis, and the PhD student in the lab made an isolate, and that ended up being a new Bartonella, and the most prevalent Bartonella that we find in dogs, in coyotes out in California, and to a lesser extent in foxes.
Dana Parish: Coyotes travel in packs and they’re right on my street even at weird times when you don’t expect them—I’m just not used to this!
Dr. Edward Breitschwerdt: Again, everybody can appreciate this with COVID and Monkeypox, but what you just said is important in the context of Bartonella as well. (With regards to) all zoonotic infectious diseases, we’re moving animals and infectious diseases around the world at a rate that is unprecedented in human history. And that’s why I think anyone who’s in the infectious disease business is very concerned because we need very good diagnostic tests, we need very good therapies for these things, and we need to be prepared for when the next one comes along that we don’t actually know what it is. And we need to be prepared for the next thing that comes along—and we don’t actually know what it is going to be. So, those coyotes that you have encountered in California, were (originally) pretty much on the other side of the Rocky Mountain—your side (West) of the Rocky Mountains. They’re now down the bottom of the hill on my farm in North Carolina. They’ve come across the entire United States. And guess what? They brought their “Bartonellas” with them.
Dana Parish: Sorry I didn’t put up a California fence for you. Even in New York City, we would hear about coyotes in Central Park and (them) occasionally making it into the city itself. And I thought that was especially early in the pandemic when nobody was out. You remember those early days and the animals were like: ‘This is our kingdom again! The people are home!’ I would hear wild stories about animals in cities, and it was very alarming because you know, hearing about Marburg now in Ghana, we are hearing about all these horrifying infectious diseases that are just coming up suddenly. Can you talk a little bit about what it does and the way it presents in humans and animals and what do you think is most prevalent among the symptoms people should be looking at?
Dr. Edward Breitschwerdt: I think we went from, back in the early 1990s, literally my research group studying cats and cats scratch disease from believing that, only veterinarians or foresters or someone that had a tremendous amount of animal contact or a tremendous amount of arthropod contact because we believed clearly that it was the ticks and the fleas likely doing the transmission, were going to be the people that became infected with Bartonella. And now I’ve changed my mind to the point that I wonder whether anyone can make it through life and not be exposed to and infected with this organism. And like with cat scratch disease, I think the important message for everyone is that the vast majority of people who are healthy and have a good immune system eliminate this organism at the site of the scratch. It never leaves the scratch, it never gets to the lymph node, it never becomes a systemic infection.
Dr. Edward Breitschwerdt (continued): Unfortunately, even with some people with cat scratch disease that we’ve studied—and there really ought to be a comprehensive study by one of our government agencies following people with cat scratch disease as they’ve done with a national registry in Israel, so that all the testing for Bartonella and Cat Scratch disease is done in the single laboratory. It (the Israeli lab) is a state-run laboratory, and they actually have followed people for the next 20 years or so. And there’s several publications that address that. So, what’s happened to those people? Some of those people have developed rheumatologic disease. Some of those people have developed other forms of musculoskeletal pain. So, the systems that we worry about the most are the skeletal system, the cardiovascular system, and the neurologic system. And on any given day, you really want all three of those systems to be working as well as they can be working, obviously. So, you don’t want any bacteria that can stay in your body for an extended period of time.
Dr. Edward Breitschwerdt (continued): So, you kind of asked this question earlier, and I didn’t do a very good job of answering it, but literally we all went from the concept that only the animal that was a reservoir host—like the cat, or the bat, or the rat—would maintain the bacterial bacteremia for months to years. So, we’ve followed the same cat belonging to one of our students for three years and we could grow Bartonella out of that cat for three years. And in a laboratory, we’ve done that for 18 months where we actually infected cats, kept them for 18 months, showed that they remained infected, and then treated the cats to try to make the Bartonella go away. And I’m sure we’ll get to treatment here eventually.
Dana Parish: Did it work?
Dr. Edward Breitschwerdt: The treatment? No, it didn’t. The cat studies that we published on treatment were probably 1998 or so, and we elected to treat the cats with doxycycline. The same way we would treat Rickettsia, Ehrlichia, Anaplasma and some of the other important tick-borne diseases. And we were unhappy and somewhat shocked when after four weeks of doxycycline we could still grow Bartonella out of their blood. So, that was the first lesson we learned was that at least if it’s a cat in a laboratory setting, doxycycline rarely clears that infection. And then we worked with Baylor Animal Health that had an antibiotic called fluoroquinolones. And that worked better, but we still had cats that failed therapy with that particular antibiotic.
Dana Parish: What about gentamicin? What about Rifampin? Can you give these drugs? I know we can use them in people. Do you give these to animals, and do they work well?
Dr. Edward Breitschwerdt: Yes, like in human medicine, we routinely use aminoglycoside in culture-negative endocarditis. That’s the primary indication for using aminoglycosides.
Dana Parish: So, we should just say that they are a class of antibiotics?
Dr. Edward Breitschwerdt: Amikacin is the one that’s used more often now because it’s not as toxic, it’s safer. But, you know, like gentamicin, there’s a class of aminoglycosides that are probably important when you’re treating a patient that is septic from Bartonella and has a big infection in the heart valve and you’re trying to get that patient stable, and maybe go in and put a new heart valve in.
Dana Parish: How well do these work? These drugs when people have endocarditis or very severe neurologic, neuropsychiatric, rheumatologic conditions?
Dr. Edward Breitschwerdt: They actually work. And I think what has evolved—and again, I don’t want to comment on treating humans because I don’t treat humans and I’m not licensed to be able to treat humans—But I think if we look at the literature from human medicine and veterinary medicine, we’ve come to appreciate is that eliminating Bartonella can be challenging. And that often it requires more than one antibiotic, and often it requires a very long duration of treatment, which is true for other intracellular bacteria with very slow dividing times like mycobacterium tuberculosis, which divides about every 24 hours, like Bartonella does.
Dana Parish: So, it can really hit you like a ton of bricks.
Dr. Edward Breitschwerdt: Yes. I think endocarditis is probably the ‘hit me like a ton of bricks’ portion.’ The bad part about Bartonella is that I’ve come to believe that this bacteria does not want to hit you like a ton of bricks. And, as you know, many of the physicians have said in their lectures, it’s the host response as much as it is the bacterial infection that determines your symptoms on any given day. So, I think you can think about this like, you know, two boxers in a ring and they’re sparring and they’re sparring and they’re sparring, and you know, nobody’s getting hurt, nobody’s bleeding. And then one guy lands a pretty good punch and you’ve got a nosebleed, and then the other guy lands a good punch to the abdomen and that guy’s bent over with pain. So Bartonella to me is (this)—if it establishes a chronic infection—and that’s clearly what our research has shown and that’s what some of the Brazilian physicians are showing in immunocompetent people. (And) Physicians, infectious disease physicians (etc.) accept the fact that Bartonella is a chronic infection of the blood in immunocompromised people. But they do not accept that at this point in time—at least most do not—that Bartonella can cause a chronic bacteremia.
Dana Parish: Why do you think that is? Why is it so hard to have the reality of this recognized in the medical community?
Dr. Edward Breitschwerdt: Medicine moves very slowly, honestly, in regard to change. I think that’s true of diagnostic tests. I think it’s true of treatment modalities. And it’s even truer when a new bug on the block comes around, because everybody wants to figure out: ‘How real and how important is this new bacteria?’ And honestly that has changed so dramatically for Bartonella in the last 30 years from not knowing it exists, to the situation in immunocompromised people, to cat scratch, to endocarditis, to our work. And perhaps it’s because I’m a veterinarian because when I would lecture on Bartonella and (share) what we were seeing in cats and dogs, and dogs in particular, I would have veterinarians come up and say, ‘Can you test me?’
Dana Parish: I’m so interested in what you found in veterinarians. I would think they would have such a high rate of exposure.
Dr. Edward Breitschwerdt: So, they have a really high rate of exposure with—depending on how many Bartonellas you test them against—of antibody prevalence’s of 40 to 50%, meaning half of the veterinarians that are tested actually have the antibodies to one of several organisms that we routinely see in cats or dogs. The more important part is being able to document that they have DNA of the organism in the blood of these veterinarians. And those studies have been around 25 to 28%. So, we’ve done two studies in the United States and one study in Spain. The prevalence in veterinarians in Spain was a little lower—around 18%. But that’s still phenomenal. We don’t believe there should be bacteria in anybody’s blood that a lab could document is present. And I truly believe that the veterinary professionals become the canaries in the coal mine, by which the human medical professional better understand this genus of bacteria.
Dana Parish: Would you say that many of these veterinarians were symptomatic? Did they describe or did you see any patterns of illness or anything among them?
Dr. Edward Breitschwerdt: Absolutely and I think the pattern that we’ve seen in veterinarians, we’ve seen subsequently when our studies opened up to test other individuals that were following the literature. Their physicians were following the literature and they asked to be entered into our IRB research project. They often have very severe fatigue, memory loss, and difficulty sleeping. Statistically, agitation was one of the things that we found in the study that we did with Duke (University) on the veterinary cohort that we looked at (during) a meeting down at Florida. But the veterinarians that had come to the meeting were actually international. What we were seeing in veterinarians and what we started publishing in regard to neurologic manifestations or symptoms in the veterinarians was what led us into focusing on Bartonella and neurologic disease—and particularly Bartonella and neuropsychiatric disease.
Dana Parish: What about anxiety and depression? I know you said agitation…
Dr. Edward Breitschwerdt: Actually, I shouldn’t have said agitation. I should have used anxiety because that was the word on the questionnaire.
Dana Parish: (But you found it to be) very prevalent, right? Knowing what I know from the humans that I know that have it, and what I went through—which was a complete falling off the cliff… (I) was totally psychiatrically really boring and steady, and then all of a sudden (I had) anxiety, depression, OCD. And I was seeing melting monstrous faces every night when I closed my eyes. And what was so fascinating is Dr. Bob Bransfield, who I think is wonderful—he’s a psychiatrist at Rutgers (University)—and he has done a brilliant body of work as well on the neuropsychiatric manifestations of vector-borne diseases. And I will never forget being at an ILADS conference my first year being well and wanting to understand these diseases better and as I was able to attend this conference in Boston, I saw him present a slide where he talked about melting monstrous faces. And it was common! Dr. Steven Phillips said it’s not like in a hallucination specifically, or a psychosis, I can’t remember how he categorized it. But this is common. And what’s so interesting is my friend’s son who had the same thing drew me a picture of what he was seeing in his head at nine years old. It was like The Scream (painting). I had the exact same thing. Have you heard about this from other people?
Dr. Edward Breitschwerdt: We have definitely, you know, documented patients with hallucinations certainly with dramatic behavior changes, at least one case report with pediatric onset neuropsychiatric illness—that led to a second study that we did that we just opened things up. And when someone called that had a child or a young adult that went from being absolutely normal and absolutely healthy to having neuropsychiatric symptoms, we would enter them into our IRB study. It went for about a year and a half. And in that period, there were thirty-two people that we studied. Twenty-nine percent of them either had antibodies to Bartonella or we could find Bartonella DNA in their blood: twenty-nine out of thirty-two. And twenty-two of them we could actually prove that they had Bartonella in their blood based on their enrichment culture techniques and PCR. So, I have tremendous respect for Robert Bransfield, and he’s done an amazing body of work, and I think Bob (Bransfield) believes the same as I do, that we clearly need better tests to better understand the role of these vector-transmitted organisms in neuropsychiatric disease. Because right now that literature is in its infancy, literally where our knowledge of Bartonella was back in 1990.
Dana Parish: That’s a shame because I feel it’s playing such a huge role in mental illness across the world and in children. I’m really worried about kids. And I wanted to talk to you about some of the really fascinating cases I’ve heard you talk about and published the neuropsychiatric (cases). I can’t emphasize enough like when you see your kid go haywire, or we could talk about the slow boiling frog versus the runaway train sort of presentations. For me, I was the runaway train, but as you pointed out, oftentimes it’s really a slow process (due to) infection. You get weird migrating low-grade symptoms, they stop, you get a little fever here and there, a little joint pain, it stops. People don’t understand that the migratory nature of these infections is one of their hallmarks. So, you think, ‘Oh, I’m better now. Oh no, now it’s my elbow.’ You know, and that’s kind of how it can unfold. But the brain stuff is so fascinating and so debilitating at the same time. Because it’s not just brain fog and anxiety. It’s full on to panic! Like every cell of your body. It feels like you’ve just become this different person. And I know from having a steady state of mental health going through this and then recovering, how fortunate I was to have seen the bite and to have known that it was the reason that I felt the way I did. And it would’ve been very easy to put me on psych meds. And doctors definitely wanted to put me on various palliative medications that would’ve just treated symptoms for joint pains and fibromyalgia. But just treating the infection completely resolved all of that. And I say I felt like I had monsters in my head. I am so curious about one of these cases that you presented that I think about often is I think it was an 18-year-old boy who was put in a psychiatric hospital. Can you talk a little bit about that case?
Dr. Edward Breitschwerdt: Yes. Again, Dana, what I can say is as an internist throughout my career, I believe that sometimes there’s a single patient, a single dog, a single case that is pivotal in our understanding of what might be going on in the greater world out there. A lot of really, really important discoveries in medicine started with one patient and one physician that paid attention to that patient and just kept trying to push the edge of the envelope to figure out what was going on. In this boy’s case, it was actually his father who would not accept that his son, who a year and a half earlier had been a straight-A student, had been on the fencing team, and had been the lead actor in several of the school plays–you know he was a scholar.
Dr. Edward Breitschwerdt (continued): And (he) just then started these, as you alluded to, very subtle behavior changes that got him to a psychiatrist. So, the first idea was: maybe he’s depressed or has anxiety? And then it just kept getting worse to the point that they finally diagnosed him with psychoses, and he progressed from psychoses to being suicidal and homicidal. And we got involved, literally about 18 months down the road when the father contacted me. At that point, and this is in the publication, which is in central nervous system disease the boy had literally failed combinations of 11 neuropsychiatric drugs, drugs for depression, behavior, all of that type thing. So, it was what you said in regard to yourself is that if you hadn’t made the association between the tick and the lymph adenopathy and what you were seeing in regard to the monsters, you would’ve been seeing a psychiatrist and you would’ve been treated for those types of things to see if they help you make it go away.
Dana Parish: And I never would’ve gotten better.
Dr. Edward Breitschwerdt: Yes. And that is a concern because if we actually have an organism that we can identify and we can treat and go away. So, the way the boy was ultimately diagnosed two months before we got involved is that after having been to several psychiatrists, to neurologists, having brain scans, having been institutionalized in a neuropsychiatric hospital for very detailed intensive testing, ultimately, he went to a physician whose nurse saw a lesion that has been referred to as Bartonella tracks. And that lesion caused the physician to start treating the boy for Bartonella. And he started to improve. But the father started chasing the literature on Bartonella because he had a target at that point in time. He found us and still after two months of doxycycline—so we talked about the cats failing a month of doxycycline. I’ve seen dogs fail three months of doxycycline clinically, and I’ve seen veterinarians who were seizing fail six months of doxycycline and were still infected. So, doxycycline alone, at least in a subset of individuals, will not clear the infection. After two months of doxycycline, we could still demonstrate that the boy had viable Bartonella in the blood. At that point, the attending physician got involved with Dr. Bob Mozayeni, who had collaborated with us and treated a large number of patients. And between the several physicians that were involved with his care, within six months, he went from 11 neuropsychiatric drugs to one, and they were just afraid to stop that one. We followed him microbiologically for about another 18 months. And I kept saying to his physicians, ‘Okay, when are we going to stop antibiotics?’ And I don’t think either the doctors or the parents wanted to stop antibiotics prematurely and have a relapse of course. And that was a good decision because when they were finally stopped, he was back to being in school, getting straight A’s, in the play. And we’re now three or four years down the road, and he is a student at the Ohio State University and is pre-med.
Dana Parish: Wow.
Dr. Edward Breitschwerdt: Last email I had, he’s doing extremely well and has had no relapses.
Dana Parish: That is a remarkable story. Parents need to hear these stories because so many parents are struggling with how to think about a future with a child who’s going through PANS PANDAS—these horrifyingly, scary neuropsychiatric syndromes that their kids are having because of these infections. And I always think that Bartonella is the main event in PANS, and it’s not necessarily strep, it’s not necessarily Lyme, even. But I talk to many clinicians that feel this is a really big problem.
Dr. Edward Breitschwerdt: But the good news is that we’ve reached the tipping point where there’s a lot of people in human medicine and veterinary medicine that believe this genus is important enough that the NIH needs to start funding research relative to Bartonella. Because right now almost all the funding for Bartonella research is coming out of foundations. And if you go to the CDC website, you’ll see that most of what I’ve said about Bartonella is discounted by what’s on the CDC website.
Dana Parish: Well, this is a problem in Lyme too.
Dr. Edward Breitschwerdt: I think it’s a problem where we’re not keeping up with the change. And the other problem is we’ve got literally one laboratory that’s a veterinary research laboratory that’s trying to understand the medical implications of a genus of bacteria across all the animal species, including humans. That puts the problem into a nutshell. But there’s finally some other groups, at least around the world, that are trying to look at Bartonella, clinically not as microbiologically, and really basic science understanding every protein and every pathway in the bacteria, which is important because that’s the basis upon which we build things like good diagnostic tests, good therapeutic tests, but we’re building them and ignoring the fact that we need to understand the medical importance of this genus.
Dana Parish: One of the other things you touched on (are) rheumatologic diseases. I’m not sure that everybody will know what this means, (for example) that’s arthritis, but we should talk about them and rattle off a couple of the associated syndromes that you feel can be caused by Bartonella.
Dr. Edward Breitschwerdt: Well, clearly, we have tested both veterinarians and non-veterinarians who had a diagnosis of rheumatoid arthritis and proven that they’ve had Bartonella, and they’ve been treated and had tremendous resolution in their joint symptoms at that point in time. The other rheumatologic disease is Ehlers-Danlos syndrome. And the reason I bring that up is because of testing a veterinarian that was diagnosed with Ehlers-Danlos type three at Harvard and saw a specialty group at Johns Hopkins that supported the Harvard diagnosis, and she happened to be a veterinary dermatologist. There’s probably nobody in veterinary medicine that has more contact with fleas and cats and flea feces than our dermatologist. She was one of the first patients that we got Bartonella koehlerae. So, this is another flea transmitted cat reservoir we got Bartonella out of. She was treated and had complete or near complete resolution of her joint laxity and went back to being a runner again.
Dana Parish: Okay. That’s really great to hear because I don’t hear a lot of insights about Ehlers-Danlos syndrome, and I think it’s all often attributed to genetics when it’s not necessarily genetic. People make a lot of assumptions, but they also think—and I’m not saying it can’t be Lyme too—but there’s also the collagen connection with Lyme. So, I think there’s also that playing a role in some of these cases, but I did not know that Bartonella could be a cause as well.
Dr. Edward Breitschwerdt: If you look at the manuscript that we did on that series of thirty-two people, and what we really wanted to emphasize is that almost three quarters of those individuals had skin lesions. And their skin lesions came on before or during their development of neuropsychiatric symptoms.
Dana Parish: What do you mean by lesion exactly? Visually?
Dr. Edward Breitschwerdt: So, this too has become a controversy, which is unfortunate, but it’s a fact of life. So, many physicians, and we in a couple of our initial case reports where we saw lesions that look like striae, we call them striae. Striae distensae is associated with stretching and defects in the collagen due to stretching. But they are striae-like lesions except they can occur on the arm in an area where something shouldn’t be stretching. They can occur vertically, which is not across stretching planes generally. They can occur transversely across the thigh. And there are linear stretch-mark-like lesions that are more prevalent in Bartonella patients than we’d like to believe based on what’s been done. And that’s very little at this point in time where it’s been confirmed by PCR DNA sequencing or imaging by Marna Ericson, where she’s looked at a few biopsies from these people and shown that within these stretch-mark-like lesions, there’s Bartonella DNA.
Dana Parish: I’ve seen some of her slides, and I’ve been in close contact with her for a couple of years. I’m blown away by what you find in the skin, and I’m blown away by the work. We don’t have to get into this, but I’m just thinking about Marna … (what about) melanomas?
Dr. Edward Breitschwerdt: What you bring up there is Bartonella and cancer. We did the microbiological testing in the melanoma group. A physician, Paul Riker, who is a co-author on the manuscript and was the primary one who contacted me and said, ‘You know, Ed, I’m seeing people in Oregon who have never seen the sun and have never taken their shirt off, and they had melanoma in places where there’s no sun.’ And we all know that the sun is considered an exposure risk for developing melanoma. And when Paul contacted me, he said, ‘You know, some of these people have a history of tick infestation and I’m wondering if they have Lyme.’ And that’s where that started. So, he did Lyme testing through iGeneX and other laboratories that were doing that, but he did the Bartonella testing on a research basis through my IRB study.
Dr. Edward Breitschwerdt (continued): And it was a small number of patients in that study. You would consider it a pilot study. And then we went back and managed to get tissue blocks from where Paul had done biopsies on these people. And that’s what Marna worked on to show not only did they have Bartonella in their blood, but they have Bartonella in the tissue. But that doesn’t mean that the Bartonella caused the melanoma. All as it means is we can find it in blood, and we can find it in the tissue at this point in time.
Dana Parish: So, we don’t know if it’s causative.
Dr. Edward Breitschwerdt: That’s right.
Dana Parish: But it could be, I guess. And so, it needs to be explored. I remember talking to Neil Specter, who I know was a dear mutual friend of ours. Dr. Neil Specter was an oncologist at Duke (University), and he lost his heart to Lyme. And he lived another about 11 years, and he passed away in June 2020, unfortunately, and was doing brilliant work with you on breast cancer and Bartonella. Can you talk a little bit about your work and your time with Neil?
Dr. Edward Breitschwerdt: It’s one of the greatest honors of my life to have gotten to know Neil (and) to have worked with Neil. Clearly (he was) the most passionate physician, the kindest physician, that anyone would ever want to meet. A brilliant mind and a very rigorous research approach, but a very open mind that was willing to encompass many, many concepts and try to see where those concepts actually fit into a picture that is called a patient in a disease. Neil and I initially met, and I explained to him what we were doing. We were at a national meeting lecturing, and he came up to me afterwards and we started talking about Bartonella. And at that point the only thing we had done in regard to breast cancer is we had had a researcher send us cells from a very aggressive form of breast cancer that’s called inflammatory breast cancer.
Dr. Edward Breitschwerdt (continued): And their laboratory had isolated these cells to be able to study them, obviously with the permission of the patients. And when they were looking at their cells, they saw something in there that looked like bacteria. And when they did a silver stain, which is the only real stain that’ll stain a Bartonella in a cell, the bacteria were still there. So, they were convinced they had a bacteria, and then they asked us if we could figure out if it was Bartonella. So, they had two cell systems going, and both of them had Bartonella henselae. That was the story that I related to Neil. And then we started looking with Neil at what Bartonella does mechanistically in regard to breast cancer cells or non-cancerous breast cells. And the two cell lines that are the workhorses in our lab are a non-cancerous breast cell line and a dog macrophage cell line that’s from a dog that had a cancer—and those are our real two workhorses. So, the pandemic really interrupted research worldwide. And it complicated trying to get anything done and do it well. So, our breast cancer research literally got put on hold, but just stay tuned.
Dana Parish: I want to hear about what you’re working on now and what’s happening with your research, because I know you never stop.
Dr. Edward Breitschwerdt: I’m extremely excited about our research right now, and I’m extremely excited about the team that I have to be able to accomplish that research. I’m most grateful to the Bay Area Lyme Foundation, to the Cohen Foundation for funding the research in our laboratory at this point in time. They are the major funders of what we have going on in the lab. There are a couple other foundations that have contributed to our research in recent years. What has happened with the Cohen Foundation is they have funded research for us to improve diagnostics. So, in collaboration with Dr. Ricardo Maggi, who’s a research microbiologist that many people have heard lecture or talk, Ricardo has pushed the envelope of being able to detect DNA of this bacteria in blood and in tissues. And then the other grant that we have is a collaboration between North Carolina State University, Duke University, pharmacology and chemistry, and Tulane University with Dr. Monica Embers doing the animal testing work on the compounds that are being generated. So, the whole goal of that is to take Neil (Spector)’s vision and Tim (Haystead)’s expertise and our knowledge of Bartonella and a lot of the cell cultural work that we’re doing at NC State and put it together and come up with a very unique (approach). And Neil said this in one of the last lectures he ever gave. He said, ‘We need to treat Bartonella like a cancer and we need to approach its therapy like a cancer.’ And that’s the approach the team’s taking. Because of the diagnostic support of the Cohen Foundation, we were able to buy a piece of equipment. We are now utilizing that equipment in collaboration with the Bay Area Lyme Foundation in collaboration with UNC where we’re doing two studies, one in children and one in adults, and there will be an additional schizophrenia study with Columbia University and Brian Fallon.
Dana Parish: I am very grateful for the Bay Area Lion Foundation and the Cohen Foundation for the incredible research that they’re funding. They’re the all-stars funding all-stars like you. I can’t tell you how many times I’ve thought of you during the pandemic and wanted to call you up and say, ‘What is going on with Bartonella in COVID? Is it being reactivated?’ I’m seeing such an overlap in symptoms and I’m seeing Bartonella patients who recovered prior to getting COVID, (and were well) for long stretches, then they (get) infected with COVID. They relapse, get retreated for Bartonella or Bartonella and Lyme or whatever infections and get better. So, Long COVID not always like persistent COVID or some other mechanism. No. COVID is also, chronic, and persistent. I mean there are like three hundred studies now showing COVID’s persistence, So, I don’t want to discount that.
Dr. Edward Breitschwerdt: Sure. Huge.
Dana Parish: It’s a huge problem. But is it also activating Bartonella?
Dr. Edward Breitschwerdt: It’s a very good question for which there’s no data that I’m aware of. I have been very concerned since the onset of the pandemic if— let’s say (there is) 25% of veterinarians walking around have Bartonella in their blood…. We did a blood donor study with physicians in Brazil using the techniques. The BAPGM (Bartonella alpha proteobacteria growth medium that we developed at NC State is now offered a Galaxy Diagnostics and they found Bartonella in the blood of 3% of the blood donors in San Paulo, Brazil. So, obviously you do not test sick people for your blood donors.
Dana Parish: Right.
Dr. Edward Breitschwerdt: So, as the techniques have gotten better, if that group can document and publish 3% of healthy blood donors, we know that there’s a lot of healthy veterinarians that we can find Bartonella in their blood. And we know that there’s a lot of sick veterinarians that we can find Bartonella in their blood. If we make the Bartonella go away, most of those veterinarians will have a much better quality of life. So, I think Bartonella is far more prevalent in blood than any of us would’ve ever dreamed back in 1990 when AIDS came along and made us realize these bacteria existed. And if that’s the case, Bartonella should be one of the primary organisms that’s being targeted by COVID laboratories in the context of reactivation. But I don’t know of anybody that’s doing it.
Dana Parish: I totally agree. And I don’t see anybody even talking about it. I feel like I’m always screaming into the void. Because to me it’s so clear. And it also, when I hear about the internal vibrations of all the Long COVID patients, and when I hear about the tinnitus and when I hear about the brain fog—it’s just so eerily familiar. And I hope that we get some of these clinicians to look for these bacteria because I think patients will have a much better outcome. If I did a talk on COVID two days ago and talked a lot about latent infections reactivating in the face of COVID. We know about EBV (Epstein Barr Virus), we know about varicella and that’s great, but nobody’s talking about the vector-borne stuff. And to me that is a huge loss for the Long COVID community. Because I think broad spectrum ID panels should be done on every single Long COVID patient. Let’s see what’s there, see what is treatable and see who we can get better. Right now, they’re all just being relegated to physical therapy—nothing that helps.
Dr. Edward Breitschwerdt: Several of the physicians that are active in regard to Lyme disease and Bartonella have strongly made the point that Long COVID is going to help all of us. Except the fact that you can have an infection that can cause different symptoms in different people. And most people will either not get sick at all, or they only get a mild flu-like illness. Some will get a severe flu-like illness, but some will get Long COVID, which is like long borreliosis and long bartonellosis.
Dana Parish: You said something interesting about the CDC website and one thing I noticed is that the animal side of the CDC website for Bartonella is really much better than the human side. They talk about chronicity, they talk about the different symptoms, and you look at the human page and it’s like blank. (The site says) its ‘self-limiting,’ which means it goes away on its own, you know, (implying people just need) to deal with it. And actually, I love looking at animal stuff because to me that’s where it’s at.
Dr. Edward Breitschwerdt: Dana, you’ve perhaps heard me say it in lectures, but from the veterinary perspective, the dog is the best naturally occurring model for human bartonellosis because dogs develop endocarditis, develop granolas, granulomatous lymphadenitis, bacillary angiomatosis, peliosis hepatis, you know, just like the AIDS patients do. So, looking across the species has been a real benefit to me no matter what infection I have looked at that was a vector-borne infection. How does it behave in a dog? How does it behave in a human? How does it behave in a cat?
Dana Parish: Yes. I’ve learned so much from you through the animal stuff. We’ve talked about dogs’ herxing before and that’s because my dog has had Lyme. She’s definitely had Bartonella, there’s no question. I went to New Jersey to visit my parents (and took my dog with me). They live in South Jersey and its suburban leafy, tick-infested deer-infested neighborhood. Three days later she couldn’t walk. So, it was very clear. And three days later I saw two ticks crawling up my wall in Manhattan. So, there you go. I gave her some of my tetracycline because the vets wouldn’t treat her for Lyme. It was weird. And I kept saying, ‘Well, she can’t walk!’ I did $1,400 worth of X-rays and tests and blood work. Finally, I called my Lyme doctor, and I told him about Lucy and he’s like, ‘Sounds like Lyme.’ And I had a little extra tetracycline and called my vet. I said, ‘If I give her one, how much can I give her?’ He said, ‘All right, fine. Give her your tetracycline.’ She got better in two days. (For) 11 days. She couldn’t walk.
Dr. Edward Breitschwerdt: Understanding these diseases across veterinary medicine and human medicine. We have got a long way to go. But to end on an encouraging note, I see manuscript after manuscript after big reviews and invited perspectives by authoritative individuals. And finally, something other than mosquito transmitted diseases is gaining traction. And ticks are number one, the bias is that fleas need to be number two—if not number one—because those fleas are throughout the world, on dogs and cats.
Dana Parish: So, my last question to you is testing. You are the CEO of a wonderful lab that I went to, that’s where I got my diagnosis.
Dr. Edward Breitschwerdt: The testing for Bartonella is complicated and because it’s complicated, it’s not necessarily cheap. I’m not the CEO of Galaxy, but I’m the Chief Scientific Officer. Dr. Amanda Elam is the Chief Executive Officer of Galaxy. And I’m glad because she has to worry about the business side, which I try to stay out of 100%.
Dana Parish: She’s incredible. I just want to say that too. Amanda is a rockstar.
Dr. Edward Breitschwerdt: She is a rockstar and Galaxy is super lucky to have her. And I guarantee you that Galaxy would not exist today if it were not for her because prior to the pandemic and during the pandemic, there were many times where it was touch and go as to whether the company would still be in existence two months, three months down the road. I think what Galaxy has tried to focus on, whether it’s Lyme disease with the Nanotrap test, is an assay to detect Osp A antigen in urine. What we believe is that the most important way for us to really be firm in a diagnosis is to be able to demonstrate an antigen—a piece of the bacteria, protein of the bacteria—or DNA of the bacteria in the patient, in a tissue, in the blood. And the direct testing is far more expensive. And, again, when I lecture to veterinarians, we shouldn’t throw serology out because it’s really important and every diagnostic test has limitations. And so, that’s why, whether it’s iGeneX doing the testing, Galaxy doing the testing, I think all the companies want to continue to offer serology and the most sensitive molecular diagnostic testing they can offer or antigen testing they can offer. And clearly the tick-borne disease task force that’s met over the last year, that is the number one recommendation and it’s the reason for the LymeX initiative to improve the diagnosis based on direct testing methods, particularly in acute infections, but equally important in chronic infections where it becomes even more critical to patients.
Dana Parish: Well, thank you so much. I loved talking to you today. I have many, many more questions for another time. I can’t thank you enough for everything that you do for this community and for the world and just for your time today. Thank you so much. Is there anything important that I missed that you wanted to say before we go?
Dr. Edward Breitschwerdt: No, I think you did an excellent job of covering a lot of territory that’s very complicated in a brief period of time. The last thing I would say is that during the COVID epidemic, one of the things that was very disappointing to me, as a clinician that spent a good part of his career trying to do science, is that it seems like people have lost faith in science. And what happened with COVID should be so reassuring: to go from a virus that we didn’t know existed to a vaccine within a year of its epidemic occurring in the United States. If it wasn’t for the science that occurred in the previous decade in virology, we would’ve still been dealing with the initial part of this epidemic five years down the road before we had a vaccine. I understand if you’re a patient and you’re sick, and you’ve gone to a lot of doctors that it’s frustrating. People become frustrated with their doctors, they become frustrated with science. Honestly, all of us are trying to do a pretty good job of helping people. It’s just not easy.
Dana Parish: Absolutely agree. And the problem unfortunately was more the messaging from the CDC and various health agencies and confusion around, do we need a mask? Is this just fomites? Is this airborne? I think that has really damaged really great science and great scientists. And I agree. It’s just, it’s a shame that things have become so divisive and that scientists are not separated out from the political stuff as much as I think that they should be. But I’m glad that you mentioned that because I think that’s a really important note to end on. So, thank you again for your time and for your expertise and we’ll talk again soon!
Dr. Edward Breitschwerdt: Thanks Dana All the best.
Dana Parish: Thank you for joining us for this episode of Ticktective, a program of the Bay Area Lyme Foundation. For more information and to get involved, visit bayarealyme.org.
This blog is part of our BAL Spotlights Series. It is based on a transcript from Ticktective, our podcast and video series. To listen or watch the original conversation, please click here. Bay Area Lyme Foundation provides reliable, fact-based information so that prevention and the importance of early treatment are common knowledge. For more information about Bay Area Lyme, including our research and prevention programs, go to www.bayarealyme.org.