Infectiologic differential diagnosis of chronic Lyme disease and so ...

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Fig. 1. Erythrocytes infected with Bartonella henselae (Bh). A. Early stage, Bh
on the outside of the erythrocytes; b. With increasing duration of
infection, Bh primarily intracellular; erythrocytes loose their lightcolored
center.
There is no information on the value of serology in the literature. In particular, the
question as to whether seronegativity rules out the disease has not been clarified.
On the other hand, as is the case for many other infectious diseases, a positive
serological finding merely proves that an infection took place, but does not indicate
that the disease currently exists.
Detecting Bartonella in culture is extremely problematical, and the sensitivity is very
low so that this method of investigation is not part of routine diagnostics.
Detection of pathogens using PCR in biopsies appears to be very promising [87,
232], but the investigation with PCR must follow the biopsy nearly immediately [88].
The chronic course of bartonellosis has been described in numerous studies, in part,
on large groups [90 - 94]. The long duration of the disease, which frequently covers
many years, and the high similarity of the disease manifestations makes it extremely
difficult to distinguish from chronic Lyme disease. Thus, bartonellosis is of great
importance in the infectiologic differential diagnosis of Lyme disease.
In this context, attention should be paid to the fact that B. henselae has been found
in ticks and that the transmission of B. henselae by ticks has been documented by
means of pathogen detection in the liquor [95]. Additionally, the prevalence of B.
henselae in ticks is apparently high; scientific studies determined a prevalence of
40% [96].
According to my own surveys, 78% of the patients with chronic Lyme disease proved
to be seropositive for Bartonella henselae.