Bartonella is one of the most difficult to treat.

Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate

There are 263 references in Dr. Horowitz book that support the persistence of infection

Borrelia is thousands of times less sensitive to antibiotics than syphilis.

Ticks cannot survive drying out; moisture is their friend.

If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.

Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.

There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment

It takes a temperature of 17 below zero to kill a tick.

Borrelia has the most complex genetic makeup of any known bacteria.

Ebola, HIV, and Borrelia have all been tested in the Space Lab.

Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.

Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.

Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.

Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.

CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook.

Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 

Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.

American blood tests are poor at picking up European strains.

Spiral Borrelia can segment and result in 20 or more new spirochetes.

5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.

Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.

Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.

Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 

Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 

We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.

Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 

Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.

In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 

Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 

Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies

When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 

A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.

When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.

IVIG stops cytokine storms without suppressing the immune system.

Ticks are nature's dirty needle.

Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.

There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.

Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.

They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 

Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.

Some veterinarians recognize that Bartonella may not be curable in animals.

Some of the medications are inhibitory but may not be "cidal" (killing).

For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 

Combinations for intravascular and intracellular properties are needed.

Fluoroquinolones work in both spaces but there have been resistant strains documented.

Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.

Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 

Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.

In some cases, Gentamicin may be added but is not used alone.

For Bartonella, 3-4 months of antibiotic treatment is a minimum.

Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.

Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 

Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.

Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 

Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 

Transfer Factors are good modulators and help to control overreactions.

Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.

Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized

There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.

IM Bicillin can be a very good option for Lyme treatment.

Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 

Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 

Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.

Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections.