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Bartonella Symptoms: Telltale Signs of an Infectious Disease

Brain fog, anxiety, depression, and pain are symptoms lots of people get sometimes. We can often remedy those symptoms by building a strong foundation with a healthy diet, lifestyle changes, and gut health support. 

But when those symptoms don’t respond fully to foundational strategies, it’s time to dig deeper into other possible root causes of the symptoms, such as a bartonella infection. 


In this article, I’ll share the key bartonella symptoms to be aware of, how people get this infection, and our clinic’s treatment strategy. 

What is Bartonellosis?

Bartonellosis is an infection caused by the gram-negative bacterium Bartonella spp (the spp. means there are several species) 1. Bartonella is known as a vector-borne microbe because it spreads to us through another organism, or vector, before causing disease. 

Here are the most common Bartonella species that cause bartonellosis in people:

  • Bartonella henselae is carried by cats and cat fleas and causes cat scratch disease. 
  • Bartonella quintana is carried by the human body louse (aka lice) and causes trench fever.
  • Bartonella bacilliformis is carried by sand flies and causes Carrion’s disease, which causes a highly fatal fever (Oroya fever), anemia, and skin lesions called verruga peruana (or Peruvian warts).

When a species of Bartonella gets into a human, it can invade blood cells, bone marrow, and the endothelial cells (inner lining) of blood vessels to cause bartonellosis 1

Bartonellosis is usually mild, self-limiting, and short-lived. And for many people, symptoms end on their own without treatment 2. But for some people, bartonella symptoms can be more serious, chronic, or relapsing when the bacteria cycles periodically into the red blood cells, aka erythrocytes 2.

What are Bartonella Symptoms?

As with other common vector-borne microbial infections, a bartonella infection may cause acute-phase (intense) flu-like symptoms, such as 3:

  • Fever
  • Fatigue
  • Brain fog
  • Body aches
  • Swollen lymph nodes (lymphadenopathy)

This table shows more specific bartonella symptoms based on symptom type:

Symptom Type Bartonella Symptoms
Neurological 
  • Brain fog, cognitive impairment
  • Anxiety
  • Depression
  • Muscle cramping
  • Uncontrollable muscle contractions
  • Tingling, weakness, numbness in the hands and feet
Pain in the…
  • Hands
  • Feet, especially the soles after waking up
  • Shins
  • Teeth
Skin
  • Streaked rash resembling pregnancy stretch marks
  • Bacillary angiomatosis (an infectious disease causing tumor-like masses on the skin or organs)
Circulatory
  • Eye redness
  • Spider veins
  • Endocarditis (inflammation of the inner lining of the heart)

Many of these bartonella symptoms could be attributed to other causes, so it’s easy to overlook a possible infection. 

How Do Humans Get Bartonella?

Bartonella bacteria are typically carried by vectors like cats, cat fleas, lice, sand flies, and possibly blacklegged (Ixodes) ticks 1 3.

Bartonella hides inside a non-human host, often an infected cat who’s had fleas. When the host bites or scratches someone, that person can end up with bartonellosis. 

If someone hasn’t had an obvious exposure, like a cat scratch or bite, bartonella may not even be on the radar as a possible cause of symptoms. 

How is a Bartonella Infection Diagnosed?

I’m not a huge fan of many of the functional medicine tests out there. But vector-borne microbial infections are one area where I feel testing is important. It can help determine the right type of treatment to get someone on the road to recovery more quickly. 

Identifying bartonella isn’t always simple. Polymerase chain reaction (PCR) assays may be the most accurate type of test, but they’re very expensive. Providers can also assess the blood for antibodies with serology tests or look for the bacteria in blood cultures. 

What’s most important is that you discuss bartonella-like symptoms and possible testing options with a healthcare provider if you believe you’ve been exposed.

Are Bartonellosis and Lyme Disease the Same?

Lyme disease is a vector-borne microbial infection, but it’s caused by the spiral-shaped bacterium, Borrelia burgdorferi. Humans get Lyme disease from black-legged tick bites.

Although bartonella does not cause Lyme disease, it is possible to get a co-infection of both bartonella and borrelia from a tick bite 1 3.

What Cures Bartonella?

If a bartonella infection requires formal antibiotic treatment, medications (such as azithromycin, rifampin, or doxycycline) 1 4 are commonly prescribed. These medications should help a person overcome the infection within 3–6 weeks 5.

But I prefer to combine herbal antimicrobials (natural antibiotics) and prescription antibiotics because it seems (from research 6 and my clinical experience) to promote more complete healing. 

We don’t have much human data on herbal antimicrobials for treating bartonella, but evidence suggests the following herbs may be good at improving cure rates 6

  • Cryptolepis sanguinolenta
  • Juglans nigra (black walnut)
  • Polygonum cuspidatum (Japanese knotweed)

Please make sure to talk to a qualified healthcare provider before trying prescription antibiotics or herbal antimicrobials.

A strong immune system may be the best defense against getting an infection from Bartonella (whether B. henselae, B. quintana, or B. bacilliformis) if the bacterium gets into the body. 

When the immune system is functioning well, a person may not need any formal treatment after being exposed to Bartonella. But if an infection does take hold, a strong immune system is important for helping antibiotics take care of it. 

So, how can we keep the immune system in tip-top shape? In the clinic, we start by optimizing gut health. 

The Gut-Immune Connection

As I discuss in my book, Healthy Gut, Healthy You, immune system function and gut health are intimately connected. Roughly 70% of our immune cells live in the gastrointestinal tract, so a healthy gut often means better immune system function 7.

For many of our clients, building a foundation with a healthy diet and lifestyle plus probiotics improves gut function, which contributes to better immune system function. Over time, their chronic symptoms disappear. 

Some clients end up needing formal treatment for bartonella symptoms. Although antibiotics (and in our clinic herbal antimicrobials) are necessary, I also recommend creating a healthy foundation with steps 1 and 2, below. A healthy gut and immune system can help the antimicrobials complete their job and blunt the side effects of treatment.

Step 1: Diet and Lifestyle

Diet is unquestionably the most impactful intervention for improving gut and overall health, so it’s a great place to start.

There isn’t one perfect diet; there’s a spectrum of options. In the clinic, we tend to recommend starting with the Paleo diet because it’s fairly easy to put into practice, it focuses on whole foods, and it removes foods that harm the gut and trigger inflammation. 

If, after 2–3 weeks, the Paleo diet doesn’t feel right, other whole-food options like a low FODMAP diet or a Mediterranean diet may be helpful. It may be best to work with a registered dietitian or other nutrition professional to determine the best option. 

In addition to dietary changes, lifestyle adjustments can have a big impact on gut and immune system function. After years of working in the clinic, I’ve found the following lifestyle strategies to be the most helpful:

Step 2: Probiotics

Fairly impressive evidence, meaning randomized controlled trials or better, demonstrates that probiotics can improve the balance of organisms in the gut, reduce overzealous immune system activity, and turn down inflammation 8 9

The take-home message here is that we at the clinic always include probiotics when working to improve gut health. But what’s the best probiotic to take? Like with diet, this is another area where we have many options. 

Nearly every probiotic product can be classified into one of three categories 10:


In the clinic, we’ve seen the most success when our clients use triple probiotic therapy, which simply means using all three categories of probiotics in combination. Here are the dosing guidelines we use:

Probiotic CategoryDoseDuration
Lacto/Bifido blend1–10 billion CFU (higher is ok)2–3 months
Saccharomyces boulardii10–15 billion CFU (500–750 mg)
Soil-Based Bacillus species2–6 billion CFU

Build a Strong Immune System to Overcome Bartonella Symptoms 

Bartonella is a bacterium carried by cats, cat fleas, lice, sandflies, and possibly ticks. If transferred to a human, bartonella can cause bartonellosis. This infection can lead to flu-like and other common symptoms—like brain fog, depression, and anxiety—that may be attributed to other conditions. 

Telltale bartonella symptoms that may clue in a provider to bartonellosis include:

  • A streaked rash that resembles pregnancy stretch marks
  • Muscle cramping
  • Uncontrolled muscle contractions
  • Spider veins
  • Pain in the hands, shins, teeth, and feet

If an existing infection calls for formal treatment, I favor using a combination of natural and prescription antibiotics. Building a strong immune system by optimizing gut health may be the best way to prevent infectious disease from bartonella and make sure the treatment for an existing infection works well. 

If you’re struggling with what you suspect are bartonella symptoms, consider reaching out to us at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

➕ References

  1. Li T, Feng J, Xiao S, Shi W, Sullivan D, Zhang Y. Identification of FDA-Approved Drugs with Activity against Stationary Phase Bartonella henselae. Antibiotics (Basel). 2019 Apr 29;8(2). DOI: 10.3390/antibiotics8020050. PMID: 31035691. PMCID: PMC6628006.
  2. Bartonellosis – Symptoms, Causes, Treatment | NORD [Internet]. [cited 2024 Sep 10]. Available from: https://rarediseases.org/rare-diseases/bartonellosis/
  3. Bartonella: A Lyme Disease Co-infection – LymeDisease.org [Internet]. [cited 2024 Sep 10]. Available from: https://www.lymedisease.org/lyme-basics/co-infections/bartonella/
  4. Mada PK, Zulfiqar H, Joel Chandranesan AS. Bartonellosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 28613624.
  5. Medscape Bartonellosis Treatment & Management [Internet]. [cited 2024 Sep 10]. Available from: https://emedicine.medscape.com/article/213169-treatment?form=fpf
  6. Shor SM, Schweig SK. The Use of Natural Bioactive Nutraceuticals in the Management of Tick-Borne Illnesses. Microorganisms. 2023 Jul 5;11(7). DOI: 10.3390/microorganisms11071759. PMID: 37512931. PMCID: PMC10384908.
  7. News & Highlights. Mucosal Immunol. 2008 Jul;1(4):246–7. DOI: 10.1038/mi.2008.17.
  8. Sanders ME. Impact of probiotics on colonizing microbiota of the gut. J Clin Gastroenterol. 2011 Nov;45 Suppl:S115-9. DOI: 10.1097/MCG.0b013e318227414a. PMID: 21992949.
  9. Derrien M, van Hylckama Vlieg JET. Fate, activity, and impact of ingested bacteria within the human gut microbiota. Trends Microbiol. 2015 Jun;23(6):354–66. DOI: 10.1016/j.tim.2015.03.002. PMID: 25840765.
  10. Fleishman MS RDN C. IPA guidelines to qualify a microorganism as probiotic [Internet]. International Probiotics Association. [cited 2021 Jun 1]. Available from: https://internationalprobiotics.org/download/ipa-guidelines-qualify-microorganism-probiotic/

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