How to Diagnose Bartonella in Chronic Lyme Disease

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How to Diagnose Bartonella in Chronic Lyme Disease Image by Marty Ross MD

Updated: 7/20/23

Bartonella is Hard to Diagnose in Chronic Lyme Disease

In this article I describe how to diagnose Bartonella in chronic Lyme disease. There are a lot of controversies in this area. These include

  • whether Bartonella is transmitted by ticks,
  • poor testing, and
  • a wide range of symptoms that look like other illnesses.

Bartonella are bacteria that infect endothelial cells that line blood vessels, immune system cells in the body and brain, and red blood cells. There are an estimated 28 different strains, of which 15 can infect humans. Bartonella could be spread by ticks, animal scratches, fleas, lice, sandflies, and mites. A common Bartonella illness is called Cat Scratch fever where Bartonella henselae is transmitted by cats.

Is Bartonella a Lyme Co-infection?

Some do not believe that Bartonella is transmitted by ticks. In Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease , IDSA does not believe there is enough high quality science to support Bartonella as a tick transmitted Lyme co-infection. While high quality science does not prove transmission, there is a body of good science that does show Bartonella is found in ticks and that in lab experiments it can be transmitted.(1) And clinically, based on symptoms, I have seen a large number of patients improve when treatments focus on getting rid of Bartonella.

So, I strongly disagree with the IDSA position on Bartonella. In my opinion, based on my extensive experience and review of the science, Bartonella is a tick transmitted Lyme co-infection.

The Testing is Not Perfect

The best test for Bartonella is the IGenex Immunoblot. I explain why below.

IFA Antibody Test for Bartonella

There are a lot of false negative tests in Bartonella. This means the test is negative, even when a person truly has the infection. One reason for this is a common immune system test to detect antibodies called an IFA test, does not exist for most strains of Bartonella. IFA testing is easily available for Bartonella henselae and Bartonella quintana. And this is the test method most doctors use. In my opinion, it is not worth doing.

Galaxy Diagnostics Enhanced PCR Test for Bartonella

Another testing method is to do a Bartonella dna detection test using blood from a patient. This is called PCR testing. But even here, there are many false negative tests when a standard PCR test technique is performed.

To overcome problems with regular PCR and IFA Bartonella testing, Galaxy Diagnositics offers an enhanced PCR test. In the Galaxy method, the growth of Bartonella is enhanced on special growing media before the PCR test is performed. Growing Bartonella this way amplifies the ability of PCR testing to detect Bartonella in blood samples. Galaxy claims it can detect all 15 human strains, and can even report which one a person has. The problem with the Galaxy method is there are no validity tests that show how good it is at detecting Bartonella when a person has it. This is called test sensitivity. So I cannot tell you if this test is generally effective at finding Bartonella. But, when it does detect Bartonella, the test result really is true. This is called the test specificity.

IGenex Immunoblot Test for Bartonella is Best

IGenex has the newest and best testing method for Bartonella called an Immunoblot. The Immunoblot can see if the immune system is making antibodies against Bartonella. More specifically, IGenex tests to see if there are antibodies against four specific strains (B. quintana, B. henselae, B. vinsonii, and B. elizibethae). But, IGenex goes one step further and also tests if there are antibodies against the whole family of Bartonella. This means it can tell if a person is infected with one of the 15 different strains of Bartonella that infect a person. Like the Galaxy PCR test, the Immunoblot is very specific. So if the test comes back positive, it really is positive. 

I prefer the IGenex Immunoblot over the Galaxy Enhanced PCR test because it is likely more sensitive at finding Bartonella. This test does not require the Bartonella germ to swim by the needle at the blood draw to detect the immune antibody reaction. Antibodies are found throughout the blood, even if the germ is not in the blood where the needle is inserted, the antibodies will still be there. 

Infectolab and Armin Elispots for Bartonella

There is one additional way to test for Bartonella called an Elispot. This test looks to see if the white blood cells called T cells have seen Bartonella before. This test has a major drawback. The two companies that offer the Elispot for Bartonella only test for reaction to B. henselae. In other words, they do not look for reactions to all the 15 strains that can infect a person.

Review of All Major Testing Options for Bartonella

For more information and a more detailed review of the testing options see The Best Lab & Test for Borrelia, Bartonella, & Babesia.

Bartonella Causes a Lot of Problems that Look Like Other Illnesses

Symptoms and signs of Bartonella are: day sweats, ongoing anxiety, pain on the soles of the feet, a rash that looks like stretch marks, a large number of swollen lymph nodes, severe thinking problems, seizures or seizure like disorder, neurologic symptoms of numbness or sharp, shooting, stabbing or burning pain, loss of nerve function in a body part, abdominal pain for which there is not an identifiable cause, bladder symptoms of pain, and urgency or burning and severe psychiatric problems.

Severe psychiatric problems in someone with Lyme is a reason to consider Bartonella -  especially if there are other Bartonella symptoms like those I mention above. These psych symptoms can include depersonalization, depression, marked anxiety, bipolar illness, hallucinations, mania, obsessive compulsions, and even rage and anger. (5,6,7)

Marty Ross MD on Bartonella & Psychiatric Problems

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Bartonella Diagnosis Approach in Chronic Lyme Disease

Figuring out if a person has Bartonella as part of Lyme disease involves putting together the pieces of the puzzle. If there are a large number (but not all) of signs or symptoms of this coinfection, then in my opinion it is appropriate to treat without testing. This is because a negative Bartonella test does not exclude or rule out the diagnosis.

When it is not clear enough based on a lack of a tick bite history and the symptoms that Bartonella is present, then I suggest doing the IGenex IGM and IGG Immunoblot for Bartonella. If it comes back positive, then definitely treat for Bartonella.

One special situation occurs with the person who has severe psychiatric illness and Lyme. In this situation, even if there are not many other Bartonella symptoms, I found it very helpful to treat for Bartonella in my Seattle practice. So based on my clinical experience, people with Lyme and severe psych symptoms also require Bartonella treatment without getting Bartonella testing first.

How to Treat Bartonella

See Kills Bartonella: A Brief Guide for herbal and prescription antibiotic options to get rid of Bartonella in a chronic Lyme disease infection.


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.


View Citations

  1. Cotté V, Bonnet S, Le Rhun D, et al. Transmission of Bartonella henselae by Ixodes ricinus. Emerg Infect Dis. 2008;14(7):1074–1080. doi:10.3201/eid1407.071110
  2. Breitschwerdt EB. Bartonellosis: One health perspectives for an emerging infectious disease. ILAR Journal. 2014;55(1):46–58.
  3. Maggi RG, Mozayeni BR, Pultorak EL, et al. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerg Infect Dis. 2012;18(5):783–791. doi:10.3201/eid1805.111366
  4. Maggi RG, Mascarelli PE, Pultorak EL, Hegarty BC, Bradley JM, Mozayeni BR, Breitschwerdt EB. Bartonella spp. bacteremia in high-risk immunocompetent patients. Diagn Microbiol Infect Dis. 2011;71:430–437. doi: 10.1016/j.diagmicrobio.2011.09.001.
  5. Balakrishnan N, Ericson M, Maggi R, Breitschwerdt EB. Vasculitis, cerebral infarction and persistent Bartonella henselae infection in a child. Parasit Vectors. 2016;9(1):254. Published 2016 May 10. doi:10.1186/s13071-016-1547-9
  6. Fallon BA, Sotsky J. Conquering Lyme Disease; Science Bridges the Great Divide. New York, NY: Columbia University Press; 2018.
  7. Buhner SH. Healing Lyme Disease Coinfections: Complementary and Holistic Treatments for Bartonella and Mycoplasma. Rochester, VT: Healing Arts Press; 2013.
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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

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