Patients with Lyme disease with chronic, resistant neurological symptoms, including encephalopathy and neuropathy, should be tested for Bartonella. These intracellular bacteria can be one of the persistent bacterial co-infections seen in Lyme-MSIDS patients. This article discusses 2 pathogenic species of Bartonella not previously reported, and the role of birds as a vector in spreading the illness. There are 30 Bartonella species/subspecies and 17 have been associated with human infections. This article highlights the role of migratory birds as a reservoir and/or mechanical vector for spreading many different infections (borrelia, anaplasma, bartonella, rickettsia, and tick-borne encephalitis virus) worldwide, and the fact that many of these species/strains are pathogenic (and not easily detected on standard commercial laboratory testing!). Future research needs to be done on Lyme-MSIDS patients to determine all of the different bacteria, viruses and parasites contributing to ongoing illness.
http://wwwnc.cdc.gov/eid/article/20/3/13-0563_article.htm
Dr Horowitz