Bartonella and Brain Fog
Guideline: CDC Bartonella guidance; recognized infection guidelines — chronic attribution controversial
What Is Bartonella-Related Brain Fog?
Bartonella is the 'stealth infection' — it causes bizarre neuropsychiatric symptoms (rage, anxiety, brain fog, depression) that get diagnosed as mental health conditions for years before anyone considers infection. The hallmark sign: 'shin streaks' — red/purple stretch-mark-like lines on the body that are NOT stretch marks. Standard testing catches only ~50% of cases. If you have brain fog + unexplained anxiety/rage + cat/flea exposure → test for Bartonella.
What to Do This Week
Seven actionable steps you can start today — free, evidence-based, and designed for when you're foggy.
Body
Gentle movement only — listen to your body. If activity worsens symptoms the next day, reduce intensity. Rest is an active intervention, not failure.
Food
Eat a proper meal with protein, vegetables, and good fat (olive oil, nuts, avocado). Skip the ultra-processed snack. One meal upgrade today.
Water
Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it — just drink regularly.
Environment
Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.
Connection
Reach out to one person today. Text, call, walk together. Isolation worsens every cause of brain fog. Connection is a biological need, not a luxury.
Tracking
Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.
Avoid
Don't change everything at once. One new habit per week. Don't compare your progress to others. Don't spend money on supplements before nailing sleep, food, and movement.
What to Eat: The Gentle Anti-Inflammatory (Recovery-Adapted) Approach
For people who are too fatigued, nauseous, or overwhelmed for complex dietary changes. The minimum effective dose.
Sample Day
- breakfast: Toast + peanut butter + banana (whatever you can manage)
- midMorning: Broth or soup if appetite poor
- lunch: Simple chicken + rice + steamed veg (whatever is easiest)
- snack: Handful berries or a piece of fruit
- dinner: Eggs on toast or tinned salmon + crackers (minimal prep)
- note: If appetite is very low, anything > nothing. Don't let perfect be the enemy of eating.
For Bartonella: Same as Lyme — anti-inflammatory eating, adequate nutrition. No Bartonella-specific dietary protocol exists in the evidence base.
⚠️ If you can barely cook, this is for you. One fish meal a week, some berries, drink water. That's enough to start. You can optimize later when you feel better.
When to Seek Urgent Help
STOP — Seek urgent medical evaluation if: sudden onset of cognitive symptoms (hours/days), new focal neurological symptoms (weakness, numbness, vision or speech changes), seizures, fever with confusion, or rapidly progressive decline. These may indicate a medical emergency requiring immediate care, not lifestyle modification.
Tests and Investigations
Bartonella Testing
- Standard IFA (Bartonella henselae + quintana) — only ~50% sensitive
- Galaxy Diagnostics ePCR (enrichment PCR) — most sensitive test available
- Triple draw blood culture (Galaxy)
- Look for: lymphadenopathy, liver/spleen granulomas, shin streaks, abnormal VEGF
Negative standard testing does NOT rule out Bartonella. Galaxy ePCR is the gold standard but expensive. Clinical diagnosis supported by response to treatment.
Evidence-Based Lifestyle Changes
Flea/Vector Prevention
Treat pets for fleas monthly. Flea-proof home environment. Tick prevention if outdoors (see Lyme #23).
Anti-Inflammatory Diet + Stress Management
Same as neuroinflammation (#01). Bartonella treatment is long (4-6+ months) — you need a sustainable foundation.
Holistic Support
Morning sunlight
Strong — resets circadian clock, improves mood, supports vitamin D.
10-15 min outside within 1 hour of waking. No sunglasses needed.
Cyclic sighing breathwork
Strong — Balban Cell Rep Med 2023.
5 min daily. Double inhale nose, long exhale mouth.
Nature exposure
Moderate — cortisol reduction, attention restoration.
20 min in green space weekly minimum.
Medical Treatment Options
Discuss these options with your prescribing physician. This information is educational, not medical advice.
Prolonged Combination Antibiotics
Minimum 4-6 months: Azithromycin + Rifampin, OR Doxycycline + Rifampin. Rifampin penetrates intracellular compartments where Bartonella hides. Expect Herxheimer reactions. Treatment may need extension based on response.
Evidence: Moderate — no large RCTs for chronic Bartonella; treatment based on clinical experience and case series
Supplements — What the Evidence Says
Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.
NAC (biofilm disruption)
Dose: 600mg 2x daily — same rationale as Lyme
Adjunct to antibiotics. Disrupts bacterial biofilms that protect Bartonella from treatment.
Psychological Support and Therapy
Same as Lyme — ACT for uncertainty. Supportive counseling.
What People With Bartonella Brain Fog Say
What Helped
- • Galaxy Diagnostics ePCR testing — standard IFA only catches about 50%
- • Combination antibiotics for 4-6+ months — this is a marathon, not a sprint
- • Recognizing shin streaks as diagnostic clue — red/purple lines that aren't stretch marks
- • Treating alongside Lyme co-infections simultaneously
What Didn't Help
- • Short antibiotic courses — Bartonella is intracellular and requires prolonged combination therapy
- • Being diagnosed with anxiety or depression when neuropsychiatric symptoms were infection-driven
- • Standard blood cultures (Bartonella grows too slowly for standard culture)
Common Mistakes
- • Not considering Bartonella if you've never been scratched by a cat — fleas and ticks also transmit it
- • Expecting quick resolution — 4-6 months minimum treatment, often longer
- • Not treating alongside Lyme when co-infected
Surprises
- • Neuropsychiatric symptoms (rage, anxiety, insomnia) can be the PRIMARY presentation — not just cat scratch fever
- • Small fiber neuropathy caused by Bartonella — explains burning, tingling, autonomic dysfunction
- • Can trigger POTS — vascular inflammation affects autonomic nervous system
"If you have brain fog + unexplained rage/anxiety + cat or flea exposure: look at your body for shin streaks. Red/purple lines that aren't stretch marks. This one visual clue has led to diagnosis for many people who spent years in psychiatric treatment for what was actually an infection."
Quick Reference
Quick Win
Look at your body for 'shin streaks' — red, purple, or pinkish stretch-mark-like lines anywhere on the body (typically shins, abdomen, thighs, back). These are NOT stretch marks — they're caused by Bartonella invading endothelial cells in blood vessels. Also ask: cat scratch history? Flea exposure? Unexplained neuropsychiatric symptoms (especially anxiety/rage out of proportion to situation)?
Breitschwerdt, Pathogens, 2023 — Bartonella and neuropsychiatric disease