Summary

Dr. Ed Breitschwerdt discusses his interest in Bartonella research and the challenges associated with studying this bacteria. He explains the discovery of Bartonella and its unique aspects, including the various vectors and modes of transmission. The prevalence of Bartonella and the challenges in diagnosing the infection are also discussed. Dr. Breitschwerdt highlights the difficulties in testing and diagnosing chronic Bartonella infections and the use of digital PCR for more accurate detection. The chapter concludes with a discussion on the pathophysiology of chronic Bartonella infection. The conversation explores the challenges in accurately diagnosing Bartonella infections and the differences in results from different labs. It highlights the importance of using the correct isolates of the organism for testing and the prevalence of different strains. ThKe discussion also touches on the phenomenon of patients stopping the production of antibodies to Bartonella and the interplay between acute and chronic infections. The conversation emphasizes the need for better diagnostic tests and the development of a vaccine to protect animals and humans from Bartonella infections.

Takeaways

Bartonella is a complex bacteria with various vectors and modes of transmission.

Diagnosing Bartonella infection, especially chronic cases, can be challenging.

Digital PCR is a promising tool for more accurate detection of Bartonella.

Chronic Bartonella infection can lead to a range of symptoms and recrudescence. Different labs may use different isolates of Bartonella, leading to different results in testing.

Patients may stop producing antibodies to Bartonella, making serology testing less reliable.

Exposure to Bartonella species is common, and many individuals may be asymptomatic carriers.

Bartonella infections may contribute to a spectrum of neurologic and neuropsychiatric diseases.

The development of a diagnostic test and a vaccine for Bartonella are important goals for future research.

Chapters

00:00 Introduction and Background

00:42 Interest in Bartonella Research

05:38 Challenges and Unique Aspects of Bartonella

08:37 Transmission of Bartonella

11:11 Vectors and Transmission to Humans

14:58 Prevalence of Bartonella and Challenges in Diagnosis

29:35 Chronic Bartonella Infection and Recrudescence

32:20 Pathophysiology of Chronic Bartonella Infection

36:06 Diagnostic Challenges and Digital PCR

41:13 Challenges in Accurate Diagnosis

42:02 Different Results from Different Labs

42:16 Different Isolates of the Organism

43:42 Prevalence of Bartonella Henselae Strains

44:41 Patients Stop Making Antibodies

45:56 Interplay Between Acute and Chronic Infections

46:45 Serofast State in Bartonella Henselae

47:21 Exposure to Bartonella Species

48:19 Testing Blood Donors for Bartonella

49:47 Role of Bartonella in Neurologic Diseases

52:43 Symptoms of Bartonella Infection

54:03 Understanding Bartonella on a Cellular Basis

57:34 Developing a Diagnostic Test for Bartonella

01:00:09 Vaccine Target for Bartonella

01:11:44 Protecting the Human-Animal Bond

01:18:03 Future Goals: Diagnostic Test and Vaccine

Dr. Ed Breitschwerdt, DVM , DACVIM

Learn more about Dr. Breitschwerdt and his work at NC State University

Learn more about Dr. Breitschwerdt’s work at Galaxy Diagnostics

Donate to the NC State Bartonella/Vector Borne Research Fund

Tom Moorcroft, DO

Learn more about Dr. Tom’s Lyme Disease Practitioner Training program.

Summary

In this conversation, I’m joined by Dr. Choukri Ben Mamoun and Dr. Tim Sellati to discuss Dr. Ben Mamoun’s recent study on the use of combination therapy for the treatment of Babesia infection entitled: Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis.

We explore the key findings of the study, including the use of immunocompromised mouse models and the potential for long-lasting immunity. The conversation also delves into the importance of understanding the differences between tick-borne infections and the challenges of translating research findings into clinical practice. The discussion highlights the need for further research on dosing and the therapeutic index of different drugs.

Overall, the conversation provides valuable insights into the current understanding of Babesia treatment and the potential for future advancements. The conversation covers topics such as combination therapy and resistance, dormant parasites and relapse, terminology and immunocompromised, immune dysregulation and cold exposure, diagnostic testing for Babesia, improving diagnostic testing, and the goal of helping patients.

Key Takeaways

Combination therapy with tafenoquine and atovaquone has shown promising results in the treatment of Babesia infection.

Immunocompromised mouse models are valuable tools for studying the efficacy of different treatments.

Understanding the differences between tick-borne infections is crucial for accurate diagnosis and treatment.

Further research is needed to determine optimal dosing and the therapeutic index of different drugs for Babesia treatment.

Recrudescence and treatment failure are important considerations in Babesia treatment.

Combination therapy can reduce the probability of resistance in parasites.

Dormant parasites may be responsible for relapse in Babesia infections.

The terminology used in scientific research may differ from the general public's understanding.

Factors like sleep, stress, and nutrition can contribute to immunocompromised states.

Diagnostic testing for Babesia needs improvement to reduce false negatives and false positives.

The ultimate goal is to help patients get better by finding the right diagnosis and treatment.

There is a need for collaboration between clinicians, researchers, and patients to advance the understanding and treatment of tick-borne infections.

Chapters

00:00 Introduction and Overview

03:00 The Study and Key Findings

06:35 Understanding the Research and Clinical Implications

11:56 The Importance of Animal Models

14:43 Immunocompromised Mouse Models

23:22 Differences Between Tick-Borne Infections

26:34 Combination Therapy: Tafenoquine and Atovaquone

32:26 Dosing and Therapeutic Index

36:48 Artemisinin as a Treatment Option

46:20 Recrudescence and Treatment Failure

48:23 Combination Therapy and Resistance

50:24 Dormant Parasites and Relapse

53:18 Terminology and Immunocompromised

56:15 Immune Dysregulation and Cold Exposure

59:14 Diagnostic Testing for Babesia

01:03:22 Improving Diagnostic Testing

01:12:12 The Goal of Helping Patients

01:20:22 Caring and Finding the Truth

Link to the paper we discussed:

Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis - https://pubmed.ncbi.nlm.nih.gov/38169301/

Learn More About My Guests:

Choukri Ben Mamoun, PhD - Professor of Medicine (Infectious Diseases) and of Microbial Pathogenesis; Affiliated Faculty, Yale Institute for Global Health https://medicine.yale.edu/profile/choukri-benmamoun/

Timothy Sellati, PhD - Chief Scientific Officer, Global Lyme Alliance https://www.globallymealliance.org/

Learn more about Dr. Tom’s Lyme Disease Practitioner Training program.