Bartonella in Children - Signs, Testing and Evidence
- Aug 16
- 13 min read
Updated: 2 days ago
Bartonella in Children: What the Evidence Actually Shows
Written by Amy Patton, DNP, APRN, CPNP-PC - pediatric nurse practitioner and founder of Happy Kid Functional Medicine, Omaha.
Bartonella is a group of bacteria that can live in the blood of animals and people. If your child changed almost overnight- rage, rituals, fear that came out of nowhere- and you have spent late nights reading that Bartonella explains all of it, I want to hand you the actual evidence. Not the loudest version of it. The real one.
Some of what you read online is supported. Some of it is not. Both of those are true at the same time, and you deserve to know which is which before anyone tests your child or puts him on a long antibiotic plan.
What do parents ask me most about this?
Short answers first. The full reasoning is below.
What is Bartonella?
Bartonella is a group of bacteria. Not a virus, not a parasite. The species that matters most in children is Bartonella henselae, which causes cat scratch disease. Cat fleas are the established way it spreads. Cat scratch disease is more common in children under 15 than in adults.
Do ticks spread Bartonella?
No study has shown a tick bite giving a person Bartonella. CDC states it plainly: "There is no evidence showing Bartonella are spread to people through tick bites." Researchers who study Bartonella closely read the animal data more generously than CDC does.
What does Bartonella look like in a child?
In children, Bartonella most often looks like cat scratch disease. A small bump or pus-filled spot forms where the cat scratched. One to three weeks later, the lymph nodes closest to that scratch swell up and get tender. A low-grade fever is common.
What about the stretch-mark rashes?
The stretch-mark-looking streaks you have seen called "Bartonella tracks" do appear in published research. The research is small and uncontrolled. No study has ever compared how often striae show up in Bartonella-positive children versus Bartonella-negative children. Causation is not established.
Can Bartonella cause sudden psychiatric symptoms in a child?
Nobody has shown that it does. There is one published pediatric case report. The one controlled study that included children found Bartonella DNA in none of the 7 children and teens with psychosis. The adult signal is real but small, and no independent laboratory has replicated it.
Why is Bartonella so hard to test for?
Bartonella testing fails in both directions. A negative test does not rule the infection out. A positive antibody test does not prove there is an active infection right now. CDC says so, and the researchers who study Bartonella most closely say so too.
What is Bartonella?
Bartonella is a group of bacteria. Not a virus, not a parasite. The species that matters most in children is Bartonella henselae, which causes cat scratch disease. Cat fleas are the established way it spreads. Cat scratch disease is more common in children under 15 than in adults.
CDC describes Bartonella as spreading through fleas, body lice, sand flies, or contact with flea-infested animals, and rarely through organ transplants. For B. henselae, the chain runs through the cat. A flea infects the cat. The cat carries the bacteria in its blood. Flea droppings get onto the cat's claws and fur during grooming. A scratch or a bite pushes it into your child's skin.
Here is the number that surprises most parents: some studies have found Bartonella in the blood of up to 1 in 3 healthy cats, and kittens carry it more often than adult cats. That healthy, purring, perfectly normal-looking kitten is the most common source. Most US cat scratch disease cases show up in fall and winter.
Two other species come up in reading. Bartonella quintana spreads through human body lice, and Bartonella bacilliformis through sand flies in the Andes. Neither is a common concern for a child here. My Lyme disease and tick-borne illness hub walks through how these all fit together.
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Do ticks spread Bartonella?
No study has shown a tick bite giving a person Bartonella. CDC states it plainly: "There is no evidence showing Bartonella is spread to people through tick bites." Researchers who study Bartonella closely read the animal data more generously than CDC does. You should see both positions, because they are both honest.
CDC's full sentence continues: "One laboratory study showed that Bartonella transferred from ticks to animals, but more research is needed to understand if this happens in nature."
Columbia University's Lyme and Tick-Borne Diseases Research Center takes the other view. Their position is that "the evidence for ticks as vectors of Bartonella organisms is circumstantial but fairly strong." They cite two animal studies, Cotte in 2008 and Reis in 2011, in which Ixodes ricinus ticks picked up Bartonella birtlesii and passed it from mouse to mouse.
Position | What they say |
|---|---|
CDC | "There is no evidence showing Bartonella are spread to people through tick bites." |
Telford and Wormser, 2010 | Bartonella DNA found inside a tick reflects the blood that tick drank. It is not proof the tick can pass it on. |
Lantos and Wormser, 2014 | Five systematic searches found no convincing evidence of tick-borne Bartonella in people, or of Lyme and Bartonella together. |
Columbia's Lyme and Tick-Borne Diseases Research Center | The evidence for ticks as vectors is "circumstantial but fairly strong," based on the mouse work. |
Now the sentence both camps sign. Columbia's own page concedes that "the ability of Ixodes ticks to actually transmit B. henselae has not been specifically demonstrated." Tick transmission to humans has not been demonstrated. Animal-model transmission has been shown for one Bartonella species. Those are different claims, and the difference is the whole argument.
What this means for you: a tick bite is a real reason to watch your child carefully, and I have a full walkthrough on what to do after a tick bite. It is not, on today's evidence, a reason to assume Bartonella. If you want the local picture, I cover ticks in Nebraska and Iowa separately.
What does Bartonella look like in children?
In children, Bartonella most often looks like cat scratch disease. A small bump or pus-filled spot forms where the cat scratched. One to three weeks later, the lymph nodes closest to that scratch swell up and get tender. A low-grade fever is common. That is the usual picture, and most of the time it settles on its own.
Rarely, CDC notes, Bartonella reaches the eye, liver, spleen, brain, bone, or a heart valve. Those children look sick. A child with liver or heart-valve involvement is not a child with vague symptoms and a normal exam.
Now the part I get asked about constantly. You have read that Bartonella causes sore soles of the feet on the first steps in the morning, deep shin or long-bone pain, and POTS. I went looking for the studies. There are none. No controlled, peer-reviewed source establishes morning sole pain, shin pain, or POTS as Bartonella-specific signs. Those claims live on clinician websites and in parent groups. They are not in CDC material, and they are not in controlled research.
I am not telling you your child's foot pain isn't real. I am telling you it does not point to Bartonella, and that a symptom list built from the internet will send you down the wrong road.
What about the stretch-mark rashes?
The stretch-mark-looking streaks you have seen called "Bartonella tracks" do appear in published research. The research is small and uncontrolled. No study has ever compared how often striae show up in Bartonella-positive children versus Bartonella-negative children. Causation is not established. I want to be scrupulous about this, because a lot of families make decisions on it.
Here is what actually exists. Breitschwerdt and colleagues published a 2020 paper in Pathogens describing 33 self-referred people with neuropsychiatric symptoms. Twenty-nine of them had antibody or PCR evidence of Bartonella, and 24 of those 29, which is 83%, reported skin lesions. Many looked like stretch marks. But this was a convenience sample with no control group, made up of people who already suspected Bartonella and sought the researchers out. That is severe selection bias, and the authors say so.
The single case with both biopsy and lab linkage is Maggi 2013 in Parasites & Vectors. It is one patient. An 18-year-old with red striae on his legs and buttock. Bartonella DNA was amplified and sequenced from a striae biopsy and was not found in a control biopsy of a mole on the same young man. That is interesting. It is n=1.
One correction worth making out loud: Mozayeni 2018 in Medicine is frequently cited as a case series about striae. It is neither. It is a single case report about joint hypermobility in one adult. It is not about striae. If a page cites it as striae evidence, that page has not read it.
Dermatology has looked at this and is not convinced. The American Academy of Dermatology published a 2018 commentary by Dr. Warren Heymann titled "Striae due to Bartonella is a stretch." His search for histologic evidence turned up exactly one case, the one above. His conclusion: "an association does not equate with causation." Meanwhile, Boozalis and colleagues, writing in Pediatric Dermatology in 2018, described 12 boys aged 11 to 17 with horizontal lower-back striae and explained them by rapid growth spurts, tall stature, and family history. Ordinary adolescent physiology.
Striae are extremely common in growing kids. That is the honest bottom line.
Can Bartonella cause sudden psychiatric symptoms in a child?
Nobody has shown that it does. There is one published pediatric case report. The one controlled study that included children found Bartonella DNA in none of the 7 children and teens with psychosis. The adult signal is real but small, and no independent laboratory has replicated it.
The case report is Breitschwerdt 2019. One 14-year-old boy. Sudden hallucinations, delusions, and suicidal and homicidal thoughts. He was psychotic for 18 months across 4 hospitalizations, on multiple psychiatric drug combinations and immunosuppressive treatment for presumed autoimmune encephalitis. B. henselae DNA was amplified and sequenced from his blood while his antibody testing was negative. His symptoms resolved gradually on combination antimicrobials, and he went back to his old life. No control, no blinding, no rechallenge. The authors' own words are that this "suggests" infection "may contribute" in a subset of patients.
The controlled data is Delaney 2024 in Frontiers in Psychiatry, 116 people, blinded testing.
Group | n | Bartonella DNA positive |
|---|---|---|
Adults with psychosis | 44 | 19 (43.2%) |
Adult controls | 29 | 5 (17.2%) |
Children and adolescents with psychosis | 7 | 0 |
Prodromal | 16 | 3 (18.8%) |
Relatives | 20 | 4 (20.0%) |
The adult comparison reached significance, 43.2% versus 14.3%, p = 0.021. Read the pediatric row again. Zero of 7. And there was no difference in antibody testing at all between cases and controls. The entire signal is PCR-based. Bartonella DNA also turned up in 17.2% of the control group, meaning finding it does not, by itself, mean much.
The Lashnits 2021 pilot found 11 of 17 adults with schizophrenia positive versus 1 of 13 controls. But within the cases, there was no difference in symptom severity between the positive and negative participants. No severity gradient.
The conflict of interest belongs on this page. Dr. Breitschwerdt holds US Patent 7,115,385 and co-founded Galaxy Diagnostics, which sells the Bartonella assay used in these studies. Dr. Maggi is its chief technology officer. The authors disclose this in every paper. It is not an allegation. It matters because the entire signal comes from assays developed and sold by two of the authors, and no outside lab has published a replication.
If the sudden-onset picture is what brought you here, my PANS and PANDAS guide and my article on Lyme, PANS and PANDAS go deeper into what is and isn't established.
Why is Bartonella so hard to test for?
Bartonella testing fails in both directions. A negative test does not rule the infection out. A positive antibody test does not prove there is an active infection right now. CDC says so, and the researchers who study Bartonella most closely say so too. The published sensitivity numbers are genuinely low.
Method | What it shows | The documented limit |
|---|---|---|
Antibody testing (IFA) | Past exposure | CDC: cannot reliably tell Bartonella species apart, and stays positive for years after effective treatment |
PCR on blood | Bartonella DNA present | CDC: "sensitivity of these methods is not optimal for blood samples" |
Culture | Live organism | Slow and fastidious; CDC advises holding cultures 21 days or longer |
Two numbers make the point. Vermeulen 2007 tested 51 patients with PCR-confirmed cat scratch disease against 56 symptom-matched controls. A commercial IgM antibody test caught 6% of them. Six percent. Bergman's 1997 study found IgG antibody sensitivity as low as 40.9%.
So a negative result tells you very little. A positive one has its own problem: antibodies are common in healthy people, and DNA turned up in 17.2% of controls in the 2024 study.
CDC's counter-position is worth sitting with. Most cat scratch disease is diagnosed clinically, is self-limited, and lab testing is generally unnecessary except in severe or unusual cases. If a test can't change what you do, running it mostly buys anxiety. I take the same view of Lyme testing in children.
What I actually do when a parent asks me about Bartonella
I don't chase a lab result I can't act on. That is the short version, and I say it out loud in the room, because parents are usually braced for me to order a panel.
What I do first is take a real exposure history. Cats in the house, and how many. Kittens, specifically. Fleas on any pet, ever. Scratches and bites, including the ones nobody thought were a big deal. Summer camps. Travel. Where the family has been and when. That history is what makes any test result mean something, and it costs nothing but time.
Then I look at the whole picture rather than one marker. Sleep. Gut. Eating. When the change started, how fast, and what else was happening in that same window. One positive number in a child who is otherwise well tells me far less than a pattern across a whole child.
And I will say the hard part plainly. I will not put a child on prolonged combination antibiotics on the strength of a positive Bartonella PCR. Not because I doubt your child is struggling. Because no randomized, placebo-controlled, or prospective controlled trial has ever tested whether that approach helps neuropsychiatric outcomes. None. Meanwhile, the harms of prolonged combination antimicrobials in children are real and documented, including serious bacterial infections acquired during that kind of treatment, and the CDC has published on them.
Here is what I can do while the picture clarifies. I work the foundations that hold a nervous system steady: gut, sleep, nutrition, and daily regulation. Those are not consolation prizes. They change how a child copes with whatever else is going on, and they are safe to start now. Where the gut is part of the story, pediatric gut testing gives me something I can actually act on. And when there are objective findings- a truly swollen node with fever, an eye finding, an abnormal liver or heart study- I coordinate with infectious disease rather than working around them.
What this means for your child
Your child changed. You noticed. You went looking. Every one of those was the right move, and none of them was hysteria.
What the evidence supports today is narrow. Bartonella is a real bacterium, cats and their fleas are the established route, and cat scratch disease in children is usually mild and self-limited. What the evidence does not support is a single case report in one 14-year-old carrying the weight of your child's diagnosis, especially when the only controlled study that included children found zero of 7 positive.
That is not me closing a door. It is me refusing to hand you a wrong answer that costs months. Something is going on with your child. I would rather spend those months finding it than defending a label. If a Babesia question came up in the same conversation, I have written about Babesia in children too, and you are always welcome to just reach out and ask me.
You are not behind. You are exactly where a parent who is paying attention ends up.
Book My Free 15-Minute Call - get clarity and learn more.
Free. No obligation. Not a sales call. Or call or text me directly at 402-988-1873.
References
CDC. About Bartonella Infection. NCEZID, reviewed March 23, 2026. CDC states there is no evidence Bartonella are spread to people through tick bites, and lists fleas, body lice and sand flies as the vectors.
CDC. Clinical Overview of Cat Scratch Disease. Source for the cat scratch disease picture, the up-to-1-in-3 healthy cats figure, and the limits of serology and blood PCR.
Telford SR 3rd, Wormser GP. Bartonella spp. Transmission by Ticks Not Established. Emerg Infect Dis. 2010;16(3). Argues Bartonella DNA in ticks reflects the blood meal rather than vector competence.
Lantos PM, Wormser GP. Chronic Coinfections in Patients Diagnosed with Chronic Lyme Disease: A Systematic Review. Am J Med. 2014;127(11):1105–1110. Five systematic PubMed searches found no convincing evidence of tick-borne Bartonella transmission in humans.
Columbia University Irving Medical Center, Lyme and Tick-Borne Diseases Research Center. Bartonellosis. States the tick-vector evidence is "circumstantial but fairly strong," citing Cotte 2008 and Reis 2011, while conceding human transmission has not been demonstrated.
Breitschwerdt EB, Bradley JM, Maggi RG, Lashnits E, Reicherter P. Bartonella Associated Cutaneous Lesions (BACL) in People with Neuropsychiatric Symptoms. Pathogens. 2020;9(12):1023. Convenience sample, no control group; 24 of 29 participants (83%) reported striae-like skin lesions.
Maggi RG, et al. Bartonella henselae bacteremia in a mother and son potentially associated with tick exposure. Parasit Vectors. 2013;6:101. The single published case with both histology and Bartonella DNA amplified from a striae biopsy. n=1.
Heymann WR. Striae due to bartonella is a stretch. American Academy of Dermatology, Dermatology World Insights and Inquiries, 2018. Dermatology's counterweight: "an association does not equate with causation."
Boozalis E, et al. Demographic characteristics of teenage boys with horizontal striae distensae of the lower back. Pediatr Dermatol. 2018;35:59–63. Twelve boys aged 11 to 17 whose lower-back striae tracked with rapid growth spurts, tall stature and family history.
Mozayeni BR, Maggi RG, Bradley JM, Breitschwerdt EB. Rheumatological presentation of Bartonella koehlerae and Bartonella henselae bacteremias: A case report. Medicine (Baltimore). 2018;97(17):e0465. Frequently miscited as a striae case series. It is a single case report about joint hypermobility.
Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019;11:1179573519832014. The pediatric case report. One 14-year-old boy, psychotic 18 months, DNA-positive while serology was negative.
Delaney S, Robveille C, Maggi RG, et al. Bartonella species bacteremia in association with adult psychosis. Front Psychiatry. 2024;15:1388442. n=116 blinded. 43.2% of adults with psychosis DNA-positive vs 14.3% of controls; none of the 7 children was positive; no serology difference.
Lashnits E, Maggi R, Jarskog F, Bradley J, Breitschwerdt E, Frohlich F. Schizophrenia and Bartonella spp. Infection: A Pilot Case-Control Study. Vector Borne Zoonotic Dis. 2021;21(6):413–421. Pilot study, 11 of 17 cases vs 1 of 13 controls, with no severity gradient among cases.
Vermeulen MJ, Herremans M, Verbakel H, et al. Serological testing for Bartonella henselae infections in The Netherlands. Clin Microbiol Infect. 2007;13(6):627–634. Commercial IgM immunofluorescence assay had 6% sensitivity in 51 PCR-confirmed patients.
Bergmans AM, Peeters MF, Schellekens JF, et al. Pitfalls and fallacies of cat scratch disease serology. J Clin Microbiol. 1997;35(8):1931–1937. IgG immunofluorescence sensitivity as low as 40.9%.
Galaxy Diagnostics. Bartonella Testing. The commercial assay used in the studies above; Breitschwerdt and Maggi are co-founders, a conflict the authors disclose in every paper.
Marzec NS, Nelson C, Waldron PR, et al. Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease — United States. MMWR. 2017;66(23):607–609. CDC documentation of real harms from prolonged and combination antimicrobial regimens.
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