The Intersection of Long COVID and Hidden Infections

As a functional medicine doctor, I've dedicated my career to being a medical detective—looking beyond symptoms to find the root causes of complex chronic illness. Throughout the COVID-19 pandemic, we've witnessed a new phenomenon emerge: Long COVID, a condition where symptoms persist for months after the initial infection. But what if I told you that in some cases, what appears to be Long COVID might actually be something else hiding in plain sight?

A fascinating case study recently published in the European Journal of Clinical Microbiology & Infectious Diseases has shed light on this exact scenario. The report details how investigating a supposed case of long COVID revealed an underlying Bartonella henselae infection that was discovered through clinical metagenomics.

This revelation doesn't surprise me. For years, I've been treating patients with complex chronic infections, and I've observed how one infection can either mask another or create the perfect conditions for a dormant infection to flourish. The connection between COVID-19 and hidden infections like Bartonella is a crucial piece of the puzzle that many conventional medical approaches might miss.

Understanding Bartonella: The Stealthy Intruder

Before we dive deeper into how Bartonella relates to Long COVID, let's understand what this bacteria is and how it operates in your body.

Bartonella is a type of bacteria that infects your cells, causing a condition known as bartonellosis. There are over 20 different strains of Bartonella, with at least 14 capable of infecting humans. This bacteria has a remarkable ability to evade your immune system's defenses, making it particularly difficult to detect and treat. Bartonella can hide out in the cells that line your blood vessels and within your red blood cells, creating a perfect stealth operation within your body.

The Case That Connected the Dots

The case study that caught my attention involved a 26-year-old woman who had experienced mild COVID-19 but continued to suffer from persistent symptoms for five months afterward, including noticeable axillary (armpit) lymph node swelling. When doctors performed a biopsy of the swollen lymph node and analyzed it with clinical metagenomic testing, they discovered something unexpected: Bartonella henselae DNA and RNA. Even more telling was that when the patient was treated with the antibiotic clarithromycin, her symptoms improved.

This case illustrates something I've suspected and observed in my practice: COVID-19 may be reactivating latent infections that were previously dormant in the body. The immune dysregulation caused by SARS-CoV-2 appears to create an environment where opportunistic pathogens like Bartonella can resurface and cause symptoms.

Bartonella and Vascular Health: A Critical Connection

What makes Bartonella particularly insidious is its profound impact on the vascular system. Unlike many other bacteria that primarily affect specific organs, Bartonella has a special affinity for blood vessels throughout the body, creating a systemic problem that can manifest in numerous ways.

Bartonella specifically targets and infects the endothelial cells—the critical cells that line the interior surface of blood vessels. Once established in these cells, Bartonella triggers a cascade of harmful processes:

1. Vascular Proliferation: Bartonella can stimulate the abnormal growth of small blood vessels, a process called angiogenesis. This inappropriate vascular proliferation can lead to lesions in various tissues, including the skin, liver, and spleen.
2. Endothelial Inflammation: The infection triggers a localized inflammatory response in blood vessel walls, leading to vascular damage and dysfunction.
3. Disruption of Vascular Integrity: As Bartonella replicates within endothelial cells, it weakens the structural integrity of blood vessels, potentially leading to microvascular leakage.
4. Impaired Blood Flow: The combination of inflammation, structural changes, and vascular dysfunction can impair microcirculation, reducing oxygen and nutrient delivery to tissues throughout the body.

Research has associated Bartonella with vascular problems, angiogenesis, and inflammation—all processes that can significantly impact overall health and contribute to the persistent symptoms seen in both bartonellosis and Long COVID.

The Fibrin Connection: How COVID-19 and Bartonella Create a Perfect Storm

One of the most concerning overlaps between Long COVID and Bartonella infection involves fibrin production and microclotting. Fibrin is a protein involved in blood clotting, and while this process is essential for wound healing, excessive fibrin production can be problematic.

Both SARS-CoV-2 and Bartonella can trigger hypercoagulability—a state where the blood clots more readily than it should:

• COVID-19 and Coagulation: The SARS-CoV-2 virus is now known to directly affect the endothelial cells lining blood vessels, triggering inflammation and activating the coagulation cascade. This can lead to increased fibrin production and microclot formation, which may persist even after the acute infection resolves.
• Bartonella's Impact on Clotting: Similarly, Bartonella infection can activate the coagulation system and promote fibrin deposition as part of the body's inflammatory response to the infection.

When both conditions are present—either simultaneously or sequentially, as in the case of Bartonella reactivation following COVID-19—the result can be significant vascular inflammation and fibrin overproduction. This creates a dangerous feedback loop:

1. Increased fibrin leads to microclot formation
2. Microclots impair circulation and oxygen delivery
3. Tissue hypoxia (low oxygen) worsens inflammation
4. Inflammation triggers more fibrin production

This vicious cycle helps explain why some patients experience persistent fatigue, cognitive dysfunction, muscle pain, and other symptoms that characterize both Long COVID and chronic Bartonella infection. The microclots essentially create a state of systemic oxygen deprivation at the cellular level, affecting energy production and organ function throughout the body.

Why This Matters for Long COVID Patients

The implications of this discovery are profound for anyone suffering from persistent post-COVID symptoms. There are studies showing herpes virus reactivations, such as Epstein-Barr virus, in patients with long COVID, and others showing reactivation of Bartonella infection as well. It appears that the SARS-CoV-2 viral infection may be triggering other pathogens that were smoldering below the surface, causing inflammation and other problems.

For those struggling with symptoms that won't resolve after COVID-19, this means that proper testing and a more comprehensive diagnostic approach may be necessary. It's not enough to simply label something as “Long COVID” without investigating potential underlying infections that may be driving or contributing to symptoms.

Common Symptoms That May Indicate Bartonella

Bartonella can cause a wide range of symptoms that often overlap with what we're seeing in Long COVID patients. These include:

• Persistent fatigue
• Cognitive dysfunction or “brain fog”
• Neurological symptoms
• Unexplained pain
• Lymph node swelling
• Recurring fever or low-grade fevers
• Anxiety and mood changes

What makes diagnosis particularly challenging is that Bartonella is a slow-growing bacterium, and bacterial culture can take up to 21 days with a high false-negative rate. Serological tests, while helpful, often fail to differentiate between Bartonella species, and positive results may persist for years after treatment.

This is why specialized testing through clinical metagenomics or other advanced methods may be necessary to uncover these hidden infections.

The Connection to Other Tick-Borne Illnesses

As someone who has written extensively about tick-borne illnesses, I see significant parallels between Long COVID and conditions like Lyme disease, Babesia, and chronic Bartonella infections. Congress recently passed a COVID relief bill that earmarked over $1 billion for Long COVID research, and these findings may also benefit the underfunded Lyme disease and ME/CFS communities since there may be similar dysfunction amongst these illnesses.

What's particularly concerning is the potential for co-infections. It has been reported that infections including Bartonella and Mycoplasma can become reactivated during an infection with COVID-19. People who develop persistent symptoms following infection with the SARS-CoV-2 virus may have had underlying low-grade infections reactivated by the acute COVID-19 infection.

A Functional Medicine Approach to Diagnosis and Treatment

If you're struggling with persistent symptoms after COVID-19, I believe a comprehensive approach is essential. Here's what I recommend:

Comprehensive Testing

Physicians should include comprehensive testing for viral and bacterial infections, including Lyme disease, Bartonella, Mycoplasma, and Epstein-Barr Virus, in the diagnostic evaluation of Long COVID. This might include:

• Clinical metagenomic testing
• Specialized PCR and FISH testing for Bartonella
• Comprehensive immune system evaluation like IgG, IgM, IgA, IgE and subclasses, T& B cell counts
• Inflammatory markers, like IL-2, TNF alpha, IFN gamma, TGF beta
• Co-infection screening, like borrelia, babesia, ehrlichia and others. 

Targeted Treatment Approaches

Based on the case study and my clinical experience, treatment for Bartonella in the context of Long COVID may include:

1. Antimicrobial Therapy: This may involve prescription antibiotics like clarithromycin or azithromycin, which was successful in the case study patient.
2. Combination Approaches: For persistent cases, a combination of prescription and herbal antimicrobials may be necessary to address both actively replicating forms of Bartonella and the “persisters” that hide within cells.
3. Biofilm Disruptors: Herbal or prescription medications that can break down the protective barriers that some bacteria create.
4. Immune Support: Supplements to decrease inflammation and support a healthy balance of cytokines and other immune messengers.

It's important to note that treatment for Bartonella can take 4-6 months or longer to fully resolve symptoms. This is why working with a practitioner familiar with these complex infections is so important.

Improving Vascular Health and Blood Flow: A Critical Component of Recovery

Given the vascular impact of both COVID-19 and Bartonella infections, supporting healthy blood flow and reducing excess fibrin becomes a crucial part of any treatment protocol. In my practice, I focus on several key strategies to improve vascular health in patients recovering from these conditions:

1. Addressing Fibrin Overproduction

Excessive fibrin can create microclots that impair circulation throughout the body. Supporting healthy fibrin metabolism involves:

• Proteolytic enzymes like nattokinase and lumbrokinase that help break down excess fibrin
• Maintaining proper hydration to prevent blood thickening
• Anti-inflammatory herbs and nutrients that modulate the clotting cascade

2. Endothelial Support

The endothelial cells lining your blood vessels need specific nutrients to repair and regenerate after damage from infections like Bartonella and COVID-19:

• Omega-3 fatty acids to reduce vascular inflammation, like OmegaPro PRM
• Nitric oxide production precursors like this one
• Antioxidants like vitamin C and quercetin to protect endothelial cells from oxidative stress

3. Optimizing Microcirculation

Improving blood flow at the capillary level ensures proper oxygen and nutrient delivery to all tissues:

• Ginkgo biloba to enhance microcirculation
• Natural vasodilators like beetroot extract and pine bark extract
• Adequate magnesium levels to support proper blood vessel relaxation

Blood Flow Pro: A Comprehensive Solution for Vascular Support

To address the complex vascular issues associated with both Bartonella and Long COVID, I formulated Blood Flow Pro—a specialized supplement designed to support healthy blood flow, reduce excess fibrin, and improve vascular function.

This unique formulation contains key ingredients specifically chosen for their synergistic effects on vascular health:

• Nattokinase: A powerful enzyme derived from fermented soybeans that helps break down excess fibrin and supports healthy blood viscosity. This is particularly important for addressing the microclotting associated with both Long COVID and Bartonella infections.
• Lumbrokinase: A highly potent fibrinolytic enzyme that complements nattokinase by targeting different aspects of fibrin metabolism. Together, these enzymes help maintain proper blood flow through even the smallest vessels.
• Rutin and Quercetin: Potent flavonoids that strengthen capillary walls, reduce vascular inflammation, and protect endothelial cells from oxidative damage.
• Bromelain: An enzyme from pineapple that helps modulate inflammation and improves the absorption of other beneficial compounds.
• Ginger Extract: Supports peripheral circulation and has natural anti-inflammatory properties that complement the other ingredients.

Blood FlowPro is designed to be taken on an empty stomach to maximize enzymatic activity and absorption. By incorporating this supplement into a comprehensive protocol for addressing Bartonella and Long COVID, many of my patients have experienced significant improvements in energy levels, cognitive function, and overall well-being.

For those dealing with the vascular effects of these complex conditions, Blood Flow Pro offers targeted support for the circulatory system. You can learn more about this formula and its benefits at drjillhealth.com/products/dr-jill-health®-bloodflowpro-60-caps.

Proactive Steps to Combat Inflammation and Infection

Whether you're recovering from COVID-19, dealing with persistent symptoms, or simply wanting to protect yourself from these stealthy infections, here are some proactive steps you can take:

1. Anti-Inflammatory Diet

Focus on foods that reduce inflammation and support immune function:

• Colorful fruits and vegetables rich in antioxidants
• Healthy fats like omega-3s found in fatty fish and flaxseeds
• Fermented foods that support gut health
• Herbs and spices with anti-inflammatory properties like turmeric and ginger
• Plenty of filtered water to support detoxification

2. Targeted Supplements

Consider the following supplements that can help address inflammation and support immune function:

• Vitamin D3
• Vitamin C
• Zinc
• N-Acetyl-Cysteine (NAC)
• Glutathione
• Curcumin
• Resveratrol
• Quercetin

3. Stress Management

Chronic stress can suppress immune function and exacerbate inflammation:

• Practice mindfulness meditation
• Engage in gentle movement like yoga or tai chi
• Prioritize quality sleep
• Consider adaptogens like ashwagandha or holy basil
• Set boundaries to protect your energy

4. Environmental Detoxification

Reduce your toxic burden to support your body's healing processes:

• Filter your drinking and shower water
• Choose organic foods when possible
• Avoid plastics for food storage
• Use natural cleaning and personal care products
• Consider air purification in your home

5. Tick Prevention

If you spend time outdoors, take these precautions:

• Wear protective clothing
• Use natural insect repellents
• Perform regular tick checks
• Shower after outdoor activities
• Consider herbal prophylaxis if you've been exposed

Are you a healthcare professional? Join Dr. Jill’s Monthly Professional Newsletter to receive curated insights and resources on integrative and functional medicine. Carefully compiled for physicians and healthcare providers to help you stay informed and inspired in your practice.

Moving Forward: Integrative Approaches to Complex Illness

The discovery of Bartonella hiding behind what appeared to be Long COVID symptoms reinforces what I've always believed as a functional medicine practitioner: we must look deeper than surface symptoms and investigate the complex interplay of factors that contribute to chronic illness.

This case study is just the beginning. Recent research has developed a multiplex droplet digital PCR assay for the simultaneous detection of tick-borne/vector-borne pathogens like Babesia, Bartonella, and Borrelia in patient blood, which will be used on blood collected from patients with long COVID, ME/CFS and hypermobile EDS diagnoses. The results of these studies will continue to illuminate the connection between these conditions and help us develop more effective treatment approaches.

As medical detectives, we must remain curious and open to these connections. The overlap between Long COVID, tick-borne infections, and conditions like ME/CFS is not coincidental—it points to shared mechanisms of immune dysfunction, inflammation, and pathogen persistence that can guide our approach to healing.

Final Thoughts and Next Steps

If you're struggling with persistent symptoms after COVID-19, don't lose hope. Consider seeking out a functional medicine practitioner who can help you investigate potential underlying infections and create a comprehensive treatment plan tailored to your specific needs.

Remember that healing complex infections like Bartonella requires patience and a multi-faceted approach. By combining the best of modern testing and treatment with foundational lifestyle modifications and targeted supplements like Blood Flow Pro, you can support your body's natural healing processes and reclaim your health.

For additional support on your healing journey, visit drjillhealth.com for science-backed supplements and resources designed to address inflammation, support immune function, and target persistent infections like Bartonella. My team and I are committed to helping you uncover the root causes of your symptoms and guiding you on the path to vibrant health.

References

1. Aubry, A., Corvilain, E., Ghelfenstein-Ferreira, T. et al. Unmasking Bartonella henselae infection in the shadows of long COVID thanks to clinical metagenomics. Eur J Clin Microbiol Infect Dis 43, 1025–1029 (2024). https://doi.org/10.1007/s10096-024-04801-2
2. Dong Y, Alhaskawi A, Zou X, et al. Post-COVID reactivation of latent Bartonella henselae infection: a case report and literature review. BMC Infect Dis. 2024;24(1):422. https://doi.org/10.1186/s12879-024-09336-7
3. Bush JC, Robveille C, Maggi RG, Breitschwerdt EB. Neurobartonelloses: emerging from obscurity! Parasit Vectors. 2024;17(1):416.
4. Putrino D. Five Years Post-Pandemic: Here's What We've Learned About Long COVID. Mount Sinai Today. February 2025.
5. Goldman J, et al. Molecular Patterns of ME/CFS and Long COVID: Potential Insights into Pathogenic Mechanisms. Biocentaur. 2022.
6. PolyBio Research Foundation. Impact of tick-borne/vector-borne infection on post-COVID symptoms. November 2024.
7. Maderis T. Long COVID: Similar to Lyme disease and ME/CFS? October 2023.
8. Carnahan J. Bartonella: How to Protect Yourself From This Stealthy Intruder. 2020.
9. Carnahan J. Tick-Borne Illnesses and the Gut: A Fascinating Look at Their Link. 2023.
10. Carnahan J. Bartonella: The Sneaky Bacteria Behind Surprisingly Complex Symptoms. 2024.