How do diagnose bart?

So were trying to choose an herbal protocol. We had a test that showed bart antibodies, but that was years ago and doesnt seem conclusive.
It seems like its really important to know if you have bart since Dr Neil Nathan recommends treating that before lyme.
Should we do the abart challenge and see if it worsens symptoms? And if it does then conclude we have bart?
Symptoms are always changing but currently are depression, anxiety, sensitivity, migrating pain in lower back and hips exacerbated by walking (especially up hills) or driving, or sitting for too long

serologic tests for Bartonella are generally very poor - this is acknowledged in mainstream medicine now - for example - The UK NHS has withdrawn them in the last 12months and not replaced them with anything yet

sensitivity of simple ELISA tests for wild species of bartonella in real patients are expected to be in the range of 20-30% sensitive - ie miss 70-80% of infected individuals !! - so extremely high chances of false negative
still if you do manage to get a positive its useful

standard PCR testing is also poor in terms of sensitivity - probably less than 50%. here it is known that persons who are PCR positive are usually serology negative - a v unusual finding - which shows bartonella inhibit the immune system in some way to prevent it forming antibodies.

the best commercially available tests are
1, Galaxy diagnostics - triple draw culture + digital droplet ePCR - expensive but best test available - from the name alone you can see how many steps / lengths they haveto go to to get sensitivity up.
2, Igenex - multispecies bartonella western/immunoblot - still serology - but multiple antigens blot - so more chances of detecting bart - especially if different species to B. henslae ( the species most simple tests look for ( there are approx 20 species know to be pathogenic to humans)

dark field microscopy is not so much use for bartonella - where it does not have advantages over brightfield techniques - it is typically used for live spirochetes - as they are too thin to show up on bright field microscopy but they do cause diffraction patterns that can be seen via darkfield. This method is best used for inspection after culturing bacteria. The issue with darkfield microscopy of fresh blood for Lyme is that real spirochetes are v rare in the blood ( they live in tissues) whereas blood contains lots of artefacts can look like spirochetes under the microscope - and practitioners often claim these are diagnostic for Lyme. Sick people also tend to have more artefacts floating around in their blood from all the inflammation and tissue damage.

i found my own bartonella infection definitively by Giemsa stained blood smear a 1000x under oil.
as per a slide in this excellent video by two of the world leading bartonella experts

i consider it the best primer on bartonella out there - and essential viewing for anyone dealing with this infection - its made by two of the leading experts in the disease.

https://www.youtube.com/watch?v=njywmmpjiku

few if any commercial labs offer this test its extremely time consuming to perform.
however once the distinctive pattern of rings of pale vacuoles inside groups of red blood cells is seen it is definitive for Bartonella
i had to buy the equipment and go on a steep learning curve to develop the skills and processed needed - see the link in my signature for more details

Garzie said “…….serologic tests for Bartonella are generally very poor - …..”

This is why my llmd doesn’t rely on testing - he treats the three B’s:
Borellia, Babesia and Bartonella.