Alpha Proteobacterium Growth Medium (BAPGM) multi-platform testing, including liquid culture, enriched agar plating and molecular techniques. Four-mm skin biopsies from non-lesional skin will be acquired from the same patients, processed using our published techniques, and imaged using confocal microscopy and compared to BAPGM test results. Urine samples will be collected and analyzed for microRNAs. Blood smears will be analyzed for intra-erythrocytic Bartonella spp.