Prof Garth L. Nicolson, Marwan Nasralla, PhD, Goerg Haier, MD and Nancy L. Nicholson, PhD.
The Institute for Molecular Medicine,
15162 Triton Lane,
CA 92649, USA
Diagnosis and Treatment of Cell-Invasive Mycoplasmal Infections in GWI, CFS (M.E.), FMS and RA Patients
Patients with chronic illnesses, such as chronic fatigue syndrome (M.E.), fibromyalgia syndrome (FMS), Gulf War illness (GWI) or rheumatoid arthritis (RA), often have overlapping signs and symptoms. We have found that a major source of their morbidity is caused by various chronic viral and bacterial infections. For example, GWI patients slowly present with chronic, complex, multiorgan signs and symptoms, such as polyarthralgia, chronic fatigue, short-term memory loss, sleep difficulties, headaches, intermittent fevers, skin rashes, diarhea, vision problems, nausea, breathing and heart and other problems. Although there is not yet a case definition for GWI, the signs and symptoms loosely fit those found in CFS and FMS1.
Using the techniques of nucleoprotein gene trapping (NGT) that utilises nuclei-isolated nucleoproteins for probing with unique cDNA sequences and forensic polymerase chain reaction-hybridisation (FPCR) ~45% (NGT) and ~55% (FPCR) of 200 GWI patients and their immediate symptomatic family members who have GWI signs and symptoms showed evidence of mycoplasmal infections inside their blood leucocytes, but not in their blood plasma or serum. The most common species found was M. fermentans. In contrast, in nondeployed, healthy adults the incidence of mycoplasma-positive tests were ~6% (4/62).
Mycoplasma-positive cases of GWI have been successfully treated with multiple 6-week cycles of antibiotics2,3: doxycycline (200-300 mg/d), ciprofloxacin (1500mg/d), azithromycin (500mg/d) or clarithromycin (800 mg/d) plus nutritional support3. All patients on antibiotic therapy (n=87) relapsed within weeks after the first cycle of therapy, but after up to 6 cycles of therapy 69/87 recovered and 18/87 are still undergoing therapy. GWI patients who recovered from their illness after several (3-7) 6-week cycles of antibiotic therapy were rested for evidence of mycoplasmal infections and were found to have reverted to a mycoplasma-negative phenotype4,5.
The results were compared to 203 patients with CFS or FMS and 100 patients with RA. Using PCR 144/203 CFS/FMS patients were positive for mycoplasmal infections (60%), whereas only 3/32 healthy controls were positive. In mycoplasma-positive CFS/FMS patients we found a variety of mycoplasma species6. RA patients also had high frequencies of mycoplasmal infections (~45%), and these patients also had various species of mycoplasmas in their blood leukocyte fractions7.
We conclude that subsets of GWI, CFS (ME), FMS and RA patients have mycoplasmal and possibly other transmittable chronic bacterial and viral infections, and treatment of these chronic patients with appropriate antibiotics can result in slow recovery from their conditions4-6.
We propose that GWI is to a large degree due to multiple exposures to chemical, radiological and biological agents that cause multifactorial illnesses, some of which are transmittable to immediate family members and involve chronic infections8. Civilians with CFS, FMS or RA also often show the presence of chronic bacterial infections (mycoplasmas and others), and these patients can be successfully treated similar to the GWI patients with long-term antibiotics and nutritional support3.
1. Nicolson, G.L. and Nicolson, N.L. J Occup, Environ Med (1996) 38:14-16
2. Nicolson, G.L. and Nicolson, N.L. JAMA (1995) 273: 618-619
3. Nicolson, G.L. Intern J Med (1998) 1: 115-117 and 123-128
4. Nicolson, G.L. and Nicolson, N.L. J Occup, Med Immunol Tox (1996) 5: 69-78
5. Nicolson, G.L., Nicolson, N.L. and Nasralla, M. Intern J Med (1998) 1: 80-92
6. Nicolson, G.L., Nicolson, G.L., Hier, J. and Nicolson, N.L. Biomed Therapy (1998) 16: 266-271
7. Hier, J., Nasralla, M. and Nicolson, G.L. Brit J Rheumatol (1999): in press
8. Nicolson, G.L. and Nicolson, N.L. Medicine Conflict & Survival (1998) 14: 74-83
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