Mycoplasma 25 August 2009
Mycoplasma are a group of microorganisms which are a cross between a virus and a bacteria. Together with Chlamydia and Rickettsia they make up a family of microorganisms known as Rickettsiae and Pararickettsiae. They are found everywhere, the hosts are usually rodents and the vectors are arthropods (insects with jointed legs) or airborne through dust. Rickettsial organisms have been found in ticks, lice, fleas, mites, meat, milk, stool and dust.
They are the smallest free living organisms. Like viruses, they are intracellular organisms but unlike viruses, they can reproduce outside cells. They lack a cell wall which makes them resistant to many antibiotics. They enter the body through skin, lungs or digestive system. They then spread through the bloodstream to infect vascular endothelium. They multiply within cells until numbers are so great that the cells burst. This then damages blood flow to multiple organs, hence the multitude of symptoms which may occur.
Most of us have an immune system which can eradicate these organisms. In people without an optimal immune system, mycoplasma can cause both acute and chronic infections. Acute mycoplasma infections can present as atypical pneumonia or a severe flu like illness which frequently involves joint pains and headaches. Symptoms can persist of months. Chronic mycoplasma infections have been implicated in:
- Rheumatoid arthritis and psoriatic arthritis
- Chronic Fatigue Syndrome
- Fibromyalgia and Polymyalgia Rheumatica
- Gulf War Syndrome
- Autoimmune diseases such as lupus, scleroderma, vasculitis, multiple sclerosis and Sjogren’s.
They have even been implicated in precipitating Hashimoto’s thyroiditis, Grave’s Disease, uveitis, appendicitis, Crohn’s Disease, ulcerative colitis and heart attacks.
Research by Dr Cecile Jardin (a French surgeon now based in South Africa and specialising in the treatment of chronic fatigue) has shown that the most common symptoms of chronic mycoplasma type infections include:
- Sweats 28%
- Chest pain and palpitations 47%
- Bruising 48%
- Visual disturbances 58%
- Depression 62%
- Recurrent sore throat 69%
- Sleep disturbances 71%
- Muscle and joint pain 73%
- Memory and concentration impairment 80%
- Headaches 80%
- Fatigue 87%
Symptoms are caused by the release of 3 types of toxins into the blood:
- Endocytokines that cause inflammation and pain.
- Neurocytokines that produce neurological symptoms including the demyelinisation found in multiple sclerosis and psychiatric symptoms such as depression and anxiety.
- Allergens causing allergies.
Mycoplasma infections can be occult. That means they can be asymptomatic and lie dormant until another bacteria, virus, parasite, stress or toxin activates it and causes the symptomatic phase.
Often these chronic conditions improve dramatically and even completely recover once the infection is identified and appropriately treated. In my opinion, everyone with the above conditions should be screened for chronic mycoplasma infection.
Acute mycoplasma infections can be diagnosed by seeing an elevation in mycoplasma antibodies in a blood test. However, chronic infections often require specialised DNA testing (polymerase chain reaction). Clues to a persistent mycoplasma infection include an elevation in inflammatory markers like C-reactive protein, low white cell count, unexplained elevation of liver enzymes, elevated thyroid antibodies (in 28%) an elevated ESR, elevated rheumatoid factor, elevated antinuclear antibody and an elevated IgM antibody.
A study published in the April 2003 edition of the Journal of Clinical Rheumatology looked at 7 patients who had developed fatigue, musculoskeletal symptoms and cognitive disturbance after tick attachment. All seven had negative serology (blood test for antibodies) but were positive for mycoplasma fermentans on PCR testing. After antibiotic treatment, M, fermentans DNA was no longer identifiable and symptoms subsided. The authors concluded that “a subset of disseminated M. fermentans infections may be a vector-mediated process in humans and should be considered in patients with puzzling musculoskeletal presentations.
A study published in the December 1999 edition of the European Journal of Clinical Microbiological Infectious Diseases found that many species of mycoplasma can result in chronic fatigue. Of 91 patients with chronic fatigue and proven mycoplasma infection, 54/91 had Mycoplasma pneumoniae, 44/91 had Mycoplasma fermentans, 28/91 Mycoplasma hominis and 18/91 had Mycoplasma penetrans. Multiple species were found in 48/91. Patients infected with more than one mycoplasma species “generally had a longer history of illness, suggesting that they may have contracted additional mycoplasma infections with time”.
A study of European patients with chronic fatigue has found a similar incidence of mycoplasma infections as American studies. A study published in the November 2002 edition of the journal FEMS Immunology Medicine and Microbiology looked for mycoplasma infections in 261 European chronic fatigue patients and 36 healthy controls. 69% of the CF patients had positive PCR tests for mycoplasma compared to 55 of the controls. Mycoplasma hominis was the most frequent infection followed by M. pneumoniae and M. fermentans. 17% had multiple mycoplasma infections.
A study published in the June 1999 edition of the journal Rheumatology found that a high percentage of rheumatoid arthritis (RA) patients had systemic mycoplasma infections. 28 patients with RA were investigated by PCR testing for chronic mycoplasma infections. 54% were found to be positive for a chronic mycoplasma infection. 36% had evidence of more than one type of mycoplasma. If mycoplasma infections are identified and treated then a marked improvement in RA frequently occurs.
A study published in the September 2002 edition of the Journal of Clinical Neurosciences has found a high incidence of mycoplasma infections in Gulf War Veterans who developed Amyotrophic Lateral Sclerosis. 83 % (30/36) of the patients with ALS had positive PCR tests for mycoplasma compared to less than 9% of controls (who did not have ALS). The authors concluded that infectious agents may play a role in ALS or ALS patients are extremely susceptible to systemic mycoplasma infections.
Treatment of an acute respiratory mycoplasma infection usually involves a 3 week course of an antibiotic such as doxycycline, rulide or a 5 day course of azithromycin. Eradication of a chronic mycoplasma infection requires long term antibiotic treatment. This can range from 3-24 months but averages around 9 months. The course has to be so long because:
- the organisms being intracellular are hard to kill.
- the infection has been present for a long time
- the organisms are present in multiple organs
- dormant organisms can be protected against antibiotics and can only be killed once they become active
Antibiotics are usually required to be rotated to avoid the development of resistance. Minocycline should be taken on an empty stomach and is unlikely to cause gastrointestinal side effects. Early side effects usually include headaches and diziness which usually settle. If a problem, the dose of minocycline can be halved and taken once a day until the body becomes accustomed to it.
I usually suggest alternating different antibiotics over a 6-9 month period to avoid antibiotic resistance. If that doesn’t work, I also use a protocol which involves doxycycline (M/W/F), low dose naltrexone and the herb cats claw.
A short 5 day course of intravenous antibiotics can be of enormous initial benefit as well because they reach much deeper into the tissue.
For the first few weeks, as the organisms start to die, symptoms can initially worsen before starting to improve. This is known as a Herxheimer reaction. Drinking lots of water and using digestive enzymes may prevent it but if it occurs it can be managed with vitamins and minerals (sometimes they are needed intravenously). It is important to always be on a high quality probiotic during the antibiotic therapy to minimize the risk of gut dysbiosis.
To maximize the chances of recovery, other problems MUST be addressed concurrently:
- Concurrent viral infections
- Gut dysfunction
- Immune dysfunction
- Environmental toxicity
- Nutritional deficiencies
Because it is so important to eliminate this organism, I always recommend immune support with high doses of vitamin C, a high quality B vitamin, Coenzyme Q10, garlic and pharmaceutical grade fish oil.
Research has shown that about 80% of patients with confirmed mycoplasma infections who are treated appropriately will recover 50-100% of their preillness health within 3 years.
Post treatment PCR testing to confirm eradication should always be done.