FAQ at G. Nicholson's site

[Guest guest]

http://www.immed.org/FAQ.htm

THE FOLLOWING QUESTIONS WERE ASKED:

QUESTION:

How long must I be off antibiotics and immune enhancement products before my blood is taken for testing?

RESPONSE:

Our usual recommendations are 4 weeks off all immune enhancement products, antibiotics or anything else that might affect testing. The reason for this is that the blood levels of intracellular infections, such as Mycoplasma, Chlamydia, Borrelia, etc., can be more easily suppressed by antibiotics and immune responses than the tissue levels. Thus the blood levels may rebound slowly after treatment is stopped, whereas the tissue levels of infections are usually not as sensitive to treatment, and they take longer to suppress with treatment. This is one reason why the treatment takes so long for chronic intracellular infections compared to rapidly growing microorganisms. Another reason is that chronic infectious agents respond more slowly to treatment, and they are often not as sensitive to a variety of treatment approaches.

Prof. Garth Nicolson

QUESTION:

Dear Dr. Nicolson,

I am a CFIDS patient and have been diagnosed with both bacteria (Mycoplasma hominis) and a virus (HHV-6). What is the best approach for treatment?

RESPONSE:

MANY, IF NOT MOST, CFS/ME PATIENTS HAVE MUTLIPLE INFECTIONS—BACTERIAL, SUCH AS MYCOPLASMAS, CHLAMYDIAS, ETC. AND VIRAL, SUCH AS HHV-6, CMV, ETC. WHEN THIS OCCURS, IT CAN BE DIFFICULT TO TREAT SUCH MULTIPLE INFECTIONS. YOUR PHYSICIAN SHOULD KNOW THE LATEST THERAPEUTIC APPROACHES, BUT WE ARE AVIALABLE TO HELP PHYSICIANS WITH COMPLEX TREATMENT QUESTIONS. GENERAL INFORMATION CAN BE FOUND ON OUR WEBSITE UNDER “TREATMENT CONSIDERATIONS.”

PROF. NICOLSON

QUESTION:

Dear Dr. Nicolson,

How do I know which tests to order, and how do I arrange for testing?

RESPONSE:

Please consult with the sections on our website titled Clinical Testing or Veterinary Testing for suggested tests for particular illnesses, or go to the website of International Molecular Diagnostics, Inc. (www.imd-lab.com). Your tests must be ordered by a physician, and the results must by law be sent to your physician. You will be able to receive a copy of your results from your physician.

QUESTION:

I have a patient that is environmentally sensitive and may not be able to tolerate some of the recommended oral antibiotics. How should I proceed with this patient?

RESPONSE:

Often patients who are very sensitive to antibiotics tolerate them better if the first 3-4 weeks are given i.v. The reason for this could be the fact that some patients react very strongly to oral antibiotics because of gut-associated reactions, but after a few weeks of i.v. therapy their GI may heal to the point that they can now tolerate oral antibiotics. Also, many patients (and their physicians) have noticed that they are less sensitive to environmental stressors as their therapy proceeds. You can contact physicians at the Institute for Molecular Medicine or its affiliated clinics for more detailed information.

QUESTION:

Dear Prof. Nicolson,

I and a friend have tried repeatedly to get info about "immune enhancers" and their use for ALS patients, and got no reply. Do you have a list?

RESPONSE:

At the Immune Institute and the Institute for Molecular Medicine here in Huntington Beach, CA we are conducting an IRB-approved experimental treatment trial for ALS patients. In addition to i.v. antibiotics and antivirals to treat their chronic bacterial and viral infections (found in >85% of cases), these patient are also receiving a combination of bioactive whey protein isolate (2X pouch per day in water or skim milk), Transfer Factor (6 capsules per day orally), and Veraloe Gold (1 Tbsp/day) orally as a part of the trial. They are also receiving neural growth factors. This is an ongoing clinical trial, and interested individuals should contact Dr. Darryl See of the Immune Institute or myself for more information.

QUESTION:

How can I tell if a chronic infection like the mycoplasma is being transmitted by my wife to me?

RESPONSE:

If your wife tested positive and you have slowly developed some of the same clinical signs and symptoms, it's a possibility that the infection has spread to you, and you should tested and if positive treated for the same infection. These infections are usually system-wide (systemic) and can invade and affect practically any tissue or organ in your body. They are especially pathogenic in the nervous system, gut, joints and endocrine glands.

Prof. Garth Nicolson.

QUESTION:

I have recently been diagnosed with RA. I had complications from a C-Section and required blood transfusions. I was HIV-negative and have no problem with that but I had an infection that one week later they could not identify (Also, after receiving an immunization for Rubella, I became extremely ill). Is there any possibility of transmission of mycoplasma or some other bacteria from this transfusion or immunization? My immune system, in retrospect, was seriously impacted from that point on.

RESPONSE:

It is certainly possible, and we know from a European study that about 6.5% of CFS patients came down with their illness after a blood transfusion. (The same holds for RA) Many of these patients later were found to have systemic mycoplasmal or other bacterial or viral infections. In terms of vaccines, a recent publication found that ~6% of commercial vaccines were contaminated with mycoplasmas. Vaccines, per se, are probably not a problem if your immune system is strong, but if you received a rare vaccine that was contaminated with a microorganism and your immune system could not suppress this infection, or you received multiple vaccines all at once, then it could cause problems.

There are various species of mycoplasmas, about a dozen are known to be pathogenic, and you were probably only tested for the 4 most commonly found species. (Note: we can also test for other mycoplasma species as well as other bacteria such as Brucella, Borrelia, and other pathogens that can cause similar signs and symptoms but are not mycoplasmas and would not be picked up on the tests for mycoplasmas.) From your responses to antibiotics, we can only assume a bacterial infection. We can't determine if it is mycoplasmal or a related infection from the clinical signs and symptoms, because they are general and not unique to mycoplasmas.

Prof. Garth Nicolson

QUESTION:

Dear Prof. Nicolson,

There may be several parallel paths by which mycoplasmas contribute to ALS. Here is one possibility. There is a link between mycoplasmas and a known aspect of ALS pathology. Mycoplasmas need and use cholesterol. But oligodendrocytes require cholesterol to synthesize neurosteroids. Neurosteroids have neuroprotective properties such as reducing neuronal responsiveness to glutamate. If the mycoplasma population is large enough, they may use so much cholesterol that they drive down neurosteroid synthesis. Low levels of neurosteroids may lead to CNS disfunction and damage.

RESPONSE:

I WAS AWARE OF THE STEROID-STEALING PROPERTIES OF MYCOPLASMAS. THIS MAY

BE HOW THEY MAKE MITOCHONDRIA LEAKY--BY STEALING THE LIPIDS SUCH AS CHOLESTEROL THAT ARE IMPORTANT IN MITOCHONDRIAL MEMBRANE INTEGRATY. WHEN MITOCHONDRIA ARE LEAKY, THEY CAN'T GENERATE THE ENERGY NECESSARY FOR CELL FUNCTION, AND NERVES ARE THE MOST SENSTIVE CELL TYPE TO ENERGY DEPRAVATION. I LIKE THE NEUROSTEROID-GLUTAMATE IDEA AND WOULD LIKE TO SEE SOMEONE FOLLOW THIS LINE OF INVESTIGATION. OF COURSE, MYCOPLASMAS ALSO DO MANY OTHER BAD THINGS TO CELLS.

PROF. NICOLSON

QUESTION:

Based on my symptoms --- can we eliminate any of the mycoplasmas listed in your publications?) -- You've done EXCELLENT WORK -- Thank you !!!

RESPONSE:

ONLY THE SPECIFIC BACTERIAL SPECIES THAT TESTED NEGATIVE CAN BE ELIMINATED. THERE ARE OTHER PATHOGENIC MYCOPLASMA SPECIES THAT WE CAN TEST FOR, AND THESE AND OTHER RELATED MICROORGANISMS CAN PRODUCE SIMILAR CHRONIC SIGNS AND SYMPTOMS.

QUESTION:

I've been off antibiotics for 6 weeks, and I am suffering from muscle, joint pain, sleep (lack of), etc. Do I need to be back on antibiotics?

RESPONSE:

YOU PROBABLY NEED TO BE BACK ON ABX OR COMBINATIONS OF ABX, PROBIOTICS,

IMMUNE ENHANCEMENT AND VITAMIN AND NUTRITIONAL SUPPORT. SEE OUR PHYSICIAN RECOMMENDATIONS UNDER TREATMENT CONSIDERATIONS, AND CONSULT WITH YOUR PHYSICIAN.

PROF. NICOLSON

QUESTION:

Our doctor did treat us with doxycycline for one year. The results were amazing. As stated in my last email, my husband eventually relapsed during the summer and the headaches began. Doxycycline does not seem to work as well now [as it did before], and it doesn’t have a huge effect on the relapse, so we moved to Biaxin which has helped the body aches, etc. Is vasculitis [in the brain] a possibility?

RESPONSE:

Yes, there is a possibility that vasculitis caused by a vascular endothelial cell can result in disruption of the blood brain barrier and leakage, creating pressure in the brain that could cause severe pain. It is very important that physicians consider that such patients should be tested for mycoplasmal infections, in particular, M. fermentans, M. genitalium and other bacterial and viral (HHV-6) infections. Consult our website, www.immed.org for further information.

Prof. Garth Nicolson

QUESTION:

My GP contacted an infectious diseases doctor with some questions. This doctor at indicated that your PCR and gene-marking tests only indicate a past history of infection, and do not

necessarily indicate a current infection. Can you refute this?

RESPONSE:

ABSOLUTELY, YOUR PHYSICIAN IS WRONG ON THIS POINT. OUR TESTS DETECT ACTIVE INFECTIONS BECAUSE THEY DETECT THE GENETIC PRESENCE OF THE MICROORGANISM. THEY DO NOT AND CANNOT DETECT HISTORICAL INFECTIONS. HISTORICAL INFECTIONS CAN, HOWEVER, BE DETECTED BY THE PRESENCE OF ANTIBODIES AGAINST THE MICROORGANISM. ALTHOUGH WE ALSO OFFER ANTIBODY TESTS FOR PHYSICIANS WHO ORDER THEM, WE DO NOT RECOMMEND THE ANTIBODY TESTS FOR THE DETECTION OF ACTIVE INFECTIONS.

QUESTION:

My doctor insists that I must not have M. pneumoniae anymore since I have already been through so many antibiotics, and that I am not contagious; yet he refuses to test me with a test *he* considers reliable to prove it, because I do not exhibit the symptoms normally identified with M. pneumoniae (pulmonary involvement, chest x-rays, etc.).

RESPONSE:

M. PNEUMONIAE INFECTIONS CAN EVOLVE FROM PRIMARILY A PULMONARY INFECTION TO PRIMARILY A SYSTEMIC (SYSTEM-WIDE) INFECTION. SHORT TERM ANTIBIOTICS CAN BE EFFECTIVE AGAINST A PULMONARY INFECTION BUT ARE UNLIKELY TO BE EFFECTIVE IN COMPLETELY SUPPRESSING SUCH INFECTIONS IF THEY HAVE BECOME SYSTEMIC (SYSTEM-WIDE INFECTION). SYSTEMIC MYCOPLASMAL INFECTIONS ARE QUITE DIFFICULT TO COMPLETELY SUPPRESS, AND IT OFTEN TAKES QUITE A BIT OF TIME AND EFFORT TO COMPLETELY SUPPRESS THEM. I STRONGLY SUSPECT THAT ONE NEVER COMPLETELY ERRADICATES SUCH INFECTIONS, BUT BY SUPPRESSING THEM AND USING IMMUNE ENHANCEMENT PRODUCTS TO BUILD UP THE IMMUNE SYSTEM, PATIENTS HAVE RECOVERED SUFFICIENTLY TO GO ON TO NORMAL HEALTHY LIVES.

QUESTION:

The question of contagion continues to be a problem, because my home care worker cannot work for me if she or her kids are at risk of infection. Our whole family has had colds this week, and I still fear that my sneezing and coughing is spreading my illness to my family.

RESPONSE:

IF YOU HAVE CHRONIC INTRACELLULAR BACTERIAL AND/OR VIRAL INFECTIONS, SUCH INFECTIONS ARE USUALLY ONLY SLOWLY PASSED TO OTHERS, AND IMMEDIATE FAMILY MEMBERS ARE AT HIGHEST RISK. IF THE INFECTION SLOWLY SPREADS TO FAMILY MEMBERS, THEY WILL EVENTUALLY EXPRESS SOME TO MANY OF THE SIGNS AND SYMPTOMS RELATED TO THE INFECTION(S). NOT ALL FAMILY MEMBERS WILL BE INFECTIBLE, HOWEVER, AND SOME MAY SUPPRESS SUCH INFECTIONS IF THEIR IMMUNE SYSTEMS ARE STRONG.

PATIENTS ON THE APPROPRIATE ANTIBIOTICS ARE MUCH LESS LIKELY, IF THEY ARE LIKELY AT ALL, TO TRANSMIT CHRONIC BACTERIAL INFECTION(S). SUCH INFECTIONS CAN BE AIRBORNE, BUT THEY CAN ALSO BE TRANSMITTED BY DIRECT FLUID CONTACT, ETC. THEY ARE NOT VERY EFFICIENT AT TRANSMISSION; HOWEVER, SO IF THEY OCCUR, THEY WILL TAKE SOME TIME TO PASS TO OTHER MEMBERS OF THE FAMILY. IN OUR STUDIES ON MYCOPLASMA-POSITIVE GULF WAR ILLNESSS PATIENTS, IT TOOK USUALLY 6-12 MONTHS OF EXPOSURE FOR THE INFECTION TO BE PASSED TO IMMEDIATE FAMILY MEMBERS AND FOR THESE FAMILY MEMBERS TO SHOW ANY SIGNS/SYMPTOMS. A U.S. SENATE STUDY INDICATED THAT THE MAJORITY OF SPOUSES AND CHILDREN OF GULF WAR ILLNESS PATIENTS EVENTUALLY DEVELOPED SIMILAR SIGNS AND SYMPTOMS AS THE SICK VETERANS, STRONGLY SUGGESTING THAT SUCH INFECTIONS CAN BE TRANSMITTED TO FAMILY MEMBERS.

PROF. NICOLSON

QUESTION:

IF I still have the mycoplasma infection, can I assume it is present in my respiratory fluids?

RESPONSE:

YES, UNLESS YOU ARE ON THE APPROPRIATE ANTIBIOTICS. IN THAT CASE THE EXTRACELLULAR LEVELS OF INFECTION IN YOUR BODY MAY BE QUITE LOW. THUS YOU MIGHT BE UNABLE TO PASS THE INFECTION TO FAMILY MEMBERS THROUGH AN AIRBORNE MECHANISM. ALTHOUGH WE HAVE NOT DONE A CONTROLLED STUDY ON THIS QUESTION, WE HAVE NOTICED THAT GULF WAR ILLNESS PATIENTS TREATED FOR MYCOPLASMAL INFECTIONS APPEARED TO HAVE FEWER FAMILY MEMBERS INVOLVED WITH CHRONIC ILLNESSES.

QUESTION:

I just wanted to let you know how I was doing, because if it wasn't for you I don't know where I would be right now. It is a long road, but it couldn't be any worse than what I have been through the past couple of years. I have been on Biaxin and Levaquin for about 4 months now and a lot of my symptoms are improving. I don't have the allergic reaction attacks when my skin and body get hot and red, and I feel as if I am going to faint. My diarrhea has improved, but I still have it every 2-3 days. I don't eat much because of it, but I have to make a trade off somewhere. I have lost 30 pounds this past year, but I still am pretty good. The death look in my eyes is not there anymore, and the color of my skin is significantly better. People are commenting, now, that I look much better, versus, telling my family I looked terrible and what is wrong with me?

When I was taken off the Biaxin and Levaquin for 2 days and was put on Cipro, boy did I take a turn for the worse. It took me about 5 days to recover from that, I was put back on the Biaxin and Levaquin. If you switch antibiotics like that does it mean the Cipro may be attacking what the other antibiotics aren't? Will my diarrhea ever go away? Just when I think I have a handle on the diarrhea it comes back. (can you answer this?)

RESPONSE:

The problem could be Herxheimer reactions due to die-off of bacteria that did not respond as well to Biaxin (clarithromycin) plus Levaquin (levofloxacin), or it could be that Cipro (ciprofloxacin) is not the best choice for a secondary antibiotic compared to the combination of Biaxin-Levaquin. Also, due to its relative tissue penetration compared to other antibiotics, Cipro must be used at relatively high doses to be effective against intracellular bacteria. You should consult with your physician. You should also be taking lots of probiotics to help your gut during antibiotic treatment.

QUESTION:

Is there a test done using saliva that you could recommend?

RESPONSE:

WE DON'T RECOMMEND SALIVA TESTS, ONLY BLOOD TESTS, BECAUSE PHYSICIANS NEED TO KNOW IF THE PATIENT HAS A DEMONSTRATED SYSTEMIC INFECTION(S). SALIVA TESTS MAY DETECT SUPERFICIAL INFECTIONS THAT MAY NOT BE CONSIDERED IMPORTANT IN PATIENT MORBIDITY.

QUESTION:

I have heard that my pets can get these infections (mycoplasma, chlamydia, etc). My dogs and cats are showing evidence of chronic fatigue, diarrhea, weight loss, hair loss and other symptoms. I have been sick for years with Fibromyalgia Syndrome, and I just heard about your wonderful new success with Fibromyalgia [patients].

RESPONSE:

If you have chronic infections, your pets can contract these infections from your or other symptomatic patients. The types of chronic infections that you list are airborne and can pass to animals with prolonged exposure. Birds, cats, dogs, hamsters, and other pets have come down with illness when their owners were sick with chronic infections. In some cases, these infections can be very serious, and they can result in fatal infections in some animals that are more susceptible than humans to the pathogenic effects of the microorganism. Therefore, we recommend our Veterinary Testing for pets. Often pets respond similar to humans to the same type of therapy recommended for treatment of chronic infections; however, the dose of antibiotic or other drug will be different in other species, so you need to consult with your veterinarian for the proper dose and regimen for treatment.

Prof. Garth Nicolson

QUESTION:

My doctor criticized your test because it "isn't a culture". Is this true? What actually goes on in your samples during the two weeks you allow before reading the results?

RESPONSE:

CULTURING SOME INFECTIOUS AGENTS, SUCH AS MYCOPLASMAS THAT ARE PATHOGENIC TO HUMANS, IS EXTREMELY DIFFICULT, BECAUSE THEY GROW VERY POORLY IN DEFINED MEDIA IN BACTERIAL CULTURES. THEY ARE INTRACELLULAR PATHOGENS THAT USUALLY GROW INSIDE MAMMALIAN CELLS NOT IN CULTURE. THE TIME REQUIRED TO GET TEST RESULTS BACK IS USALLY DUE TO THE CONFORMATION OF THE PCR PRODUCT BY SOUTHERN BACK-HYBRIDIZATION OR PRODUCT SEQUENCING. WE ARE THE ONLY LAB THAT DOES THE CONFORMATION OF THE PCR PRODUCT ON EACH AND EVERY PATIENT.

QUESTION:

Can oxygen be used to treat chronic conditions like CFS, FMS and Gulf War Illness?

RESPONSE:

Yes, oxygen, and expecially hyperbaric oxygen (HBOT, oxygen under pressure, usually in a chamber), has been used to treat chronic illnesses. At one of our affiliated clinics, Molecular Hyperbaric Medicine (www.o2med.com), we are examining the use of HBOT to treat ME/CFS, FMS and GWI in IRB-approved clinical trials. Often these illnesses have associated chronic, anaerobic infections that should respond to oxygen therapy. The oxygen therapy will be given along with antibiotics, and there is some evidence in the medical literature that combining antibiotic therapy with HBOT will yield a better result than antibiotics or HBOT alone.

QUESTION:

My husband and I are planning a trip to the Middle East this year. Will this cause me problems [with my chronic bacterial infection]?

RESPONSE:

AIR TRAVEL OVER LONG DISTANCES CAN BE A PROBLEM IF YOU HAVE CHRONIC INFECTIONS. IF YOU HAVE A PROBLEM AT LOW OXYGEN PRESSURE, SUCH AS HIGH ELEVATIONS, THEN AIR TRAVEL OVER LONG DISTANCES FOR MANY HOURS SHOULD BE AVOIDED, IF POSSIBLE, BECAUSE YOU MAY RELAPSE WITHIN A FEW DAYS AFTER YOUR ARRIVAL. THE POSSIBLE REASON FOR THIS IS THAT INFECTIONS, SUCH AS MYCOPLASMAL INFECTIONS, ARE BORDERLINE ANAEROBIC INFECTIONS THAT GROW BETTER UNDER LOW OXYGEN PRESSURES, SUCH AS FOUND AT HIGH ALTITUDE OR WHEN FLYING IN COMMERCIAL AIRCRAFT.

Prof. Garth Nicolson

QUESTION:

Isn't there a danger for me with my chronic illness to have vaccines? Can I have the different vaccinations to travel overseas? hepatitis, polio, etc...

RESPONSE:

THE QUESTION OF APPROPRIATE USE OF COMMERCIAL VACCINES IS A DIFFICULT ONE TO ANSWER. MOST VACCINES ARE COMPLETELY SAFE; HOWEVER, SOME MIGHT BE CONTAMINATED WITH MICROORGANISMS. ALTHOUGH THIS IS PROBABLY RARE, YOU SHOULD NOT TAKE THE CHANCE OF ADDITIONAL INFECTIONS. IN ONE PUBLISHED STUDY, ~6% OF COMMERCIAL VACCINES WERE CONTAMINATED WITH MYCOPLASMAS, AND ALTHOUGH IN HEALTHY INDIVIDUALS THIS MIGHT NOT BE A PROBLEM, IN IMMUNE COMPROMISED INDIVIDUALS THIS COULD BE A PROBLEM.

QUESTION:

The severity of such infections seems to be related to hormone levels, and womens' CFS in particular seems to be hormonally related.

RESPONSE:

THE GROWTH OF CHRONIC INFECTIONS, SUCH AS MYCOPLASMA, CHLAMYDIA, ETC. SEEMS TO BE RELATED TO HORMONAL ENVIRONMENT. CHANGES ARE SEEN DURING MENSTRAL CYCLE, PREGNANCY, ETC. THAT ARE PROBABLY RELATED TO HORMONE LEVELS. MICROORGANISMS LIKE MYCOPLASMAS ARE VERY SENSITIVE TO STEROIDS, AND STEROID LEVELS MAY BE QUITE IMPORTANT IN REGULATING THEIR GROWTH PROPERTIES.

Prof. Garth Nicolson

QUESTION:

I was diagnosed with CFIDS 3 years ago. I began a course of Doxycycline (200 mg per day, all at once) 10 months ago and have had improvement, with the occasional short relapse. I am into 10 days of a very serious relapse and wonder if it could be connected to beginning some hormone replacement for osteoporosis. My relapse began about 8 days after beginning 180 CPD Progesterone 1 ml twice daily (in a cream). Do you have any information on the use of hormone replacement for those recovering from mycoplasma infection (namely pneumonia and hominis)?

RESPONSE:

AS MENTIONED ABOVE, HORMONAL LEVELS MAY BE IMPORTANT IN STIMULATING THE GROWTH OF CERTAIN CHRONIC INTRACELLULAR BACTERIA. ALTHOUGH IN YOUR CASE THE EXACT REASON FOR RELAPSE IS PROBABLY UNKNOWN, STEROID HORMONES COULD CAUSE A PROBLEM.

QUESTION:

My husband has not usually suffered from chronic headache as one of his Gulf War [illness] complaints. However, when he had a relapse during July of last year (due, I believe to the air quality here in Utah with the extensive forest fires) he also developed a headache as well. It has been almost persistent since August of 2000. My husband describes the headache as a pressure in his head; he says it feels as if his head is solid. He feels actual pain when he shakes his head or at the end of an extremely active day. The pressure does not go away, it simply lessens or increases in degree of discomfort. Thus far, has undergone treatment for allergies and various bacterial infections. He has been treated for migraines. We have checked for sinus infections, brain tumors, changes in eyesight, toothache, and lower back problems. We have tried treating this as a stress headache--nothing seems to affect the headache. has another doctor's appointment today in which the next plan of action, as of the last appointment, was to be a headache specialist. We have only been able to conclude that perhaps this is somehow related to his other symptoms and is manifesting itself in a new way which we are at odds to alleviate or diagnose. Based on what I have told you, do you have any further

information?

RESPONSE:

One possibility is that he has a vasculitis or inflammation of the vascular system caused by an infection(s) in the vascular endothelial cells. In the brain this can cause disruption of the blood brain barrier and leakage, creating pressure in the brain that can create severe pain. It is very important that he be tested for mycoplasmal infections, in particular, M. fermentans and M. genitalium infections, among other bacterial (Chlamydia species) and viral (HHV-6, CMV) infections. Consult our website, www.immed.org for further information on diagnosis and treatment.

Prof. Garth Nicolson

QUESTION:

My degenerative neck and spine problem gets worse every year--also in ‘95 they said I had cryloglobunemia--Does mycoplasma have anything do that?—I can’t tolerate cold and I have no health insurance--but these doctors seem to treat mycoplasma as a minor thing--but [it’s the] only thing they found in blood besides high crylogobulin? My x-rays show degenerative disc and or vertebrae in spine and odd curve in spine --any ideas on what I can do--especially with stiff neck and spine problem.

RESPONSE:

It seems like you could have a chronic mycoplasmal or other bacterial or viral infection, usually found in about 50% of chronic joint disease patients, such as Rheumatoid Arthritis. Patients with these infections often have joint and back pain. If you had a positive test for a systemic mycoplasmal or other bacterial infection, such as Chlamydia species then we feel that it should be treated, just like any systemic bacterial infection.

QUESTION:

I have a chronic urinary infection, and my doctors can’t seem to diagnose the source? On some antibiotics my condition does seem to get better, but the infection comes back eventually. Now I am developing other symptoms, including joint and muscle pain, bowel problems, etc. What do you think is wrong with me?

RESPONSE:

Only your physician can diagnose your exact problem; however, you may be suffering from an infection(s) that is difficult to find with conventional urine analyses that are used for rapidly growing microorganisms. Patients with chronic signs and symptoms that develop from an initial bladder or urinary tract infection often have infections like Mycoplasma genitalium or Ureaplasma urealyticum. These mycoplasmas can be difficult to diagnose, but they can be found with molecular tests offered by our certified reference diagnostic laboratory, International Molecular Diagnostics, Inc. (www.imd-lab.com). If you have such an infection, it should be treated.

QUESTION:

I believe I've wrongly been diagnosed with Fibromyalgia [syndrome], and am interested in knowing how I would have testing done at your facility.

RESPONSE:

THE DIAGNOSIS OF FIBROMYALGIA IS BASED PRIMARILY ON PATIENT SIGNS AND SYMPTOMS, SUCH AS PAINFUL MUSCLE AREAS (OFTEN CALLED TRIGGER POINTS), NOT LABORATORY TESTS. OUR AFFILIATED CERTIFIED REFERENCE DIAGNOSTIC LABORATORY, INTERNATIONAL MOLECULAR DIAGNOSTICS, INC., USES MOLECULAR CLINICAL LABORATORY TESTS TO IDENTIFY POSSIBLE UNDERLYING CAUSES FOR FIBROMYALGIA SYNDROME MORBIDITY. FOR EXAMPLE, WE HAVE FOUND MYCOPLASMAL INFECTIONS IN ~60% OF FMS PATIENTS. SEE WWW.IMMED.ORG FOR MORE DETAILS.

PROF. GARTH NICOLSON

QUESTION:

Can you help me? I have a support group for women harmed by saline implants. I myself have been a victim. I have been explanted for almost 3 years now. I have improved in most areas--almost all of my symptoms are gone, except for one devastation symptom. It is my brain function. I have had many periods recently where I felt good, but I still suffer from exacerbations where I feel like my head is stuffed with cotton balls, and I am going through a deepening depression right now because of it. I am highly motivated to get better, but after 3 years, I wonder if I am fighting a losing battle.

I have done almost all of the natural therapies, including ozone therapy (I have a cold plasma generator) and feel that they have helped me a lot. However, I guess I need to know for sure if I am fighting a mycoplasma infection, and how I can get treated for this properly. My doctor has analyzed my saline implants, and has written "Both implants were grossly contaminated with at least one class of micro-organisms (mycobacteria). Having such implants in that condition would be approximately equivalent to bearing two large abscesses for more than a year."

Have you had success in healing women who have been harmed by saline implants?

Would you be willing to help direct me as to what path I should follow to finally resolve this health issue?

RESPONSE:

We have found that many implant victims that have chronic illness even after removal of their implants usually have chronic infections, such as Mycoplasma, Chlamydia, and various other chronic bacterial and viral (such as Herpes Viruses, etc.) infections. Once these infections are identified, patients can be treated. Your partial responses to ozone therapy support the notion that anaerobic infections may be involved in your illness. If you are interested, please consult our website, www.immed.org for more information.

Prof. Garth Nicolson

QUESTION:

Is Azythromycin used for 6 months straight without other antibiotic rotation and then followed by further Azythromycin treatments, or are other antibiotics used in the rotation of treatment of Chlamydia?

RESPONSE:

THE IMPORTANT POINT IS THAT ANTIBIOTICS ARE USED CONTINUOUSLY FOR AT LEAST 6 MONTHS BEFORE THE CYCLING OF ANTIBIOTICS. THE TYPE OF ANTIBIOTIC CAN BE IMPORTANT, AND WE HAVE SEVERAL RECOMENDATIONS, INCLUDING AZITHROMYCIN, DOXYCLCLINE, ETC. [sEE IMMED.ORG, TREATMENT CONSIDERATIONS]. IT IS IMPORTANT THAT AN APPROPRIATE ANTIBIOTIC IS USED AS INDICATED BY YOUR BLOOD TESTS. YOUR PHYSICIAN SHOULD BE ABLE TO HELP YOU WITH CHOSING THE APPROPRIATE ANTIBIOTIC OR COMBINATION OF ANTIBIOTICS AND THE MOST USEFUL REGIMEN FOR THERAPY.

QUESTION:

How soon should some improvement be felt after beginning treatment, and if none is experienced, how long before treatment should be discontinued?

RESPONSE:

WE SUGGEST AT LEAST 12 WEEKS TO BEGIN WITH. IF THERE IS NO IMPROVEMENT, THEN YOUR PHYSICIAN SHOULD CONSIDER CHANGING THE TYPE OF ANTIBIOTIC. ANTIBIOTICS ALONE WITHOUT NUTRITIONAL AND IMMUNE SUPPORT IS NOT ADVISED.

QUESTION:

Some doctors have reported encouraging results using intravenous hydrogen peroxide as a treatment for chronic fatigue. Have you heard of this and could it assist in Chlamydia treatment?

RESPONSE:

H202 HAS BEEN USED I.V. TO TREAT CHRONIC INFECTIONS SUCH AS CHLAMYDIA, MYCOPLASMA, ETC. SOME PATIENTS REACT VERY STRONGLY TO I.V. H202, SO IT MUST BE USED INITIALLY AT A VERY, VERY LOW DOSE AND BUILT UP SLOWLY. MANY PHYSICIANS USE I.V. OZONE-TREATED SALINE INSTEAD, BECAUSE IT APPEARS TO BE SAFER [FEWER ADVERSE REACTIONS DURING I.V. THERAPY]. DISCUSS WITH YOUR PHYSICIAN WHICH APPROACH MIGHT BE BEST FOR YOU.

QUESTION:

I was diagnosed with mycoplasma pneumonia about twelve years ago. My symptoms included fever, vomiting, diarrhea, and vaginal sores. Ten years later, I had the same symptoms, but a blood test was never done. Then, I got the same thing two years later. Does this sound like it could be a mycoplasma also? None of the doctors could diagnose it.

RESPONSE:

YES, IT COULD BE A MYCOPLASMAL INFECTION. SINCE MOST PHYSICIANS DO NOT TREAT MYCOPLASMAL INFECTIONS PROPERLY, THEY OFTEN RECURR. SOMETIMES THEY CYCLE, SO YOUR SYMPTOMS CAN GET BETTER, BUT THEN WORSE LATER ON. ADDITIONAL INFORMATION IS ON OUR WEBSITE, WWW.IMMED.ORG

PROF. GARTH NICOLSON

QUESTION:

I have had ankylosing spondylitis for years, and I have not had any luck in getting this treated. Can you help me?

RESPONSE:

WE HAVE FOUND THAT MANY IF NOT MOST PATIENTS WITH ANKYLOSING SPONDYLITIS HAVE CHRONIC INFECTIONS THAT MAY UNDERLY THEIR CONDITION OR EVEN BE A CAUSE OF IT. AFTER TESTING FOR CHRONIC INFECTIONS, MANY AS PATIENTS SLOWLY RECOVER ON THE APPROPRIATE ANTIBIOTICS AND IMMUNE AND NUTRITIONAL SUPPORT. SEE OUR WEBSITE FOR FURTHER DETAILS ABOUT TESTING AND TREATMENT.

PROF. GARTH NICOLSON

QUESTION:

I have a 67 year-old patient with ALS (spinal progressive muscular type), who I placed on artificial ventilation at home with good physical condition. First cardinal sign of this patient was chronic respiratory failure due to weakening of respiratory muscle, a relatively rare symptom as the onset of ALS. I am interested in your theory and your trial of treatment with macrolides. I would like to know if this patient is also infected with mycoplasma and/or enterovirus and if so, I would like to treat him with macrolides. Please let me know if I can send the blood sample to your laboratory and let it be analyzed. Although I am pulmonologist, my colleague, a neurologist, also has some patients with ALS and is interested in your therapy.

RESPONSE:

IN COLLABORATION WITH DRS. DARRYL SEE AND FERRE AKBARPOUR OF THE IMMUNE INSTITUTE, WE HAVE FOUND THAT >85% OF ALS PATIENTS HAVE AT LEAST TWO CHRONIC INFECTIONS, A SYSTEMIC MYCOPLASMAL INFECTION, AND A CNS INFECTION OF ECHO-7 RELATED ENTEROVIRUS. THESE TWO INFECTIONS MAY SYNGERIZE IN SOME WAY IMPORTANT IN THE PATHOGENESIS OF ALS. TREATMENT USING THE APPROPRIATE I.V. ANTIBIOTICS AND I.V. ANTIVIRALS, PLUS IMMUNE ENHANCEMENT AND NUTRITIONAL AND NEURONAL SUPPORT, HAS RESULTED IN ARRESTING OR SLOWING OF ALS PROGRESSION, AND IN SOME PATIENTS A PARTIAL REVERSAL OF ALS SIGNS AND SYMPTOMS. THIS PROTOCOL IS AN IRB-APPROVED EXPERIMENTAL TREATMENT PROTOCOL BASED ON DIAGNOSIS OF CHRONIC INFECTIONS IN ALS PATIENTS. FURTHER INFORMATION CAN BE OBTAINED BY CONTACTING ME OR DR. DARRYL SEE DIRECTLY.

PROF. NICOLSON

QUESTION:

I have neurological symptoms, and I tested positive for Mycoplasma and Chlamydia infections. What is the difference between the various antibiotics, and which one (or ones) do I use?

RESPONSE:

THE VARIOUS ANTIBIOTICS THAT WE RECOMMEND FOR CHRONIC BACTERIAL INFECTIONS HAVE DIFFERENT MECHNANISMS OF ACTION, DIFFERENT EFFECTS ON DIFFERENT BACTERIA AND DIFFERENT ABILITIES TO PENETRATE INTO TISSUES. IN THE CASE OF THE DUAL INFECTION THAT YOU HAVE, I WOULD SUGGEST TO YOUR PHYSICIAN THAT GOOD TISSUE PENETRATION IS IMPORTANT FOR THESE BACTERIA, SINCE THEY HIDE INSIDE CELLS. ALSO, YOU WILL NEED ONE (OR MORE) ANTIBIOTICS THAT CAN SUPPRESS THESE PARTICULAR BACTERIA. ONE SUGGESTION IS DOXYCYCLINE, WHICH HAS GOOD ACTIVITY AGAINST THESE MICROORGANISMS AND GOOD TISSUE PENETRATION. THIS CAN BE FOLLOWED BY OTHER ANTIBIOTICS OR COMBINATIONS OF ANTIBIOITCS, IMMUNE ENHANCEMENT, NUTRITIONAL SUPPORT, ETC.

QUESTION:

I have been diagnosed with Fibromyalgia Syndrome, Chronic Fatigue Syndrome, Meniers Disease, depression, anxiety and other problems. I am not getting much support from the VA. Even though I am 50 years old, they say that I look too young to be ill.

RESPONSE:

ONE OF THE MOST OFTEN STATED GENERALIZATIONS ABOUT FMS, CFS AND OTHER CHRONIC FATIGUING ILLNESSES IS THAT PATIENTS DO NOT LOOK AS SICK AS THEY FEEL, AND THEY OFTEN DON’T APPEAR AS SICK LOOKING AS OTHER PATIENTS. THIS HAS RESULTED IN RANK DESCRIMINATION AND MISDIAGNOSES AMONG CHRONIC ILLNESS PATIENTS WHO HAVE REAL MEDICAL-ORGANIC PROBLEMS NOT PSYCHIATRIC ILLNESSES. WE HAVE PIONEERED THE DEVELOPMENT OF MOLECULAR TESTS FOR CHRONIC INFECTIONS IN THESE ILLNESSES, RESULTING IN THERAPIES THAT CAN HELP PATIENTS EVENTUALLY RECOVER THEIR HEALTH. FURTHER INFORMATION CAN BE FOUND ON OUR WEBSITE, WWW.IMMED.ORG.

Prof. Garth Nicolson

QUESTION:

Dear Prof. Nicolson, There may be several parallel paths by which mycoplasmas contribute to ALS. Here is one possibility. It's a bit lengthy so I will write an abstract. There is a link between mycoplasmas and a known aspect of ALS pathology. Mycoplasmas need and use cholesterol. But oligodendrocytes require cholesterol to synthesize neurosteroids. Neurosteroids have neuroprotective properties such as reducing neuronal responsiveness to glutamate. If the mycoplasma population is large enough, they may use so much cholesterol that they drive down neurosteroid synthesis. Low levels of neurosteroids may lead to CNS disfunction and damage.

RESPONSE:

I WAS AWARE OF THE STEROID-STEALING PROPERTIES OF MYCOPLASMAS. THIS MAY BE HOW THEY ALSO MAKE MITOCHONDRIA LEAKY--BY STEALING THE LIPIDS SUCH AS CHOLESTEROL THAT ARE IMPORTANT IN MITOCHONDRIAL MEMBRANE INTEGRATY. WHEN

MITOCHONDRIA ARE LEAKY, THEY CAN'T GENERATE THE ENERGY NECESSARY FOR CELL

FUNCTION, AND NERVES ARE THE MOST SENSTIVE CELL TYPE TO ENERGY DEPRAVATION.

I LIKE THE NEUROSTEROID-GLUTAMATE IDEA. OF COURSE, MYCOPLASMAS ALSO DO MANY OTHER BAD THINGS TO CELLS, AND IN THE CASE OF ALS ONE OF THOSE MAY BE INHIBITION OF NEUROSTEROID PRODUCTION OR LOSS OF NEUROSTEROIDS.

PROF. NICOLSON

QUESTION:

My physician placed me on 1,000 mg/day Ciprofloxacin to treat my mycoplasma infection. Is this high enough dose? I was on a higher dose, but my symptoms became worse.

RESPONSE:

IT MAY NOT BE A HIGH ENOUGH DOSE. OUR USUAL RECOMMENDATION IS 1,500 MG/DAY CIPRO. THE RATIONALE FOR THIS IS THAT AT THIS DOSE MORE DRUG WILL PENETRATE INTO TISSUES AND CELLS, AND THIS IS WHERE IT IS NEEDED. THE REASON THAT YOUR SIGNS AND SYMPTOMS MAY HAVE BECOME GRADUALLY WORSE COULD HAVE BEEN DUE TO HERXHEIMER REACTIONS OR DIE-OFF REACTIONS THAT CAUSE WORSING OF SIGNS AND SYMPTOMS FOR DAYS TO WEEKS. THIS USUALLY RESOLVES GRADUALLY WITH FURTHER TREATMENT. IF IT DOESN’T, THEN YOUR PHYSICIAN SHOULD PROBABLY CONSIDER ANOTHER ANTIBIOTIC. IF YOU HAD AN IMMEDIATE ACUTE ADVERSE REACTION, THEN THIS ANTIBIOTIC IS PROBABLY NOT FOR YOU. CONSULT WITH YOUR PHYSICAN.

QUESTION:

How do we know if a patient is recovered enough on antibiotic therapy? Is it purely subjective or should we have her blood tested after her year of antibiotic therapy. If a patient’s blood is negative for the mycoplasma, does that indicate that the mycoplasma has been completely eliminated?

RESPONSE:

WE USUALLY CONSIDER THAT A NEGATIVE BLOOD TEST INDICATES THAT THE BLOOD

LEVELS ARE TOO LOW TO BE DETECTED BY THE PCR PROCEDURE WHICH, BY THE WAY, IS VERY, VERY SENSITIVE. WHEN PATIENTS ARE ON ANTIBIOTICS, THEY GENERALLY TEST NEGATIVE

INDICATING THAT THE BLOOD LEVELS HAVE BEEN SUPPRESSED BY THE ANTIBIOTIC

TREATMENT TO VERY LOW OR UNDECTIBLE LEVELS. AT THIS TIME WE CONSIDER PATIENTS ESSENTUALLY NONINFECTIVE, SINCE BLOOD LEVELS OF MICROORGANISM ARE RELATED TO THE LEVELS EXPELLED BY THE LUNGS. IN SUPPORT OF THIS NOTION, WE HAVE NEVER HEARD OF PATIENTS ON ANTIBIOTIC THERAPY SPREADING THE INFECTION. THUS IT IS PROBABLY UNLIKELY THAT PATIENTS ON ANTIBIOTICS ARE SPREADING THEIR INFECTION. THE APPROPRIATE TIME OF TREATMENT CAN ONLY BE ESTIMATED BY YOUR PHYSICIAN BASED ON YOUR SIGNS AND SYMPTOMS WHEN YOU GO OFF THE ANTIBIOTIC. PATIENTS THAT REQUIRE ADDITIONAL TREATMENT GENERALLY RELAPSE WITHIN A FEW WEEKS AFTER DISCONTINUING THERAPY.

QUESTION:

Dr. Nicolson:

Your research on Gulf War Illness helped my husband immensely two years ago. He has had a relapse of very mild symptoms--mostly headache, back pain, and sleeplessness. I am writing to inquire if you have additional information I can pull off your site or elsewhere.

RESPONSE:

Your husband may have a residual infection of the same or different type, or his signs and symptoms could be due to other residual problems (chemical, environmental). If he responds to the same or similar antibiotics and continues recovering, then his problem was likely a mild relapse. However, he may additional problems that need to be properly diagnosed and treated.

QUESTION:

Is there a connection between Crohn’s Disease and other bowel diseases and mycoplasma infections?

RESPONSE:

We have found that patients with Chronic inflammatory Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis, Chronic Esophagitis and other diseases often have Mycoplasma, Helicobacter (H. pylori) and other chronic infections. Many physicians successfully treat such patients with antibiotics, strongly suggesting that their illness or at least their morbidity was due to the infection(s).

QUESTION:

We have a child diagnosed with Reiter's syndrome who has recurrent attacks. He also has had sporadic episodes of diarrhea prior to increased urinary symptoms. Blood and urine cultures are negative. Would Chlamydia and Mycoplasma tests be beneficial in this case, and if so what is the collection and transfer procedure and more importantly what treatment is offered?

RESPONSE:

We have found that RS patients often have chronic infections that could be the cause of their illness, a cofactor in their illness or opportunistic infections that cause patient morbidity (sickness). More information can be found on our website. For testing your physician can call Client Services at International Molecular Diagnostics (714-799-7177, ext. 202), and obtain a test kit. Treatment recommendations for your physician are on our website under Treatment Considerations.

QUESTION:

How does my physician get the testing kits that are used to ship the blood for testing?

RESPONSE:

Call Client Services at International Molecular Diagnostics (714-799-7177, ext. 202), and they will be pleased to send your or your physician a blood test kit containing a small Styrofoam

Box, vacuum tubes for blood and a chemical ice pack to keep them cold during overnight shipment. Note that foreign shipments require shipment of frozen samples with dry-ice. The reason for this is that foreign samples take longer to reach the lab.

QUESTION:

I have heard that rheumatoid arthritis may be caused by an infection, and it can be treated with antibiotics?

RESPONSE:

Rheumatoid Arthritis, Reiter’s Syndrome, Rheumatoid Spondylitis, and other rheumatic diseases show strong associations with chronic infections. In about one-half of these diseases mycoplasmal and other infections have been found, and these patients do quite well on long-term antibiotics. In fact, a large placebo-controlled clinical trial conducted by the NIH showed the benefits of the antibiotic minocycline in the treatment of certain rheumatic diseases, such as RA. For more information go to the section on Autoimmune Illnesses on this website. Additional information can be found from the Road Back Foundation (www.roadback.org).

Prof. Nicolson

QUESTION:

Dear Dr. Nicolson:

I have reviewed a few of the articles re: treatment of M. fermantens, and would like to start treating one of my patients. I would appreciate any suggestions you have for number of cycles, time between cycles and whether it is useful to use another antibiotic (i.e. Augmentin) between cycles. Thank you for your time and interest in CFIDS!

RESPONSE:

We generally recommend treatment for at least 6 months without a break using doxycycline (200 mg/day) or one or more of the other antibiotics (consult Treatment Considerations on our website). After the 6 months treatment we usually recommed cycling--6 weeks on, 2 weeks off. If necessary, the Augmentin is used in between the on-cycles to suppress secondary bacterial infections. If the patient plateaus during the treatment, then we recommend switching to another antibiotic. The other recommendations are also important, such as diet, nutritional supplements, immune enhancement products, etc. Many patients have yeast infections during the treatment that must be treated.

Prof. Nicolson

QUESTION:

I have been diagnosed with Mycoplasma, and I am currently in the VA Clinical Trial with doxcycline vs. placebo. I believe my fianc‚e' and child may now have the same infection, (my fianc‚e' has been diagnosed with Chronic Fatigue Syndrome). My fianc‚e' explained to her physician the situation regarding me testing postive for mycoplasma....he had absolutely no idea what to do or how to test for it. I would sincerely appreciate any information that you can provide for me to educate this physician.

RESPONSE:

Information on Mycoplasma and other chronic airborne infections that are involved in Gulf War Illnesses and Chronic Fatigue Syndrome and how to be tested for these infections can be found on our website, www.immed.org, and that of our certified reference diagnostic laboratory, International Molecular Diagnostics, Inc., www.imd-lab.com. A U.S. Senate study found that 77% of spouses and 65% of children born after the war now have illnesses similar to Gulf War Illness. Our findings indicate that when this occurs, the spouses and children usually have the same chronic infections as the sick veteran, and they should be treated using a similar treatment program to those we have published for Mycoplasma-positive Gulf War Illness.

QUESTION:

I happened upon your web site and found it quite enlightening. I have a question about the article on Mycoplasmal Infections in Chronic Illnesses. I have RA and have had it since 1984. if my RA is due to this type of infection, how would the treatment effect me.

RESPONSE:

We have published in the British peer-reviewed medical journal Rheumatology that a very high percentage of Rheumatoid Arthritis patients have mycoplasmal infections. This was also seen earlier by Dr. Harold and others. Such infections can be treated with long-term minocycline or other antibiotics, immune enhancement, nutritional supplements and other support (see Treatment Considerations on this website and also Road Back Foundation (www.roadback.org).

Prof. Nicolson

QUESTION:

Dear Dr. Nicolson:

Is part of the reason that we are in such trouble with mycoplasma because they have the ability to adapt to antibiotics by incorporating the antibiotic into the DNA structure?

Thanks for your reply.

RESPONSE:

Mycoplasmas are just very slow-growing, especially the intracellular pathogenic variety, and not as metabolically active as the fast-growing bacteria and are thus less susceptible to antibiotics and antimetabolites of any kind. However, if these infections are inappropriately treated (too brief treatment or too low concentration of antibiotic), then resistant strains could arise.

QUESTION:

I am especially interested in those with Ankylosing Spondylitis who have used the antibiotic drugs over a long period of time. I know antibiotics will help me greatly as I have experimented with them for one thirty-day course. My most pressing question is simply how long will they work before the bugs mutate into resistant strains? Also, what strategies can be used to minimize the chances of this happening. I feel that I only have one chance at undertaking this therapy, and I don't want to screw it up by not completing detailed research from multiple sources. Any answers, information, or contacts would be greatly appreciated!

RESPONSE:

To my knowledge the recovery of patients with chronic infections on antibiotics was gradual and sometimes cyclic, similar to what we have seen with other rheumatic illness patients. I don't think that resistant strains will emerge while on antibiotics, unless the dose is too low or the treatment not long enough. The problem is that many physicians stop and then restart antibiotics for no apparent reason, or they use too low dosages to be effective. These conditions can select for resistant substrains