Mycoplasma and Chronic Fatigue Syndrome/ dental work

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Mycoplasma and Chronic Fatigue Syndrome

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Question

In a very high percentage of my patients with chronic fatigue syndrome (CFS), I

have noted a history of significant dental work (more than routine cleaning)

during the 3 to 6 months before symptoms began. Because CFS may have a

potentially infectious origin (or at least an infectious agent stimulating a

neuroimmunologic disorder of the central nervous system), I was wondering if

Mycoplasma fermentans is a common resident of the mouth, from which it might be

disseminated by significant dental work?

Second, one of my patients with CFS had a sore throat that was so severe she

almost seemed to have stridor. Her C1-esterase inhibitor was drawn and was low

(8 mg/dL, with normal being 12-25 mg/dL). Repeat values were confirmatory. In a

substantial percentage of subsequent patients with CFS, C1-esterase inhibitor

levels were less than 12 mg/dL. Is there any potential relationship between a

low level of a complement component inhibitor and CFS?

Steve Arthur, MD

Response

from I. Fox, MD, 05/08/01

Mycoplasma are present in the oral cavity and have been associated with

accelerated periodontal disease in immunocompromised patients (eg, patients with

HIV). It is highly likely that Mycoplasma will enter the bloodstream after

dental procedures. However, the causal relationship of Mycoplasma and CFS

remains controversial. In one study, certain strains of Mycoplasma were found by

polymerase chain reaction (PCR) methods more frequently in CFS patients than in

controls.[1] However, CFS patients did not show an antibody response to the

Mycoplasma[2] and no organisms could be cultured. This suggests that Mycoplasma

(or their nucleic acids) could be " innoculated " at the time of dental

manipulation but that they are not immunogenic; the nucleic acids are

subsequently detected by the very sensitive methods of PCR. As with other

ubiquitous agents (eg, Epstein-Barr virus), the presence of the colonizing

pathogen does not prove a causal relationship to a clinical syndrome.

Nevertheless, the potential role of Mycoplasma in CFS and other neurologic

diseases remains unclear.[3,4]

The second question involves the potential finding of low complement levels or

inhibitors of C1 esterase. There is one published study (in German) that

reported low C1-esterase inhibitor levels, but this study used unusual detection

methods. Because so many CFS patients have been screened for both C4- and

C1-esterase inhibitor levels during the past 10 years, it seems unlikely that a

high proportion of your patients would be low. I suspect that the detection

assay in your laboratory is artifactually low.

References

1.. Choppa PC, Vojdani A, Tagle C, Andrin R, Magtoto L. Multiplex PCR for the

detection of Mycoplasma fermentans, M. hominis and M. penetrans in cell cultures

and blood samples of patients with chronic fatigue syndrome. Mol Cell Probes.

1998;12:301-308.

2.. Komaroff AL, Bell DS, Cheney PR, Lo SC. Absence of antibody to Mycoplasma

fermentans in patients with chronic fatigue syndrome. Clin Infect Dis.

1993;17:1074-1075.

3.. Greenlee JE, Rose JW. Controversies in neurological infectious diseases.

Semin Neurol. 2000;20:375-386.

4.. Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain

syndrome. Curr Opin Rheumatol. 2000;12:113-123.