- While it is still not known what causes CFS, FMS, and
MCS, we are hearing of reports that a very high number (75-80%) test
positive
for a pathogenic form of the organism called Mycoplasma. While there are
several species of this organism, most of us have been found to have active
infections in our bodies of the Mycoplasma fermentans (incognitus),
Mycoplasma
penetrans, and Mycoplasma pneumoniae types. These organisms are a
pathogenic
form of Mycoplasma which are very slow-growing, invasive into deeper parts
of the body (i.e., brain, central and peripheral nervous system, muscles
and joints, bone marrow, gastrointestinal system, lungs and heart, and
the immune system, itself), and are very difficult to treat. These are
the same organisms that have been found in AIDS patients and Gulf War
Syndrome
patients.
-
- Those who test positive for active infection with a
Mycoplasma
are realizing a tremendous improvement &/or recovery in their health
with appropriate antibiotic treatment. This treatment is long term (1-2
years of continuous antibiotics). The initial segment of the treatment
can be difficult and the continuous antibiotic dose is very harsh on the
body. Many people with CFIDS are concerned (and some are even frightened)
to take antibiotics for prolonged periods of time. However, years of
medical
experience in the use of antibiotics to treat chronic infectious conditions
such as rheumatic fever, acne, recurrent ear infections, Chronic
Obstructive
Pulmonary Disease, bronchiectasis, and others, have not revealed any
consistent
dire consequences as a result of such medications. Indeed, the very real
consequences of untreated, chronic persistent infection with Mycoplasma
can be far worse than the potential consequences of this treatment. If
you begin treatment, it is recommended that you be monitored closely by
a knowledgeable physician. If your physician is not familiar with long-term
antibiotic therapy, or if he/she is unsure of the pathophysiology of the
Mycoplasmas, they are invited to call Dr.'s Garth or Nancy Nicolson (see
Resource List).
-
- Since this form of treatment is so new for CFS, FMS and
MCS, we are all involved in research of a sort. Because of that, we need
to keep in touch and share triumphs and problems encountered. And, as we
get well, we need to spread the word and help others. If you test positive
for the organism, please send the enclosed form to the Mycoplasma Registry
(see Resource List). The Mycoplasma Registry is a non-profit organization
set up to track those who test positive. They have over 800 in the registry
thus far, and have compiled some excellent statistics. Approximately 85%
of those in the registry listing come from the CFS, FMS and MCS community!
Of course, all listings are confidential. Also, feel free to copy and share
any of the papers in this Mycoplasma Packet with others.
-
- We are all-different, and will undoubtedly respond
differently
to the treatment. As with any treatment suggestions given, the information
in this packet is intended to help you make informed decisions about your
care. It is not intended to take the place of medical advice. Please work
closely with your physician to tailor any treatment to your individual
needs and differences.
-
- Enclosed in this packet are the following:
-
- 1. Mycoplasma: A Simple Overview, written
by Sharon
Briggs
- 2. Antibiotics Recommended When Indicated
for Treatment
of Gulf War Illness/CFIDS, written by Garth Nicolson,
Ph.D.
- 3. Additional Considerations When
Undergoing Treatment
For GWI/CFS/FMS, written by Garth Nicholson, Ph.
D.
- 4. Mycoplasma Treatment Suggestions,
written by
Sharon Briggs
- 5. An Overview of My Symptoms and Recovery
from CFIDS
With Antibiotics, written by Sharon Briggs
- 6. Mycoplasma Resource List
- 7. Mycoplasma Registry Form
- 8. Institute for Molecular Medicine, Blood
Test Order
and Information Form
-
- Any donations to offset the cost and postage of this
packet would be greatly appreciated.
-
- Sharon Briggs Support Group Leader
-
- MYCOPLASMA: A SIMPLE
OVERVIEW
-
- For years we in the CFS/FMS/MCS community have been
watching
the reports of Gulf War Illness (GWI) knowing, instinctively, that we all
had something in common. Not only do we all have common symptoms, but we
may also be infected with common pathogenic organisms. That pathogen is
a Mycoplasma. Various pathogenic strains have been identified including
the fermentans (incognitus), penetrans, genitalium, hominis, and
pneumoniae.
And, we may be infected with several of these strains at one time.
Following
is a simple overview of the information I have gathered about this
Mycoplasma
pathogen and how it affects us.
-
- How Was Mycoplasma Infection Identified
In GWS and CFIDS Patients?
-
- The information trail started with Garth and Nancy
Nicolson.
Their daughter returned from the Gulf War with an unexplained illness.
She was unable to continue her studies at college, and moved back home.
Soon after, her parents both became ill with the same symptoms. Medical
tests revealed nothing abnormal, but they all continued to worsen.
Fortunately
for them, however, the Nicolson's were molecular pathologists with an
entire
research laboratory at their disposal. The Nicolson's drew blood and tissue
samples >from themselves and their daughter, and set the research team,
to work.
-
- Garth Nicolson Ph.D. is a professor and former chairman
of the Department of Tumor Biology at the University of Texas, M.D.
Anderson
Cancer Center, Houston, TX. He is also a professor of Internal Medicine,
Pathology and Laboratory Medicine at the University of Texas Medical
School.
He has published over 500 scientific and medical papers, has edited 13
books, he is the current editor of two scientific and medical journals.
Dr. Nicolson has been nominated for the Nobel Prize in cell microbiology,
is among the 100 most cited researchers in the world, and sits on the board
of the American Association of Cancer Research. Nancy Nicolson, Ph.D. was
president of the Rhodon Foundation for Biomedical Research. She, also,
has published numerous scientific papers and was a professor in the
Department
of Immunology and Microbiology at Baylor College of Medicine.
-
- What they found was a living Mycoplasma pathogen. In
order to find this organism, they had to break open the leukocytes (white
blood cells), and perform a specific test called a Polymerase Chain
Reaction
(PCR) of the DNA of the organism. Nancy also perfected another test, called
Gene Tracking, which confirms the PCR results. To gather more information,
they then started testing other GWI patients. What they found was that
approximately 50% were positive for the live organism. The Nicolson's then
researched treatment options and found a number of antibiotics that were
effective against the organism. (2) After a lengthy course of antibiotics,
they recovered. But, the word was out, and requests for testing of GWI
patients kept coming in to the lab. They were inundated! As their evidence
mounted, they published their data (3) (4) (5) and testified before the
President's Panel on Gulf War Illnesses. (6) Then the connection was made
by the government of the similarities between GWI and CFIDS. (7) By this
time, the Nicolson's lab was already running tests of those with
CFIDS---with
the same results-- approximately 50% positive! Garth and Nancy Nicolson
even wrote an article for the CFIDS Chronicle outlining the diagnosis and
treatment of GWI/CFIDS. (8)
-
- But, the politics of medicine and research have slowed
the gears of progress! Garth and Nancy had to relocate their non-profit
lab (The Institute for Molecular Medicine), first to Irvine, CA, then to
Huntington Beach, CA. They have had difficulty finding funding for the
Mycoplasma research. For their research to continue with CFIDS testing,
they need a new grant. In the meantime, they have formed a non-profit
organization
and take tax deductible donations, and they are making plans to take
third-party
billing in order to bill insurance for part of the cost of the tests.
Presently,
one can become a "Friend of the Institute" and have the various
tests done at The Institute for Molecular Biology lab, as well as,
participate
in the research (see Resource List for full instructions).
-
- Those of us who have tested positive and have begun
treatment
with the antibiotics recommended by the Nicolson's have had tremendous
success. Some of these people have been ill with CFS/FMS/MCS for 15-20
years. But, they are feeling better for the first time since becoming ill!
Some have even returned to work. Many have completed several months of
antibiotics, and several have been taking them continuously for 1-12 to
2 years. Since most of us in the CFS/FMS/MCS community have been ill with
this organism for a lot longer than the GWI patients do, it may take longer
to successfully treat the infection.
-
- What Is Mycoplasma?
-
- Mycoplasmas are the smallest and simplest organism known.
They are not new. They were discovered over 100 years ago and evolved from
bacteria. The "garden variety" mycoplasma is not usually
associated
with severe diseases. (13) However, sometime over the past 30 years, the
organism has been altered to become more lethal. The Mycoplasmas found
by the Nicolson's, in their lab, contain unusual gene sequences that were
probably inserted into the Mycoplasma by a specific laboratory procedure.
This discovery has led them to conclude that the new forms of mycoplasma
were specifically engineered for germ warfare. (9) In it's laboratory
evolution,
the Mycoplasmas have became more invasive, more difficult to find, and
capable of causing severe diseases in humans. Diseases, like Gulf War
Illness,
CFS, FMS, MCS, Rheumatoid Arthritis, and AIDS, for instance.
-
- The earlier form of Mycoplasma was studied by Dr. Shyh
Lo, formerly of Tanox Biosystems, a spin-off biotechnology company from
the Baylor College of Medicine, but now affiliated with the Armed Forces
Institute of Pathology in Washington D.C. Dr. Lo has been credited with
discovering the new pathogenic form of Mycoplasmas, and he currently holds
several patents on methods for special handling of the organisms for study
and development. (10) In one of his patents (in 1991), Dr. Lo lists the
following diseases that are caused by Mycoplasma: HIV infection, AIDS,
Aids Related Complex (ARC), Chronic Fatigue Syndrome, Wegener's Disease,
Sarcoidosis, Respiratory Distress Syndrome, Kibuchi's Disease, Alzheimer's
Disease, and Lupus. (10) In addition, Baseman and Tully have reviewed the
literature on the role of Mycoplasmal infections in human disease and have
concluded that they are important factors or co-factors in a variety of
chronic illnesses. (11)
-
- Unlike bacteria, the Mycoplasma has no cell wall. This
enables it to invade tissue cells, incorporating the cell's nutrients,
and using the cell to replicate itself (much like a retrovirus). (13) When
the Mycoplasma breaks out of the cell, it takes a piece of the host cell
membrane with it. When the immune system attacks the Mycoplasma, it also
gets "turned on" to attacking the host cell. In this way, an
autoimmune condition can begin. Autoimmune conditions associated with
Mycoplasmas
include arthritis, fibromyalgia, myositis, thyroid dysfunction (Hashimoto's
or Grave's Diseases), and adrenal dysfunction, signs and symptoms of Lupus,
Multiple Sclerosis, Lou Gehrig's Disease. (12)
-
- The Mycoplasma organism has the capacity to invade cells,
tissues and blood, producing systemic infections in numerous organ systems.
According to Dr. Nicholson, it can penetrate the central and peripheral
nervous system. Because it has the ability to damage the immune system
by invading the natural killer cells (NK cells) of the lymphocytes, it
weakens them, reduces their numbers, and renders them susceptible to viral
infections, such as Human Herpes Virus 6 (HHV6). (14) (15) (16) It may
also explain some of the environmentally sensitive responses that are seen
with CFIDS and MCS.
-
- Mycoplasma infection can trigger inflammatory cytokine
over-production that is commonly seen in CFS/FMS. With the induction of
CD-4+ helper cells of the immune system, an over production of cytokines
such as Interleukin-1, Interleukin-6 and Tumor Necrosis Factor-alpha
occurs.
(15)(16)(17) These elevated cytokines have been implicated in the
development
of many of the CFS/FMS symptoms, including neurological involvement.
(19)(20)
They can have specific or nonspecific stimulatory or suppressive effects
on lymphocytes, as measured by B and T cell activation. (18) In addition,
the Mycoplasma infection has immunomodulating effects, activating the
hypothalmic-pituitary-adrenal
axis. This can cause a cascade of limbic system symptoms characteristic
of CFS/FMS. (19)
-
- The Mycoplasma is a slow-growing, stealth-type organism
that can cause the patient to be very ill. It activates the immune system,
then can successfully hide from it within the host immune cells. It can
then circulate throughout the body and go wherever a white blood cell can
go. It can cause infection deep within any or all organs. It can even cross
the blood/brain barrier and cause brain and spinal infection. It has also
been known to cross the placental barrier to an unborn fetus. Unless the
white blood cell is split open and examined for the evidence of the live
organism, it can go undetected for years. Because the organism resides
deep within the cells, conventional antibody tests may be relatively
useless.
(21) The splitting open (fraction) of leukocytes (white blood cells) from
a fresh blood sample, with a forensic PCR test is the most accurate way
to detect the presence of active infection with a live pathogen. Further
gene-tracking techniques perfected by the Nicolson's are even more
accurate.
(22)
-
- Contagion
-
- Although the researchers have not clearly established
how contagious the Mycoplasmas are, they have made some inferences from
the data they have collected. The Mycoplasma organism has been found in
the blood and body fluids, spinal fluid, bone marrow, urine, and in the
lungs, nose and mouth. The Mycoplasma is reported to be able to survive
for two hours outside the body. Of those with Gulf War Illness, 50% of
their spouses have contracted the disease and 100% of their children.
Several
babies have also been known to be born with the disease. Some sort of
chemical
exposure or immune distress (i.e., auto accident, surgery, cancer) appears
to pre-date the onset of illness. Of those with CFS, FMS, and MCS, numerous
friends and spouses have the illness, as well as close relatives. So, from
the anecdotal reports, it would appear that Mycoplasma is contagious after
both casual and intimate contact. This means that the organism may possibly
be passed to another through sputum (coughing droplets that contain the
organism), saliva, sexual secretions, blood, and urine. The disease is
also developing in family pets.
-
- If one test positive for any of the Mycoplasmas, in order
to safeguard those with whom you have close contact, it would be prudent
to do the following: Wash your hands a lot, never share your food or drink
with another, wash eating utensils with extremely hot water, keep your
hands away from your face, avoid closed-air spaces where air is
re-circulated
(i.e., offices, airplanes), and use protective sexual practices.
-
- Treatment
-
- If detected early, the diseases associated with invasive
mycoplasmal infections are treatable with long cycles of high-dose
antibiotics.
(23)(24)(25) Since the organism is a slow-growing, intracellular type with
a long life cycle, several, long term courses of antibiotics may be
necessary.
The infection may need to be treated for several months or years. (The
disease is treated much as Lyme's Disease is treated.) If a person is
taking
antibiotics, the testing will not detect the presence of Mycoplasma in
the blood. And, if a person has been taking antibiotics, they must wait
for 2-3 months after stopping the antibiotics for the test to be
accurate.
-
- As yet, we do not know if antibiotics are a cure for
Mycoplasma infections. Mycoplasma fermentans (incognitus) has the ability
to enter any cell and alter itself, changing its cellular makeup with every
cell division. This may make it impossible for readily available
antibiotics
to clear the body of this organism. (14)
-
- What we are hoping for is to cause the organism to be
diminished or go dormant until a cure is discovered. To do that, we need
to kill as much of the live organisms from our bodies as possible with
the antibiotics. Once our white blood cells are free of the infection,
then they can become healthier and can, hopefully, do a better job to keep
the Mycoplasma under control. This may take several months/years of
antibiotic
treatment to accomplish. During this time, it is important to not lower
the dose or stop taking the antibiotic too early, for a relapse is
certain.
-
- Is Treating Mycoplasma Infection
The Answer To Curing CFIDS?
-
- The precise nature and cause of CFS/FMS/MCS is not clear
at this time. However, recent studies have shown that several
microorganisms
may be a factor in CFIDS. Clinical PCR testing has been positive for all
of the human herpes viruses, particularly Epstein-Barr Virus (EBV) and
Human Herpes Virus-6, Types A and B (HHV-6). Most recently, organisms like
Human T-lymphotropic virus (HTLV) types I and II, the foamy or Spuma virus,
and the Chlamydia pneumoniae bacteria have also been demonstrated.
(26)
-
- Perhaps with this evidence, it would appear that CFIDS
has many causative organisms? That is a possibility. Researchers studying
AIDS have found that Mycoplasma and HHV-6a may be co-factors for causing
AIDS. (14) And, it is further speculated that this same HHV-6 virus may
be a co-factor in CFIDS and Multiple Sclerosis. Dr.'s Konnie Knox and
Donald
Carrigan from the Greenfield, Wisconsin Laboratory (see Resource List),
offer some of the most sophisticated human herpes assays in the world.
They have been doing extensive research into the various forms of human
herpes and their effects on the body. Present in about 98% of the
population,
HHV-6 remains dormant and harmless in healthy people. But, when activated
(possibly by the Mycoplasma infection), it can cause a highly dysregulated
immune system often resulting in severe immune suppression which increases
an individuals vulnerability to control severe infections (such as
Mycoplasma).
Perhaps, if HHV-6 were a co-factor of our disease (along with Mycoplasma),
it would appear to be best to be tested and treated for both concurrently,
if one is found to be positive.
-
- While the researchers sort out the chicken-or-the-egg,
one-organism-one disease, multi-factor theories, it seems prudent for us
to test for and consider treating the organisms that we can. Especially
when, in the case of Mycoplasma, a few simple antibiotics can bring us
so much relief! In the case of a positive test for HHV-6, the antiviral
Zovirax may be helpful, and the FDA will soon release a new drug, called
Labucavir that may be effective against the Human Herpes Virus family,
specifically. However, it is still in the testing phase and is not yet
available.
-
- Conclusion
-
- Infection with a Mycoplasma organism appears to cause
most of the signs and symptoms of CFS/FMS/MCS. It can also account for
most of the dysregulation of the immune system and the abnormal immune
tests. It seems prudent to be tested for this organism, and if positive,
to be treated with the recommended antibiotics. Many of us have been ill
for 10-20 years and have spent thousands of dollars on treatments that
did nothing. Wouldn't it be a Godsend to have a treatment that
worked?
-
- The treatment course is long term and often difficult
for many. And, while we may not become completely well, there is
preliminary
evidence that many of us who are taking the antibiotics are improving!
It has certainly been a horrible disease for the Gulf War Vets to contract,
but for us, the fact that they did has saved many lives in the CFS/FMS/MCS
community!
-
- References
-
- 1. Nicolson, N.L. and Nicolson, G.L., The
Isolation,
Purification and Analysis of Specific Gene-containing
Nucleoproteins and Nucleoprotein Complexes, Methods of
Molecular Genetics, 5:281-298 (1994)
-
- 2. Nicolson, Garth L., Antibiotics Recommended
When Indicated
for Treatment of Gulf War Illness/CFIDS, (1996)
-
- 3. Nicolson, G.L., and Nicolson, N.L., Chronic
Illness
of Operation Desert Storm: The Presence of Stealth
Microorganisms
in Gulf War Veteran's Blood Suggests that Biological
Warfare May Have Been Used In Desert Storm, Extraordinary
Science, (1995)
-
- 4. Nicolson, G.L., Hyman, E., Korenyi-Both,
A., Lopez,
D.A., Nicolson, N.L., Rea, W., and Urnovitz, H., Progress
on Persian Gulf War Illness-Reality and Hypotheses,
International
Journal of Occupational Medicine and Toxicology, Vol.
4, No.3, pp. 365-370, (1995)
-
- 5. Nicolson, G.L., and Nicolson, N.L.,
Diagnosis and
Treatment of Mycoplasmal Infections in Persian Gulf War
Illness-CFIDS Patients, International Journal of
Occupational
Medical Immunology and Toxicology, 5: 69-78 and 83-86,
(1996)
-
- 6. Nicolson, Garth L & Nicolson, Nancy L.,
Mycoplasma
Infections In Gulf War Illness: Results of a Preliminary
Study on the Prevalence of Mycoplasmal Infections in
Desert Storm Veterans with Chronic Fatigue and other
Symptoms, Presented to the President's Panel on Gulf
War Syndrome, Washington, DC, August 14-16, (1995)
-
- 7. Schmidt, P., Blanck, R.M., Gulf War
Syndrome and CFS,
The CFIDS Chronicle, 8:25-27 (1995)
-
- 8. Nicolson, G.L. and Nicolson, N.L.,
Mycoplasma Infections-Diagnosis
and Treatment of Gulf War Illness/CFIDS, CFIDS Chronicle,
9 (3): 66-69, (1996)
-
- 9. Nicolson, Garth L., Ph.D. and Nicolson,
Nancy L..,
Ph.D., Summary Of Persian Gulf War Illness Pilot Study
On Mycoplasmal Infections In Veterans and Family Members,
1997
10. Lo, Shyh-Ching, Patent # 5215914: Adherent and Invasive
Mycoplasma,
Patent # 5534413: Adherent and Invasive
Mycoplasma,
Patent # 5242820: Pathogenic Mycoplasma,
Patent
#5532134: Mycoplasma Diagnostic Assay, IBM Patent
Server
Database
-
- 11. Baseman, J. and Tully, J, Mycoplasmas: Sophisticated,
Reemerging, and Burdened by their Notoriety,
Emerging Infectious Diseases, 1997;
3:21-32
-
- 12 Nicolson, Garth L. Chronic Infections In CFS,
FMS and Gulf War Illness, 1997
-
- 13. "Archives of Pathological Laboratory
Medicine",
May, (1993)
-
- 14. Montagnier, L., HIV, Cofactors and AIDS, Abstract
from the International Conference on AIDS,
June 6-11 (1993)
-
- 15. Rawadi, G., Roman-Roman, S, et.al., Effects of
Mycoplasma
fermentans on the Myelomonocytic Lineage:
Different Molecular Entities with
Cytokine-inducing
and Cytocidal Potential, Journal of
Immunology,
Jan. 15 (1996)
-
- 16. Gallily, R., Salman, M., Tarshis, M., Rottem, S.,
Mycoplasma fermentans (incognitus strain)
Induces TNF alpha and IL-1 Production by
Human Monocytes and Murine Macrophages,
Immunological
Letters, 34(1):27-30 Sept. (1992)
-
- 17. Brenner, T., Yamin, A., Abramsky, O., and Gallily,
R., Stimulation of Tumor Necrosis
Factor-alpha
Production by Mycoplasma and Inhibition by
Dexamethasone in Cultured Astrocytes, Brain
Research, 608(2):273-79 Apr. 16 (1993)
-
- 18. Haier, Joerg, M.D., Nasralla, Marwan, and Nicolson,
Garth L., Mycoplasmal Infections in Blood
from Patients with Chronic Fatigue Syndrome,
Fibromyalgia Syndrome or Gulf War Illness,
Abstract from the International CFS Congress, Sydney,
Australia,
1998
-
- 19. Brenner, T., Yamin, A., and Gallily, R., Mycoplasma
Triggering of Nitric Oxide Production by
Central Nervous System Glial Cells and its
Inhibition by Glucocorticoids, Brain Research,
641(1):51-56
Mar. 28 (1994)
-
- 20. Weidenfeld, J., Wohlman, A., and Gallily, R.,
Neuroreport
6(6):910-12 Apr. 19 (1995)
-
- 21. Komaroff, A. L., Bell D.S., Cheney, P.R., Lo, S.C.,
Absence of Antibody to Mycoplasma fermentans
in patients with Chronic Fatigue Syndrome,
Clinical Infectious Disease, 17(6):1074-75
Dec.
(1993)
-
- 22. Nicolson, G.L., and Nicolson, N.L., The Eight Myths
of Operation Desert Storm and Gulf War
Syndrome,
Medicine, Conflict & Survival
(1997)
-
- 23. Hannan, P.C., Antibiotic Susceptibility of Mycoplasma
fermentans Strains From Various Sources and
the Development of Resistance to
Aminoglycosides
in Vitro, Journal of Medical Microbiology,
Jun. 42(6):421-28 Jun (1995)
-
- 24. Poulin, S.A., Perkins, R.E., Kundsin, R.B.,
AIDS-Associated
Mycoplasmas and Antibiotic Susceptibilities,
Abstract of American Society of Microbiology
Meeting, (1993) (abstract no. G-21)
-
- 25. Poulin, S.A., Perkins, R.E., Kundsin, R.B.,
Antibiotic
Susceptibilities of AIDS-Associated
Mycoplasmas,
Journal of Clinical Microbiology, Apr.
32(4):1101-03
Apr (1994)
-
- 26. Vojdani, Ari, Immunology of Chronic Fatigue Syndrome,
pp.36-42 (1997)
Courtesy of Sharon Briggs
SHASTA CFIDS
&n
bsp; &nbs
p; __________________
-
- Antibiotics Recommended When Indicated for
Treatment of Gulf War Illness/CFIDS/FMS
-
- By Prof. Garth L. Nicolson
- The Institute for Molecular Medicine
- 15162 Triton Lane, Huntington Beach,
- California 92649-1041
- Tel: (714) 903-2900 Fax: (714) 379-2082
- e-mail: gnicimm@ix.netcom.com
-
- Doxycycline
(AKA Vibramycin, Monodox, Doxychel, Doxy-D, Doryx)
-
- Doxycycline is a broad spectrum tetracycline with good
lipid solubility and ability to penetrate the blood-brain-barrier. This
antibiotic acts by inhibiting microorganism protein synthesis, it is
readily
absorbed by the (normal) gut, and peak blood concentrations are maintained
between 2-18 hours (half-life 18-22 hours) after an oral dose of drug.
Food, calcium, magnesium and antacids reduce absorption, and alcohol,
phenytoin
[Dilantin] or barbiturates reduce blood half-life.
-
- For Gulf War Illness/Chronic Fatigue
Syndrome/Fibromyaligia
Syndrome (GWI/CFIDS/FMS) use, the recommended dose is 200-300 mg/day (oral,
2-3x100 mg capsules) for each 6 week cycle of therapy. Initially,
doxycycline
initially exacerbates symptoms (Herxheimer reactions or adverse antibiotic
responses, such as transient fever, skin, gut discomfort, etc.) but these
are usually gone within 2 weeks or so. Patients usually start feeling
better
with alleviation of most major signs and symptoms within 2-6 weeks, but
in some patients major symptoms are not alleviated until the second 6-week
course. Severe reactions or prior damage to the gastrointestinal system
may require I.V. administration of 100-150 mg/day (rapid I.V.
administration
is to be avoided) for 2-3 weeks, then the remainder of the 6 week course
should be on oral antibiotic (to avoid thrombophlebitis complications which
can occur with prolonged I.V. therapy). Some react to the starch filler
in the capsules and must use Doryx, a granular form of doxycycline.
-
- Virtually all patients relapse (show the same major signs
and symptoms) after the end of the first and second 6-week course of
therapy,
and these can be run together without a pause. In a pilot study, >85%
relapsed after 2 cycles, and after 5 and 6 cycles, 27% and 11%,
respectively,
still relapsed after discontinuing antibiotic therapy.
-
- In some cases doxycycline has been used successfully
with other antibiotics in situations where either antibiotic alone appeared
to have minimal effect (for example, doxycycline in combination with
Ciprofloxacin).
Doxycycline is primarily bacteriostatic and effective against the following
organisms: gram-negative bacteria (N. gonorrhoeae, Haemophilus influenzae,
Shigella species, Yersinia pestis, Brucella species, Vibrio cholera); gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes); myco
plasmas
(Mycoplasma pneumoniae, Mycoplasma fermentans [incognitis], Mycoplasma
penetrans); others (Bacillus anthracis [anthrax], Clostridium species,
Chlamydia species, Actinomyces species, Entamoeba species, Treponema
pallidum
[syphilis], Plasmodium falciparum [malaria] and Borelia species).
-
- Precautions: Avoid direct
sunlight and drink fluids liberally. Doxycycline therapy may result in
overgrowth of fungi or yeast and nonsensitive microorganisms (see Other
Considerations). Patients on anticoagulants may require lower anticoagulant
doses. Last half of pregnancy, infancy and children under 8 years are not
recommended, in the latter case due to tooth discoloration, but lower doses
of doxycycline have proven to be very effective in children under 8 with
GWI/CFIDS (if weight 100 lbs. or less, 1-2 mg/lb. divided into two doses;
if is weight over 100 lbs. use adult doses). Patients with impaired kidney
function should not take doxycycline, and the following drugs should not
be taken with doxycycline: methoxyflurane [Penthrane], carbamazepine
[Tegretol],
digoxin or diuretics.
-
- In case of complicating bacterial infections, a 2 week
course of Augmentin (3 X 500 mg/day) should be taken between courses of
doxycycline or other antibiotics. For fungal and yeast complications,
please
see the instructions under. Other Considerations at the end of this
handout.
-
- Adverse Reactions: In a few
patients doxycycline causes gastrointestinal irritation, anorexia,
vomiting,
nausea, diarrhea, rashes, mouth dryness, hoarseness and in rare cases
hypersensitivity
reactions, hemolytic anemia, skin hypersensitivity and reduced white blood
cell counts. In general, doxycycline is considered a safe drug, in that
there are few adverse reactions reported in the literature.
-
- Ciprofloxacin
- (AKA Cipro, Cifox, Cifran, Ciloxan,
Ciplox)
-
- Ciprofloxacin is a broad spectrum synthetic
fluoroquinolone
antibiotic with good absorption characteristics. This drug acts on
bacterial
DNA gyrase to inhibit bacterial DNA synthesis. Ciprofloxacin is secreted
rapidly in the urine and has a half-life in the blood of about 4 hours.
Food delays the absorption of antibiotic (by ~2 hours) but not the total
absorption; antacids containing magnesium, aluminum or other salts reduce
absorption and should not be taken at the same time of day.
-
- For GWI/CFIDS/FMS use, the recommended dose is 1500
mg/day
(for oral use, 3x500 mg capsules) for each 6 week cycle of therapy.
Ciprofloxacin
may or may not be taken with meals. Initially, Ciprofloxacin may exacerbate
some symptoms (Herxheimer reactions or adverse antibiotic responses) but
these are usually gone within a week or so, and some patients report that
doses of 1000 mg/day or lower are not effective in alleviating
GWI/CFIDS/FMS
symptoms. Patients usually start feeling better with alleviation of most
major signs and symptoms within 1-4 weeks, but in some patients major
symptoms
are not alleviated until the second 6-week course. Ciprofloxacin has been
used in patients in which doxycycline cannot be tolerated or in some
patients
that no longer respond to doxycycline. In a few cases Ciprofloxacin has
been used simultaneously with doxycycline, but the usual course is one
type of antibiotic alone.
-
- Herxheimer reaction, if present, usually passes within
a few days to 2 weeks or so; prior damage to the gastrointestinal system
may require I.V. administration of 400 mg/day (over one hour per each
infusion,
rapid I.V. administration is to be avoided) for 2-4 weeks, then the
remainder
of the 6-week course should be on oral antibiotic (oral doses). Virtually
all patients relapse (show the same major signs and symptoms) after the
end of the first or second 6-week course of therapy. Additional cycles
of antibiotic result in milder relapses after drug is discontinued.
Subsequent
cycles of antibiotics may require the use of doxycycline or other
antibiotics
instead of Ciprofloxacin.
-
- Ciprofloxacin is effective against the following
organisms:
gram-negative bacteria (Shigella species, Citrobacter diversus, Citrobacter
freundii, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae,
Enterobacter species, Proteus vulgaris, Psuedomonas aeruginosa, Yersinia
pestis, Vibrio cholera); gram-positive bacteria (Streptococcus pneumoniae,
Streptococcus pyogenes, Staphylococcus hominis, Staphylococcus
saprophytieus);
mycoplasmas, moderately active (Mycoplasma species); others (Clostridium
species, Chlamydia species, Mycobacterium tuberculosis).
-
- Precautions: Direct sunlight
is to be avoided, and patients should not take Ciprofloxacin and
theophyline
concurrently. Ciprofloxacin therapy may result in drug crystals in the
urine in rare cases, and patients should be well hydrated to prevent
concentration
of urine. Pregnant women and children should not use this drug due to
reduction
in bone and cartilage development.
-
- Adverse Reactions: Adverse
antibiotic responses resulted in discontinuing drug in ~3.5% of patients,
and such reactions included nausea (5%), diarrhea (2%), vomiting (2%)
abdominal
pain (1.7%), headache (1.2%) and rash (1.1%). In rare cases Ciprofloxacin
may cause cardiovascular problems (<1%) and central nervous system
(dizziness,
insomnia, tremor, confusion, convulsions and other reactions (<1%).
Small numbers of patients have experienced hypersensitivity (anaphylactic)
reactions which have required immediate emergency treatment.
-
- Azithromycin
(AKA Zithromax)
-
- Azithromycin is an azalide (macrolide) antibiotic with
good absorption and a serum half-life of 68 hours. This class of drug acts
by binding to the 50S ribosomal subunit of susceptible organisms where
it interferes with protein synthesis. Food decreases absorption rate, but
absorption is unaffected by antacids containing magnesium, aluminum or
other salts. For GWI/CFIDS/FMS use, the recommended dose is 500 mg/day
(for oral use, 2x250 mg capsules) for each 6-week cycle of therapy.
Azithromycin
should not be taken with meals (1 hour before or 1 hour after). Initially,
azithromycin may exacerbate some symptoms but these are usually gone within
a week or so. Patients usually start feeling better with alleviation of
most major signs and symptoms within 1-2 weeks, but in some patients major
symptoms are not alleviated until the second 6 week course. Azithromycin
has been used in patients in which doxycycline cannot be tolerated or in
some patients that no longer respond to doxycycline. Herxheimer reactions
are rare and usually pass within a few days to a week or so. Virtually
all patients relapse (show the same major signs and symptoms) after the
end of the first or second 6-week course of therapy. Additional cycles
of antibiotic result in milder relapses after drug is discontinued. Azithromycin has been shown to be safe for pediatric use (10 mg/kg/day is recom
mended
for children under 14).
-
- Azithromycin is effective against the following
organisms:
gram-negative bacteria (Bordetella pertussis, Shigella species, Haemophilus
influenzae, Chlamydia species, Yersinia pestis, Brucella species, Vibrio
cholera); gram-positive bacteria (Streptococci group C, F, G); mycoplasmas
(Mycoplasma species); others (Clostridium species, Treponema pallidum
[syphilis],
and Borelia sp.).
-
- Precautions: Azithromycin
is principally absorbed by the liver, and caution should be exercised with
patients with impaired liver function. Antacids containing magnesium,
aluminum
or other salts should not be taken at the same time of day with
azithromycin.
Macrolides and terfenadine (Seldane) or astemizole (Hismaral) may
dangerously
elevate plasma antihistamine and cause arrhythmia's and increase serum
theophyline levels in some patients, particularly those receiving
methylated
xanthine causing nausea, vomiting, seizures. Plasma levels of carbamazepine
(Tegretol) can also be elevated, leading to carbamazepine toxicity and
nausea, vomiting, drowsiness and ataxia.
-
- Adverse Reactions: Adverse
antibiotic responses were mild to moderate in clinical trials and included
diarrhea (5%), nausea (3%), abdominal pain (3%). In rare cases (<1%)
azithromycin may cause cardiovascular problems (palpitations, tachycardia,
chest pain) and central nervous system (dizziness, headache, vertigo),
allergic (rash, photosensitivity, angioderma), fatigue and other reactions
(<1%). In pediatric patients >80% of the adverse responses were
gastrointestinal.
-
- Clarithromycin
(AKA Biaxin)
-
- Clarithromycin is a broad spectrum macrolide antibiotic
with good absorption and serum half-life. This class of drug acts by
binding
to the 50S ribosomal subunit of susceptible organisms and interfering with
protein synthesis. The drug is mostly bacteriostatic but high
concentrations
can be bactericidal. Food decreases absorption rate, but absorption is
unaffected by antacids containing magnesium, aluminum or other
salts.
-
- The recommended dose is 500-750 mg/day (for oral use,
2-3x250 mg capsules) for each 6-week cycle of therapy. Clarithromycin
should
not be taken with meals (1 hour before or 1 hour after). Initially,
Clarithromycin
may exacerbate some symptoms due to Herxheimer reaction and bacterial death
but these are usually gone within a week or so.
-
- Patients usually start feeling better with alleviation
of most major signs and symptoms within 1-2 weeks, but in some patients
major symptoms are not alleviated until the second 6-week course.
Clarithromycin
has been used in patients that do not respond to doxycycline or in patients
that cannot tolerate doxycycline. Herxheimer reactions usually pass within
a few days to over a week or so. Virtually all patients relapse (show the
same major signs and symptoms) after the end of the first or second 6-week
course of therapy. Additional cycles of antibiotic result in milder
relapses
after drug is discontinued.
-
- Clarithromycin is effective against the following
organisms:
gram-negative bacteria (Neisseria gonorrhoeae, N. meningitides, Moraxella
catarrhalis, Campylobacter jejuni, Eikenella corrodens, Haemophilus
ducreyi,
Bordetella pertussis, Shigella species, Salmonella species, Haemophilus
influenzae, Chlamydia species, Yersinia pestis, Brucella species, Vibrio
cholera, Aeromonos species, E. coli, gram-positive bacteria (Streptococcus
pyogenes, S. pneumeniae, anerobic Streptococci, Enterococcus faccalis,
Staphlococcus aureus, S. epidermidis, Bacillus anthracis, Corynebacterium
diptheriae, C. minutissimum, Listeria monocytogenes, Actinomyces israelii);
mycoplasmas (Mycoplasma species, M. pneumoniae, Ureaplasma urealyticum);
others (Clostridium species, Treponema pallidum [syphilis], Legionella
pneumophilia, L. micdadei, Mycobacterium avium, M. chelonae, M. chelonae
absessus, M. fortuitim, Rickettsia species and Borrelia species). Yeast's,
fungi and viruses are resistant.
-
- Precautions: Clarithromycin
is principally absorbed by the liver, and caution should be exercised with
patients with impaired liver function. Antacids containing magnesium,
aluminum
or other salts should not be taken at the same of day as azithromycin.
Macrolides and terfenadine (Seldane) or astemizole (Hismaral) may
dangerously
elevate plasma antihistamine and cause arrhythmia's and increase serum
theophyline levels in some patients, particularly those receiving
methylated
xanthine causing nausea, vomiting, seizures. Plasma levels of carbamazepine
(Tegretol) can also be elevated, leading to carbamazepine toxicity and
nausea, vomiting, drowsiness and ataxia. Macrolides should not be used
with cyclosporin (Sandimmune).
-
- Adverse Reactions: Adverse
antibiotic responses were mild to moderate in clinical trials and included
diarrhea, nausea, and abdominal pain. In rare cases (<1%) azithromycin
may cause cardiovascular problems (palpitations, tachycardia, chest pain)
and central nervous system (dizziness, headache, vertigo), allergic (rash,
photosensitivity, angioderma) and fatigue.
-
- Other [Important] Information
(see Additional
Considerations...)
-
- GWI/CFIDS/FMS patients are often low in vitamins (B,
C and E) and minerals. Sublingual (under the tongue) natural B-complex
vitamins (Total B, Real Life Research, Norwalk, CA) can be ordered from
Vitamin Park (Irvine, CA). General vitamins plus extra C and E and general
mineral supplements are also useful, but not at the same time of day that
antibiotics are taken because minerals can affect the absorption of the
antibiotics. Selenium and magnesium are two of the minerals that are low
in GWI/CFIDS/FMS patients. Some have recommend 300-500 mg/day sodium
selenite
for a few days, followed by lower maintenance doses. Some zinc
supplementation
is recommended. L- cysteine supplementation has been proposed but should
not be taken at the same time as minerals.
-
- Antibiotics can result in yeast overgrowth, especially
in female patients. Gynecologists recommend Nizoral, Diflucan, Mycelex,
or anti-yeast creams for women on antibiotics. In some cases, simultaneous
use of metronidazole (Flagyl, Prostat) have been used to prevent fungal
and parasite overgrowth or antifungals (Nystatin, Amphotericin B,
Fluconazole)
have been administered for fungal infections that can occur while on
antibiotics.
To replace bacteria in the gastrointestinal system yogurt, Lactobacillus
acidophillus tablets are recommended. In some patients 'organic' food has
been beneficial. Caffeine should be avoided. On page 1 are instructions
for suppressing bacterial overgrowth (if necessary) in between cycles of
antibiotics with a 2 week course of Augmentin (3 X 500 mg/day). Augmentin
can be taken concurrently with the other antibiotics, if necessary.
-
- A number of natural remedies, such as ginseng root, whole
lemon/olive oil drink or an extract of olive leaves with antioxidants (Eden
or Immunoscreen of Covina, CA), and a mixture of herbals and vitamins
(Nu-Life
Formula, Sophista-Care of Indian Wells, CA) have been used to boost immune
systems. Although these products appear to help CFIDS/FM patients, their
effectiveness in GWI/CFIDS/FM patients has not been examined. They appear
to be useful after antibiotic therapy.
-
- Finally, GWI/CFIDS/FMS patients should not smoke and
not drink alcohol, caffeinated products or eat refined sugar, and they
should avoid pollutant exposure, especially those who are chemically
sensitive.
Flying, excessive exercise and lack of sleep can make signs/symptoms worse;
some exercise (don't over do it!) and dry saunas help rid the system of
contaminating chemicals.
-
- _____________
-
- Additional Considerations when Undergoing
Treatment for Gulf War Illness/CFS/FMS
- By Prof. Garth L. Nicolson
The Institute for Molecular Medicine
15162 Triton Lane, Huntington Beach,
California 92649-1041 Tel: (714) 903-2900
Fax: (714) 379-2082
e-mail: gnicimm@ix.netcom.com
-
- There are a number of considerations that should be taken
into account when undergoing therapy for Gulf War Illness/Chronic Fatigue
Syndrome/Fibromyaligia [GWI/CFS/FMS]. A few are mentioned below, and some
product examples are given. The Institute for Molecular Medicine is a
nonprofit
institution and does not endorse commercial products. The products
mentioned
below are only examples of the types of substances that could be beneficial
to patients. Consult with your physician.
-
- Antibiotic Therapy for Associated Chronic
Infections
-
- Please consult Antibiotics Recommended When Indicated
for Treatment of Gulf War Illness/CFS/ FMS for general information. We
are finding that subsets of GWI (~45%) and FMS/CFS (~60%) patients have
chronic mycoplasmal infections, and probably other chronic infections as
well. We usually recommend to physicians that antibiotics (doxycycline,
ciprofloxacin, Biaxin, minocycline, azithromycin) be given for several
6 week cycles with 2 week cycles of Augmentin in between or concurrently,
if needed. To overcome Herxheimer reactions or die-off that cause chills,
low grade fever, night sweats, muscle aches, joint pain, short term memory
loss and fatigue) or adverse responses, IV antibiotics have been used,
and a whole lemon/olive drink is useful (1 blended whole lemon, 1 cup fruit
juice, 1 TBS olive oil--strain and drink liquid). This period usually
passes
within 1-2 weeks. During recovery, which is often slow and can take over
a year with ups and downs in your condition, a number of additional
nutritional
and immune problems must be considered.
-
- General Nutritional
Considerations
-
- GWI/CFS [or CFIDS]/FMS patients are often
immunosuppressed
and could be susceptible to a variety of opportunistic infections, so
proper
nutrition and exercise are important. GWI/CFS/FMS patients should not smoke
or drink alcohol or caffeinated products. Drink as much fresh fluids as
you can, lots of fruit juices or pure water are best. Try to avoid high
sugar and fat foods, such as military (MRE) or other fast foods and
acid-forming,
allergen-prone and stressing foods or junk foods. Increase your intake
of fresh vegetables, fruits and grains, and decrease your intake of fats
and eliminate simple or refined sugars that can suppress your immune
system.
To build up your immune system cruciferous vegetables, soluble fiber foods,
such as prunes and bran, wheat germ, yogurt, fish and whole grains are
useful. In some patient's exclusive use of 'organic' foods have been
beneficial.
-
- Vitamins and Minerals
-
- GWI/CFS/FM patients are often depleted in vitamins
(especially
B, C and E) and certain minerals. Unfortunately, illnesses like GWI result
in poor absorption. Therefore, high doses of some vitamins must be used,
and the gut (oral capsules) cannot easily absorb others, such as vitamin
B complex. Sublingual (under the tongue) natural B-complex vitamins in
small capsules or liquids (such as Total B, Real Life Research, Norwalk,
CA, 310-926-5522) should be used instead of oral capsules that are
swallowed.
General vitamins plus extra C, E, CoQ-10, beta-carotene, folic acid,
bioflavoids
and biotin are best. L-cysteine, L-tyrosine, L-carnitine and malic acid
are reported by some to be useful. Certain minerals are also often depleted
in GWI/CFS/FMS patients, such as zinc, magnesium, chromium and selenium.
Some recommend doses as high as 300-mg/day-sodium selenite for a few days,
followed by lower maintenance doses. Minerals should not be taken at the
same time of day that antibiotics are taken because the minerals can affect
the absorption of certain antibiotics.
-
- Replacement of Natural Gut
Flora
-
- GWI/CFS/FMS patients are often undergoing treatment with
antibiotics and other substances that can destroy the normal gut flora.
Antibiotic use that depletes normal gut bacteria and can result in
over-growth
of less desirable bacteria. To supplement bacteria in the gastrointestinal
system yogurt and especially Lactobacillus acidophillus tablets are
recommended.
One product is a mixture of Lactobacillus acidophillus, Lactobacillus
bifidus
and FOS (fructoologosaccharides) to promote growth of these
"friendly"
bacteria in the gut (example, DDS-Plusor Multi-Flora ABF, UAS Labs of
Minnetonka,
MN, 800-422-3371). L. acidophillus should be taken daily to restore gut
flora. A human bowel culture, Replete (Interplex) has proven useful to
restore natural gut flora.
-
- Natural Immunoenhancers or
Immunomodulators
-
- A number of natural remedies, such as ginseng root,
herbal
teas, whole lemon/olive extract drink or an extract of olive leaves with
antioxidants are available and are potentially useful, especially during
or after antibiotic therapy has been completed. Some examples are botanical
mixtures, such as Eden, Echinacea-C (NF Formulas, 800-547-4891),
Super-Immunotone
(Phyto Pharmica, 800-553-2370), olive leaf extract (Immunoscreen of Covina,
CA, 818-966-1610), NSC-100 (Nutritional Supply, Carson City, NV,
888-246-7224),
a mixture of herbals and vitamins (Nu-Life Formula, Sophista-Care, Indian
Wells, CA, 760-837-1908) or Super Defense Plus (BioDefense Nutritionals,
Grand Terrace, CA, 800-669-9205). These have been used to boost immune
systems. Although these products appear to help some CFS/FMS patients,
their clinical effectiveness in GWI/CFS/FMS patients has not been
evaluated.
They appear to be useful during therapy to boost the immune system or after
antibiotic therapy in a maintenance program to prevent relapse of
illness.
-
- Yeast/Fungal or Bacterial
Overgrowth
-
- Yeast overgrowth can occur, especially in female patients
(vaginal infections). Gynecologists recommend Nizoral, Diflucan, Mycelex,
or anti-yeast creams for women on antibiotics. In some cases, use of
metronidazole
(Flagyl, Prostat) have been used to prevent fungal or parasite overgrowth
or other antifungals (Nystatin, Amphotericin B, Fluconazole, Diflucan)
have been administered for fungal infections that can occur while on
antibiotics.
As described above, L. acidophillus should be taken daily to restore gut
flora. Bacterial overgrowth can also occur, for example, in between cycles
of antibiotics or after antibiotics have been stopped. This can be
controlled
with 2-week courses of Augmentin (3 X 500 mg/day) in between cycles or
concurrent with other antibiotics.
-
- Flying and Exercise
-
- Flying, especially in unpressurized aircraft, excessive
exercise and lack of sleep can make GWI/CFS/FMS signs/symptoms worse. Some
exercise (Please don't over do it! A common problem when recovering from
this illness is over-exertion followed by relapse!) is useful and even
necessary for recovery. The main problem here is to adjust your exercise
level to help the recovery process without causing a relapse. Dry saunas
help rid the system of contaminating chemicals, and saunas should be taken
at least 3-5X per week--moderate exercise, followed by 15-20 min of dry
sauna and tepid shower. The sauna can be repeated, by not more than two
per day. The idea is to raise body temperature enough to work up a good
sweat, eliminating chemicals without placing too much stress on your
system.
During exercise GWI/CFS/FMS patients should always try to avoid pollutant
and allergen exposures. For recovery after exercise and to decrease muscle
soreness, some use a Jacuzzi or hot tub, but only after a sufficient
cool-down
period. Don't get overheated in the process.
-
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