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Thursday, January 14, 2016

Chronic mycoplasmal infections and chronic fatigue

Mycoplasmas are bacteria belonging to the class Mollicutes. They are the smallest free-living self-replicating bacteria known. They have no cell wall and a very limited genome of between 600 to 1500 kbp, which makes them highly dependent upon their host for survival. Recently, certain mycoplasma species have received a great deal of attention from the medical and scientific communities. Some mycoplasma species have been implicated as possible cofactors in a number of diseases. Mycoplasma fermentans, Mycoplasma hominis and Mycoplasma penetrans have been isolated from individuals suffering from a variety of diseases including primary atypical pneumonia, urogenital infections, rheumatoid arthritis (RA) and AIDS related infections. Although the role that mycoplasmas may play as cofactors in HIV infection remains a subject of much debate, it does raise intrigue as to their possible involvement in other chronic illnesses.

Chronic fatigue syndrome (CFS) is an illness that is being reported at an increased frequency in the United States and other industrialized countries. Chronic fatigue syndrome is a self-reported disease which is characterized by a wide variety of multiple non-specific symptoms such as debilitating fatigue, joint pain, head ache, recurrent sore throat, cognitive difficulties and muscle pain. In addition to these characteristic symptoms, recent studies have shown immune system dysregulation with an increase in cytokine production and antiviral interferon cascade transcripts. The fact that abnormal cytokine production exists in CFS with an unknown etiology and the ability of mycoplasma species to be potent immunomodulators led the authors to investigate the possibility of mycoplasma infection in CFS.


It has been well documented that people who suffer from fibromyalgia exhibit many of the same symptoms found in CFS. These two illnesses are so similar that for years many medical practitioners have considered them as the same condition. They are still regarded as closely associated in the scientific literature with only the exception of a few distinction criteria. Other research has stated the uncanny similarities between chronic fatigue syndrome and gulf war syndrome. Patients suffering from rheumatoid arthritis also exhibit certain symptoms characteristic to each illness. Although RA exhibits a narrower spectrum of clinical symptoms than CFS, FMS, and GWS, it does exhibit a significant overlap of symptoms found in each condition. The fact that these four illnesses have such a high degree of similarities led us to investigate the possibility that mycoplasma infection may be a common link to each condition. A successful clinical practice greatly depends on rapid and reliable detection techniques. Mycoplasma detection by culture is laborious and may take as long as five weeks to generate results that even then may be inconclusive or inaccurate due to the fastidious nature of mycoplasmas.


Marwan Y. Nasralla, Jörg Haier, Nancy L. Nicolson Garth L. Nicolson. Examination of Mycoplasmas in Blood of 565 Chronic Illness Patietns by Polymerase Chain Reaction.. International Journal Medicine Biol¬ogy Environment 2000; 28(1):15-23.

Nasralla M, Haier J, Nicolson GL. Multiple mycoplas¬mal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome.
Eur J Clin Microbiol Infect Dis 1999 Dec;18(12):859-65.

Gerhard K. M. Endresen. Mycoplasma blood infec¬tion in chronic fatigue and fibromyalgia syndromes. Rheumatology International Issue: Volume 23, Number 5 September 2003: 211 – 215

Marwan Nasralla, Ph.D., Joerg Haier, M.D., Ph.D. and Garth L. Nicolson, Ph.D. Mycoplasmal Infections in Blood from Patients with Chronic Fatigue Syndrome,
International CFS Conference, Sydney, Australia, 1998.

Lerner AM, Beqaj SH, and Deeter RG et al. A six-month trial of valacyclovir in the Epstein-Barr virus subset of chronic fatigue syndrome: improvement in left ventricular function. Drugs of Today. 2002;38:549-561.

Lerner AM, Zervos M and Dworkin HJ et al. New cardiomyopathy: A pilot study of intravenous ganciclo¬vir in a subset of the chronic fatigue syndrome. Infec¬tious Diseases In Clinical Practice 1997;6:110-117.

Vojdani A, Choppa PC, Tagle C, Andrin R, Samimi B, Lapp CW. Detection of Mycoplasma genus and Mycoplasma fermentans by PCR in patients with Chronic Fatigue Syndrome. FEMS Immunol Med Microbiol 1998 Dec;22(4):355-65

Vojdani, Aristo, and Al Robert Franco. Multiplex PCRF for the Detection of Mycoplasma fermentans, M. hominis, and M. penetrans in Patients with Chronic Fatigue Syndrome, Fibromyalgia, Rheumatoid Arthritis, and Gulf War Syndrome. Journal of Chronic Fatigue Syndrome Vol. T, No. ¾, 1999, pp. 187-197;

Vojdani, A, Franco A. Chronic Fatigue Syndrome: Advance in Epidemiologic, Clinical, and Basic Science Research. 1999, pp. 187-197. The Haworth Press, Inc., 1999

Choppa PC, Vojdani A, Tagle C, Andrin R, Magtoto L. Multiplex PCR for the detection of Mycoplasma fer¬mentans, M. hominis and M. penetrans in cell cultures and blood samples of patients with chronic fatigue syndrome. Mol Cell Probes 1998 Oct;12(5):301-8

Nicolson G, Nasralla M, Franco R, DeMeirleir K et al. Role of Mycoplamsal Infections in Fatigue Illness: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis. Journal of Chronic Fatigue Syndrome 2000;6(3/4):23-39.


Antibiotics used to treat bacteria can have a significant effect on the level of illness in CFS. “In 71% of CFS and fibromyalgia patients mycoplasma spp. were detected, multiple infections being found in approximately one-half of the patient population. In healthy individuals the incidence of mycoplasmal infections was only 6%. These results are similar to those reported by Choppa et al. and Vodjani et al. who showed increased PCR-detectable mycoplasmas in patients.” p. 241 “Mycoplasmas penetrate into nerve cells, synovial cells, and other cell types and are also very effective at evading the immune system.” p. 241 “In our studies using PCR with gene tracking, which involved 272 Belgian CFS patients, one or more mycoplasma infection were identified in 68% of the patients. The following species were identified: Mycoplasma fermentans (25%), Mycoplasma pneumoniae (26%), and Mycoplasma hominis (36%.) Interestingly, Mycoplasma spp. were found to be associated with increased low molecular RNase L levels, suggesting that they more readily invade cells that have defects in this enzyme system or that they are able to induce changes in the RNase L pathway.” p. 242 Nicolson et al. have recommended the use of four antibiotics, doxycycline (200-300 mg a day), azithromycin (500 mg a day), minocyclin (200-300 mg a day), and ciprofloxacin (1000-1500 mg a day).Many weeks of therapy are required. Oxidative therapy and nutritional supplements in addition result in gradual recover of patients with these bacterial infections. Chia et al. have done a study showing that chronic Chlamydia infection can be treated with azithromycin.

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