Abstract
Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) are characterised by a lack of consistent laboratory and clinical abnormalities. Although they are distinguishable as separate syndromes based on established criteria, a great number of patients are diagnosed with both. In studies using polymerase chain reaction methods, mycoplasma blood infection has been detected in about 50% of patients with CFS and/or FMS, including patients with Gulf War illnesses and symptoms that overlap with one or both syndromes. Such infection is detected in only about 10% of healthy individuals, significantly less than in patients. Most patients with CFS/FMS who have mycoplasma infection appear to recover and reach their pre-illness state after long-term antibiotic therapy with doxycycline, and the infection can not be detected after recovery. By means of causation and therapy, mycoplasma blood infection may permit a further subclassification of CFS and FMS. It is not clear whether mycoplasmas are associated with CFS/FMS as causal agents, cofactors, or opportunistic infections in patients with immune disturbances. Whether mycoplasma infection can be detected in about 50% of all patient populations with CFS and/or FMS is yet to be determined.
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References
Aaron LA, Buchwald D (2001) A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 134:868–881
White KP, Speechley M, Harth M, Østbye T (2000) Co-existence of chronic fatigue syndrome with fibromyalgia syndrome in the general population. Scand J Rheumatol 29:44–51
Nicolson GL, Nicolson NL (1998) Gulf War illnesses: complex medical, scientific and political paradox. Med Confl Surviv 14:156–165
Escalante A, Fischbach M (1998) Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation. J Rheumatol 25:2228–2235
Grady EP, Carpenter MT, Koenig CD, Older SA, Battafarano DF (1998) Rheumatic findings in Gulf War veterans. Arch Intern Med 158:367–371
Bourdette DN, McCauley LA, Barkhuizen A, Johnston W, Wynn M, Joos SK, Storzbach D, Shuell T, Sticker D (2001) Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. J Occup Environ Med 43:1026–1040
Hotopf M, David A, Hull L, Ismail K, Unwin C, Wessely S (2000) Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study. BMJ 320:1363–1367
Baseman JB, Tully JG (1997) Mycoplasmas: sophisticated, reemerging, and burdened by their notoriety. Emerg Infect Dis 3:21–32
Razin S, Yogev D, Naot Y (1998) Molecular biology and pathogenicity of mycoplasmas. Microbiol Mol Biol Rev 62:1094–1156
Dallo SF, Baseman JB (2000) Intracellular DNA replication and long-term survival of pathogenic mycoplasmas. Microb Pathog 29:301–309
Choppa PC, Vojdani A, Tagle C, Andrin R, Magtoto L (1998) 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 12:301–308
Vojdani A, Choppa PC, Tagle C, Andrin R, Samimi B, Lapp CW (1998) Detection of mycoplasma genus and mycoplasma fermentans by PCR in patients with chronic fatigue syndrome. FEMS Immunol Med Microbiol 22:355–365
Vojdani A, Franco AR (1999) Multiplex PCR for the detection of mycoplasma fermentans, m. hominis, and m. penetrans in patients with chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, and Gulf War syndrome. J Chronic Fatigue Syndr vol T (no 3/4):187–197
Nicolson GL, Nicolson NL (1996) Diagnosis and treatment of mycoplasmal infections in Persian Gulf War illness-CFIDS patients. Int J Occup Med Immunol Tox 5:69–78
Nicolson GL, Nicolson NL, Nasralla M (1998) Mycoplasmal infections and fibromyalgia/chronic fatigue illness (Gulf War illness) associated with deployment to Operation Desert Storm. Int J Med 1:80–92
Nicolson GL, Nasralla M, Haier J, Nicolson NL (1998) Diagnosis and treatment of chronic mycoplasmal infections in fibromyalgia and chronic fatigue syndromes: relationship to Gulf War illness. Biomed Therapy 16:266–271
Nasralla M, Haier J, Nicolson GL (1999) Multiple mycoplasmal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome. Eur J Clin Microbiol Infect Dis 18:859–865
Nasralla MY, Haier J, Nicolson NL, Nicolson GL (2000) Examination of mycoplasmas in blood of 565 chronic illness patients by polymerase chain reaction. Int J Med Biol Environ 28:15–23
Nijs J, Nicolson GL, De Becker P, Coomans D, De Meirleir K (2002) High prevalence of mycoplasma infections among European chronic fatigue syndrome patients: examination of four mycoplasma species in blood of chronic fatigue syndrome patients. FEMS Immunol Med Microbiol 34:209–214
Gray GC, Kaiser KS, Hawksworth AW, Watson HL (1999) No serologic evidence of an association found between Gulf War service and mycoplasma fermentans infection. Am J Trop Med Hyg 60:752–757
Lo SC, Levin L, Ribas J, Chung R, Wang RY, Wear D, Shih JW (2000) Lack of serological evidence for mycoplasma fermentans infection in army Gulf War veterans: a large scale case-control study. Epidemiol Infect 125:609–616
Blanchard A, Montagnier L (1994) AIDS-associated mycoplasmas. Annu Rev Microbiol 48:687–712
Grau O, Slizewicz B, Tuppin P, Launay V, Bourgeois E, Sagot N, Moynier M, Lafeuillade A, Bachelez H, Clauvel JP (1995) Association of mycoplasma penetrans with human immunodeficiency virus infection. J Infect Dis 172:672–681
Patarca R, Mark T, Fletcher MA, Klimas N (2000) Review: immunology of chronic fatigue syndrome. J Chronic Fatigue Syndr 6:69–107
Patarca R (2001) Cytokines and chronic fatigue syndrome. Ann N Y Acad Sci 933:185–200
Natelson BH, Haghighi MH, Ponzio NM (2002) Evidence for the presence of immune dysfunction in chronic fatigue syndrome. Clin Diag Lab Immunol 9:747–752
Kaufmann A, Muhlradt PF, Gemsa D, Sprenger H (1999) Induction of cytokines and chemokines in human monocytes by mycoplasma fermentans-derived lipoprotein MALP-2. Infect Immun 67:6303–6308
Kikkawa S, Matsumoto M, Sasaki T, Nishiguchi M, Tanaka K, Toyoshima K, Seya T (2000) Complement activation in mycoplasma fermentans-induced mycoplasma clearance from infected cells: probing of the organism with monoclonal antibodies against M161Ag. Infect Immun 68:1672–1680
Seya T, Matsumoto M (2002) A lipoprotein family from mycoplasma fermentans confers host immune activation through toll-like receptor 2. Int J Biochem Cell Biol 34:901–906
Into T, Nodasaka Y, Hasebe A, Okuzawa T, Nakamura J, Ohata N, Shibata K (2002) Mycoplasmal lipoproteins induce toll-like receptor 2- and caspases-mediated cell death in lymphocytes and monocytes. Microbiol Immunol 46:265–276
Brightbill HD, Libraty DH, Krutzik SR, Yang RB, Belisle JT, Bleharski JR, Maitland M, Norgard MV, Plevy SE, Smale ST, Brennan PJ, Bloom BR, Godowski PJ, Modlin RL (1999) Host defense mechanisms triggered by microbial lipoproteins through toll-like receptors. Science 285:732–736
Bernet C, Garret M, Barbeyrac BD, Bebear C, Bonnet J (1989) Detection of mycoplasma pneumoniae by using the polymerase chain reaction. J Clin Microbiol 27:2492–2496
Taylor-Robinson D, Bebear C (1997) Antibiotic susceptibilities of mycoplasmas and treatment of mycoplasmal infections. J Antimicrob Chemother 40:622–630
Collins JF, Donta ST, Engel CC, Baseman JB, Dever LL, Taylor T, Boardman KD, Martin SE, Wiseman AL, Feussner JR (2002) The antibiotic treatment trial of Gulf War veterans' illnesses: issues, design, screening, and baseline characteristics. Control Clin Trials 23:333–353
Buskila D, Shnaider A, Neumann L, Zilberman D, Hilzenrat N, Sikuler E (1997) Fibromyalgia in hepatitis C virus infection: another infectious disease relationship. Arch Intern Med 157:2497–2500
White PD, Thomas JM, Amess J, Crawford DH, Grover SA, Kangro HO, Clare AW (1998) Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry 173:475–481
Rea T, Russo J, Katon W, Ashley RL, Buchwald D (1999) A prospective study of tender points and fibromyalgia during and after an acute viral infection. Arch Intern Med 159:865–870
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Endresen, G.K.M. Mycoplasma blood infection in chronic fatigue and fibromyalgia syndromes. Rheumatol Int 23, 211–215 (2003). https://doi.org/10.1007/s00296-003-0355-7
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DOI: https://doi.org/10.1007/s00296-003-0355-7