From Johns Hopkins Intelihealth

An Evasive Bacteria May Cause Fatigue "Syndromes"

February 4, 2000
NYT Syndicate

"Your friends, your colleagues, your boss, your family all have to take on faith that you have an illness, and that you are telling them the truth about the way you feel," says Sophie Wilkinson, who has suffered with chronic fatigue syndrome for 12 years.

Only in the last six months has a doctor finally confirmed that Sophie has an illness.

A tiny bacteria called mycoplasma may play a role in such puzzling conditions that defy easy diagnosis and treatment, but persist tenaciously over time.

Patients with chronic fatigue and Gulf War illness, and other chronic disorders experience exhaustion, muscle and joint pain and a lack of mental acuity dubbed "brain fog."

Resistant to treatment, the diseases cause some formerly active people to become bedridden. Others can barely work or attend school part time.

THREE MAIN SYMPTOMS
"It's not the kind of disease that you would make up," says Sophie. "You have no life. There's a whole constellation of symptoms that wax and wane, depending on the particular episode. The lack of stamina is a consistent feature."

The elusive array of complaints shared by chronic illness patients generally comprise a triad of symptoms:

--lack of stamina
--muscle or joint aches
--neurologic problems like poor memory and concentration.
It's not clear how mycoplasma drive these symptoms, but the tiny bacteria leave clues that researchers are beginning to decipher.

"We can now identify the DNA of mycoplasma in the blood of some Gulf War syndrome patients," says Sam Donta, M.D., specialist in infectious diseases at Boston University School of Medicine. "But just finding the DNA footprint doesn't tell us if that's the cause of the disease."

Mycoplasma represent the tiniest free-living bacteria. They can thrive on open surfaces of the body including the mouth, respiratory system, the genital tract, and the urinary tract. Unlike viruses that need to reproduce themselves inside living cells, mycoplasma can replicate on their own.

"They have finger-like projections that stick out, and researchers have begun to identify the chemicals that make mycoplasma sticky," says Donta. "That stickiness helps them live on the open surfaces of the body."

Mycoplasma proved very difficult to grow in the laboratory for research purposes, and remained a mystery for years. "They were first associated with an unusual kind of pneumonia," says Donta.

"They're tricky, because if you didn't know about mycoplasma, you might think a patient had a viral form of pneumonia. There aren't very good drugs for the treatment for viral pneumonia, but antibiotics work against bacterial pneumonia."

Today's antibiotics kill active bacteria, but mycoplasma grow too slowly, and antibiotic treatment doesn't wipe them out. "Apparently, mycoplasma go through very slow periods of growth with low metabolic activity, kind of like hibernation," says Donta.

Many antibiotics either interfere with the metabolism of the bacteria, or destroy their cell walls. Neither approach, however, works well against the ultra-slow-metabolizing mycoplasma, which have no cell walls.

Donta explains that scientists recently identified a few more mycoplasma, in addition to the well-known mycoplasma pneumonii. Some were renamed, like ureaplasma, which is associated with the urinary tract. Ureaplasmas have been link to small birth weights and miscarriages as well as genital-urinary diseases.

"There is strong evidence that mycoplasma species are associated with many illnesses including chronic fatigue syndrome, rheumatoid arthritis, and other chronic infectious diseases," says Donta.

"Researchers discovered that mycoplasma get into the body's tissues and just sit for a while. Periodically they become more active and take some nutrition. Then they go into a resting phase again with low metabolism.

"That's why an antibiotic doesn't kill them," says Donta. "Antibiotics either target the cell wall, which mycoplasma lack, or they block metabolic pathways used to make new proteins."

LONGER TREATMENT NEEDED
"It could be that slow metabolic activity is the mycoplasma's staying power," says Donta. "Like a turtle, it may be slow, but it hangs on."

Researchers think prolonged antibiotic treatment may improve symptoms for some chronic sufferers of Gulf War illness. "We set up a Gulf War illness study to track mycoplasma DNA," says Donta. "We're trying to see if the mycoplasma disappear in patients whose illness improves after taking the antibiotic doxycyclene. The purpose is to learn what role, if any, mycoplasma play in the illness."

In the study, which is being conducted at 30 Veterans Affairs Medical Centers around the country, patients take either the antibiotic, or a placebo for one year. During six months of follow-up care, doctors will try to determine if patients taking the antibiotic improved, and if they stayed better.

"DNA analysis will be done so researchers can determine if the patients who got better showed a decrease in mycoplasma DNA," says Donta, who leads the study.

MULTIPLE SYMPTOM DISORDERS
There's a lot of controversy about chronic disorders like chronic fatigue syndrome and Gulf War illness. "Some doctors think they are psychological," says Donta, "But I have long since given up the "evil humor' theory of disease. Patients are suffering from these diseases even when physical exams don't reveal anything of note."

"I spent thousands of dollars on medical tests," says Sophie. "And I had doctors tell me that I was healthy when I was sitting in their office feeling miserable."

The National Institutes of Health recognize chronic fatigue syndrome as a serious illness. Still, many people with the disease fail to receive disability or insurance benefits because doctors and employers don't believe they suffer from a debilitating condition.

Research studies in immunology, endocrinology and other fields keep probing the mysteries of chronic illnesses in a search for urgently needed therapies.

"Wouldn't it be nice if we could wake up all of the mycoplasma bacteria, and keep them from slowing down. And then slam them with an antibiotic," says Donta. "We need more research to develop drugs that work against mycoplasma."