Infections in CFS, fibromyalgia and pain

Townsend Letter for Doctors and Patients,  Nov, 2004  by Jacob Teitelbaum

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Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep, adrenal inadequacy, immune suppression/exhaustion because of yeast infections and leaky gut, and glutathione and other nutritional deficiencies are major contributors. The immune dysfunction can result in many unusual infections. These include viral infections (e.g.--HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g. mycoplasma, chlamydia, Lyme, etc) and fungal infections. Yeast overgrowth is the most important infection to treat for. Many of these infections are not considered by conventional physicians because they are "opportunistic" and not present in people with a healthy immune system.

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That there are so many infections involved in these syndromes suggests that the immune dysfunction is the primary problem and that the infections are secondary. Many if not most of these infections will often go away when the immune system is normalized. Many of the infections that may have initially triggered the onset of the CFS/fibromyalgia are already gone as well. For example, I suspect that in many cases of Post Lyme Disease syndrome, the infection is no longer present. In our experience however, it's critical to treat the yeast infections and any parasites that are present (even if they are normally considered nonpathogenic).

Many other recurrent infections can also occur because of a malfunctioning immune system. Chronic sinus, bladder, prostate, and respiratory infections are common and are often treated with repeated courses of antibiotics. This simply aggravates the yeast overgrowth, which can then further suppress the immune system. How to treat all of these infections, both with and without antibiotics, will be discussed in this upcoming series of columns. We will begin however, by discussing the treatment of parasitic infections.

Evaluation and Treatment of Parasitic Infections

People with CFS/fibromyalgia frequently have bowel parasite infections. Bowel parasites can cause severe allergic or sensitivity reactions, which in turn can trigger fibromyalgia and fatigue. Often, a patient will finally recover from longstanding and disabling fatigue within a week or two after beginning treatment for bowel parasites.

A number of years ago, the news focused our attention on Milwaukee because of repeated outbreaks of an infection by a bowel parasite called Cryptosporidium. Scores of Milwaukeeans died from the outbreaks. A cartoon even made the rounds showing Mexican tourists being warned not to drink the water in Milwaukee! Although this infection usually resolves on its own within a week or two, it can persist in people with suppressed immune function. For example, people with acquired immune deficiency syndrome (AIDS) are particularly susceptible.

Unfortunately, in many places throughout the United States, the water supply is contaminated, and parasites are no longer just a Third World problem. Doctors frequently see cases of infection by Giardia, amoebae, and numerous other bowel parasites. The symptoms of parasitic infections can mimic those of CFIDS and, as noted above, in immune-suppressing situations like CFIDS, all parasites should be treated.

Diagnosing Bowel Parasites

Most laboratories miss parasites when they do stool testing. I initially tested for bowel parasites by sending my patients' stool samples to a respected local lab. The tests kept coming back negative, so I eventually stopped testing. Finally, I started doing my own laboratory stool testing. Doing the testing properly was very time consuming, taking up to five hours per specimen. However, when my tests were processed properly, they frequently turned out positive.

If you would like your stool tested, make sure that the laboratory doing the test specializes in stool testing and that the patient follows the lab's directions for obtaining the specimen. The routine random tests performed in almost all standard laboratories are generally not adequate or reliable. In speaking with several lab technicians, I was told they had less than one hour of training in looking for parasites--which they found to be useless. In fact, a gastroenterologist friend once noted that during a colonoscopy he saw a large number of parasites swimming in the patient's bowel. He removed a big glob consisting of nothing but mucus and parasites and sent it off to the major local laboratory, just for confirmation of the infection and identification of the parasite. Even this sample came back negative for parasites! This is why I stress that stool testing must be done at a lab that specializes in parasitology. Because two excellent labs are available to mail specimens to, I no longer have to do the testing in my office. These labs are the Parasitology Center (480-777-1078) and the Great Smokies Diagnostic Laboratory (800-522-4762).