New Parasite Found In Chronic Fatigue Syndrome (CFIDS)

[Guest guest]

http://www.immunesupport.com/library/showarticle.cfm/ID/1215/ New Parasite Found In Chronic Fatigue Syndrome (CFIDS)by Immunesupport.com StaffImmuneSupport.com 01-16-2000 CFS Radio Program Jan. 16th, 2000. Roger G. Mazlen, M.D. Host with Dr.Larry Klapow. Dr. Mazlen: Dr. Larry Klapow was a guest on this past Sunday's CFSRadio Show and gave a very important and very informative report ofthe work he has been doing. Dr. Klapow has been finding a newroundworm type of parasite in CFS patients called "Cryptostrongyluspulmoni". I found this show to be of particular interest to me becauseI have been found to have this particular parasitic infection and wasvery interested to learn of the immunologic dysfunctions that it cancause. I truly think that this important work definitely plays a partin the complex puzzle that is known as Chronic Fatigue Syndrome. Dr. Mazlen To kick off the new millennium with a good show that you'llfind of great interest and great importance, I'm talking today withDr. Larry Klapow, a Ph.D. in Invertebrate Biology who's in Burlingame,California near San Francisco. Good morning Larry, welcome to our show. Dr. Klapow Good morning, Roger, I'm glad to be here. Dr. Mazlen Can you tell our audience something about the thissuspected new parasite that you've found in a percentage of patientswith Chronic Fatigue Syndrome? How'd you find it? Dr. Klapow Well, Roger, it came about as a result of a conversation Iwas having with an immunologist friend of mine, Dr. VincentMarinkovich, here in Redwood City, California. He was treating a CFSpatient we thought might have a roundworm infection. The patient had alow grade eosinophilia and some unusual rashes on the torso thatsuggested the possibility of threadworm disease. Antibody tests andstool tests were negative. I thought about this for a while and I knowthat some chronic parasites migrate between the digestive tract andthe respiratory tract and some of them are coughed up in sputum. So Ilooked at the sputum and that's where I found it. I called the newparasite "Cryptostrongylus pulmoni", that's a provisional name and itmeans "the hidden lung worm". Dr. Mazlen That's pretty appropriate in terms of what you say. Dr. Klapow It definitely is, Roger. It's very difficult to find. And Ihope other people will start looking for it. In fact, I've puttogether some material that I think can help them. Dr. Mazlen You recently completed a small blinded study in cooperationwith a small number of CFS doctors including Dr. Anthony Komaroff inHarvard. You're now doing a larger blinded trial and you're alsotrying to develop a clinical test for the parasite. But for theseother investigators and clinicians, can you tell us what does theparasite look like and how can they find it? Dr. Klapow You can identify the parasite, the female by its mouthparts and the male by its very intricate reproductive structure. Thisparasite is very small. The female is less than a millimeter long andthe male is about a third that length. So, in addition to being smallthere's also a lot of difficulties. The specimens I usually pick upare naturally expelled in sputum and they're usually very decayed andrare and because of this you need very specialized imaging techniquesto find them. They're not expensive techniques, they're justspecialized. In any case I wanted to help people look for thisparasite and so I put together a website which describes how to findit in great detail. It also includes anatomical drawings. I can giveyou the website address if you like. Dr. Mazlen Yes, give us theaddress right now, that'll be great. Dr. Klapow OK, I'll give you my own email address and then I can postthe other rather longer address for people who contact me. My emailaddress is lak123. Dr. Mazlen Now, this is really important because this introduces awhole new dimension about Chronic Fatigue Syndrome and its possiblerelationship to roundworm infestation. Can you tell us so far, atleast, as you've been looking, what percentages of Chronic FatigueSyndrome patients are turning out to be positive for this worm? Dr. Klapow Yes, I find the parasites in about 40% of three-day sputumsamples from CFS patients. However, I have to tell you that yields arevery low. In fact, they're so low that I think I'm probably missing asmany positive patients as I'm finding. The problem here is that over80% of the positives I get are represented by only one identifiablespecimen. So just by chance it looks like I'm missing a fairly highpercentage. Dr. Mazlen So, the prevalence can be a lot higher and this, of course,stirs some very great interest in terms of causation and etiologywhich we'll go into later. Can you tell us anything about the blindedtrials so far? Dr. Klapow Yes, I did a small blinded trial in cooperation with anumber of doctors including Dr. Anthony Komaroff at Harvard and hereare the results. I think they're interesting but you judge foryourself. 5 of the 11 patients were positive while all 6 controls werenegative. Now, it's a small trial but if you were trying to do as wellby guessing, say by just tossing a coin, you'd only do as well as Ireport here in about 1 in a 100 tests, so it's a very hard thing to doby just guessing. The results of this small trial can be used todevise an experimental design for a large trial that could give astatistically significant result and going through that exercisesuggests that between 50 and 80 samples will be needed. Now, it maytake some time to process these samples microscopically. It's nowtaking me somewhere between 50 and 100 hours to find a single positivepatient so I think the progress will be slow, that is unless we canget something more rapid going in the form of a PCR test. Dr. Mazlen Well, I certainly congratulate you though for the effortthat you're making because this is totally important to patients fortheir prognosis and recovery ultimately. There's a lot more to learnand, of course, we're going to go into that and you mentioned the PCRtest and that you have some arrangements whereby this can be developedand hopefully you'll get some funding to help this along soon. Ifanybody in the audience is interested in helping in this regard theycan reach me at rgm1 which is my email address and I'llforward it on to Dr. Klapow. Larry where do you think these parasitesmight be coming from? Dr. Klapow Well, Roger, they have some specialized anatomicalstructures that suggest that they're related to parasites of animalsthat live in the jungles of Southeast Asia. In fact, there's beensomewhat of a history of hard to diagnose parasites coming out of thatarea and being brought back to "Western" countries after periods ofwarfare. It happened in the Victorian era when French soldiers werereturning from this area and brought back the chronic parasiteStrongyloides stercoralis to Europe where it was first diagnosed in1894. It also happened again in World War II. This time Britishsoldiers became infected while they were imprisoned in Burma returnedto England and 30 years later, in 1974 they were diagnosed withchronic parasites they had gotten while they were in prison. It's kindof a testament to how difficult some of these parasites are to findand treat. I would like to look at people who've been to SoutheastAsia and I think I plan to do that as soon as I finish with the largetrial I'm doing on CFS patients now. Dr. Mazlen It's a natural sequitur because you're going to be having achance to look at all of the veterans of the Viet Nam era who eitherserved in Viet Nam or Cambodia or neighboring areas. Dr. Klapow That will happen, I think, rather quickly if I can get thePCR test going. Dr. Mazlen You say it might be coming from this source and that's apossibility. How is it contracted? How do you get it then? Dr. Klapow I'm really not sure. What I can tell you is this. I'venever seen a fresh transmissible stage of the parasite in any sputumsample I've seen so far. I've done a couple of hundred samples at thispoint. So I don't think there's any evidence right now of casualtransmission. But roundworm parasites are typically acquired by eatingcontaminated food, but an outbreak of Cryptostrongylus infection, ifit were transmitted in this way, would look very different then atypical food poisoning incident where people get sick within a coupleof hours after eating. Dr. Mazlen That's due to the long latency that you mentioned. Dr. Klapow Cryptostrongylus is very small but it produces a larvaewhich is very large so there's an implication here that it must bereproducing very slowly and possibly has a very long latency time. Ofcourse, we know that the outbreak of Chronic Fatigue Syndrome usuallytake place over several months and in some cases a couple of years andthat I think would be consistent with the possibility of a food borneinfection with a very long latency period. Dr. Mazlen Well, now we're going to turn to the clinical side. Most ofthe time that doctors are looking for parasitosis, they look to seeelevated eosinophil and serum IgE, or immunoglobulin E, levels inpatients. Isn't this usually the case? Dr. Klapow Yes, but that's the first question that I get from doctorswhen I tell them that I found what I think is a new species ofroundworm parasite. Where's the elevated IgE? And the answer iselevated IgE is mainly apparent in acute roundworm infections. Withtime, the chronic parasites are able to suppress the IgE response andmany of them produce a clinical picture where the patients either havenormal or lower than the normal average level of IgE and, in fact,that's the picture you see in CFS and in all the studies I'vereviewed, IgE is lower in CFS patients than in healthy controlpopulations. Dr. Mazlen Here I want to interject that I'm part of the new studylooking into C.pulmoni in CFS patients and one of the things thatprompted me to call you and talk to you about getting involved is thefact that I had been seeing low IgE levels, low eosinophile counts inpatients that I thought were inappropriate. Dr. Klapow In fact, there was a paper that's a few years old in theJournal of Chronic Fatigue Syndrome that indicates that if youcorrelate IgE and eosinophil levels with the number of symptoms thepatients report, the sicker they are the lower the IgE and eosinophilcounts and that's a statistically significant relationship. Dr. Mazlen And I see it and it seems to be borne out. Now, what do youthink is suppressing IgE in this CFS or Chronic Fatigue Syndromepatients? What's the mechanism? Dr. Klapow Well, I think the mechanism may involve the cell markerCD23 which suppresses IgE. There are a couple of other things thatactivate CD23, the IgE suppresser and those are active herpes virusesand some of the TH1 cytokines, particularly interferon-gamma and the2'-5'A, the activator of the latent RNase enzyme. Both herpes virusesand 2'-5'A, as you know, are highly elevated in CFS patients. In fact,it looks like some roundworms may be using chronic viruses ascofactors to help perpetuate their own survival. Dr. Mazlen That certainly rings true from what I've seen clinicallyand that leads us to another question. If a lot of Chronic FatigueSyndrome patients have allergies, they should have elevated IgE levelsbut a lot of them, as we were just saying, don't. It seems to fit themodel you propose of a suppresser. Dr. Klapow Yes, there are some doctors, in fact, that think allergy isa risk factor for getting a roundworm infection and that's becausepatients who tend to produce too much IgE to non-specific stimuli,harmless things, may not have enough reserves left over to fight offthe parasites so they get a foothold, and in fact, initially, you caneven see patients who report increased allergies, but later on whenthey're diagnosed with CFS and the presumptive parasite, if we may goso far and speculate, has suppressed their IgE response and the valuescome out clinically low. Dr. Mazlen Now, this brings us to a leading question, which, obviouslyis a speculation, but that's all right because that's what this showis about. We want to raise issues and have other people contribute toanswering them as well. There seem to be many infectious agents thathave been proposed as being possible etiological agents for ChronicFatigue Syndrome. None of them have held up specifically as a singlecausative agent. What do you think about this roundworm infection,c.pulmoni, is it a primary infection or is it just anotheropportunistic organism? Dr. Klapow Well, I don't know if it's a primary cause of CFS. We'lljust have to have to go through the rules of Koch's postulates and seehow far we can get. I think it's an interesting candidate for apossible primary agent. I don't think it's an opportunistic infection.Opportunistic infections are usually airborne and are presenteverywhere. They're just waiting for our immune systems to be weakenedbefore they establish a chronic infection. Cryptostrongylus doesn'tseem to be ubiquitous. If I'm right about the taxonomy, it looks likeit's coming out of a particular geographic area. They're are also anumber of things that I think can connect roundworm infection to themajor physiological systems that malfunction in CFS. And they have todo with the wide variety of physiologically active agents roundwormsare able to secrete. Dr. Mazlen We're going back now and talking about the hormones thatthese roundworms secrete, namely vasoactive intestinal polypeptide,which is known as VIP, and hippocampal cholinergic neurostimulatorypeptide which is known as HCNP, and what they do and Larry, what dothese hormones cause? What do they do? Dr. Klapow Well, VIP is involved in regulating blood pressure andblood flow. It's important in regulating blood flow to the brain. It'sbelieved to be implicated in orthostatic intolerance from which anumber of CFS patients suffer. And, it also controls hypothalmic CRH,a hormone that's ultimately responsible for the level of cortisol inthe blood which is suppressed in CFS and it's also suppressed inchronic roundworm infections. And the other one, HCNP, is a limbicsystem neuropeptide and it's believed to be involved in memory andimmune function. When it goes wrong in areas that have Alzheimer'slesions, there are cognitive symptoms. In fact, some doctors havesuggested that CFS looks in some respects like a reversible form ofAlzheimer's. Dr. Mazlen It seems like that sometimes. Dr. Klapow Well, the bad news is that it bare's any resemblance tothat disease. *What good news there is, is that the cognitive symptomscome and go, without apparently doing permanent damage. I think it isa reasonable hope that increasingly effective treatments for CFS willbe found in time to substantially help most of those who now sufferfrom this difficult and often misunderstood disease. Transcribed by Carolyn Viviani *Added to transcript by Dr. Klapow after the show. Source: Transcribed by Carolyn Viviani; carolynv. (Note: TheCFS Radio Show has once again lost its sponsor so this will be thelast show until a new sponsor can be found.)