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 Staff

ImmuneSupport.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 CFS

Radio Show and gave a very important and very informative report of

the work he has been doing. Dr. Klapow has been finding a new

roundworm type of parasite in CFS patients called " Cryptostrongylus

pulmoni " . I found this show to be of particular interest to me because

I have been found to have this particular parasitic infection and was

very interested to learn of the immunologic dysfunctions that it can

cause. I truly think that this important work definitely plays a part

in the complex puzzle that is known as Chronic Fatigue Syndrome.

 

Dr. Mazlen To kick off the new millennium with a good show that you'll

find of great interest and great importance, I'm talking today with

Dr. 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 this

suspected new parasite that you've found in a percentage of patients

with Chronic Fatigue Syndrome? How'd you find it?

 

Dr. Klapow Well, Roger, it came about as a result of a conversation I

was having with an immunologist friend of mine, Dr. Vincent

Marinkovich, here in Redwood City, California. He was treating a CFS

patient we thought might have a roundworm infection. The patient had a

low grade eosinophilia and some unusual rashes on the torso that

suggested the possibility of threadworm disease. Antibody tests and

stool tests were negative. I thought about this for a while and I know

that some chronic parasites migrate between the digestive tract and

the respiratory tract and some of them are coughed up in sputum. So I

looked at the sputum and that's where I found it. I called the new

parasite " Cryptostrongylus pulmoni " , that's a provisional name and it

means " 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 I

hope other people will start looking for it. In fact, I've put

together some material that I think can help them.

 

Dr. Mazlen You recently completed a small blinded study in cooperation

with a small number of CFS doctors including Dr. Anthony Komaroff in

Harvard. You're now doing a larger blinded trial and you're also

trying to develop a clinical test for the parasite. But for these

other investigators and clinicians, can you tell us what does the

parasite look like and how can they find it?

 

Dr. Klapow You can identify the parasite, the female by its mouth

parts and the male by its very intricate reproductive structure. This

parasite is very small. The female is less than a millimeter long and

the male is about a third that length. So, in addition to being small

there's also a lot of difficulties. The specimens I usually pick up

are naturally expelled in sputum and they're usually very decayed and

rare and because of this you need very specialized imaging techniques

to find them. They're not expensive techniques, they're just

specialized. In any case I wanted to help people look for this

parasite and so I put together a website which describes how to find

it in great detail. It also includes anatomical drawings. I can give

you the website address if you like. Dr. Mazlen Yes, give us the

address right now, that'll be great.

 

Dr. Klapow OK, I'll give you my own email address and then I can post

the other rather longer address for people who contact me. My email

address is lak123.

 

Dr. Mazlen Now, this is really important because this introduces a

whole new dimension about Chronic Fatigue Syndrome and its possible

relationship to roundworm infestation. Can you tell us so far, at

least, as you've been looking, what percentages of Chronic Fatigue

Syndrome patients are turning out to be positive for this worm?

 

Dr. Klapow Yes, I find the parasites in about 40% of three-day sputum

samples from CFS patients. However, I have to tell you that yields are

very low. In fact, they're so low that I think I'm probably missing as

many positive patients as I'm finding. The problem here is that over

80% of the positives I get are represented by only one identifiable

specimen. So just by chance it looks like I'm missing a fairly high

percentage.

 

Dr. Mazlen So, the prevalence can be a lot higher and this, of course,

stirs some very great interest in terms of causation and etiology

which we'll go into later. Can you tell us anything about the blinded

trials so far?

 

Dr. Klapow Yes, I did a small blinded trial in cooperation with a

number of doctors including Dr. Anthony Komaroff at Harvard and here

are the results. I think they're interesting but you judge for

yourself. 5 of the 11 patients were positive while all 6 controls were

negative. Now, it's a small trial but if you were trying to do as well

by guessing, say by just tossing a coin, you'd only do as well as I

report here in about 1 in a 100 tests, so it's a very hard thing to do

by just guessing. The results of this small trial can be used to

devise an experimental design for a large trial that could give a

statistically significant result and going through that exercise

suggests that between 50 and 80 samples will be needed. Now, it may

take some time to process these samples microscopically. It's now

taking me somewhere between 50 and 100 hours to find a single positive

patient so I think the progress will be slow, that is unless we can

get something more rapid going in the form of a PCR test.

 

Dr. Mazlen Well, I certainly congratulate you though for the effort

that you're making because this is totally important to patients for

their prognosis and recovery ultimately. There's a lot more to learn

and, of course, we're going to go into that and you mentioned the PCR

test and that you have some arrangements whereby this can be developed

and hopefully you'll get some funding to help this along soon. If

anybody in the audience is interested in helping in this regard they

can reach me at rgm1 which is my email address and I'll

forward it on to Dr. Klapow. Larry where do you think these parasites

might be coming from?

 

Dr. Klapow Well, Roger, they have some specialized anatomical

structures that suggest that they're related to parasites of animals

that live in the jungles of Southeast Asia. In fact, there's been

somewhat of a history of hard to diagnose parasites coming out of that

area and being brought back to " Western " countries after periods of

warfare. It happened in the Victorian era when French soldiers were

returning from this area and brought back the chronic parasite

Strongyloides stercoralis to Europe where it was first diagnosed in

1894. It also happened again in World War II. This time British

soldiers became infected while they were imprisoned in Burma returned

to England and 30 years later, in 1974 they were diagnosed with

chronic parasites they had gotten while they were in prison. It's kind

of a testament to how difficult some of these parasites are to find

and treat. I would like to look at people who've been to Southeast

Asia and I think I plan to do that as soon as I finish with the large

trial I'm doing on CFS patients now.

 

Dr. Mazlen It's a natural sequitur because you're going to be having a

chance to look at all of the veterans of the Viet Nam era who either

served in Viet Nam or Cambodia or neighboring areas.

 

Dr. Klapow That will happen, I think, rather quickly if I can get the

PCR test going.

 

Dr. Mazlen You say it might be coming from this source and that's a

possibility. 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've

never seen a fresh transmissible stage of the parasite in any sputum

sample I've seen so far. I've done a couple of hundred samples at this

point. So I don't think there's any evidence right now of casual

transmission. But roundworm parasites are typically acquired by eating

contaminated food, but an outbreak of Cryptostrongylus infection, if

it were transmitted in this way, would look very different then a

typical food poisoning incident where people get sick within a couple

of 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 larvae

which is very large so there's an implication here that it must be

reproducing very slowly and possibly has a very long latency time. Of

course, we know that the outbreak of Chronic Fatigue Syndrome usually

take place over several months and in some cases a couple of years and

that I think would be consistent with the possibility of a food borne

infection with a very long latency period.

 

Dr. Mazlen Well, now we're going to turn to the clinical side. Most of

the time that doctors are looking for parasitosis, they look to see

elevated eosinophil and serum IgE, or immunoglobulin E, levels in

patients. Isn't this usually the case?

 

Dr. Klapow Yes, but that's the first question that I get from doctors

when I tell them that I found what I think is a new species of

roundworm parasite. Where's the elevated IgE? And the answer is

elevated IgE is mainly apparent in acute roundworm infections. With

time, the chronic parasites are able to suppress the IgE response and

many of them produce a clinical picture where the patients either have

normal 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've

reviewed, IgE is lower in CFS patients than in healthy control

populations.

 

Dr. Mazlen Here I want to interject that I'm part of the new study

looking into C.pulmoni in CFS patients and one of the things that

prompted me to call you and talk to you about getting involved is the

fact that I had been seeing low IgE levels, low eosinophile counts in

patients that I thought were inappropriate.

 

Dr. Klapow In fact, there was a paper that's a few years old in the

Journal of Chronic Fatigue Syndrome that indicates that if you

correlate IgE and eosinophil levels with the number of symptoms the

patients report, the sicker they are the lower the IgE and eosinophil

counts and that's a statistically significant relationship.

 

Dr. Mazlen And I see it and it seems to be borne out. Now, what do you

think is suppressing IgE in this CFS or Chronic Fatigue Syndrome

patients? What's the mechanism?

 

Dr. Klapow Well, I think the mechanism may involve the cell marker

CD23 which suppresses IgE. There are a couple of other things that

activate CD23, the IgE suppresser and those are active herpes viruses

and some of the TH1 cytokines, particularly interferon-gamma and the

2'-5'A, the activator of the latent RNase enzyme. Both herpes viruses

and 2'-5'A, as you know, are highly elevated in CFS patients. In fact,

it looks like some roundworms may be using chronic viruses as

cofactors to help perpetuate their own survival.

 

Dr. Mazlen That certainly rings true from what I've seen clinically

and that leads us to another question. If a lot of Chronic Fatigue

Syndrome patients have allergies, they should have elevated IgE levels

but a lot of them, as we were just saying, don't. It seems to fit the

model you propose of a suppresser.

 

Dr. Klapow Yes, there are some doctors, in fact, that think allergy is

a risk factor for getting a roundworm infection and that's because

patients who tend to produce too much IgE to non-specific stimuli,

harmless things, may not have enough reserves left over to fight off

the parasites so they get a foothold, and in fact, initially, you can

even see patients who report increased allergies, but later on when

they're diagnosed with CFS and the presumptive parasite, if we may go

so far and speculate, has suppressed their IgE response and the values

come out clinically low.

 

Dr. Mazlen Now, this brings us to a leading question, which, obviously

is a speculation, but that's all right because that's what this show

is about. We want to raise issues and have other people contribute to

answering them as well. There seem to be many infectious agents that

have been proposed as being possible etiological agents for Chronic

Fatigue Syndrome. None of them have held up specifically as a single

causative agent. What do you think about this roundworm infection,

c.pulmoni, is it a primary infection or is it just another

opportunistic organism?

 

Dr. Klapow Well, I don't know if it's a primary cause of CFS. We'll

just have to have to go through the rules of Koch's postulates and see

how far we can get. I think it's an interesting candidate for a

possible primary agent. I don't think it's an opportunistic infection.

Opportunistic infections are usually airborne and are present

everywhere. They're just waiting for our immune systems to be weakened

before they establish a chronic infection. Cryptostrongylus doesn't

seem to be ubiquitous. If I'm right about the taxonomy, it looks like

it's coming out of a particular geographic area. They're are also a

number of things that I think can connect roundworm infection to the

major physiological systems that malfunction in CFS. And they have to

do with the wide variety of physiologically active agents roundworms

are able to secrete.

 

Dr. Mazlen We're going back now and talking about the hormones that

these roundworms secrete, namely vasoactive intestinal polypeptide,

which is known as VIP, and hippocampal cholinergic neurostimulatory

peptide which is known as HCNP, and what they do and Larry, what do

these hormones cause? What do they do?

 

Dr. Klapow Well, VIP is involved in regulating blood pressure and

blood flow. It's important in regulating blood flow to the brain. It's

believed to be implicated in orthostatic intolerance from which a

number of CFS patients suffer. And, it also controls hypothalmic CRH,

a hormone that's ultimately responsible for the level of cortisol in

the blood which is suppressed in CFS and it's also suppressed in

chronic roundworm infections. And the other one, HCNP, is a limbic

system neuropeptide and it's believed to be involved in memory and

immune function. When it goes wrong in areas that have Alzheimer's

lesions, there are cognitive symptoms. In fact, some doctors have

suggested that CFS looks in some respects like a reversible form of

Alzheimer's.

 

Dr. Mazlen It seems like that sometimes.

 

Dr. Klapow Well, the bad news is that it bare's any resemblance to

that disease. *What good news there is, is that the cognitive symptoms

come and go, without apparently doing permanent damage. I think it is

a reasonable hope that increasingly effective treatments for CFS will

be found in time to substantially help most of those who now suffer

from 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: The

CFS Radio Show has once again lost its sponsor so this will be the

last show until a new sponsor can be found.)