Prof. Nicolson
Thanks for having me on board.

Dr. Mazlen
We're delighted to have you on board. It's an exciting thing for us because a lot of people's health and lives may hang in the balance on the work that you're doing and publishing. Could you tell our listening audience some of the advances in this area of mycoplasma disease causation, since you were a guest in the year?

Prof. Nicolson
Well, I think what we've done in the intervening period of time is that we've really nailed down the fact that chronic infections are a very important aspect of a variety of different chronic illnesses, from rheumatoid arthritis, chronic fatigue syndrome, fibromyalgia syndrome, inflammatory bowel disease, a lot of respiratory diseases, chronic asthma, and so on and not only mycoplasma but a variety of other chronic infections as well and people, I think, in the past did not realize the extent, or the involvement of these types of infections in these chronic disorders and the fact that these disorders can be either causative or they can a cofactor in the disease, that is be an important element in the disease or it can even be operative if the infections after the disease are triggered by something else and they're involved in the progression of the disease and making it worse.

Dr. Mazlen
How many years can you have a mycoplasma infection without being aware of it by a diagnostic procedure?

Prof. Nicolson
Well, it's not really well known. We do know, for example, from the Gulf War that it took some patients as long as three years before they started exhibiting signs and symptoms of infection that we felt occur in 1991 and their family members, when they came down there was often a delay anywhere from 6 months to 2 years before they showed signs and symptoms. So, there's a significant delay.

Dr. Mazlen
How long can it stay in your body if you don't treat it?

Prof. Nicolson
Well, we don't know. This is one of the important questions to which we'd like the answer. We do know that some people in the general population will test positive, a few percent, for example, and we don't know if these are people that will ultimately become sick because of the long latency of this type of infection or whether they're just carriers.

Dr. Mazlen
Of course, and you make the point, in many of your papers that this is a slow growing organism.

Prof. Nicolson
It's very slow growing and I think that's why these problems show up only after a very long latency period.

Dr. Mazlen
Now, you mentioned in the letter that you wrote to me recently, that you've learned that as of 1994 over 6,000 U.S. soldiers have died of infectious, chemical exposures and other causes from operation Desert Storm and that the numbers are much higher. What's going on there in your opinion?

Prof. Nicolson
Well we don't know the actual numbers, because the actual numbers are classified. We've heard everything from 15,000 to more than 20,000 of our veterans have died of a variety of different illnesses including these very unusual chronic infections that can progress.

Dr. Mazlen
And, of course, I want to congratulate you on your efforts to bring this to the attention of Congress where you have testified. Now, you mention also that there is a study ongoing, a multi-center clinical trial based on your work on treatment with the VA. What's that about?

Prof. Nicolson
Well, that 6 million dollar trial is really to diagnose and treat Gulf War Veterans who have mycoplasma illnesses and it's taking place at over 30 VA and DoD institutions around the country and we hope within a year, a year and a half that we'll get information about the antibiotic treatment that we've, of course, developed to treat these types of infections.

Dr. Mazlen
We're going to get back to that in a few minutes, but maybe you could just tell us very briefly... you mentioned that you're now using a forensic PCR or polymerase chain reaction technique for diagnosing this disease and I know it's going to be available because you're opening up a new center, you have a new international diagnostic lab which is now open. What does this forensic PCR test mean?

Prof. Nicolson
Well the forensic PCR test is simply using some of the tools of forensic pathology where you can isolate very small amounts of blood, blood cells like white blood cells that have DNA and then couple that with an amplification technique, polymerase chain reaction, you have a very sensitive tool to find these infections inside the blood of a patient, and up until just a few years ago when we first started using this it was very difficult to find these types of infections and that's why you didn't hear very much about it.

Dr. Mazlen
Well, I've noticed that already in my practice, because I've been applying the variety of tests to patients based on your early work, I've been finding that the standard antibody testing which is typical IgG and IgM for mycoplasma pneumoniae, for example, is not at all a valid test compared to PCR. Just how bad is it in terms of making the diagnosis? How inaccurate?

Prof. Nicolson
Well, I think it's very inaccurate and the reason for that is that these infections are intracellular, that is, they get inside the cells in your tissues and because they reside inside the cells they don't stimulate much of an immune response. There's been some very interesting animal studies that were published by the army, the Armed Forces Institute of Pathology, that shows that if you take these types of infectious agents like mycoplasma fermentans and inject them into monkeys, they don't show any antibody response until years later and only a few months before they die. So these can cause a fatal progressive disease, so they can be dangerous and antibodies won't really pick this up until a person has very well progressed in the disease process.

Dr. Mazlen
Well that, of course, is alarming and it also points out the opportunity to use the new testing in order to be able to offer therapy to patients early before this type of progression and for that, we thank you for bringing that to the attention of the medical community at large and to Congress as well. Now, what about Chronic Fatigue Syndrome, what's happening with the patients there who might have mycoplasma infections?

Prof. Nicolson
We're finding about 60% of these patients do have these types of infections and we're also looking at other types of chronic infections like chlamydial infections. There are a very high percentage that have those. And we just have a study coming out in a European microbiology journal showing that with time, Chronic Fatigue Syndrome patients tend to collect these infections and so patients who've been sick a decade or more tend to have multiple infections and they also tend to have worsening signs and symptoms, that is patients that have the multiple infections, there signs and symptoms slowly become worse, so we can actually tag the number of infectious agents, the number of different types, the severity of the disease and also the length of the disease process. So this explains why so few patients with Chronic Fatigue Syndrome ever recover from their illness. With time their immune systems are compromised, they can collect these opportunistic infections and they will make them worse or keep them just as sick as they were before and they can't seem to recover.

Dr. Mazlen
That's certainly true from what I've seen over 20 years. In addition to that I have patients that you've diagnosed with your laboratory testing who have multiple infections of mycoplasma and the ones with m.hominus, in particular, are pretty sick and they have that in combination with others which you mention in your paper and the paper entitled "Multiple Mycoplasma Infections Detected in Blood of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Patients" and that's in the European Journal of Clinical Microbiology and Infectious Diseases. I'll give you the number where you can reach the Institute for Molecular Medicine and, of course, Dr. Nicolson which is 714-903-2900. Also you may fax your messages to them at 714-379-2082. Garth, tell me about some progress in the area of treatment. What have you been seeing and what are you recommending. I know that doxycycline is one of the staples, but what else are you using.

Prof. Nicolson
Actually, we're using several different antibiotics, sometimes these have to be cycled in. And in some patients that are really severely sick we often have to combine different antibiotics. I'll be glad to send people information on that if they write to me at the Institute for Molecular Medicine or they could go to our website at www.immed.org and find information about treatment, but the antibiotics I think are very useful in suppressing the infections but as you know, this is not the whole story, most people that have these infections have compromised immune systems and so we have to worry about building them back up. Proper nutrition is very important, proper vitamins and minerals are important. A lot of these patients have poor absorptions so they're not getting the proper B vitamins and other essential materials that they need to overcome these illnesses so we have to attend to a lot of different problems with these people, not just a matter of suppressing the infection.

Dr. Mazlen
Also, one interesting thing, because we know that these patients tend to have relapses when there's low oxygen tension like in air travel, for example, which you pointed out in an earlier show, and we're going to get back to that in terms of treatment with hyperbaric oxygenation in a minute, but what does the mycoplasma do to the oxygen delivery system in the blood?

Prof. Nicolson
Well, we're not exactly sure what the mycoplasma does to that in these patients but we do know that it does infect the endothelium, the cell lining the vascular systems and causes changes, we think, possibly in the exchange of oxygen in the tissues. We do know that higher oxygen will suppress these types of infections because basically they're what you call borderline anerobic infections, so we know that the people that take long flights often in pressurized aircrafts at high altitudes, often have relapses after they land if they have Chronic Fatigue Syndrome or fibromyalgia or other chronic illnesses. We often see this is air crews and airline pilots and we're working with a number airline pilots on this. We just established near our institute a hyperbaric center, it's called Molecular Hyperbaric Medicine and this is headed by Dr. Robert Irwin, he's actually the son of the former Deputy Surgeon General of the Navy and he's very interested in hyperbaric medicine, so we'll be offering that to patients along with some of the other therapies that we've been trying to develop to treat these chronic illnesses.

Dr. Mazlen
So you see that as an adjunctive therapy along with antibiotics.

Prof. Nicolson
Yes, we do, and particularly people that have acute episodes, I think it's quite useful. It's not in itself going to help people overcome these types of infections, because the generally high oxygen will suppress these infections but will not eliminate them. It will suppress the growth of them and some of the signs and symptoms will be temporarily alleviated but they eventually come back again, so we have to really get at these infections and that just requires long term antibiotics and nutritional support.

Dr. Mazlen
OK. That's all very important and people can write to you for that information. I have an important question to ask you. It's a leading question. You may not be able to answer it. But can these chronic mycoplasma infections, in some way, maybe not yet known, contribute to the causation of cancer?

Prof. Nicolson
Well, this is a hot topic right now because we know that these microorganisms give off genotoxic substances, that is substances that can modify our genes and actually mutate them. Some of these are activated oxygen species that will attack DNA. We do know that if you take these types of mycoplasmas that we found in patients and put them into cell cultures that they will result in spontaneous transformation of those cells eventually and lower their threshold to chemicals thousands of fold, so in effect, what they may be doing is lowering the threshhold of carcinogenesis. You if you have these infections, it might make you more prone to have cancer. We just don't know, there's not enough information on this right now, but it's certainly a troubling sign.

Dr. Mazlen
Well, that's exactly why I asked you and I appreciate your candid answer about it. What about the actual damage to chromosones themselves because some people have reported, and this is Urnovitz's work with others, that there's been nucleic acid or pieces resulting from chromosomal damage found in Gulf War patients. What about that?

Prof. Nicolson
Right now we don't know if the damage that they're looking at is the damage caused by mycoplasmas or not because they only find it in one half of the specimens that they look at that's about the same percentage that we find are infected with mycoplasma and we know that the mycoplasma gives out substances which can cause the same kind of chromosome damage that they're looking at. The chromosome damage is not a new thing. This has been seen for years. In fact, there's about a 20 year literature history on this, and what's been found is even if you look at smokers compared to non-smokers, there's an increase in chromosome fragility or chromosome damage, so this is something that you see quite often in people that have been exposed to toxic materials of any type, be it biological or chemical or radiological.

Dr. Mazlen
OK, now that's fair and that's certainly in the literature. There's no question about the fact that that's been shown. What about, however, the possible connection from this genotoxic stuff that's put out by mycoplasma and the birth defects noted in the children of the Gulf War veterans?

Prof. Nicolson
Well, again, we just don't know. There's just not enough research on this to know whether this contributed to, in fact, the birth defects that are found in Gulf War famililes, particularly in their offspring, or whether that was caused primarily by chemicals or both. It's just a very very difficult area to work in because of the multiple toxic exposures that occurred during the Gulf War.

Dr. Mazlen
Well, of course, I knew it was a difficult question. But I wanted to ask you because we needed to get even your theoretical thinking about it and how other people start looking at it and thinking about it also and for that I appreciate even mentioning even a tentative possibility of it's connection because it needs to be explored. Garth, I have a question for you about the mycoplasma's effect on the host immune system. You've had papers published on this and you call it a stealth type of response. Talk to the audience about this mycoplasma stealth activity is.

Prof. Nicolson
Well, these types of microorganisms, as I mentioned, penetrate into cells and tissues and they can virtually go into any organ or tissue in the body. We find some patients, for example, that have coronary problems because of these infections. My own father has this, by the way, when he had a mycoplasma pneumoniae infection and he had endocarditis, and was really headed for a major heart attack. We were able to diagnose it and turn that around and now he's made a full recovery. We just don't know how many people are in this situation that might have liver failure, lung problems with chronic pneumonia, heart problems, coronary problems, renal problems, problems with their kidneys because of infections. These types of infections are insidious because when they hide inside the cells they can really escape from the immune system, but these types of infections also have another property that also helps them escape from the immune system and that is that they can suppress the immune system. They can actually attack the immune system, just like they attack other cells in our body, and this ends up in some cases resulting in a suppression of immunity in general. And so we can have patients whose immune systems are compromised and this leaves them wide open to a variety of other opportunistic infections. And these patients, which are the worst, I think, to deal with, they have a variety of different infections. They yeast infections, they have other bacterial infections, viruses, and so on and it's extremely difficult dealing with these patients, because building back their immune systems is very very difficult.

Dr. Mazlen
I certainly can second that because I've seen that, and I'm dealing with it currently in my practice. And I want to say that Dr. Nicolson has helped me greatly by his work and by his advice over time and he has protocols which you can also get for your treating physicians and healthcare personnel. Once again his phone number at the Institute for Molecular Medicine is 714-903-2900 and can you give your website again?

Prof. Nicolson
Yes, it's www.immed.org. If you remember "immediately" you can remember the website.

Dr. Mazlen
I think, Garth, and I'm extending an information to you to come to New York and we'll organize a symposium on mycoplasma illnesses. I want to help put it together with you so, let's work on that or something like it in the future because your work is just extremely important. A lot of people's health is slipping by the boards, or as they say, slipping through the cracks, so to speak, and they're not being treated adequately and not enough serious attention is being paid to these problems. I've actually had infectious disease specialists call me to ask me about things like this looking for advise with Chronic Fatigue Syndrome, for example, in terms of what type of multiple infections may be present and this really is pandora's box. Almost anything is possible, as you pointed out. And as you mentioned about your father with the infected endocarditis, people could even go on to die, I've seen it happen. We can't work fast enough or do too much in this area. I urge you to support the Institute for Molecular Medicine. This is my personal appeal to you and I want to say that we're delighted. We're going to want to have you back again but we're going to want to do some other things to get this information out and we're going to try to work it out in the future. How contagious is it, Garth?

Prof. Nicolson
Well, it's only moderately contagious. It does seem to require some time to pass it. The most at risk are immediate family members because they make the closest contact with an individual who is sick.

Dr. Mazlen
What about children?

Prof. Nicolson
Well, children can pick this up. We have a lot of family members who have gotten sick because of it. Children's immune systems are a little bit stronger and some of them are able to withstand it, but we have a lot of children in Gulf War Illness families who are sick because of this.

Transcribed by 

Carolyn Viviani 
carolynv@inx.net 

Permission is given to repost, copy and distribute this transcript as long as my name is not removed from it. 

© 1999 Roger G. Mazlen, M.D.