Could Infections Be Behind Chronic Lyme Disease?

Nathan D. Childs, Senior Writer

Skin & Allergy News 30(8):13, 1999. 
© 1999 International Medical News Group.

NEW YORK -- Could chronic Lyme disease, fibromyalgia,
chronic fatigue, and Gulf War syndrome all be caused by
persisting bacterial infections?

That question might be answered by an $8 million Department of
Veterans Affairs study of antibiotic therapy for Gulf War
syndrome. 

The study is slated to begin at 30 VA centers this summer.

"It is striking that all four diseases share the same hallmark
symptoms -- fatigue, musculoskeletal pain, and neurocognitive
dysfunction," the study's primary investigator Dr. Sam T. Donta
said at a meeting on the disease sponsored by the Lyme Disease
Foundation and the College of Physicians and Surgeons of
Columbia University. 

"On clinical grounds, there is little basis to separate or distinguish one
disorder from the other," he added.

The study investigators are expected to enroll 450 patients with
Gulf War illness. The patients will be instructed to take 200 mg of
doxycycline in the morning and 100 mg at night for a period of 12
months, said Dr. Donta, a professor of medicine at Boston
University.

At the meeting, many clinicians noted that this is the same regimen
they prescribe for patients with chronic Lyme disease (LD).

The study is ostensibly targeting Mycoplasma fermentans, a tiny
bacteria known for burrowing into cells, but Dr. Donta said that
he wouldn't be surprised if some Gulf War patients are infected
with Borrelia burgdorferi.

Dr. Lauren Krupp, a neurologist at the State University of New
York at Stony Brook, has found that 38 of 45 patients whose LD
symptoms failed to go away after treatment met the clinical criteria
for chronic fatigue syndrome.

"It's clear that post-Lyme overlaps with chronic fatigue," she said
at the conference.

Dr. Donta speculated that the long-term neurologic effects of LD
are largely caused by a newly identified toxin produced by B.
burgdorferi.

Mark J. Cartwright, Ph.D., a microbiologist at Boston University,
reported at the meeting that he and his colleagues have identified a
gene in B. burgdorferi that encodes a 37 kD toxin that appears
to be very similar to botulinum C2 and other cytoskeletal toxins.

"Perhaps it's this toxin, released by dormant bacteria, that causes
the neurophysiologic symptoms of chronic Lyme," he suggested. 

Dr. Cartwright and Dr. Donta have identified a homologous gene
in Treponema pallidum, the spirochete that causes syphilis. They
believe that this gene also encodes a neurotoxin.

Could Infections Be Behind Chronic Lyme Disease?, 
Skin & Allergy News 30(8):13, 1999
http://www.medscape.com/IMNG/SkinAllergyNews/1999/v30.n08/sa3008.13.02.html