What are Mycoplasmas?
Mycoplasmas are a large group of bacteria, most of them harmless, but they can also cause significant infection in people. Their primary habitats in humans are the mucous surfaces of the respiratory and urogenital tracts, digestive system, joints, eyes, and mammary glands.
The most common species of Mycoplasma is Mycoplasma pneumoniae, which can result in acute respiratory infection. There are other varieties like Mycoplasma genitalium and Mycoplasma hominis, which are primarily sexually transmitted, and infect the urogenital tracts.
What Symptoms can they Cause?
M.pneumoniae can infect someone’s upper and lower respiratory tracts causing cough, fever, and headache and may persist for several weeks. The bacteria attaches to receptors on the tracheal epithelium and cause oxidative tissue damage and inflammation by releasing free radicals.
Likewise, M.genitalium or M.hominis can exist without symptoms, but if someone has a weakened immune system it can cause problems like pelvic inflammatory disease in women or an inflamed urethra in men.
How prevalent are mycoplasmas in people with Chronic Fatigue/Fibromyalgia?
The prevalence of Mycoplasmas is widely underestimated, as many infected patients usually don’t have symptoms. There are no specific hallmarks, clinically or on x-rays, which means there can be lengthy delays before an accurate diagnosis is made.
There are at least seven studies showing that mycoplasma DNA has been detected in about 50% of several hundred CFS and FMS patients. Researchers also determined that up to 52% of people them were infected with multiple species of Mycoplasmas. In contrast, mycoplasma DNA was found only in about 10% of several hundred healthy, asymptomatic individuals.
Are mycoplasmas causative in CFS/FMS or does CFS/FMS just make people more susceptible to infection?
It is not clear whether mycoplasma infection is associated with CFS/FMS as causative agents, cofactors, or opportunistic infections.
However, there are several studies showing that CFS/FMS can be associated with transient or episodic immune disturbances and therefore, it’s been argued this can increase susceptibility to mycoplasma infection.
Mycoplasmas have been shown to impact the immune system by modulating the activity of white blood cells called macrophages and natural-killer cells by triggering the release of inflammatory cytokines.
The fact that people with CFS/FMS respond well to mycoplasma treatment, suggests that mycoplasmas can play a role in the pathogenesis of these syndromes.
Testing for Mycoplasmas in Australia
For lung infections, a sputum sample, throat swab or flush your nasopharyngeal area can be taken if looking for M.pneumoniae. On the other hand, infections of the urogenital tract will require collection of a urine sample or genital swab, if M.hominis or M.genitalium are suspected. Otherwise, a blood test can be ordered to look for antibodies against mycoplasmas which are less invasive and very easily obtainable.
Mycoplasmas have ways of evading detection from the immune system. Hence, a ‘normal’ antibody test from the laboratory does not necessarily rule out a potential mycoplasma infection.
An infection may also be missed because mycoplasmas do not grow on the standard petri dishes used in laboratories since their nutrient requirements are very specific. Hence, it is difficult for laboratories to test and it usually takes weeks.
Sometimes a polymerase chain reaction (PCR) test may be requested, which is very sensitive and specific to the detection of mycoplasmas and can distinguish between the different mycoplasma species by their DNA products.
Possible Treatment Options for Mycoplasmas
Mycoplasmas lack a rigid cell wall making them tricky to treat. They are naturally resistant to common antibiotics like penicillin which target bacterial cell walls. Therefore, treatment usually involves specific types of antibiotics such as macrolides (e.g. erythromycin) which are used for respiratory tract infections or tetracyclines (doxycycline) which are more commonly used for genital tract infections.
These antibiotics however, can only suppress mycoplasmas by inhibiting their proliferation, not eradicate mycoplasmas. That’s probably why clearing the infection is often slow and patients can relapse.
To overcome this problem, the antibiotic therapy may be required for 6 to 12 months in 6-week cycles, with 2 weeks in between, for optimal patient recovery. In fact, recent evidence suggests that “quinolones” are an exception because they have “killing” abilities. The longer it takes to diagnose the presence of mycoplasma, the more difficult it is to eradicate the infection.
There is also a paucity of studies in vitro investigating certain types of essential oils such as cinnamon bark oil, which showed it could have potent antimicrobial activity against M.hominis and citrus bergamot oil, which had some promising activity against M.pneumoniae. Again, people might need to exercise caution when using these alternative, non-regulated therapies.
Since mycoplasmas tend to cause problems in people with compromised immune systems, it is prudent to implement lifestyle interventions which help support immune health, such as getting plenty of regular sleep, eating minimally processed foods and exercising at least 30 mins each day.