infection with Chlamydophila pneumoniae
in Multiple Sclerosis
After much controversy there is now powerful evidence for the respiratory pathogenChlamydophila (Chlamydia) pneumoniae being a causal factor in some variants of the neurological illness multiple sclerosis. A series of remarkable studies finds:
• the presence of C. pneumoniae gene sequences in the cerebrospinal fluid of patients who have the disease, and culture of the organism when sensitive cultural methods are used [Sriram S, Stratton CW, Yao S, Tharp A, Ding L, Bannan JD, Mitchell WM. Chlamydia pneumoniae infection of the central nervous system in multiple sclerosis. Ann Neurol. 1999 Jul;46(1):6-14.]
• MRI improvement, with reduction of the number of Gd-enhancing lesions, in a second treatment study with minocycline [Metz LM, Zhang Y, Yeung M, Patry DG, Bell RB, Stoian CA, et al. Minocycline reduces gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol. 2004 May;55(5):756.]
• An association of C. pneumoniae in the CNS with MS is demonstrated by immunohistochemical, molecular and ultrastructural methods. [Sriram S, Ljunggren-Rose A, Yao SY, Whetsell WO Jr. Detection of chlamydial bodies and antigens in the central nervous system of patients with multiple sclerosis. J Infect Dis. 2005;192(7):1219-28.]
The evidence for a causal association of C. pneumoniae with majority subsets of MS has been garnered by a surprisingly diverse array of methods; cultural, molecular (both DNA and RNA based), immunohistological, serological (blood and CSF based), animal model, ultrastructural and therapeutic trial. It is this very diversity of methodology which makes the evidence compelling. The subject has recently been reviewed in some detail by Chuck Stratton and myself [Stratton CW, Wheldon DB. Multiple sclerosis: an infectious syndrome involving Chlamydophila pneumoniae. Trends Microbiol. 2006 Nov;14(11):474-9.]
The results of antichlamydial treatment have been very promising, particularly in early disease.
It should be stressed at the outset that this bacterium is not sexually transmitted. It causes respiratory infection and is spread by droplet infection — coughing and sneezing.
Sarah, my wife, an artist of considerable ability, was given a diagnosis of MS in July 2003. Her illness in fact stretched back to 1989, when she experienced a sudden weakness of the right arm. After a fortnight she recovered its function completely. A few years later she experienced a slight greying of vision in one eye; this resolved over a few weeks. Occasional relapses followed, all with a complete recovery. In 1999 the remissions started to become less complete. Right foot-drop began insidiously and did not resolve. Then, in 2001, shortly after a prolonged upper respiratory infection which led to mild new-onset asthma, Sarah began to enter a new, rapidly progressive stage of the illness. Within two years she was unable able to stand unaided, had to hold furniture, was unable to hold or use a pencil or paint-brush with her right hand, and she felt giddy. She said that she seemed to live in a mental fog: indeed, in the evenings she would fall into a half-sleep from which she obtained no rest. Her speech was becoming slurred. There was a continual sense of flickering and worsening neurological deficit. She suffered tinnitus, hearing the continual sound of distant machinery. She developed L'hermitte's sign, manifested as an electric-shock-like pain down the back on bending the head forward and signifying damage to the cervical spinal cord.
An MRI scan showed many typical active lesions, visible as variably-sized bead-like hyperintensities in the white matter of the brain. The neurologist told Sarah that she had Multiple Sclerosis; the disease had entered a secondary progressive phase for which there was no treatment, and that the illness must be expected to take its course.
I’m much more interventional than he — this goes with the territory of my being a medical microbiologist — and I recommended the following oral antichlamydial regimen:
doxycycline 200mg once daily
roxithromycin 300mg once daily (azithromycin 250mg three days a week is an alternative.)
Short courses of metronidazole will later be added to this regimen.
We started the doxycycline first, as it was immediately available. The results were astonishing. For five days she suffered a worsening of her symptoms; this was accompanied by a flu-like illness, with headache round the eyes, pains in the large joints (hips and shoulders) and night-sweats. This is a typical Herxheimer-like reaction; it is caused when a large bacterial load is broken up by antibiotics or other agents. After five days she lost the mental fog: indeed, she said she felt clearer than for two years. The roxithromycin was added three weeks later, when it became available.
This information has been made available at Sarah's request. It has to be said that, despite all the research which has been published in the scientific literature, the existence — let alone the therapeutics — of chronic infection with C. pneumoniae is barely understood by the medical community.