Very Informative Article by Nicolson

[Guest guest]

Don't let the title fool you, Lyme is also discussed in this article.

http://www.immunesupport.com/library/bulletinarticle.cfm?ID=4168

Co-Infections in Fibromyalgia Syndrome, Chronic Fatigue Syndrome &

Other Chronic Illnesses

ImmuneSupport.com

12-18-2002

By Prof. Garth L. Nicolson

The Institute for Molecular Medicine (Website www.immed.org)

15162 Triton Lane, Huntington Beach, CA 92649-1401

This article was published in Fibromyalgia Frontiers (Vol. 10, No. 3,

pp. 5-9 & 27-28, 2002), the official publication of The National

Fibromyalgia Partnership (www.fmpartnership.org).

Fibromyalgia Syndrome (FMS), Chronic Fatigue Syndrome/Myalgic

Encephalomyelitis (CFS) and Gulf War Illnesses (GWI) are

characterized by overlapping chronic signs and symptoms. The

characteristic difference is that FMS patients present with

widespread pain, but this is sometimes seen in CFS/ME and GWI

patients. This is why we originally proposed that GWI is a CFS/ME or

in some patients a FMS- or CFS-like illness [1]. In addition, FMS

patients often have a secondary diagnosis of CFS.

Other chronic illnesses, such as Rheumatoid Arthritis (RA),

Inflammatory Bowel Disease, among others, also show some of the same

signs and symptoms in addition to their obvious differences,

suggesting that there may be some overlap in the underlying causes of

these chronic conditions or at least in the factors that may result

in sickness (morbidity) or illness progression [2].

MICROORGANISMS CAUSE MORBIDITY IN MANY FMS, CFS AND GWI PATIENTS

Although the causes of chronic illnesses are for the most part

unknown, the complex signs and symptoms that evolve in many, perhaps

even a majority of patients, may be due, in part, to systemic chronic

infections (bacteria, viruses, fungi). Such infections can follow

acute or chronic chemical or other insults (viral, environmental,

trauma, etc.) that have the potential to temporarily suppress the

immune system and modify the endocrine system [2]. Chronic illnesses

probably evolve over time as a multi-step process that may require

additional, multiple toxic exposures, including infections that can

be causative for the illness in some patients, cofactors for the

illness (not causative but important to morbidity) in others or

opportunistic in immune-compromised patients.

Chronic infections that are usually held in check by our immune

systems can take hold if they can avoid immune surveillance and

penetrate and hide in various tissues and organs, including cells of

the Central and Peripheral Nervous Systems. When such infections

occur, they can cause many of the complex signs and symptoms seen in

FMS, CFS, RA and GWI, including widespread pain and immune

dysfunction [2]. Changes in environmental responses as (allergies,

chemical sensitivities, etc.) as well as increased titers to various

endogenous viruses that are commonly found to be expressed in these

patients have been seen in FMS, CFS/ME, RA and GWI patients [2, 3].

Chronic infections have been found to be important cofactors in some

illnesses, including HIV-AIDS and other immunodeficiency disorders,

skin diseases and some autoimmune diseases [3]. It is proposed that

autoimmune signs and symptoms are caused when intracellular

pathogens, such as mycoplasmas and other bacteria, escape from

cellular compartments. Such microorganisms can incorporate into their

own structures pieces of host cell membranes that contain important

host membrane antigens that can trigger autoimmune responses, and

they can also produce products that mimic host cell antigen

structures.

Thus, patients with such infections may respond immunologically to

microorganism antigens as well as their own membrane antigens,

producing unusual autoimmune signs and symptoms. When such

microorganisms colonize peripheral nerves, they can induce autoimmune

attacks on nerve cells that cause chronic inflammation and even some

destruction of nerve cells.

BACTERIAL INFECTIONS IN FMS AND OTHER CHRONIC ILLNESSES

Bacterial infections have been commonly found in FMS and other

chronic illness patients [2, 3], and these infections may be

important factors in the illness that require treatment. Although

chronic illness patients like other patients are exposed to various

bacterial pathogens, only certain bacterial species have the capacity

to cause chronic signs and symptoms. As an example, one type of

airborne microorganism that has received renewed interest of late as

an important cause, cofactor or opportunistic infection in these

disorders is represented by various primitive classes of bacteria

[2]. These microorganisms, principally Mycoplasmas and other

primitive bacteria (Chlamydia, iella, Brucella, Borrelia, etc.),

although not as well known as other agents in causing disease, are

now considered important emerging pathogens in various chronic

diseases where a majority of patients show evidence of these

infections in their blood.

In our recent study on CFS and FMS patients, most patients had

multiple bacterial infections, especially if they had been sick for

many years or had severe signs and symptoms [4]. These infections

invade the vascular system and cause coagulation problems, and they

can cause or increase the risk of coronary diseases, such as

endocarditis and myocarditis.

We found that some patients have Borrelia, Brucella or Chlamydia

infections. For example, most patients diagnosed with Borrelia

burgdorferi infections (Lyme Disease) show the same signs and

symptoms as CFS patients and some have FMS-like signs and symptoms.

Although few urban patients have Brucella infections, these are more

commonly found in rural patients. Chlamydia pneumoniae infections

were found in approximately 7% of CFS or FMS patients and one control

subject out of 100 that also did not have other bacterial or viral

infections [5]. This finding is similar but somewhat lower than

previously reported for CFS patients [6].

VIRAL INFECTIONS IN FMS AND OTHER CHRONIC ILLNESSES

Another type of infection that appears to play an important role in

various chronic illnesses is viral in origin. Different types of

viruses have been found in CFS, FMS and various autoimmune diseases.

One of the most common viral infections found in CFS patients is

Human Herpes Virus-6 or HHV-6 [7, 8]. Antibodies against HHV-6 are

routinely found in CFS patients, and most of these patients have the

HHV-6A variant [9]. HHV-6 appears to play a role as a major

contributing factor in several chronic illnesses [7, 8]. Although

several studies have associated HHV-6 with CFS [9-13], there are also

reports that could not find a HHV-6 association with CFS/ME [14, 15].

When we studied CFS or FMS patients we found that approximately 31%

had HHV-6 infections [5].

Others have found even higher percentages of patients with HHV-6

infections [9-12]. In control subjects without evidence of signs or

symptoms we found HHV-6 infections in 9 of 100 subjects. None of

these HHV-6-positive control subjects had other infections [5].

In addition to HHV-6, cytomegalovirus or CMV has been found in

chronic illness patients. CMV-like " stealth virus " has been

identified in CFS/ME patients by isolation and nucleotide sequencing

[16]. Similar viruses have also been found in bipolar patients and

patients with acute encephalopathy [17]. Although the exact role that

this type of virus plays is not known, this class of virus is known

to cause neurological dysfunction, and they can produce molecules

similar to known chemokine or chemical messenger molecules important

in inflammation [18].

MULTIPLE CO- NFECTIONS IN CHRONIC ILLNESSES

Previously we found multiple co-infections of various mycoplasma

species in a majority of North American [4] and European [19] CFS and

FMS patients. This occurred when one of the mycoplasma species was

either M. fermentans or M. hominis. When we examined the incidence of

active HHV-6 infections in mycoplasma-positive and –negative

patients, we found that there was no preference for HHV-6 infections

in mycoplasma-infected patients. For example, we found that the

incidence of HHV-6 in mycoplasma-positive patients was 30.7%, whereas

in mycoplasma-negative patients HHV-6 infections were found in 30.2%

of patients. There was also no preference for particular Mycoplasma

species in HHV-6 co-infections [5]. We also examined the incidence of

C. pneumoniae infections in mycoplasma-positive and –negative

patients and found that there was no preference for multiple

infections, nor was there a preference for particular Mycoplasma

species in C. pneumoniae+mycoplasma co-infections. In mycoplasma-

positive patients C. pneumoniae infections were found in 7.7% of

patients, whereas in mycoplasma-negative patients C. pneumoniae

infections were found in 7.3% of patients. Similarly, in HHV-6-

positive patients C. pneumoniae infections were found in 8.2% of

patients, whereas in HHV-6-negative patients C. pneumoniae infections

were found in 7.2% of patients [5].

Although we expected to find patients infected with different types

of infectious microorganisms, an unexpected finding in our study was

that Mycoplasma species, Chlamydia pneumoniae and HHV-6 infections

were not clustered together in most patients. When we examined the

incidence of Chlamydia pneumoniae or HHV-6 in mycoplasma-positive or –

negative patients, we that clustering of these infections is not more

likely in certain patients. Although patients that had multiple

infections had on the average more severe signs and symptoms, we did

not find differences between the types of infections and signs and

symptoms.

Many of the signs and symptoms of FMS and CFS are relatively non-

specific; therefore, the possibility of unique patient subsets with

different patterns of signs/symptoms based on the types of infections

present is probably unlikely and consistent with our laboratory

results.

FAMILY STUDY SHOWS THAT SOME GWI PATIENTS HAVE A CONTAGIOUS ILLNESS

Veterans of the Gulf War with chronic illnesses (Gulf War Illnesses

or GWI) display multiple signs and symptoms [1]. Upon examination,

the signs and symptoms of GWI were indistinguishable from civilian

patients in the same immediate family diagnosed with CFS or FMS [1],

expect for symptomatic children aged 3-12 who were also diagnosed

with autism [20]. Similar to previous studies on GWI patients [21,

22], we found that 45 of 110 patients or ~42% had mycoplasmal

infections , and almost all of these (37 out of 45 or ~82%) were

single infections [20]. M. fermentans was found in ~85% of these

single infection cases.

When the few multiple species infection cases were examined, most

were found to have combinations of M. fermentans plus either M.

pneumoniae, M. hominis or M. genitalium. In contrast, in healthy

control subjects only 6 of 70 subjects (8.5%) were positive for

mycoplasmal infections, and all of these were single species

infections of various types [20].

In families of Gulf War veterans with GWI there was evidence of

transmission of the illness to immediate family members. In our study

the families were not randomly chosen; they were families in which

one or more veteran members were found to be positive for a

mycoplasmal infection and one or more family members reported

illnesses. We found that 57 out of 107 (53.2%) of these members from

families with one or more Gulf War veteran diagnosed with GWI and

with a positive test for a mycoplasmal infection showed symptoms of

CFS or FMS (and Autism or Attention Deficit Hyperactivity Disorder in

their children) [20].

Among symptomatic family members, most (40 out of 57 or 70.2%) had

mycoplasmal infections compared to the few non-symptomatic family

members who had similar mycoplasmal infections (6 out of 50 or 12%).

When the incidence of mycoplasmal infection(s) was compared within

families, the symptomatic family members were significantly more

likely to have mycoplasmal infections compared to non-symptomatic

family members. Symptomatic children (mostly diagnosed with Autism

and other chronic disorders) in these families were also infected

with mycoplasmas at high incidence, but this was not seen in aged-

matched control subjects.

Although some non-symptomatic family members did have mycoplasmal

infections (6 out of 50 or 12%), this was not significantly different

from the incidence of mycoplasmal infections in control subjects (6

out of 70 or 8.5%) [20]. Some of these control subjects may be

carriers and some may eventually present with CFS/ME or other

illnesses related to mycoplasmal infections.

GWI patients had similar infections to their symptomatic family

members. In 45 mycoplasma-positive symptomatic family members, most

(77.5%) had single species infections, similar to the mycoplasma-

positive Gulf War veterans (82%). Most mycoplasma-positive GWI

patients as well as mycoplasma-positive family members or children

diagnosed with Autism had M. fermentans infections. We did not find

differences in the incidence of infection or type of infections

between males and females, children versus adults or spouses versus

other family members [20].

POSSIBLE SOURCE OF MICROORGANISMS FOUND IN CHRONIC ILLNESS PATIENTS

Most microorganisms are not considered as important human pathogens

when they are found at superficial sites, such as the oral cavity or

gut, but some species, such as certain species of mycoplasma, among

others, have the capacity to penetrate into the blood circulation and

colonize various tissues, and these cell-penetrating microorganisms

have been associated with various human diseases [3].

Similarly, infections such as HHV-6 also penetrate the blood vascular

where they colonize blood vessel endothelial cells. Do such

infectious agents actually cause FMS or other chronic illnesses?

Probably not on their own, but microorganisms like Mycoplasma,

Chlamydia, Brucella, iella and other bacteria and some viruses, in

particular HHV-6 and CMV, appear to be important in causing chronic

illness progression and patient morbidity, exacerbating the major

signs and symptoms seen in patients with chronic illnesses. Our

recent results have shown that the combination of multiple bacterial

and viral infections can be particularly difficult for patients to

overcome.

How do patients contract the bacterial and viral infections found in

FMS? The answer to this is not known, but many patients may already

have these infections in dormant or latent forms, and their

triggering of illness may be associated with a decline in the ability

of the immune system to hold them in check. For example, many chronic

illness patients report prior severe trauma or acute infections

preceded their illness. In these patients, infections may occur by a

variety of routes, including airborne transmission, fluid exchange

(such as blood transfusions), or in contaminated vaccines.

Only rarely are vaccines contaminated, and most vaccinations would

not be expected to cause illness, but in some commercial vaccines

contamination has been documented. For example, some of the more

common contaminants of commercial vaccines are mycoplasmas, found in

approximately 6% of commercial vaccines [23].

In the case of GWI, the multiple vaccines that the Armed Forces

received upon deployment to the Persian Gulf have recently been

associated with GWI. Unwin and colleagues [24] studied British Gulf

War veterans with GWI and found an association with the multiple

vaccines that they received during deployment. In the U.S. there has

been a rash of GWI signs and symptoms in Armed Forces personnel who

recently received the anthrax vaccine. In some cases this has

resulted in chronic illnesses in as many as 7-10% of personnel

receiving the vaccine [25].

The chronic signs and symptoms associated with anthrax vaccination

are very similar to those found in GWI patients, suggesting that at

least some of the chronic illnesses suffered by veterans of the 1991

Gulf War may have been caused by vaccines in combination with other

exposures [25]. The anthrax vaccine, in particular, should not be

used in Armed Forces personnel because of valid questions concerning

its safety and efficacy.

ANTIBIOTIC AND ANTIVIRAL TREATMENTS FOR CHRONIC ILLNESSES

When microorganism infections are identified in blood fractions of

subsets of patients with FMS or other chronic illnesses, these

patients can be treated as medical not psychological or psychiatric

patients, just like any other patients with systemic bacterial

infections. This does not mean that psychological or psychiatric

problems are not important in some chronic illness patients. But if

such infections are important in these disorders, then appropriate

treatments with antibiotics, antivirals or other medications that

suppress chronic infections should result in improvement and even

recovery.

Long-term treatment is required for the types of bacterial infections

found in FMS and other chronic illnesses [26]. Few patients recover

after only a few cycles of therapy, possibly because of the

intracellular locations of the infections and the slow-growing nature

of most of these microorganisms. We now recommend that patients who

have been diagnosed with blood infections receive continuous

antibiotics for at least 6 months before using 6-week cycles of

treatment [24] Although patients starting such therapy usually have

Herxheimer reactions and feel initially worse due to die-off or

release of toxic materials from damaged microorganisms, they

eventually stabilize and then slowly begin to recover. Unfortunately,

the treatment requires long-term therapy and recovery is usually very

slow. Patients that have been sick for many years are unlikely to

recover within a year of therapy. We are also examining oxygen

therapy using hyperbaric oxygen treatment.

The clinical responses seen with antibiotics that are seen are not

due to placebo effects, because administration of some antibiotics,

such as penicillins to patients with mycoplasmal infections, resulted

in patients becoming more not less symptomatic. In addition, they are

not due to immunosuppressive effects of some of the antibiotics,

because other antibiotics that do not cause immune suppression are

also effective but only if they suppress the chronic infections.

Some patients recover to a certain point and then fail to continue to

respond to the recommended antibiotics, suggesting that other

problems, such as viral infections, environmental exposures and other

toxic events also play an important role in these illnesses, and may

even play a predominant role in some patients [27].

Since many patients also have viral (HHV-6, CMV, etc.) infections,

these must also be treated. For severe infections, there are some

antivirals that can help, but most patients do well on immune

enhancement and nutritional supplements (see www.immed.org for

further information).

COMPLEX ROLE OF TOXIC EXPOSURES IN CHRONIC ILLNESSES

Do chronic infections explain illnesses like FMS or CFS? It is

unlikely that there are only one or even a few explanations for

complex chronic illnesses. Rather, these illnesses are probably due

to a combination of multiple toxic exposures, chemical and

biological, in combination with genetic susceptibility (immune

systems and/or detoxification systems) that determines whether a

person becomes chronically ill. These considerations probably also

play an important role in determining who will recover to various

extents on different types of therapy. In addition, recovery can be

complicated by patients' over-dependence on drugs, such as certain

antidepressants or other drugs that can suppress portions of the

immune system.

The treatments of chronic illnesses that are due to toxic exposures

from chemical or radiological agents are quite different from the

treatment of chronic infections [2]. The treatment of chemically

exposed patients usually involves removal of offending chemicals from

the patient's environment, depletion of chemicals from the patient's

system and treatment of the signs and symptoms caused by chemical

exposure(s).

Chemically exposed patients are often extremely sensitive to a

variety of commonly encountered chemicals, including perfumes and air

fresheners, petrochemical fumes, chlorine, cleaning solutions and

solvents, among others. They are also very sensitive to certain

foods, and special diets are often necessary, and in some cases

direct skin contact with certain substances can cause strong

cutaneous reactions. Therefore, an important part of treatment for

chemical exposures requires limiting exposures to a variety of common

chemicals and gradual removal of the toxic chemical [28].

FOR FURTHER INFORMATION

The Institute for Molecular Medicine and its certified reference

diagnostic lab, International Molecular Diagnostics (www.imd-lab.com)

can test patients for evidence of bacterial and viral infections of

the types that are associated with chronic diseases like FMS, CFS,

GWI and RA and autoimmune diseases. The website for further

information is: www.immed.org. Contact:

Prof. Garth L. Nicolson

The Institute for Molecular Medicine (website: www.immed.org)

15162 Triton Lane, Huntington Beach, CA 92649-1401

Tel: 714-903-2900 Fax: 714-379-2082

email: gnicolson@...

References

1. Nicolson GL, Nicolson NL. Chronic fatigue illness and Operation

Desert Storm. J. Occup. Environ. Med. 1996; 38:14-16. [find article

at www.immed.org]

2. Nicolson GL, Nasralla M, Hier J, et al. Mycoplasmal infections in

chronic illnesses: Fibromyalgia and Chronic Fatigue Syndromes, Gulf

War Illness, HIV-AIDS and Rheumatoid Arthritis. Med. Sentinel 1999;

4:172-176. [find article at www.immed.org]

3. Nicolson GL, Nasralla M, Franco AR, De Meirleir K, et al.

Mycoplasmal infections in chronic diseases. J. Chronic Fatigue Syndr.

2000; 6(3/4):23-39. [find article at www.immed.org]

4. Nasralla M, Haier J, Nicolson GL. Multiple mycoplasmal infections

detected in blood of Chronic Fatigue and Fibromyalgia Syndrome

patients. Eur. J. Clin. Microbiol. Infect. Dis. 1999; 18:859-865.

[find article at www.immed.org]

5. Nicolson GL, Nasralla M, De Meirleir K, Gan, Haier J. Evidence for

bacterial (mycoplasma, Chlamydia) and viral (HHV-6) co-infections in

chronic fatigue syndrome patients. J. Chronic Fatigue Syndr. 2002;

10: In press. [find article at www.immed.org]

6. Chia JKS, Chia LY. Chronic Chlamydia pneumoniae infection: a

treatable cause of Chronic Fatigue Syndrome. Clin. Infect. Dis. 1999;

29:452-453.

7. Braun DK, Dominguez G, Pellett PE. Human herpesvirus-6. Clin.

Microbiol. Rev. 1997; 10:521-567.

8. Campadelli-Fiume G, Mirandela P, Menetti L. Human herpesvirus-6:

an emerging pathogen. Emerg. Infect. Dis. 1999; 5:353-366.

9. Patnaik M, Komaroff AL, Conley C, Orjin-Amaine EA, JB.

Prevalence of IgM antibodies to human herpesvirus-6 early antigen in

patients with chronic fatigue syndrome. J. Infect. Dis. 1995;

172:1164-1167.

10. Wagner M, Krueger GRF, Ablashi DV, Whitman JE. Chronic fatigue

syndrome (CFS): a critical evaluation of testing for active human

herpesvirus-6 (HHV-6) infection: a review of data on 107 cases. J.

Chronic Fatigue Syndr. 1996; 5:3-16.

11. Zorsenon M, Colle R, Rukh G et al. Active HHV-6 infection in

Chronic Fatigue Syndrome patients from Italy: new data. J. Chronic

Fatigue Syndr. 1996; 2:103-113.

12. Knox K, Brewer JH, Carrigan DR. Persistent active human

herpesvirus 6 (HHV-6) infections in patients with chronic fatigue

syndrome. J. Chronic Fatigue Syndr. 1999; 6:245-246.

13. Ablashi D, Eastman HB, Owen CB, Roman MM, et al. Frequent HHV-6

reactivation in multiple sclerosis (MS) and chronic fatigue syndrome

(CFS) patients. J. Clin Virol. 2000; 16:179-191.

14. Wallace HL, Natelson B, Gruse W, Hay J. Human herpesviruses in

chronic fatigue syndrome. Clin. Diagn. Lab. Immunol. 1999; 6:216-223.

15. Reeves WC, Stamey FR, Black JB, Mawie AC, JA, Pellett PE.

Human herpesviruses 6 and 7 in chronic fatigue syndrome: a case

control study. Clin. Infect. Dis. 2000; 31:48-52.

16. WJ. Detection of RNA sequences in cultures of a stealth

virus isolated from the cerebrospinal fluid of a health care worker

with chronic fatigue syndrome. Case report. Pathobiology 1997; 65

(1):57-60

17. WJ. Simian cytomegalovirus-related stealth virus isolated

from the cerebrospinal fluid of a patient with bipolar psychosis and

acute encephalopathy. Pathobiology. 1996; 64(2):64-6.

18. Murdoch C, Finn A. Chemokine receptors and their role in

inflammation and infectious diseases. Blood. 2000; 95:3032-43.

19. Nijs J, Nicolson GL, De Becker P, Coomans D, De Meirleir K.

Prevalence of mycoplasmal infections among European chronic fatigue

syndrome patients. . J. Chronic Fatigue Syndr. 2002; 10: In press.

20. Nicolson GL, Nasralla M, Nicolson NL, Haier J. High prevalence of

mycoplasmal infections in symptomatic (Chronic Fatigue Syndrome)

family members of mycoplasma-positive Gulf War Illness patients. J.

Chronic Fatigue Syndr. 10: in press. [find article at www.immed.org]

21. Nicolson GL, Nicolson NL. Diagnosis and treatment of mycoplasmal

infections in Persian Gulf War Illness-CFIDS patients. Intern. J.

Occup. Med. Immunol. Tox. 1996; 5:69-78. [find article at

www.immed.org]

22. Nicolson GL, Nicolson NL, Nasralla M. Mycoplasmal infections and

Chronic Fatigue Illness (Gulf War Illness) associated with deployment

to Operation Desert Storm. Intern. J. Med. 1988; 1:80-92. [find

article at www.immed.org]

23. Thornton D. A survey of mycoplasma detection in vaccines. Vaccine

1986; 4:237-240.

24. Unwin C, Blatchley N, CokerW, et al. Health of UK servicemen who

served in the Persian Gulf War. Lancet 1999; 353:169-178.

25. Nicolson GL, Nass M, Nicolson NL. The anthrax vaccine

controversy. Questions about its efficacy, safety and strategy. Med.

Sentinel 2000; 5:97-101. [find article at www.immed.org]

26. Nicolson GL, Nasralla M, Franco AR, et al. Diagnosis and

Integrative Treatment of Intracellular Bacterial Infections in

Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness,

Rheumatoid Arthritis and other Chronic Illnesses. Clin. Pract. Alt.

Med. 2000; 1(2):92-102. [find article at www.immed.org]

27. Nicolson GL. Considerations when undergoing treatment for chronic

infections found in Chronic Fatigue Syndrome, Fibromyalgia Syndrome

and Gulf War Illnesses. Part 1: Commentary. Part 2: Antibiotics and

General Considerations. Intern. J. Med. 1998; 1:115-117 (Part 1),

1:123-128 (Part 2). [find article at www.immed.org]

28. Rea WJ, Pan Y, AR, Ross GH, et al. Reduction of chemical

sensitivity by means of heat depuration, physical therapy and

nutritional supplementation in a controlled environment. J. Nutrit.

Environ. Med. 1996; 6: 141-148.

For FMS, CFS/ME or RA or other autoimmune disease patients, The

Institute for Molecular Medicine suggests the following lab tests

(codes are IMD or CPT codes). Please note that patients should be off

all antibiotics and immune enhancement products for 4 weeks prior to

testing to insure that the test will not be a false-negative due to

the antibiotic suppression of a blood infection.

1. Test Panel 1007 (CPT: 87798x3, 87581)—Mycoplasma species panel of

4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M. hominis,

M. penetrans) by PCR. Specimen Requirements: one (1) 5 cc Lavender

top Plastic Tube (EDTA). The blood is collected, immediately mixed

and placed on ice, then shipped on wet ice or immediately flash

frozen and shipped with dry ice by courier (foreign shipments) to IMD

to arrive within 24-36 hours.

2. Test 1006 (CPT: 87486)—Chlamydia pneumoniae by PCR. Specimen

Requirements: one (1) 5 cc Lavender top Plastic Tube (EDTA). Specimen

Requirements: one (1) 5 cc Lavender top Plastic Tube (EDTA). The

blood is collected, immediately mixed and placed on ice, then shipped

on wet ice or immediately flash frozen and shipped with dry ice by

courier to IMD to arrive within 24-36 hours.

3. Test 07056 (CPT: 87486)—Brucella species by PCR. Justification:

Specimen Requirements: one (1) 5 cc Lavender top Plastic Tube (EDTA).

Specimen Requirements: one (1) 5 cc Lavender top Plastic Tube (EDTA).

The blood is collected, immediately mixed and placed on ice, then

shipped on wet ice or immediately flash frozen and shipped with dry

ice by courier to IMD to arrive within 24-36 hours.

4. Test 07047 (CPT: 87476)—Borrelia burgdorferi (Lyme Disease) by

PCR. Specimen Requirements: one (1) 5 cc Lavender top Plastic Tube

(EDTA). Specimen Requirements: one (1) 5 cc Lavender top Plastic Tube

(EDTA). The blood is collected, immediately mixed and placed on ice,

then shipped on wet ice or immediately flash frozen and shipped with

dry ice by courier to IMD to arrive within 24-36 hours.

5. Test 07039 (CPT: 87532)—Human herpes virus 6 (HHV-6) test by PCR.

Specimen Requirements: Collect blood in one (1) 5 cc Lavender Top

Plasma Tubes (EDTA), mixed and separate blood plasma by

centrifugation. The plasma is then shipped on wet ice or immediately

flash frozen and shipped with dry ice by courier to IMD to arrive

within 24-36 hours.

6. Test 07034 (CPT: 87496)—Cytomegalovirus (CMV) test by PCR.

Specimen Requirements: Collect blood in one (1) 5 cc Lavender Top

Plasma Tubes (EDTA), mixed and separate blood plasma by

centrifugation. The plasma is then shipped on wet ice or immediately

flash frozen and shipped with dry ice by courier to IMD to arrive

within 24-36 hours.

For best price and highest quality I suggest that the above PCR

specialty tests for FMS/CFS patients be ordered through International

Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington Beach, CA

92649 USA. Tel: 714-799-7177, ext. 202 (Client Services). Order forms

and additional information are available upon request. Tests must be

ordered by a physician. The IMD website is www.imd-lab.com. On this

site you will find additional information about testing and disease.

The Institute for Molecular Medicine website is www.immed.org. On

this site you will find publications and documents on CFS/ME, FMS,

autoimmune diseases and other chronic illnesses. Immediate Fax-back

information is available 24 hours per day by calling our telephone

number 714-903-2900.