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Markers of exposure to spotted fever rickettsiae in patients with chronic illness, including fatigue..., 2008, Unsworth et al

Discussion in 'ME/CFS research' started by Hutan, Aug 2, 2023.

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  1. Hutan

    Hutan Moderator Staff Member

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    Abstract
    Background: Some investigators believe that a proportion of chronically unwell patients, many with fatigue, have an underlying rickettsial disease.

    Aim: To investigate the prevalence of markers of rickettsial infection in patients with chronic illnesses.

    Design: Observational study.

    Methods: A 526 patient cohort with chronic illnesses from Melbourne, Australia and 400 control patients from Newcastle, Australia were assessed using serology, culture and PCR for the detection of rickettsiae. Rickettsial serology was performed on another cohort of 581 chronically unwell patients (and 34 non-fatigued patients from the same practice) from Adelaide, Australia.

    Results: Of the Melbourne patient cohort, 14/526 (3%) were real-time PCR positive for rickettsial DNA compared to none of the 400 control patients (P < 0.001). Of these 14 patients, Rickettsia honei strain ‘marmionii’ was detected in 5 and isolated from 2. Rickettsaemia was seasonal, with more in winter (8/145; P < 0.03) and less in spring (0/143; P < 0.03). Positive rickettsial serology titres of ⩾1:256 were seen in 206 (39%) patients. Of the Adelaide patient cohort, 238/581 (41%) had positive rickettsial antibodies titres. Of the 34 control sera, 5 (15%) were serologically positive (P < 0.002). Both Melbourne and Adelaide patient cohorts had significantly higher seropositivity than the Newcastle control cohort (3/399; P < 0.0001).

    Conclusions: In patients with chronic illness, rickettsial DNA in peripheral blood and/or rickettsial seropositivity may represent exposure to rickettsiae or underlying rickettsial diseases. It is not known whether the presence of rickettsiae is causally related to the patients’ chronic illnesses, or reactivation of a latent rickettsial infection.

    https://academic.oup.com/qjmed/article/101/4/269/1545064
    N. Unsworth, S. Graves, C. Nguyen, G. Kemp, J. Graham, J. Stenos
     
    Hutan, Aug 2, 2023
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  2. Hutan

    Hutan Moderator Staff Member

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    I've posted about this old paper before, but I think the detail must have been on Phoenix Rising.

    I wasn't in this study, but I have tested positive to rickettsias.

     
    Hutan, Aug 2, 2023
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  3. Hutan

    Hutan Moderator Staff Member

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    It's a not a perfect study. The chronically unwell cohorts were not well characterised, and neither were the controls.


    There was thinking about t-cell activation from latent infections back then:
    So, only 5 of the 14 people who had rickettsia DNA in their blood were recorded as positive to rickettsia antigens using the standard test.
     
    Hutan, Aug 2, 2023
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  4. duncan

    duncan Senior Member (Voting Rights)

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    Supposedly Willy Burgdorfer was convinced that what was making all those people get and stay sick back in the late 70's was Rickettsial. No one is really clear on why he changed his mind suddenly to a Borrelia spirochete since he found both in virtually all the same samples from sick individuals.

    Of course, testing eventually demonstrated Lyme was due to a spirochete.

    I still wonder why they aren't testing for Rickettsia to see if a pathogen tandem is involved in generating severity and chronicity, but oh well.
     
    duncan, Aug 2, 2023
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  5. Hutan

    Hutan Moderator Staff Member

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    I find the lack of followup on this result odd.

    One of the authors is Professor Stephen Graves who runs the Australian Rickettsial Reference Laboratory which I think is a mainstream legit lab, mostly focussed on Q fever. Professor Graves was kind when I contacted him after getting the positive rickettsia result early in my illness, although was not able to help further.
     
    Hutan, Aug 2, 2023
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  6. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    COMMENTARY: IS THERE A SCIENTIFIC BASIS FOR TREATING PATIENTS WITH CHRONIC FATIGUE SYNDROME WITH PROLONGED COURSES OF DOXYCYCLINE?
    CommDisBull 10(2)-May final2012.pdf (nicd.ac.za)

    might contain info of interest.

    (another 'treatment' I tried early on (although it involved two types of anti-biotics), due to articles about rickettsia and also chlamydia pneumoniae being implicated in ME.)

    *****
    This can be discussed more on the     Antibiotics thread
     
    Last edited by a moderator: Aug 7, 2023
    Sly Saint, Aug 2, 2023
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  7. duncan

    duncan Senior Member (Voting Rights)

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    They should be able to tell us. They should have all rickettsial diseases well-characterized by now. They should have unquestionable yes-or-no diagnostics available anywhere any time Rickettsia falls into a differential diagnosis.

    You can replace "Rickettsia" with any number of infections: Herpes, Borrelia, Bartonella, Babesia, just off the top of my head.

    The state of Medical acumen is blunted, maybe beyond repair in my lifetime. It's a bleak joke.
     
    duncan, Aug 2, 2023
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  8. Art Vandelay

    Art Vandelay Senior Member (Voting Rights)

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    One of the authors, John Graham, was a specialist physician who continued to help people with ME/CFS after he retired. I never saw him but exchanged emails with him on occasion. He unfortunately suffered from significant health issues that stopped him seeing patients quite some time ago.

    On the basis of this hypothesis, I was tested for rickettsia at Graves' lab. My test was negative but a later test for Borrelia at the same lab was positive (IgM). I believe Graves has earned the ire of many whose illness began after a tick bite by marking all positive tests for Borrelia as "false positive" as he claims that Borrelia doesn't exist in Australia.
     
    Last edited: Aug 3, 2023
    Art Vandelay, Aug 3, 2023
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  9. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    Totally agree @duncan

    It is shocking that patients and their doctors fly blind about these infections still. And likely will do for the foreseeable. A few brave doctors have stuck with clinical diagnoses, variable quality of tests and my reaction to various medications with success, but it should not be this lottery, nor should so many patients remain so ill with few, if any, treatment options. Profoundly sad place to find ourselves in 2023 :grumpy:
     
    Joan Crawford, Aug 3, 2023
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