Date:   1/5/2003 8:19:25 PM ( 22 y ago)
Hits:   3,144
URL:   https://www.curezone.org/forums/fm.asp?i=129566

Hello everybody, I don't know if this was ever posted in this forum, it is from two years ago and I will post it also in the Chronic-Fatigue-Syndrome forum.

Blessings and well being to all.
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New parasite Discovered
In Some Chronic-Fatigue-Syndrome Patients


CFS Radio Program 1-16-00

Host: Roger G. Mazlen, M. D. Guest Dr. Larry Klapow, PhD


Dr. Mazlen To kick off the new millennium with a good show that you'll find
of great interest and great importance, I'm talking today with Dr. Larry
Klapow, a Ph. D. in Invertebrate Biology who's in Burlingame, California
near
San Francisco. Good morning Larry, welcome to our show.

Dr. Klapow Good morning, Roger, I'm glad to be here.

Dr. Mazlen Can you tell our audience something about the this suspected new
parasite that you've found in a percentage of patients with Chronic Fatigue
Syndrome? How'd you find it?

Dr. Klapow Well, Roger, it came about as a result of a conversation I was
having with an immunologist friend of mine, Dr. Vincent Marinkovich, here in
Redwood City, California. He was treating a Chronic-Fatigue-Syndrome patient we thought might
have a roundworm infection. The patient had a low grade eosinophilia and
some unusual rashes on the torso that suggested the possibility of
threadworm disease. Antibody tests and stool tests were negative. I thought
about this for a while and I know that some chronic parasites migrate
between the digestive tract and the respiratory tract and some of them are
coughed up in sputum. So I looked at the sputum and that's where I found it.
I called the new parasite "Cryptostrongylus pulmoni", that's a provisional
name and it means "the hidden lung worm".

Dr. Mazlen That's pretty appropriate in terms of what you say.

Dr. Klapow It definitely is, Roger. It's very difficult to find. And I hope
other people will start looking for it. In fact, I've put together some
material that I think can help them.

Dr. Mazlen You recently completed a small blinded study in cooperation with
a small number of CFS doctors including Dr. Anthony Komaroff in Harvard.
You're now doing a larger blinded trial and you're also trying to develop a
clinical test for the parasite. But for these other investigators and
clinicians, can you tell us what does the parasite look like and how can
they find it?

Dr. Klapow You can identify the parasite, the female by its mouth parts and
the male by its very intricate reproductive structure. This parasite is very
small. The female is less than a millimeter long and the male is about a
third that length. So, in addition to being small there's also a lot of
difficulties. The specimens I usually pick up are naturally expelled in
sputum and they're usually very decayed and rare and because of this you
need very specialized imaging techniques to find them. They're not expensive
techniques, they're just specialized. In any case I wanted to help people
look for this parasite and so I put together a website which describes how
to find it in great detail. It also includes anatomical drawings. I can give
you the website address if you like.

Dr. Mazlen Yes, give us the address right now, that'll be great.


Dr. Klapow OK, I'll give you my own email address and then I can post the
other rather longer address for people who contact me. My email address is
lak123@gateway.net.

Dr. Mazlen Now, this is really important because this introduces a whole new
dimension about Chronic Fatigue Syndrome and its possible relationship to
roundworm infestation. Can you tell us so far, at least, as you've been
looking, what percentages of Chronic Fatigue Syndrome patients are turning
out to be positive for this worm?

Dr. Klapow Yes, I find the parasites in about 40% of three-day sputum
samples from CFS patients. However, I have to tell you that yields are very
low. In fact, they're so low that I think I'm probably missing as many
positive patients as I'm finding. The problem here is that over 80% of the
positives I get are represented by only one identifiable specimen. So just
by chance it looks like I'm missing a fairly high percentage.

Dr. Mazlen So, the prevalence can be a lot higher and this, of course, stirs
some very great interest in terms of causation and etiology which we'll go
into later. Can you tell us anything about the blinded trials so far?

Dr. Klapow Yes, I did a small blinded trial in cooperation with a number of
doctors including Dr. Anthony Komaroff at Harvard and here are the results.
I think they're interesting but you judge for yourself. 5 of the 11 patients
were positive while all 6 controls were negative. Now, it's a small trial
but if you were trying to do as well by guessing, say by just tossing a
coin, you'd only do as well as I report here in about 1 in a 100 tests, so
it's a very hard thing to do by just guessing. The results of this small
trial can be used to devise an experimental design for a large trial that
could give a statistically significant result and going through that
exercise suggests that between 50 and 80 samples will be needed. Now, it may
take some time to process these samples microscopically. It's now taking me
somewhere between 50 and 100 hours to find a single positive patient so I
think the progress will be slow, that is unless we can get something more
rapid going in the form of a PCR test.

Dr. Mazlen Well, I certainly congratulate you though for the effort that
you're making because this is totally important to patients for their
prognosis and recovery ultimately. There's a lot more to learn and, of
course, we're going to go into that and you mentioned the PCR test and that
you have some arrangements whereby this can be developed and hopefully
you'll get some funding to help this along soon. If anybody in the audience
is interested in helping in this regard they can reach me at rgm1@aol.com
which is my email address and I'll forward it on to Dr. Klapow. Larry where
do you think these parasites might be coming from?

Dr. Klapow Well, Roger, they have some specialized anatomical structures
that suggest that they're related to parasites of animals that live in the
jungles of Southeast Asia. In fact, there's been somewhat of a history of
hard to diagnose parasites coming out of that area and being brought back to
"Western" countries after periods of warfare. It happened in the Victorian
era when French soldiers were returning from this area and brought back the
chronic parasite Strongyloides stercoralis to Europe where it was first
diagnosed in 1894. It also happened again in World War II. This time British
soldiers became infected while they were imprisoned in Burma returned to
England and 30 years later, in 1974 they were diagnosed with chronic
parasites they had gotten while they were in prison. It's kind of a
testament to how difficult some of these parasites are to find and treat. I
would like to look at people who've been to Southeast Asia and I think I
plan to do that as soon as I finish with the large trial I'm doing on CFS
patients now.

Dr. Mazlen It's a natural sequitur because you're going to be having a
chance to look at all of the veterans of the Viet Nam era who either served
in Viet Nam or Cambodia or neighboring areas.

Dr. Klapow That will happen, I think, rather quickly if I can get the PCR
test going.

Dr. Mazlen You say it might be coming from this source and that's a
possibility. How is it contracted? How do you get it then?

Dr. Klapow I'm really not sure. What I can tell you is this. I've never seen
a fresh transmissible stage of the parasite in any sputum sample I've seen
so far. I've done a couple of hundred samples at this point. So I don't
think there's any evidence right now of casual transmission. But roundworm
parasites are typically acquired by eating contaminated food, but an
outbreak of Cryptostrongylus infection, if it were transmitted in this way,
would look very different then a typical food poisoning incident where
people get sick within a couple of hours after eating.

Dr. Mazlen That's due to the long latency that you mentioned.

Dr. Klapow Cryptostrongylus is very small but it produces a larvae which is
very large so there's an implication here that it must be reproducing very
slowly and possibly has a very long latency time. Of course, we know that
the outbreak of Chronic Fatigue Syndrome usually take place over several
months and in some cases a couple of years and that I think would be
consistent with the possibility of a food borne infection with a very long
latency period.

Dr. Mazlen Well, now we're going to turn to the clinical side. Most of the
time that doctors are looking for parasitosis, they look to see elevated
eosinophil and serum IgE, or immunoglobulin E, levels in patients. Isn't
this usually the case?

Dr. Klapow Yes, but that's the first question that I get from doctors when I
tell them that I found what I think is a new species of roundworm parasite.
Where's the elevated IgE? And the answer is elevated IgE is mainly apparent
in acute roundworm infections. With time, the chronic parasites are able to
suppress the IgE response and many of them produce a clinical picture where
the patients either have normal or lower than the normal average level of
IgE and, in fact, that's the picture you see in CFS and in all the studies
I've reviewed, IgE is lower in CFS patients than in healthy control
populations.

Dr. Mazlen Here I want to interject that I'm part of the new study looking
into C. pulmoni in CFS patients and one of the things that prompted me to
call you and talk to you about getting involved is the fact that I had been
seeing low IgE levels, low eosinophile counts in patients that I thought
were inappropriate.

Dr. Klapow In fact, there was a paper that's a few years old in the Journal
of Chronic Fatigue Syndrome that indicates that if you correlate IgE and
eosinophil levels with the number of symptoms the patients report, the
sicker they are the lower the IgE and eosinophil counts and that's a
statistically significant relationship.

Dr. Mazlen And I see it and it seems to be borne out. Now, what do you think
is suppressing IgE in this CFS or Chronic Fatigue Syndrome patients? What's
the mechanism?

Dr. Klapow Well, I think the mechanism may involve the cell marker CD23
which suppresses IgE. There are a couple of other things that activate CD23,
the IgE suppresser and those are active herpes viruses and some of the TH1
cytokines, particularly interferon-gamma and the 2'-5'A, the activator of
the latent RNase enzyme. Both herpes viruses and 2'-5'A, as you know, are
highly elevated in CFS patients. In fact, it looks like some roundworms may
be using chronic viruses as cofactors to help perpetuate their own survival.

Dr. Mazlen That certainly rings true from what I've seen clinically and that
leads us to another question. If a lot of Chronic Fatigue Syndrome patients
have allergies, they should have elevated IgE levels but a lot of them, as
we were just saying, don't. It seems to fit the model you propose of a
suppresser.

Dr. Klapow Yes, there are some doctors, in fact, that think allergy is a
risk factor for getting a roundworm infection and that's because patients
who tend to produce too much IgE to non-specific stimuli, harmless things,
may not have enough reserves left over to fight off the parasites so they
get a foothold, and in fact, initially, you can even see patients who report
increased allergies, but later on when they're diagnosed with CFS and the
presumptive parasite, if we may go so far and speculate, has suppressed
their IgE response and the values come out clinically low.

Dr. Mazlen Now, this brings us to a leading question, which, obviously is a
speculation, but that's all right because that's what this show is about. We
want to raise issues and have other people contribute to answering them as
well. There seem to be many infectious agents that have been proposed as
being possible etiological agents for Chronic Fatigue Syndrome. None of them
have held up specifically as a single causative agent. What do you think
about this roundworm infection, c. pulmoni, is it a primary infection or is
it just another opportunistic organism?

Dr. Klapow Well, I don't know if it's a primary cause of CFS. We'll just
have to have to go through the rules of Koch's postulates and see how far we
can get. I think it's an interesting candidate for a possible primary agent.
I don't think it's an opportunistic infection. Opportunistic infections are
usually airborne and are present everywhere. They're just waiting for our
immune systems to be weakened before they establish a chronic infection.
Cryptostrongylus doesn't seem to be ubiquitous. If I'm right about the
taxonomy, it looks like it's coming out of a particular geographic area.
They're are also a number of things that I think can connect roundworm
infection to the major physiological systems that malfunction in CFS. And
they have to do with the wide variety of physiologically active agents
roundworms are able to secrete.

Dr. Mazlen We're going back now and talking about the hormones that these
roundworms secrete, namely vasoactive intestinal polypeptide, which is known
as VIP, and hippocampal cholinergic neurostimulatory peptide which is known
as HCNP, and what they do and Larry, what do these hormones cause? What do
they do?

Dr. Klapow Well, VIP is involved in regulating blood pressure and blood
flow. It's important in regulating blood flow to the brain. It's believed to
be implicated in orthostatic intolerance from which a number of CFS patients
suffer. And, it also controls hypothalmic CRH, a hormone that's ultimately
responsible for the level of cortisol in the blood which is suppressed in
CFS and it's also suppressed in chronic roundworm infections. And the other
one, HCNP, is a limbic system neuropeptide and it's believed to be involved
in memory and immune function. When it goes wrong in areas that have
Alzheimer's lesions, there are cognitive symptoms. In fact, some doctors
have suggested that CFS looks in some respects like a reversible form of
Alzheimer's.

Dr. Mazlen It seems like that sometimes.

Dr. Klapow Well, the bad news is that it bares any resemblance to that
disease. *What good news there is, is that the cognitive symptoms come and
go, without apparently doing permanent damage. I think it is a reasonable
hope that increasingly effective treatments for CFS will be found in time to
substantially help most of those who now suffer from this difficult and
often misunderstood disease.

*Added to transcript by Dr. Klapow after the show.

Transcribed by

Carolyn Viviani carolynv@inx.net

Permission is given to repost, copy and distribute this transcript as long
as my name is not removed from it.

© 2000 Roger G. Mazlen, M. D.


 

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