Abstract
Autism patients have systemic bacterial, viral and fungal infections that may play an important part in their illnesses. We found that immediate family members of veterans diagnosed with Gulf War Illnesses (GWI) often complain of fatigue and other problems, and upon analysis they report similar signs and symptoms as their veteran family members, except that their children are often diagnosed with Autism. Since a relatively common finding in GWI patients is a bacterial infection due to Mycoplasma fermentans, we examined military families (149 patients: 42 veterans, 40 spouses, 32 other relatives and 35 children with at least one family complaint of illness) selected from a group of 110 veterans with GWI who tested positive (~42%) for mycoplasmal infections. Consistent with previous results, over 80% of GWI patients who were positive for blood mycoplasmal infections had only one Mycoplasma species, M. fermentans. In healthy control subjects the incidence of any mycoplasmal infection was ~8.5% and none were found to have multiple mycoplasmal species (P<0.001). In 107 family members of mycoplasma-positive GWI patients there were 57 patients (53%) that had essentially the same signs and symptoms as the veterans and were diagnosed with Chronic Fatigue Syndrome (CFS/ME) and/or Fibromyalgia Syndrome. The majority of children (n=35) in this group were diagnosed with Autism. Most of these CFS or Autism patients also had mycoplasmal infections compared to the few non-symptomatic family members (P<0.001), and the most common species found was M. fermentans. In contrast, in the few non-symptomatic family members that tested mycoplasma-positive, the Mycoplasma species were usually different from the species found in the GWI patients. The results suggest that a subset of GWI patients have mycoplasmal infections, and these infections can be transmitted to immediate family members who subsequently display similar signs and symptoms, except for their children who are often diagnosed with Autism. In a separate study in Central California we examined a group of Autism patients and also found a high incidence of mycoplasmal infections, but in contrast to the military families a variety of Mycoplasma species were detected.
Keywords: Autism, fatiguing illnesses, mycoplasmal infections
1. Introduction
Children with Autism generally suffer from an inability to properly communicate, form relationships with others and respond appropriately to their environment. Autism patients do not all share the same signs and symptoms but tend to share certain social, communication, motor and sensory problems that affect their behavior in predictable ways. These children often display repetitive actions and develop troublesome fixations with specific objects, and they are often painfully sensitive to certain sounds, tastes and smells [1]. These signs and symptoms are thought to be due to abnormalities in brain function or structure. In some patients there are also a number of other less specific chronic signs and symptoms. Among these are fatigue, headaches, gastrointestinal and vision problems and occasional intermittent low-grade fevers and other signs and symptoms that are generally excluded in the diagnosis of Autism.
Autism causes are unknown and may include genetic defects, heavy metal, chemical and biological exposures, among others, and are probably different in each patient. However, among Autism patients there may be similarities in genetic defects and environmental exposures [2, 3] that are important in patient morbidity (sickness) or in illness progression. Other chronic illnesses have some of the same chronic signs and symptoms, suggesting that there may be some overlap in the underlying causes of these conditions or at least in the factors that cause illness or morbidity or illness progression.
The signs and symptoms in many, perhaps even a majority, of chronic illness patients may be due, in part, to systemic chronic infections (bacteria, viruses, fungi) that can penetrate into the central nervous system (CNS). Such infections often follow acute or chronic heavy metal, chemical, biological (viral, bacterial, fungal infections) exposures or environmental insults or even multiple vaccines that have the potential to suppress the immune system and leave children susceptible to opportunistic infections [2-5]. These illnesses generally evolve slowly over time in a multi-step process that may require genetic susceptibility along with multiple toxic exposures.
Chronic infections may be an important element in the development of Autism. Such infections are usually held in check by immune surveillance, but they can take hold and become a problem if they can avoid host immunity and penetrate and hide in various tissues and organs, including cells of the CNS and peripheral nervous system. When such infections occur, they may cause many of the complex signs and symptoms seen in various chronic illnesses [5, 6]. Changes in environmental responses and increased titers to various endogenous viruses as well as bacterial and fungal infections have been commonly seen in chronic illnesses [5, 6].
One type of airborne infection that has received renewed interest of late as an important cause, cofactor or opportunistic infection in various chronic illnesses is represented by relatively primitive intracellular bacteria. These bacteria, principally Mycoplasma, Chlamydia, Coxiella, Brucella, Borrelia, etc. are not as well known as other agents in causing disease but are now considered important emerging pathogens in various chronic diseases. In fact, a majority of patients with various chronic illnesses show evidence of these infections in their blood [5, 6].
Autism patients often show their first signs and symptoms after multiple childhood immunizations [2]. Rimland [2] noted that the sharp rise in Autism rates only occurred after the multiple vaccine MMR came into widespread use. In the U.S. children typically receive as many as 33 vaccines, a dramatic increase in the use of childhood vaccines over the last few decades. Such vaccines often contain mercury and other preservatives [3]. Commercial vaccines have also been examined for contaminating microorganisms, and one study found that approximately 6% of commercial vaccines were contaminated with Mycoplasmas [6]. Thus we examined the extent of mycoplasmal infections in patients with Autism. We were aided in this examination by data that we collected on families of Gulf War veterans where there was a high incidence of Autism in their children [8].
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4. Discussion
The data presented here and elsewhere [8] document that the chronic infections found in Gulf War veterans with GWI can be found in symptomatic family members, including their children with Autism. Because of the size of this cohort, we cannot extrapolate our results to the entire GWI patient population or their family members [8]. First, our patient sample was not randomly selected. The presence of a positive mycoplasma test result on a veteran with GWI who reported illness in his/her immediate family formed the criteria for inclusion in the study. Although chronic illnesses in immediate family members were commonly seen in our study, which examined families of mycoplasma-positive GWI patients, these illnesses are expected to be more difficult to find in the general GWI population where chemical, radiological and environmental exposures probably account for the majority of cases [17]. Second, GWI patients and their family members were recruited from veterans groups, word of mouth, physician referrals and the Institute for Molecular Medicine website (www.immed.org); they were not recruited from specific military units. Although some of these patients were examined by physicians at our associated clinics, most were seen by their own private physicians. Fourth, the validity of PCR techniques for Mycoplasma species detection has been questioned. In our studies, however, the sensitivity and specificity of the PCR method for Mycoplasma species detection were determined by examining serial dilutions of purified DNA from M. fermentans, M. pneumoniae, M. hominis and M. genitalium or the microorganisms themselves in blood samples. The primers produced the expected amplification product size in all test species, which was confirmed by hybridization using the appropriate 32P-labeled internal probe. Amounts as low as a few fg of purified DNA were detectable for all species with the specific internal probes. There was no cross-reactivity between the internal probes of one species and the PCR product from another species [12].
Symptomatic family members of GWI patients were diagnosed with CSF or a related fatiguing illness, Fibromyalgia Syndrome (FMS), but their symptomatic children were usually diagnosed with Autism or ADHD [8]. At least 50-60% of CFS and/or FMS patients are positive for mycoplasmal infections [5, 6, 9, 12-16]. However, in contrast to mycoplasma-positive GWI patients and their mycoplasma-positive family members diagnosed with CFS/ME or Autism, several species of mycoplasmas in addition to M. fermentans were found in CSF/ME and FMS patients from non-military families [12-16]. Similarly, we also found various species of mycoplasma in children diagnosed with Autism from Central California.
There could be different sources of the mycoplasmal infections found in GWI patients [17]. An important possible source for the mycoplasmal infections found in GWI patients is the multiple vaccines that were administered during the time of deployment to the Persian Gulf. A strong association has been found between GWI and the multiple vaccines that were administered during deployment [18-20]. Steele [20] found a three-fold increased incidence of GWI in non-deployed veterans who had been vaccinated in preparation for deployment, compared to non-deployed, non-vaccinated veterans, and Mahan et al. [21] found a two-times higher incidence of GWI signs and symptoms in veterans who recalled receiving anthrax vaccinations versus those who thought they had not. Although the mycoplasmal infections found in GWI patients could have come from several sources, including offensive Biological Warfare attacks [22], we consider the most likely source of the mycoplasmal infections in GWI patients was the multiple vaccines administered during deployment [17]. Indeed, the signs and symptoms that have developed in Armed Forces personnel who recently received the anthrax vaccine are similar to those found in GWI patients. On some military bases this has resulted in chronic illnesses in as many as 7-10% of personnel receiving the vaccine [23]. Undetectable microorganism contaminants in vaccines could have resulted in illness, and this may have been more likely in individuals with compromised immune systems caused by chemical and other exposures [17]. Similarly, the onset of Autism in children from civilian families is also associated with multiple vaccines [2]. Mycoplasmal infections could have originated from the vaccines or from opportunistic infections in immune suppressed children.
Contamination with mycoplasmas has been found in commercial vaccines. In one study 6% of commercial vaccines were found to be contaminated with mycoplasmas [7]. Thus the vaccines used in the Gulf War should be considered as a possible source of the chronic infections found in mycoplasma-positive GWI patients and by airborne transmission in their mycoplasma-positive, CFS-symptomatic family members. And the appearance of mycoplasmal infections in children diagnosed with Autism from civilian families may eventually be linked to the multiple vaccines received during childhood either as a source or from opportunistic infections in immune suppressed recipients of multiple vaccines.
