Mycoplasma

Does anyone have any info on Mycoplasma infection and thrombocytopenia. I was just listening to a radio show about mycoplasma and lyme disease and heard that mycoplasma travels on platelets and can cause thrombocytopenia.

I'm assuming the thrombocytopenia would be acute and brief during an infection but who knows. Supposedly people can have chronic cases of mycoplasma. It makes me wonder if it could influence chronic thrombocytopenia.


thedrpatshow.com/searchshowsAll.php?search=Mycoplasma&x=0&y=0

It's funny you would mention that. Mycoplasma was a huge area of discussion when I first joined the Forum in 1998. We threw the word around a lot but never did come up with anything. Since that time, I've never read anything to confirm that it's a known cause for ITP or that treating it in any way would cause remission, so for now, there isn't much to the theory.

I remember mycoplasma from a microbiology class I took a few years back. There are some pathogenic species, in particular M. pneumoniaa. From the Wikipedia articles on mycoplasma ( en.wikipedia.org/wiki/Mycoplasma ):

The P1 antigen is the primary virulence factor of mycobacteria. P1 is a membrane associated protein that allows adhesion to epithelial cells. The P1 receptor is also expressed on erythrocytes which can lead to autoantibody agglutination from mycobacteria infection.

A check of PubMed resulted in an article ( www.ncbi.nlm.nih.gov/pubmed/22379296 ) from 2011 with this abstract.

Mycoplasma pneumonia (M. pneumonia) is usually not considered among the several pathogens that induce immune thrombocytopenia (ITP). We report a child with a clinical diagnosis of severe ITP that was associated with M. pneumonia pneumonia, and review the few cases described in the English literature. We suggest that thrombocytopenia associated with M. pneumonia infection may constitute a subset of ITP, although unlike ITP it occurs concomitantly with the infection and tends to be more severe than "classic" ITP. We recommend that prompt specific antibiotic and immune modulating treatment should be initiated in appropriate clinical settings.

So it seems there may be a connection.

Maybe, but bacteria and viruses are often a trigger for ITP. Treating the illness may or may not resolve the ITP. Is this one any different?

I wondered about that issue. Based on that article, the distinction may be that M. pneumonia and thrombocytopenia occur at the same time, with the former seemingly causing the latter. I think the distinction the authors were driving at is between ITP that occurs soon after a viral or bacterial infection (and thus may be induced by it) versus thrombocytopenia that occurs with an infection (and thus is not ITP).

I don't know if anyone with ITP (i.e.: chronic thrombocytopenia with other causes ruled out) would turn out to have a clinically significant but not readily detectable infectious disease process underway. That strikes me as unlikely, but my knowledge is largely gleaned from books, meaning that I know very little about clinical medicine.

It's interesting that mycoplasma attaches itself to platelets to travel. I think that would make it different from other infections, unless that is common among infectious diseases. I don't know. I would assume your immune system would then clear out your platelets to get rid of the infection.

A lyme Dr tested me for mycoplasma pneumonia. It's a very common coinfection to have along with lyme. I had an unusually high level of IGG antibodies. IGG antibodies are believed to represent a past infection. Its a bit odd that the level of antibodies is still so high but I changed Dr's and my new dr didn't think much of the result. The antibiotics to treat it are the same for lyme.

Supposedly everyone has probably come in contact with it. I don't know much about it but I'm always more curious when I hear of a platelet connection. Thanks for your feedback!

Based on that article, the distinction may be that M. pneumonia and thrombocytopenia occur at the same time, with the former seemingly causing the latter. I think the distinction the authors were driving at is between ITP that occurs soon after a viral or bacterial infection (and thus may be induced by it) versus thrombocytopenia that occurs with an infection (and thus is not ITP).

Perfect point. If this is true, it would be acute, transient thrombocytopenia and not ITP.

It's interesting that mycoplasma attaches itself to platelets to travel. I think that would make it different from other infections, unless that is common among infectious diseases. I don't know. I would assume your immune system would then clear out your platelets to get rid of the infection.

This is a good theory. But again goes back to the idea that once the Mycoplasma is treated, the ITP should then resolve.

Interesting!

In 2013, Ellen suffered what turned out to be chemical (aseptic) meningitis on her first and only round of IVIG. She was hospitalized and given intravenous antibiotics as though her meningitis was bacterial, until her cultures came back negative. Her platelets shot up to 290, and then gradually tapered off to below 50, six months later - whereas a full course of IVIG typically gives results lasting 3-4 weeks.

I have often wondered whether that remission was due to the single course of IVIG, or due to the antibiotics suppressing some infection. Mycoplasma pneumoniae could possibly be that infection. How does one find out? Even if she has antibodies, that doesn't mean she has it, right?

Btw, there is some stuff in the literature about M. pneumoniae becoming chronic, so not necessarily acute. It can morph into resistant strains that can linger.

Rob - wondering about what causes counts to stay up one time and not another is the million dollar question. It happens to people often. Some things we will just never know.

You raise a good point about chronic, resistant infection. It is something to question, but you'd think that if this were a recurring theme as far as ITP patients, it would be a well-known causative factor to look for when diagnosing ITP.

I love brainstorming, so if you guys can keep this going.....go for it!

I would not rule out an explanation because it seems too obvious, especially when there is no possibility of drug companies profiting.

It wasn't that long ago that someone came up with the idea that most ulcers are caused by bacteria (H Pylori) and not by too much stomach acid! You would have thought someone would have figured that out much sooner. Only then, when H Pylori began getting treated, did someone observe that eradicating H Pylori could help to treat ITP in some patients.

I'm not ruling it out. There are lists of known possible ITP triggers or primary disorders in which ITP is a symptom. I'm just wondering why Mycoplasma pneumoniae wouldn't have been discovered and added if it were a common, relevant event? Seems simple enough to diagnose. Just asking. I'm not sure that would be something that would be overlooked (but I'm not ruling it out).

As for your second paragraph....I am actually in the middle of putting together a post about that very thing. It's about the need to conform to what has always been believed vs having an open mind and possibly accepting that a new concept is plausible. I probably won't get it on here until tomorrow. I got the idea from a homework assignment that my daughter has going on. It has nothing to do with ITP but has everything to do with making life decisions which can be beneficial when it comes to health issues.

Very interesting. Mycoplasma is huge in my field (swine vet). There are three distinct mycoplasma like species that affect various ages and body locations. Generally a pneumonia like (M. hyopneumonia) leaves pulmonary abscesses that should be detectable via radiograph and a good radiologist.

From Wikipedia:

M. pneumoniae is known to cause a host of symptoms such as primary atypical pneumonia, tracheobronchitis, and upper respiratory tract disease. Primary atypical pneumonia is one of the most severe types of manifestation, with tracheobronchitis being the most common symptom and another 15% of cases, usually adults, remain asymptomatic.[2][13] Symptomatic infections tend to develop over a period of several days and manifestation of pneumonia can be confused with a number of other bacterial pathogens and conditions that cause pneumonia. Tracheobronchitis is most common in children due to a reduced immune system capacity, and up to 18% of infected children require hospitalization.[2] Common mild symptoms include sore throat, wheezing and coughing, fever, headache, coryza, myalgia and feelings of unease, in which symptom intensity and duration can be limited by early treatment with antibiotics. Rarely, M. pneumoniae pneumonia results in death due to lesions and ulceration of the epithelial lining, pulmonary edema, and bronchiolitis obliterans. Extrapulmonary symptoms such as autoimmune responses, central nervous system complications, and dermatological disorders have been associated with M. pneumoniae infections in up to 25% of cases.[2]

Diagnosis
Diagnosis of Mycoplasma pneumoniae infections is complicated by the delayed onset of symptoms and the similarity of symptoms to other pulmonary conditions. Often, M. pneumoniae infections are diagnosed as other conditions ...
... Neither of these methods [of diagnosis], along with others, has been available to medical professionals in a rapid, efficient and inexpensive enough form to be used in routine diagnosis, leading to decreased ability of physicians to diagnose M. pneumoniae infections.

Treatment and prevention:
The difficulty in eradicating Mycoplasma pneumoniae infections is due to the ability of the bacterium to persist within an individual, as well as the lack of cell wall in M. pneumoniae, which renders multiple antibiotics directed at the bacterial cell wall ineffective in treating infections.[2] M. pneumoniae therefore displays resistance to antimicrobials such as [long list of antibiotics that don't work] ... ... antibiotics used to treat M. pneumoniae infections [include] macrolides, tetracycline, ketolides, and fluoroquinolone...

Doing searches on this website for Pneumonia" and "cough" I was surprised by how many cases were subsequent to pneumonia or severe bronchitis, or accompanied by chronic cough or nasal/sinus conditions. There was even one case attributed to the codeine in cough syrup (which was obviously accompanied by severe coughing). ITP caused by M Pneumoniae would fit those scenarios.

Mycoplasma routinely goes undetected, because there are not reliable tests readily available.

The association with CVID could be causative: an impaired immune system would make it difficult to resist or recover from an infection of M. Pneumoniae. This also could be the case with HIV related ITP.

There are numerous known or suspected bacterias and viruses, many of which are not tested during workups for ITP. Who knows what else there is, but I wouldn't be surprised if most non-hereditary ITP be found to be caused by microbes emulating their host and triggering an autoimmunity.

There are numerous cases of IVIG successfully treating M. Pneumoniae.
Coincidence?

Hmmm. Interesting. I have some of those symptoms...chronic sinus problems and chronic cough.

If it can cause arthritis, why not ITP?

www.ncbi.nlm.nih.gov/pubmed/10402069
Rheumatology (Oxford). 1999 Jun;38(6):504-9.
Detection of mycoplasmal infections in blood of patients with rheumatoid arthritis.
Haier J1, Nasralla M, Franco AR, Nicolson GL.

Abstract
OBJECTIVE:
Mycoplasmal infections are associated with several acute and chronic illnesses. Some mycoplasmas can enter a variety of tissues and cells, and cause system-wide or systemic signs and symptoms.
METHODS:

RESULTS:
The Mycoplasma spp. sequence, which is not entirely specific for mycoplasmas, was amplified from the peripheral blood of 15/28 patients (53.6%) and specific PCR products could not be detected in 13 patients (46.4%). Significant differences (P < 0.001) were found between patients and positive healthy controls in the genus test (3/32) and in the specific tests (0/32). Moreover, the incidence of mycoplasmal infections was similar in female and male patients. Using species-specific primers, we were able to detect infections with M. fermentans (8/28), M. pneumoniae (5/28), M. hominis (6/28) and M. penetrans (1/28) in RA patients. In 36% of the patients, we observed more than one Mycoplasma species in the blood leucocytes. All multiple infections occurred as combinations of M. fermentans with other species.
CONCLUSIONS:
The results suggest that a high percentage of RA patients have systemic mycoplasmal infections. Systemic mycoplasmal infections may be an important cofactor in the pathogenesis of RA, and their role needs to be explored further.
PMID: 10402069 [PubMed - indexed for MEDLINE] Free full text

It wasn't that long ago that someone came up with the idea that most ulcers are caused by bacteria (H Pylori) and not by too much stomach acid! You would have thought someone would have figured that out much sooner. Only then, when H Pylori began getting treated, did someone observe that eradicating H Pylori could help to treat ITP in some patients.

That's not the history of H. pylori I learned in a microbiology class I took a few years back. From the Wikipedia article on H. pylori :

Previous to the research of Marshall and Warren, German scientists found spiral-shaped bacteria in the lining of the human stomach in 1875, but they were unable to culture them, and the results were eventually forgotten.[72] The Italian researcher Giulio Bizzozero described similarly shaped bacteria living in the acidic environment of the stomach of dogs in 1893.[95] Professor Walery Jaworski of the Jagiellonian University in Kraków investigated sediments of gastric washings obtained from humans in 1899.

More recent research, mentioned by Robert Sapolsky in his book Why Zebras Don't Get Ulcers, shows that H. pylori is a necessary but not sufficient condition for developing GI ulcers. Stress and other factors seem to play a role.

N.b.: Sapolsky is aware that zebras do in fact get ulcers.

Aoi, you are refining my point, not contradicting it. As you wrote,

"German scientists found spiral-shaped bacteria in the lining of the human stomach in 1875

Of course, that did not influence treatment as antibiotics hadn't been invented. More recently:

"H. pylori was first discovered in the stomachs of patients with gastritis and stomach ulcers in 1982".

It was not until "In 1994, the National Institutes of Health (USA) published an opinion stating most recurrent duodenal and gastric ulcers were caused by H. pylori, and recommended antibiotics be included in the treatment regimen."

Similarly, it was known in 1970 that mycoplasma could cause arthritis:

www.ncbi.nlm.nih.gov/pmc/articles/PMC472220/
Thorax. 1970 Nov; 25(6): 748–750. PMCID: PMC472220
Arthritis and arthralgia in infection with Mycoplasma pneumoniae

More recently it has been found that mycoplasma plays a larger role in arthritis.
Still, testing and/or treatment for mycoplasma is not standard treatment for arthritis sufferers.

Arthritis is much more common than ITP, but in time I expect that many cases of arthritis will be treated with antibiotics, and for ITP a connection will be as accepted as it currently is accepted for other infections.

I'm glad to help refine your point. You did the same for one I'm trying to make: Testing for a pathogen is often difficult, and a good test is frequently developed years after an initial idea about the pathogen is explored. In the same manner, a good treatment for a pathogen often comes much later. So it's wait and possibilities like M. pneuomnia, I suppose.