Stealth Infections: What are they and could they be causing your illness?

Stealth infections are microbial or viral pathogens that cause chronic illness. They employ strategies to evade the immune system and/or alter the immune response in order to survive within the body, whilst triggering inflammation and disease. Emerging research is linking these pathogens to a range of chronic illness, including chronic fatigue, fibromyalgia, neurological disorders, and behavioural disorders.

Gut Issues and Stealth Pathogens

The blood-brain barrier plays an important role in protecting the brain from microbial invasion (Spindler & Hsu, 2012).  Some stealth pathogens, such as Borrelia spp., can cross the blood brain barrier and enter the brain (Pulzova & Bhide, 2009). However, generally the blood-brain-barrier ensures microbes are unable to colonise the brain (Braniste, et. al., 2014). Sometimes an opportunity arises where pathogens can enter the brain. This opportunity often occurs when a leaky blood-brain-barrier develops due to alterations to the gut microbiota (Braniste, et. al., 2014). Essentially you develop a ‘leaky gut’ that then causes a ‘leaky brain’. This is one of the reasons it is common to see a history of gut issues in people with stealth pathogens. The problem is once the blood-brain-barrier becomes leaky, microbial invasion occurs alongside toxins and immune cells that drives inflammation. This neuro-inflammation, or an inflamed-brain, sets off a range of symptoms across a number of different systems of the body.

Types of Stealth Pathogens

There’s a variety of bacterial and viral pathogens that may be considered stealth infections. The following are some commonly identified that can cause chronic disease.

Tick-Borne Infections

Ticks can transmit a range of infections and it’s common that more than one pathogen can be transmitted in a single tick bite. In Australia, the incidence of tick-related medical problems is largely unknown (Graves & Stenos, 2017). Lyme disease, or lyme-like illness, is a contentious issue in Australia. Currently the medical model fails to acknowledge an endemic disease caused by Borrelia burgdorferi – the common species causing the North American and European Lyme disease. However, there have been ticks identified with other types of Borrelia and other types of tick-borne infections are acknowledged to cause disease (Graves & Stenos, 2017). This includes Rickettsia group.,Coxiella burnetti, Babesia duncani, Bartonella henselae, Anaplasma and Ehrlichia species, which have all been identified in Australian ticks (Graves & Stenos, 2017). In my own clinical practice, I have seen a range of these infections and in recent years commonly seen Rickettsia group infections frequently detected.

Common symptoms associated with tick-borne illness include:

  • Fatigue
  • Cognitive impairment
  • Burning and/or tingling in hands and feet
  • Headaches
  • Dizziness
  • Fever
  • Sweats
  • Muscle fatigue
  • Joint pain
  • Rash
  • Swollen lymph nodes

Symptoms can initially present with a bullseye rash, but in many cases this isn’t present. It is also common to experience flu-like symptoms in the acute infection phase, but again this is not always present.

If you do suspect a tick-borne infection, identifying the type of infections involved is important for developing the correct treatment approach. There are a number of labs within Australia and internationally that are useful for diagnosing tick-borne infections. Choosing the appropriate test can be confusing and expensive, so it is best to review with a practitioner that can guide on the most appropriate types of tests for the presenting symptoms.

Mycoplasma

Mycoplasma are a unique type of stealth bacteria and is known to be the smallest free-living pathogen on the planet. Twenty-nine species of Mycoplasma are known to infect humans. Mycoplasma are difficult to culture within laboratories, so can be commonly missed on investigations. Mycoplasma has the ability to live within host cells, without killing the cell, and are then able to evade the immune system Morris et. al., 2016).. They are unlikely to cause disease unless the immune system is under stress. Evidence has linked Mycoplasmainfection with a range of health issues including:

  • Pneumonia
  • Urinary tract infections
  • Eye conditions
  • Sudden hearing loss and tinnitus
  • Heart issues
  • Neurological issues
  • Rheumatoid arthritis

Research has demonstrated that patients with chronic fatigue syndrome and/or fibromyalgia commonly had Mycoplasma spp. detected and those with multiple species of Mycoplasma had generally longer history of illness (Nasralia et. al., 1999; Morris et. al., 2016). Mycoplasma has also been indicated in Amyotrophic Lateral Sclerosis (ALS), an adult-onset, neurodegenerative disease that causes a gradual and progressive weakening and paralysis of muscles due to the destruction of motor neurons (Nicolson, G.L., 2008).

Viruses

There’s a number of virus that can act as stealth pathogens. It is not uncommon for a person with lowered immunity to be affected by a combination of bacterial and viral pathogens (Morris et. al., 2016). Common viruses that exhibit sophisticated immune evading strategies include, Herpes Simplex, Epstein-Barr (EVB), Cytomegalovirus, and Parvovirus B12 (Morris et. al., 2016). EBV causes infectious mononucleosis, more commonly known as glandular fever. However, a post-viral syndrome, called Chronic Activated Epstein-Barr Virus Syndrome (CAEBV) can occur, with symptoms that include:

  • Chronic or intermittent fever
  • Lymph node tenderness or pain
  • Unrelenting severe fatigue
  • Sore throat
  • Muscle pain/fatigue
  • Headaches
  • Joint pain

(Morris et. al., 2016).

PANDAS / PANS

Paediatric autoimmune neuropsychiatric disorders associated with streptococcus infections (PANDAS) is a rare presenting autoimmune condition in children that develops due to exposure of Streptococcusspp. bacteria, commonly developing from an untreated sore throat (Sigra & Hesselmark, 2018). PANDAS develops when the immune system attacks part of the brain as it attempts to target the Streptococcal infection. This commonly results in a range of neurological and emotional issues, including obsessive compulsive disorder. It typically is a sudden onset and involves some of the following symptoms:

  • Anxiety
  • Emotional lability and/or depression
  • Irritability
  • Oppositional behaviour
  • Behavioural regression
  • Deterioration in school performance
  • Sensory or motor abnormalities
  • Nervous tics
  • Loss of attention
  • Constant blinking of the eyes         (Sigra & Hesselmark, 2018)

In some circumstances another stealth pathogen may be involved, rather than strep. This is commonly referred to as paediatric acute-onset neuropsychiatric syndrome or PANS.

Management

Identifying the types of pathogens involved is an important part of managing illnesses associated stealth infections. Choosing the right investigations is essential for lowering the risk of receiving false-negative results. Identifying the type of microorganisms involved assists the development of herbal protocols that can clear pathogen load. Most patients affected by stealth pathogens have poor gut-immunity. Therefore, it’s essential to provide foundational support to both the gut and immune systems for long-term recovery. It’s common to see symptom relapse after ‘successful’ protocols that focus purely on killing bacteria, without foundation support. If you are interested in screening for stealth infections or would like to discuss, please call or book an appointment online.

 

REFERENCES

Spindler, K. & Hsu, T., 2012, Viral Disruption of the Blood-Brain Barrier. Trends Microbiology, 20(6), pp282-290.

Pulzova, L., Bhide, M. & Andrej, K., 2009. Pathogen translocation across the blood-brain barrier. FEMS Immunology & Medical Microbiology, 57(3), pp203-213.

Braniste et al., 2014. The gut microbiota influences blood-brain barrier permeability in mice.Science Translation Medicine, 6(263).

Graves, S. & Stenos, J., 2017. Tick-borne infectious diseases in Australia.Medical Journal of Australia, 206(7), pp320-324.

Nasralia, M., Haler, J., & Nicolson, G.L., 1999. Multiple mycoplasmal infections detected in blood of patients with chronic fatigue and/or fibromyalgia syndrome. European Journal of Clinical Microbiology, 18(12), pp. 859-65.

Morris, G., Berk, M., Walder, K., & Maes, M., 2016. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability. Molecular Microbiology, 53, pp. 2550-2

Nicolson, G.L., 2008. Chronic Bacterial and Viral Infections in Neurodegenerative and Neurobehavioral Diseases. Lab Medicine, 39(5), pp. 291-299.

Sigra, S. & Hesselmark, H., 2018. Treatment of PANDAS and PANS: a systemic review. Neuroscience & Biobehavioral Reviews, 86(2018), pp51-65.