Pathogenic Mycoplasma Infections in Chronic Illnesses: General Considerations in Selecting Conventional and Integrative Treatments
According to Dr. Nicolson, 80% of Lyme/MSIDS patients also have Mycoplasma.
CFS/ME patients according to PCR have various mycoplasmas.
Pathogenic mycoplasmas can evade immune recognition and destruction by undergoing rapid surface antigenic variations  . Even with their slow intracellular growth rates, by rapidly altering their cell surface antigenic structures as well as modulating host immune responses, pathogenic mycoplasmas can evade host surveillance mechanisms  . This helps explain the chronic nature of mycoplasmal infections and the inability of hosts to completely suppress pathogenic mycoplasmal infections via host responses that are effective against other more rapidly growing bacteria .
The most common fatiguing illness is chronic fatigue syndrome (CFS) or myalgic encephalomyelitis. This is an unexplained, long-term, persistent illness characterized by disabling fatigue plus additional signs and symptoms  . Most if not all patients with CFS show evidence of chronic viral and bacterial infections (reviewed in   ). In fact, the odds ratio for the presence of chronic infections was calculated to be 18.0 (p < 0.001), suggesting that CFS patients have a very high probability of multiple chronic infections . The most commonly found infections (by PCR of blood monocytes) were various pathogenic species of mycoplasmas  . M. pneumoniae was the most common mycoplasma species found, followed by M. fermentans, M. hominis, and M. penetrans .
In many cases mycoplasmal infections are not the definitive infection that defines the condition. An example of this is chronic Lyme disease, a complex clinical condition with Borrelia species as the prominent infectious agent but with other bacterial, parasite, and viral components as co-infections    . Pathogenic mycoplasmal co-infections are important in such multiple infection diseases, being present in up to 80% of chronic Lyme diseases cases  .
The conventional antimicrobial treatments of pathogenic mycoplasmal infections usually involve systemic therapy with oral antibiotics, but the choice of antibiotic(s) depends to a certain degree on the mycoplasma species being treated. Since mycoplasmas do not have a cell wall, antibiotics that act on cell wall synthesis are ineffective        . Instead, mycoplasmas are treated with anti-microbials that attack their metabolism, replication, synthetic machinery or other specific bacterial targets. Since most mycoplasmas and ureaplasmas are generally sensitive to tetracyclines (doxycycline, minocycline, among others), with some notable exceptions, these should be considered for frontline treatment, and quinolones (ciprofloxacin, sparfloxacin, levofloxacin, ofloxacin, among others)     , as alternative treatment. However, M. pneumoniae and M. genitalium strains are especially sensitive to macrolides (azithromycin, clarithromycin, erythromycin, among others), whereas M. hominis strains are usually resistant   . Ureaplasmas are moderately susceptible to macrolides  . M. hominis and Ureaplasma urealyticum are generally more resistant to tetracyclines than other species   , and M. hominis strains have been observed to be resistant to quinolones . Some discussion of these antimicrobials and their uses in treating pathogenic mycoplasmal infections in chronic illnesses can be found in   .
Treatment of pathogenic mycoplasma infections with oral antibiotics generally involves daily or pulsed treatment, such as every-other-day administration, at the maximum dose recommended for a particular antibiotic    . Due to the cyclic nature of mycoplasmal proliferation some organizations recommend every-other-day antibiotic regimens .
Another important consideration is antibiotic resistance, which can occur during treatment  . A major problem has been the shifting minimum inhibitory dose concentrations required to treat mycoplasmal infections with antibiotics, such as treatment of M. genitalium infections with oral tetracyclines . This requires increasing dose levels or shifting to a different antibiotic regimen .
When antibiotics are used to treat pathogenic mycoplasmal infections, Jarisch-Herxheimer reactions (J-H reactions) usually occur  . These are observed as temporary increases in the severity of signs and symptoms, and J-H reactions generally involve fevers, chills, muscle aches, fatigue, skin rashes, pain and other signs and symptoms related to cytokine release .
There are some alternative procedures that can increase the in vivo effectiveness of antimicrobial therapies. One method that has been used to increase the effectiveness of antibiotics has been the use of agents that increase the penetrability or the intracellular activities or effectiveness of antibiotics or other drugs. For example, the anti-malarial drug Plaquenil (hydroxychloroquine) has been used to alkalize intracellular compartments and improve antimicrobial entry and cytotoxic effects   .
https://madisonarealymesupportgroup.com/2017/07/14/clinical-association-lyme-disease-and-guillain-barre/Epstein-Barr, also known as Mono, is an infection that triggers Guillain-Barre as well as mycoplasma and cytomegalovirus. http://www.webmd.com/brain/tc/guillain-barre-syndrome-topic-overview#1