Autoimmune neurological diseases: role of chronic infections in morbidity and progression

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Lyme Disease Diagnosis & Therapy Suggestions 2006 ACAM Meeting
DIAGNOSIS AND THERAPY OF CHRONIC SYSTEMIC CO-
INFECTIONS IN LYME DISEASE AND OTHER TICK-BORNE
INFECTIOUS DISEASES
The Institute for Molecular Medicine (Website www.immed.org) 16371 Gothard Street H, Huntington Beach, CA 92647 The diagnosis of Lyme Disease should be based on clinical and laboratory data as well as the likelihood of
exposure to the Lyme spirochete. Most Lyme Disease patients have multiple co-infections. In addition to the
Lyme spirochete (Borrelia burgdorferi), the majority of Lyme patients are also infected with tick-borne
mycoplasma, rickettsia and/or protozoa. There are a number of considerations when undergoing therapy for
multiple infections found in chronic illnesses, including whether to use traditional as well as integrative
nutraceutical approaches. These are discussed in the following sections, including antibiotic/antiprotozoan
therapies and dietary supplements.
_________________________________________________________________________________________
Lyme Disease is the most common tick-borne disease in North America and has been reported in 48 U.S. states
and in Eastern Canada. Found in Old Lyme, CT in 1975, the infection is caused by a tick bite and the entry into
the skin approximately 24 hours later of the spiral-shaped spriochete Borrelia burgdorferi [1] and other co-
infections. Borrelia and its co-infections can be carried into new habitats by a variety of ticks, such as the deer
tick, black-legged tick and bear tick, and their vectors, such as rodents, birds and other animals. After its
incubation for a few days to a month, the Borrelia spriochete and also its co-infections migrate through the skin
and into the lymph and blood where it can disseminate to near and distant sites in the host [2]. Transplacental
transmission of Borrelia (and its co-infections) can occur in pregnant animals, including humans, and blood-
borne transmission by blood transfusion is likely but unproven. The tick-borne co-infections can and usually do
appear at the same time and may also be introduced by tick bites. These will be discussed in this brief review of
Lyme Disease diagnosis and treatment.
DIAGNOSIS OF TICK-BORNE CO-INFECTIONS: BORRELIA, MYCOPLASMA, BABESIA AND OTHERS
About one-third of Lyme Disease cases start with the appearance of a round, red, bulls-eye skin rash called
erythema migrans at the site of the tick bite, usually within 3-30 days [2]. Within days to weeks after the entry of
the Borrelia spirochete from the tick mild flu-like symptoms can occur that include shaking chills, intermittent
fevers and local lymph node swelling (local disease). After this localized phase that lasts weeks to months, the
infection can spread to other sites (disseminated disease), and patients then show malaise, fatigue, fever and
chills, headaches, stiff neck, facial nerve palsies (Bell’s palsy) and muscle and joint pain and other signs and
symptoms. Later this disseminated disease can become persistent or chronic and involve the central and
peripheral nervous systems as well as ophthlamic, cardiac, musculoskeletal and internal organ invasion. At this
late persistent phase chronic arthritis, neurologic impairment with memory and cognitive loss, cardiac problems
(mycocarditis, endocarditis causing palpitations, pain, bradycardia, etc.) and severe fatigue are often apparent
[2-4]. Unfortunately, the signs and symptoms in the late persistent phase of the disease usually overlap with
other chronic conditions, such as Chronic Fatigue Syndrome, Fibromyalgia Syndrome, Rheumatoid Arthritis,
among others [5], causing confusion in the diagnosis and treatment of the late persistent phase in Lyme
Disease patients. Some contend that the late persistent phase is not even related to Lyme Disease, resulting in
failure to successfully identify and treat the chronic condition. The involvement of co-infections, such as
Mycoplasma species, among other co-infections, in causing chronic signs and symptoms in patients has not
been investigated; however, such infections on their own have been shown to produce similar signs and
symptoms [6].
As is the case for many chronic illnesses, diagnostic laboratory testing at various clinical stages is,

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unfortunately, not full-proof, and experts often stress the need to diagnose Lyme Disease with a checklist of
signs and symptoms and potential exposures, along with multiple laboratory tests [2,7]. The laboratory tests
used for Lyme Disease diagnosis include: detection of Borrelia surface antigens by enzyme-linked
immunosorbant assay (ELISA), immunofluorescent assay (IFA), and Western blot of Borrelia proteins.
Alternatively, polymerase chain reaction (PCR) for Borrelia DNA has been used to detect the intact organism in
blood. A true-positive test result usually consists of more than one positive test from the above list. The
problem with these tests is that they are blood tests requiring the presence of antibodies or Borrelia proteins in
the blood or are dependent on the spirochete and thus its DNA being present in the blood. Some of the tests,
such as serology testing for antibodies against Borrelia antigens, can cross-react with other microorganisms and
in some cases are only useful 4-6 weeks after onset of signs and symptoms; thus the quality of the test can
vary. The most sensitive type of test (PCR) requires that the spirochete be released into the blood where its
DNA can be detected. Other tests that are offered have been criticized. For example, diagnosis of Lyme
Disease based on culture of B. burgdorferi is unreliable and is not recommended [7]. One laboratory offers a
one-step Lyme antigen urine test (LUAT), but some researchers have criticized this test for its high rate of false-
positive tests [8]. Most consider a patient positive if Borrelia antigens (more than one antigen by Western Blot
analysis) are present in blood serum in more than one test, or the patient is PCR-positive for Borrelia b. in a
blood test.

There are other co-infections that complicate the diagnosis and signs and symptoms of Lyme Disease. These
infections can also occur by themselves or in various combinations. For example, another tick-borne infection is
caused by the intracellular protozoan Babesia, first described in domestic animals in Romania [9]. There are
over 100 species of the genus Babesia, but most infections in humans in the United States are caused by
Babesia microti and in Europe by Babesia divergens and Babesia bovis. This type of infection can occur as a
co-infection with Borrelia (about 20-30% of cases of Lyme Disease have Borrelia plus Babesia infections).
When both infections are present, the number of signs and symptoms, their severity and duration of illness can
be greater in the early stages of disease [9], including high fever, chills, generalized weakness, gastrointestinal
symptoms (anorexia, nausea, abdominal pain, vomiting, diarrhea, among others), anemia, muscle and joint
pain, respiratory problems and dark urine. This combination can be lethal in some patients (about 7% of
patients can have disseminated intravascular coagulation, acute respiratory distress syndrome and heart
failure), but the majority of patients with Babesia have the chronic persistent form of the infection. In Babesia
infections patients can show mild to severe hemolytic anemia (probably correlating with the protozoan
colonization of erythrocytes, which can be seen by experienced individuals in blood smears) and a normal to
slightly depressed leukocyte count [9]. However, this is usually not seen in patients who have progressed to the
chronic phase of the disease.
We have found that the most common co-infection with Borrelia are various species of Mycoplasmas.
Approximately 60-70% of Lyme Disease patients also have mycoplasmal infections (Mycoplasma fermentans >
Mycoplasma hominis > Mycoplasma pneumoniae, M. genitalium, M. penetrans, other species). In some cases
multiple mycoplasmal infections can be present in Lyme Disease patients. The presence of mycoplasmal
infections complicates the diagnosis and treatment of Lyme Disease, and some of the generalized signs and
symptoms found in Borrelia-positive patients are also found in mycoplasma-positive patients [5,6]. Like the
Borrelia spirochete, the mycoplasmas are found at intracellular locations in various tissues and are only rarely
found free in the blood. This can make detection difficult, and in some patients the appearance of Borrelia and
various mycoplasmas in their blood cells can be cyclic, and they are not present all of the time. We recommend
that mycoplasmal infections be tested for in every case of Lyme Disease using the most sensitive PCR
procedures to detect the mycoplasma DNA in white blood cells [5,6,10]. Mycoplasmal infections can
independently cause many of the signs and symptoms found in Lyme Disease, and they generally exacerbate
the clinical signs and symptoms and complicate treatment of the condition [10]. In addition to Lyme Disease,
mycoplasmal infections have been found at high incidence (40-60%) in Fibromyalgia Syndrome, Chronic
Fatigue Syndrome, Rheumatoid Arthritis and Gulf War Ilness [5,6.10]. These are emerging infections, and the
medical community is just beginning to respect the involvement of this type of co-infection in many clinical
conditions.

Another co-infection found in some Lyme Disease patients is a rickettsial infection caused by Ehrlichia species
[2,3]. These small, gram-negative, pleomorphic, obligate intracellular infections are similar to Mycoplasmas in
their structures, intracellular locations and resulting patient signs and symptoms. Commonly found species are
E. chaffeensis and E. phagocytophila, and these microorganisms can cause signs and symptoms within 1-3

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weeks of exposure, resulting in fever, shaking chills, headache and muscle pain and tenderness and less
commonly nausea, vomiting, abdominal pain, diarrhea, cough and confusion [3]. Laboratory features include
mild to moderate transient hemolytic anemia, decreases in white blood cell count (leucopenia,
thrombocytopenia) and elevated erythrocyte sedimentation rate, and sometimes increases in liver enzymes and
less often increases in blood urea nitrogen and creatinine. Serology is usually only positive after 1-2 weeks with
the limitations discussed above. Since culturing the microorganism is not practical, PCR has been used for
confirmation of the infection [3].
Lyme Disease patients are at risk for a variety of other opportunistic infections, including other bacterial
infections as well as viral and fungal infections. These can complicate diagnosis and treatment, but they may be
principally a problem in the late, persistent phase of the disease. Late stage patients with neurological
manifestations, meningitis, encephalitis, peripheral neuropathy and other signs and symptoms may have
complicated co-infections that are not recognized or treated by their physicians.
TREATMENT OF LYME DISEASE BORRELIA AND CO-INFECTIONS

If their physician recognizes the complex nature of their disease, patients with Borrelia infections or
combinations of Borrelia and Mycoplasma, Babesia, Bartonela and/or Ehrlichia infections can do well on
combinations of antibiotics plus nutritional modifications and nutraceutical support. Experts agree that Lyme
Disease is much easier to treat in the earlier phases, but some of the co-infections can be difficult to treat,
especially if the disease is in the late chronic persistent stage. The most common recommendations for the
treatment of Lyme Disease Borrelia and co-infections involve antibiotics that can effectively suppress early
localized or early disseminated Lyme disease Borrelia [2-4]. A variety of antibiotics in 2-week regimens show
good activity against early-stage Borrelia infections, such as combinations of doxycycline plus amoxicillin,
doxycycline plus penicillin V and amoxicillin or pencillin V plus cefuroxime axetil, in that order, in terms of
effectiveness and expense [2,11], although some reports indicate that the latter antibiotics are just as effective
as the doxycycline combinations [12,13]. Also, doxycycline also shows good activity against most species of
Mycoplasma and Ehrlichia, and doxycycline shows good penetration into the central nervous system (CNS).
Doxycycline should not be used in children under the age of 8 years, but some have suggested that short
duration treatment (2 weeks) at pediatric doses are very useful [11]. Alternatives include the use of
erythromycin, but most experts do not consider this a first line treatment for Lyme Borrelia [2,11].
A major problem in the treatment of Lyme Disease is finding effective treatments of the late stage persistent or
chronic disease, especially when they involve CNS infections. The table below (Table 1) shows the antibiotics
useful for treating Lyme Disease based on the clinical situation [11,12].
Table 1. Treatment of Lyme Disease During the Different Stages of the Disease (refs. 11, 12)
Clinical
Early localized
Early disseminated
Late disseminated

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Since with time late stage Borrelia infections are intracellular with cystic or persistent forms, Plaquenil, Falgyl or
Tinidazole should be added along with a macrolide (azithromycin, Biaxin or Dynabac) and/or fluoroquinolones
(ciprofloxacin, gatifloxacin, levofloxacin, ofloxacin). With antibiotic treatment, Herxheimer reactions (or ‘die-off’
reactions involving chills, fever, night sweats, muscle aches, joint pain, short term memory loss and fatigue or a
general worsening of symptoms) usually occur for days to weeks due to release of bacterial cell wall
degradation products and stimulation of interleukins or chemical messengers that cause worsening of some
signs and symptoms. Oral antibiotics must be taken with a full glass of water, crackers or bread to avoid
esophageal irritation (do not lie down for at least 1 hr). With some antibiotics direct sunlight must be avoided.
To overcome Herxheimer reactions or other adverse responses i.v. antibiotics have been used for a few
weeks—then oral. Oral Benadryl (diphenhydramine, 50 mg) should be taken at least 30 min before antibiotics,
and lemon/olive drink (1 blended whole lemon, 1 cup fruit juice, 1 tbs olive oil—strain and drink liquid) is often
useful [15]. This period usually passes within a few weeks and differs from allergic reactions that can cause
immediate rashes, itching, swelling, dizziness, trouble breathing and other problems—if these occur, seek
immediate medical attention. Many antibiotics cannot be used during pregnancy or by infants. For Lyme
Disease the dosing for pediatric use has been worked out [2].
ANTIBIOTIC THERAPY FOR CO-INFECTIONS OF BORRELIA, MYCOPLASMA, BABESIA AND OTHERS,

Patients with co-infections of Borrelia plus Mycoplasma species the therapy should be the same as in Table 1
(with doxycycline) but the duration of therapy must be increased. The reason for this is that the slow-growing
mycoplasmal infections are not readily susceptible to antibiotics, and thus the therapy must be more gradual
[6,14]. Some patients with mycoplasma co-infections may benefit from combinations of antibiotics other than
those listed in the table, such as adding additionally azithromycin or a floxacin, especially if there are limited
responses [14]. These can be worked into the regimen slowly over weeks, if necessary. The protocol for
infections involving Borrelia plus Mycoplasma species should be continued for at least 6 months. If necessary,
the antibiotics can be continued for 6-week on, 2-week off cycles, which in some cases can be supplemented
with Augmentin (in between the 6-wk cycles) or concurrently, if needed, to help in suppressing other secondary
bacterial infections.
When Babesia infections are present as co-infections with Borrelia, patients can be treated with quinine
(Quinamm) and clindamycin (cleocin) [9]. For co-infections with Mycoplasma or Ehrlichia species doxycycline
should be added to the antibiotic regimen [3]. Dr. Richard Horowitz has presented a scheme for treating co-
infections in Lyme Disease [16], and I have added a section on Mycoplasma/Ehrlichia co-infections (Table 2). If
in addition to Mycoplasmal infections Chlamydia pneumoniae is present, then two penetrating antibiotics active
against these microorganisms should be considered, such as doxycycline plus a fluoroquinolone (levofloxacin,
ofloxacin or gatifloxacin).
GENERAL NUTRITIONAL CONSIDERATIONS WHEN UNDERGOING THERAPY

Chronic illness patients are often immunosuppressed and susceptible to opportunistic infections, so proper
nutrition is imperative [15]. You should not smoke or drink alcohol or caffeinated products. Drink as much fresh
fluids as you can, lots of juices or pure water are best. Try to avoid high sugar and fat foods, such as military
(MRE) or other fast foods and acid forming, allergen-prone and system stressing foods or high sugar/fat junk
foods. Increase intake of fresh vegetables, fruits and grains, and decrease intake of fats and simple or refined
sugars that can suppress your immune system. To build your immune system cruciferous vegetables, soluble
fiber foods, such as prunes and bran, wheat germ, yogurt, fish and whole grains are useful. In some patients
exclusive use of 'organic' foods has been beneficial. For heavy metal removal we find the use of Detoxamin
suppositories useful (www.detoxamin.com). For help with bowel bacteria and bladder infections, many
recommend D-mannose (Biotech). This natural sugar inhibits binding of bacteria to biological membranes.
Chronic illness patients are often depleted in vitamins (especially B complex, C, E, CoQ-10) and certain
minerals. These illnesses often result in poor absorption. Therefore, high doses of some vitamins are useful;
others, such as vitamin B complex, cannot be easily absorbed by the gut (oral dose). Sublingual (under the
tongue) natural B-complex vitamins in capsules or liquids (also injectable) (Total B, Real Life Research or GNC
or www.vitaninshoppe.com) should be used instead of swallowed capsules. B complex vitamins are especially
important in Borrelia and Mycoplasma infected patients. General vitamins plus extra C, E, CoQ-10, beta-

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carotene, folic acid, bioflavoids and biotin are best. L-cysteine, L-tyrosine, L-glutamine, L-carnitine, malic acid
and especially flaxseed or fish oils are reported to be useful. Certain minerals are depleted in chronic illness
patients, such as zinc, magnesium, chromium and selenium. Some recommend up to 300 mcg/day sodium
selenite, followed by lower doses. Extra vitamins and minerals are very important if patients are removing
heavy metals with chelating agents. Vitamins and minerals should not be taken at the same time of day (3 hr
difference) as antibiotics or antivirals (or oxygen therapy), because they can affect absorption. Some
recommend that antioxidant vitamins be taken at least 2 hr before or after antibiotic therapy. The suggested
doses of vitamins can vary dramatically among patients; consult with your physician or nutritionist for
appropriate dosage. [Researched Nutritionals, 800-755-3402 carries a
400mg CoQ 10]
Table 2. Combination Treatments for Lyme Borrelia Plus Co-Infections (Horowitz, ref. 16)

Lyme Borrelia

OXIDATIVE THERAPY FOR CHRONIC LYME DISEASE CO-INFECTIONS

Borrelia and Mycoplasma species infections are intracellular infections and should be considered borderline
anaerobic infections that grow and survive better in low oxygen environments. Oxidative therapy can be useful
in suppressing a variety of anaerobic infections, but this approach should be considered experimental and
should only be done in an approved clinical trial. We recommend several weeks to months of Hyperbaric
Oxygen (1.5-2.0 ATM, 60 min) treatments, because these are well tolerated by most patients with chronic
infections. Alternatively, American Biologics Dioxychlor, i.v. ozone or hydrogen peroxide might be useful. Some
patients have used peroxide baths with 2 cups of Epsom salt in a hot bath or Jacuzzi. After 5 min, add 2-4
bottles 16 oz. of 3% hydrogen peroxide. Repeat 2-3X week; but no vitamins must be taken 4 hr before the bath.
The hydrogen peroxide is added after your pores open. This appears to have some benefit to patients,
especially those with skin/muscle problems. Hydrogen peroxide can also be directly applied to skin after a
work-out or hot shower/tub. Leave hydrogen peroxide on for 5 min, and then wash off. For oral irrigation, mix 1
part 3% hydrogen peroxide with 2 parts water and use like a mouth wash 3X per day. Most chronic illness
patients have periodontal problems, and oral infections and bone cavitation infections are common. These
should not be ignored, because they can become systemic and spread to other sites.

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REPLACEMENT OF GUT FLORA
Patients undergoing treatment with antibiotics and other substances risk destruction of normal gut flora.
Antibiotic use that depletes normal gut bacteria and can result in over-growth of less desirable bacteria. To
supplement bacteria in the gastrointestinal system yogurt and especially live cultures of Lactobacillus
acidophilus in capsules or powder are strongly recommended. Mixtures of Lactobacillus acidophillus, L. bifidus,
B. bifidum, L. bulgaricus and FOS (fructoologosaccharides) to promote growth of these probiotics in the gut
(example, DDS-1, NutraCeuticals, DDS-Plusor Multi-Flora ABF, UAS Labs, www.uaslabs.com Intestinal Care-
DF. L. acidophillus mixtures (above 2.5-3 billion live organisms) should be taken 3X per day. For irritable
bowel, the soil based probiotic, Prescript-Assist [distributed by Researched Nutritionals] has proven to be very
effective in clinical trials. In addition, to improve digestion and especially absorption enzyme mixtures have
proved useful. The best known of these is Wobenzym.

NATURAL IMMUNE MODULATORS AND NATURAL REMEDIES
A number of natural remedies, such as ginseng root, herbal teas, lemon/olive drink, olive leaf extract with
antioxidants are sometimes useful, especially during or after antibiotic therapy. More important examples are
immune modulators, such as bioactive whey protein (ImuPlus, www.imuplus.com; Immunocal,
), Transfer Factor (Transfer Factor Multi-Immune, Researched Nutritionals, 800-755-3402
www.ResearchedNutritionals.com). Some additional remedies are: olive leaf extract (many sources), NSC-100
(Nutritional Supply, Tahitian Noni (Morinda, 800-445-8596, www.tahitiannoni.com), Laktoferrin (Nutricology,
888-563-1506 or www.iherb.com), Echinacea-C (several sources). These products have been used to boost
immune systems. Although they appear to help many patients, their clinical effectiveness in chronic illness
patients has not been carefully evaluated. They appear to be useful during therapy to boost the immune system
or after antibiotic therapy in a maintenance program to prevent relapse and opportunistic secondary infections.
LIPID REPLACEMENT THERAPY FOR CHRONIC INFECTIONS AND RESTORING MITOCHONDRIAL FUNCTION
Lipid Replacement Therapy can be useful in providing membrane lipids in unoxidized form to repair nerve
membranes and mitochondrial membranes that are damaged by heavy metals, chemicals and infections [16].
For Lyme Disease patients we recommend the oral supplement NT Factor Energy™ (Researched Nutritionals,
800-755-3402 www.ResearchedNutritionals.com.). This product comes as tablets that are taken twice per day.
For children it should be ground up between two spoons into a course powder that can be added to several
spoonfuls of applesauce. The NT Factor is not bitter, but it is slightly sour, and some children actually like the
taste. The dose should be 4-6 tablets twice per day. For children 1/2-1 tablet for children up to 2 years-old, 2
tablets for 2-3 years old and 3-4 tablets for 4-5 years-old and 4-5 tablets 5 years-old and older. Research has
demonstrated no adverse responses with NT Factor even many times these doses. Since this formulation is a
completely natural membrane lipid mixture, there are no known toxicities and no known toxic dose limits.

YEAST/FUNGAL OVERGROWTH WHILE ON ANTIBIOTICS
Yeast overgrowth can occur, especially in females (vaginal infections) [Please read the report by Dr. Teitelbaum
on our website, www.immed.org]. Gynecologists recommend Nizoral, Diflucan, Mycelex, or anti-yeast creams.
Metronidazole [Flagyl, Prostat] has been used to prevent fungal or parasite overgrowth or other antifungals
[Nystatin, Amphotericin B, Fluconazole, Diflucan or Pau d’ arco, 7 capsules/2X/day] have been administered for
fungal infections that can occur while on antibiotics. Some patients have as their principal problem systemic
fungal infections that can be seen using dark field microscopy of blood smears. For superficial fungal infections,
such as fungal nail, a topical mixture of Laminsil in 17% DMSO 2X/day is effective. As mentioned above, L.
acidophilus mixtures are used to restore gut flora. Bacterial overgrowth can also occur, for example, in between
cycles of antibiotics or after antibiotics have been stopped. Nutraceutical approaches to controlling yeast
infections include: Pau d’ arco, grapefruit extract, olive leaf, caprylic acid, garlic extract and oregano oil. Diet is
especially important in controlling yeast overgrowth, and the dietary instructions above should be followed, such
as the elimination of most simple sugars from the diet [15].



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For Further Information:
Prof. Garth L. Nicolson
16371 Gothard Street Bld H Huntington Beach, CA 92647
References

1. Burgdorfer WA, Barbour AG, Hayes SF, et al. Lyme disease – a tick-borne spirochetosis? Science 1982;
216:1317-1319.
2. Kind A, Schned E, Anderson F, et al. Lyme Disease guidelines for Minnesota clinicians: epidemiology,
microbiology, diagnosis, treatment and prevention. Minnesota Department of Public Health, 1999.
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3. Gale A, Ringdahl E. Tick-borne diseases. Amer Fam Physican 2001; 64:461-466.
http://www.aafp.org/afp/200110801/461
4. Burrascano JJ, Jr. Advanced topics in Lyme Disease. Diagnostic hints and treatment guidelines for Lyme and
other tick borne illnesses. LymeNet On-Line Library, Burrascano Treatment Guidelines, 2000.
5. Nicolson GL, Nasralla M, Franco AR, et al. Diagnosis and Integrative Treatment of Intracellular Bacterial
Infections in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and other Chronic Illnesses. Clin Pract Alt Med 2000; 1(2):92-102. /illness/infectious_disease_research 6. Nicolson GL, Nasralla M, Franco AR, et al. Mycoplasmal infections in fatigue illnesses: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis. J Chronic Fatigue Syndr 2000; 6(3/4):23-/illness/infectious_disease_research 7. Verdon ME, Sigal LH. Recognition and management of Lyme Disease. Amer Fam Physician 1997; 56: http://www.aafp.org/afp/970800ap/lymedis 8. Klempner MS, et al. Intralaboratory reliability of serologic and urine testing for Lyme disease. Amer J Med 2001: 110:217-219. 9. Mylonakis E. When to suspect and how to monitor Babesiosis. Amer Family Physican 2001; 63:1969-1974. 10. Nicolson GL, Gan R, Haier J. Multiple co-infections (Mycoplasma, Chlamydia, human herpesvirus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms. Acta Pathol Microbiol Immunol Scand 2003; 111: 557-566. 11. Eppes SC. Lyme Disease: current therapies and prevention. Infect Med 2001; 18:388-395. 12. Dattwyler RJ, Volkman DJ, Conaty SM, et al. Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 1990; 336:1404-1406. 13. Luger SW, Paparone P, Wormser GP, et al. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother 1995; 39:661-667. 14. Nicolson GL: Considerations when undergoing treatment for chronic infections found in Chronic Fatigue
Syndrome, Fibromyalgia Syndrome and Gulf War Illnesses. (Part 1). Antibiotics Recommended when indicated
for treatment of Gulf War Illness/ CFIDS/FMS (Part 2). Intern J Med 1998; 1:115-117, 123-128.
15. Nicolson GL, Ngwenya R. Dietary considerations for patients with chronic illnesses and multiple chronic
infections. A brief outline of eighteen dietary steps to better health. Townsend Lett 2001; 219:62-65.
16. Horowitz R. Lyme Disease and other tick-borne diseases. ILADS Annual Conference, October 29-30,
2005.
17. Nicolson GL, Ellithrope R. Lipid replacement and antioxidant nutritional therapy for restoring mitochondrial
function and reducing fatigue in chronic fatigue syndrome and other fatiguing illnesses. J Chronic Fatigue Syndr
2006; 13(1): in press.

Source: http://researchednutritionals.com/FactSheets/NicolsonACAM2006.pdf