A prolonged antibiotic protocol to treat persistent Chlamydophila pneumoniae infection improves the extracranial venous circulation in multiple sclerosis

Abstract

Objective Chronic cerebrospinal venous insufficiency (CCSVI) is a condition associated with multiple sclerosis (MS). One mechanism that has been proposed is that the venous obstructions found in MS are due to a chronic persistent venulitis caused by the intra-cellular bacterial parasite, Chlamydophila pneumoniae (Cpn). The objective of the current study is to determine the effect of a combined antibiotic protocol (CAP) on the venous flow in MS patients as measured by a quantitative duplex ultrasound examination (QDUS). Method A non-randomised before-after cohort study was conducted to investigate differences in blood flow volumes pre and 6-months post antibiotic treatment for Cpn infection. Flow volume data were measured by QDUS across affected and unaffected sides from multiple veins segments, including internal jugular vein (IJV) segments J2 and J3, and vertebral vein (VV), as well as global arterial blood flow (GABF). Results 91 patients were included in the study. 64 (70%) were found to have positive Cpn serology. There was a statistically significant post-treatment difference seen for the affected side of Cpn infected patients (mean difference = 56 mL/min, p = 0.02). There was a non-significant increase seen for the affected side of uninfected patients (mean difference = 23 mL/min, p = 0.2). The difference in these effects (34 mL/min) was not statistically significant ( p = 0.3). The mean flow rate decreased in the unaffected side for both infected (-27 mL/min, p = 0.5) and uninfected patients (-69 mL/min, p = 0.01). There was a statistically significant post-treatment increase in GABF for the infected patients (mean difference = 90 mL/min, p = 0.02) and a difference of 76 mL/min for non-infected patients ( p = 0.01). Conclusion A CAP appears to improve the extra-cranial circulation in patients diagnosed with MS. This effect is statistically significant in patients with positive Cpn serology, although patients with negative Cpn serology also show some benefit, betraying a lack of specificity of this effect.

Hemodynamics of cerebral veins analyzed by 2d and 4d flow mri and ultrasound in healthy volunteers and patients with multiple sclerosis

“…Since then, differences in venous hemodynamics between MS patients and controls were not only observed by supporters, but also by critics of this hypothesis . As a consequence, experimental treatment approaches based on controversial hypotheses were published, aiming to cure venous anomalies in MS, ranging from venous angioplasty to prolonged antibiotic treatment against Chlamydophila pneumoniae …”

Pathogenesis and Management in Cerebrovenous Outflow Disorders

“…Unfortunately, recent multicenter randomized controlled trials have concluded that endovascular treatment does not improve the outcome of MS, and suggested that endovascular treatment for MS patients should be discouraged until appropriate highquality trials confirm safety and efficacy [153]. Another perspective on CCVSI was provided by Thibault et al, who proposed that chronic persistent venulitis caused by Chlamydophila pneumoniae, an obligate intracellular bacterium, may play a role in CCVSI and other vascular diseases; their non-randomized cohort study found that extracranial blood flow improved after treatment with a combined antibiotic protocol [154][155][156]. In summary, although some CNS disorders appear to be associated with IJV stenosis, causal relationships between these entities and IJV stenosis have not been firmly established.…”

Chlamydiae from Down Under: The Curious Cases of Chlamydial Infections in Australia

“…However, a subsequent study detected Cpn in 15 of the atheromatous lesions as well as in three of the normal tissues [57], further suggesting that Cpn infection might be an initial trigger of atherosclerotic development. Cpn infections have also been reported in adult patients with multiple sclerosis, namely in venous obstructions due to Cpn-associated chronic persistent venulitis [60]. An increased risk of Cpn-associated cardiovascular events in HIV-infected Australians have also been evaluated [61], however the role of chronic infections (such as Cpn) in immunosuppressed patients, with respect to the possible increase in vascular events noted in association with HIV infection, remains to be elucidated.…”