Sinus
Disclaimer. This web site is for research and educational purposes only. The information given in this site is not intended to replace a therapeutic practitioner relationship.
There are three issues that I am aware of:
(1) Mould or fungus colonisation of the sinuses.
(2) MARCoNS colonisation of the sinuses associated with Chronic Inflammatory Response Syndrome
(3) Staphylococci associated with Staph Toxin Illness.
(1) Mould or fungus colonisation of the sinuses.
(2) MARCoNS colonisation of the sinuses associated with Chronic Inflammatory Response Syndrome
(3) Staphylococci associated with Staph Toxin Illness.
Mould or yeast in the nose or sinuses
I think this is uncommon, but I have seen it in a few patients and treatment was quite effective. How do you know if this is a problem for you? Some persons have no major local sinus symptoms so you need to do either a swab or a therapeutic trial of antifungal medications. I don't recommend urine testing for mycotoxins at this stage as it expensive and despite Dr. Brewer's study below, I am not sure about its reliability. Even though there may be few, if any, local symptoms there may be many generalised symptoms. The list of sympoms given in Brewer JH et. al., Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome, Toxins (Basel). 2013 Apr 11;5(4):605-17 consists of fatigue, headache, flu-like symptoms, cognitive complaints, myalgia, arthralgia, gastrointestinal problems and various neurologic symptoms. And for the patient group studied in this reference, of whom 93% were positive for mycotoxins, the following previous diagnoses had been made: fibromyalgia, Lyme disease, peripheral neuropathy, orthostatic intolerance (including postural orthostatic tachycardia syndrome and neural-mediated hypotension), migraine, chronic dermatitis, gastroparesis, chronic abdominal pain, irritable bowel syndrome, interstitial cystitis, anxiety, depression, chemical sensitivity, vertigo, chronic sinusitis, glutenintolerance, tremor, myoclonus and cognitive dysfunction.
Another interesting study on the subject of sinus Mycotoxins and fatigue syndromes is Brewer JH et. al., Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?, Toxins (Basel). 2014 Jan; 6(1): 66–80.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920250/
Dr. Brewer's research is still, in my opinion, controversial and has not, to my knowledge been replicated. Nevertheless, based on my clinical experience, I believe there is a small subset of patients with fatigue from nasal fungal or yeast colonisation.
My current favourite nasal spray program for a therapeutic trial is the same as that given later in this page under the treatment section - Amphotericin with a biofilm dissolver. I certainly don't recommend oral anti-fungal medication. We are looking for an improvement in symptoms over about 3-4 weeks as a positive sign. Die-off or herx reactions can also occur and are usually a positive sign. Other clues to the fact that you may have this issue are persistent sinus troubles, especially if they are all year round, a tendency to crave sugar and a history of living or working in a mould affected building. By improvement in symptoms, I don't mean runny nose and sinus congestion (though this might improve), I am referring to improvements in energy and general well-being.
Nasal swabs for fungus or yeast can be done by ordering a swab kit online from the US company microbiologydx.com and sending the sample to them for testing. The Melbourne lab called Nutripath have just started (April, 2016) doing a nasal MARCoNS and fungus/mould combined test. I believe these swab tests are can miss fungal or yeast that is higher up in the nasal passages. They also can give false positive results since our nasal passages filter out mould and yeast spores and so if you have been around a mouldy area and got a significant number of spores in your nose the swab could just pick these up and grow them. So these swabs need to be treated with some caution. I rarely do them. I prefer, if suspicious, to do a therapeutic trial of anti-fungal nasal spray.
Treatment of nasal fungus: Start with Xylitol nose spray which is a biofilm buster. Get it OTC or online. OTC products usually have other ingredients which can sometimes confuse things. To avoid this complication you can make xylitol yourself by adding about a 1/4 of a tsp of xylitol crystals to a nose spray bottle with some clean water added. Remake it every four days or so as this does not have any preservative in it. An alternative is a combination of EDTA 0.1% and Polysorbate, made up at a compounding pharmacy. One-two sprays both sides twice a day. Stay on this. After three days on this add in Amphotericin B nasal spray. This is a script medication that you get made up at a compounding pharmacy - Amphotericin B 0.25%. It needs to be kept refrigerated. Gradually work up to a dose of 2 sprays each side twice or three times a day. An alternative to Amphotericin is to use Nystatin and make up your own nasal spray using a diluted version of the OTC oral nystatin mouth drops. Pharmacy prices vary greatly for the Ampho spray, so if you are paying significantly more than $100 keep phoning around.
For those who wish to use something non-pharmaceutical:
I still recommend using the Xylitol as your biofilm buster. You could replace the Amphotericin with water that is ozonated or has a few drops of chlorine dioxide water purification drops in. These are both anti-fungal from my research and understanding. I have used both of these for treatment of my MARCoNS and found them pretty good. I used 2-4 drops of chlorine dioxide solution per 30ml. For ozonated water, you would need to purchase a machine that makes ozone and bubble the ozone through the water for 1/4 to one hour before putting the ozonated water in a nasal spray bottle and using it. You would need to make up a fresh batch of ozonated water for each treatment. Do NOT use ozone gas up your nose from the end of the ozone generator tube! You must use ozonated water.
I have read or known of people using iodine in water too. I think it is a little more irritating and has more risk of side effects if used regularly due to iodine being absorbed and interacting with the thyroid.
Another interesting study on the subject of sinus Mycotoxins and fatigue syndromes is Brewer JH et. al., Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?, Toxins (Basel). 2014 Jan; 6(1): 66–80.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920250/
Dr. Brewer's research is still, in my opinion, controversial and has not, to my knowledge been replicated. Nevertheless, based on my clinical experience, I believe there is a small subset of patients with fatigue from nasal fungal or yeast colonisation.
My current favourite nasal spray program for a therapeutic trial is the same as that given later in this page under the treatment section - Amphotericin with a biofilm dissolver. I certainly don't recommend oral anti-fungal medication. We are looking for an improvement in symptoms over about 3-4 weeks as a positive sign. Die-off or herx reactions can also occur and are usually a positive sign. Other clues to the fact that you may have this issue are persistent sinus troubles, especially if they are all year round, a tendency to crave sugar and a history of living or working in a mould affected building. By improvement in symptoms, I don't mean runny nose and sinus congestion (though this might improve), I am referring to improvements in energy and general well-being.
Nasal swabs for fungus or yeast can be done by ordering a swab kit online from the US company microbiologydx.com and sending the sample to them for testing. The Melbourne lab called Nutripath have just started (April, 2016) doing a nasal MARCoNS and fungus/mould combined test. I believe these swab tests are can miss fungal or yeast that is higher up in the nasal passages. They also can give false positive results since our nasal passages filter out mould and yeast spores and so if you have been around a mouldy area and got a significant number of spores in your nose the swab could just pick these up and grow them. So these swabs need to be treated with some caution. I rarely do them. I prefer, if suspicious, to do a therapeutic trial of anti-fungal nasal spray.
Treatment of nasal fungus: Start with Xylitol nose spray which is a biofilm buster. Get it OTC or online. OTC products usually have other ingredients which can sometimes confuse things. To avoid this complication you can make xylitol yourself by adding about a 1/4 of a tsp of xylitol crystals to a nose spray bottle with some clean water added. Remake it every four days or so as this does not have any preservative in it. An alternative is a combination of EDTA 0.1% and Polysorbate, made up at a compounding pharmacy. One-two sprays both sides twice a day. Stay on this. After three days on this add in Amphotericin B nasal spray. This is a script medication that you get made up at a compounding pharmacy - Amphotericin B 0.25%. It needs to be kept refrigerated. Gradually work up to a dose of 2 sprays each side twice or three times a day. An alternative to Amphotericin is to use Nystatin and make up your own nasal spray using a diluted version of the OTC oral nystatin mouth drops. Pharmacy prices vary greatly for the Ampho spray, so if you are paying significantly more than $100 keep phoning around.
For those who wish to use something non-pharmaceutical:
I still recommend using the Xylitol as your biofilm buster. You could replace the Amphotericin with water that is ozonated or has a few drops of chlorine dioxide water purification drops in. These are both anti-fungal from my research and understanding. I have used both of these for treatment of my MARCoNS and found them pretty good. I used 2-4 drops of chlorine dioxide solution per 30ml. For ozonated water, you would need to purchase a machine that makes ozone and bubble the ozone through the water for 1/4 to one hour before putting the ozonated water in a nasal spray bottle and using it. You would need to make up a fresh batch of ozonated water for each treatment. Do NOT use ozone gas up your nose from the end of the ozone generator tube! You must use ozonated water.
I have read or known of people using iodine in water too. I think it is a little more irritating and has more risk of side effects if used regularly due to iodine being absorbed and interacting with the thyroid.
Staph Bugs and CFS/ME and Fibromyalgia
There are two separate issues that I am aware of: Multiple Antibiotic Resistant Coagulase Negative Staphylococcus (MARCoNS) colonisation of the sinuses associated with Chronic Inflammatory Response Syndrome (CIRS) and Staphylococci associated with Staph Toxin Illness.
MARCoNS and CIRS
'Chronic Inflammatory Response Syndrome (CIRS) is a condition proposed and researched by Dr. Ritchie Shoemaker. In these patients, according to Shoemaker, MARCoNS tend to prevent the normalisation of Melanocyte Stimulating Hormone. For more information, please see Dr. Shoemaker's website at survivingmold.com. For basic information on mould see our page on sick buildings. Shoemaker recommends eradication of nasal and sinus MARCoNS with an antibiotic nose spray ('BEG spray') and I have read in his material that most of these patients treated with BEG do not get major Herx reactions from killing the MARCoNS. Note: A patient with CIRS will usually fail a VCS test (see his web site) and, according to his protocol, will need to be removed from any mould exposure and be treated with cholestyramine before anti-MARCoNS therapy is started.
Staph Toxin Illness
This is a problem with Staph toxins in general and can in my opinion be an issue for anyone, including sufferers of CIRS. This Staph issue may include the presence of MARCoNS as well as CoNS (Coagulase Negative Staphylococcus) and also other coagulase positive species of Staph that live in the sinuses, nose, skin, vagina in females and sometimes even the gut. I believe this Staph issue which I am about to describe is one of the commonest causes of CFS/ME and Fibromyalgia. It is, in my opinion, a major issue to consider for all persons who have had a prolonged course of antibiotics, including those treated with antibiotics for Lyme Disease and for anyone found to have any sort of Staph in their nose and who has unexplained fatigue or muscle pain.
There is some very relevant research on CoNS and its toxins. Nasal carriage of this bug may or may not produce local symptoms. Also there may be generalised symptoms. The fullest published symptom list that I have seen comes from Table 5.1 of a thesis done by Niel McGregor referenced later in this page. I believe this list relates to any one with Staph Toxin Illness and that it is not a complete list of possible symptoms:
Musculoskeletal symptoms
Jaw muscle pain
TMJ (jaw joint) clicking or locking
Neck/Shoulder pain or tenderness
Arm pain or tenderness
Sciatica (nerve pain down the leg)
Arthritis/Painful or stiff joints
Infectious symptoms
Swollen or tender cervical and/or axilliary lymph nodes
Night sweats
Sore throat
Recurrent sinusitis
Aphthous ulceration (mouth ulcers)
Hyperaesthesia/Paraesthesia
Clenching or grinding of the teeth
Earaches and Tinnitus
Headache and Migraine headaches
Hair loss
Irritable bowel and abdominal symptoms
Diarrhoea
Palpitations
Blood pressure problems
Faintness / dizziness
Muscle fatigue
Generalised lethargy and sleep disturbance
I diagnose Staph Toxin Illness based on history, a nasal swab showing Staph and a therapeutic trial of treatment. A standard nasal swab done by most big labs where they perform a 2-3 day culture is inadequate. Some types of Staph can apparently be slow growing and a two week culture is necessary. In Australia you can call the private test company called Nutripath and order a swab test kit. You can also contact the US company www.microbiologydx.com directly (this is the lab that Nutripath refers their specimens to). The advantage of using Nutripath is a slightly easier postage experience.
Staph bugs are considered to be a normal part of body colonization. I have read that they are found on about 55% of the population. In most people they appear to cause no trouble unless certain conditions cause the Staph to get nasty. In relation to fatigue and associated symptoms the issue is the Staph being triggered to produce toxins. Such toxins can produce a large array of symptoms including fatigue and fibromyalgia. If you have Staph in your nose with fatigue or fibro but no evidence of CIRS then in my opinion you may well have toxin activation going on.
Let us consider some of the evidence that the triggering of Staph toxin production can lead to CFS and/or Fibromyalgia. The following studies have associated a type of Staph toxin with chronic facial and muscle pain:
Butt Hl et al., An association of membrane-damaging toxins from coagulase-negative staphylococci and chronic orofacial muscle pain, Journal of Medical Microbiology 1998; 47:577-584
McGregor NR et al., Coagulase-negative staphylococcal membrane-damaging toxins, pain intensity, and metabolic changes in temporomandibular disorder patients with chronic muscle pain, J Orofac Pain. 2003 Spring;17(2):125-32.
Niel McGregor, lead author of the above study did a whole thesis on chronic face pain and its association with Staph (McGregor Niel Roland, CHRONIC FACE PAIN/TMD: BIOCHEMISTY AND MICROBIOLOGY, A Thesis submitted to the Faculty of Dentistry, University of Sydney for the degree of Doctor of Philosophy, esp. pages 227-228 in the original work or pages 226-227 of the Sydney Uni archive file (dated 1999). The Sydney University URL for the thesis is: http://ses.library.usyd.edu.au/handle/2123/369.)
In this thesis McGregor provides evidence for many interesting things, including:
CFS appears to be associated with delta and beta Staph toxins (p. 206).
On p. 189 he mentions that part of the Staph chromosome called the 'Accessory Gene Regulator” (arg) is responsible for toxin production and can be turned on or off by certain environmental stimulii. He mentions “Importantly a reduction in osmolarity (low sodium levels) in the medium is associated with an increase in toxin production and arg-associated RNA whilst an increase in extracellular sodium results in inhibition of arg expression (Regassa & Betley, 1993).” The reference for Regassa and Betley is: Regassa LB, Betley MJ. High sodium chloride concentrations inhibit staphylococcal enterotoxin C gene (sec) expression at the level of sec mRNA. Infect Immun 1993; 61:1581-1585.
It is interesting to study the various things that can cause a low sodium level or low osmolality. If you want to study the topic check out SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone).
On p. 204 he mentions an association of toxin production with antibiotic use at the time of onset of temporomandibular pain syndrome and on page 217 he states that antibiotic use, especially prolonged antibiotic use, is associated with higher levels of delta Staph toxins. In addition on page 229 he comments that antibiotic use may select for more toxicogenic Staph species.
So, what about treatments for this Staph toxin illness causing face pain and CFS?
On page 229 of his thesis McGregor tells us that toxins produced by Staph have a low antigenicity, so the body's immune system does not readily produce antibodies against these toxins. This is why we would need a Staph toxoid vaccine enabling the body to produce antitoxin.
Has such a vaccine been tried? Yes, with very good results. See the following studies and thesis:
Andersson M, et al., Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome, Eur J Pain, 1998; 2(2):133-142.
Zachrisson O, et al., Immune modulation with a staphylococcal preparation in fibromyalgia/chronic fatigue syndrome: relation between antibody levels and clinical improvement. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):98-105. Epub 2004 Jan 20.
http://www.ncbi.nlm.nih.gov/pubmed/14735403
Zachrisson O, et al., Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue syndrome--a randomised controlled trial. Eur J Pain. 2002;6(6):455-66.
http://www.ncbi.nlm.nih.gov/pubmed/12413434
Thesis (in English) by Olof Zachrisson, Fibromyalgia Chronic Fatigue Syndrome - Aspects on biology, treatment, and symptom evaluation. Doctoral thesis from institute of clinical neuroscience, section of psychiatry, Gteborg University, Sweden, 2002. ISBN 91-628-5386-4.
Gottfries C, et al., Long-Term Treatment with a Staphylococcus Toxoid Vaccine in Patients with Fibromyalgia and Chronic Fatigue Syndrome, Journal of Chronic Fatigue Syndrome Vol. 13, Issue 4, 2006.
These studies all sound wonderful, but the vaccine is, to my knowledge, not available at the time of this article being written (July, 2016). Please read Dr. Lars Lagerstrand (MD, PhD) personal testimony which I found at the meassociation.org.uk web site, dated Sept. 2009 (and also keep reading this page to understand alternative options):
Dr. Lagerstrand's personal testimony: “I am a medical doctor and associate professor working at the Karolinska University Hospital in Stockholm and a member of the committee of the Swedish Association for ME patients in Stockholm. However, I am also a patient with ME/chronic fatigue syndrome since 14 years and have been successfully treated with a vaccine against staphylococcus during the last 8 years.
“A Swedish research group has developed a treatment against ME/CFS that reduces symptoms significantly. In Sweden we have about one hundred and fifty patients with ME/CFS that have been successfully treated with a vaccine against staphylococcus. The vaccine has been given to us monthly during 5-10 years without any adverse effects. The treatment has made it possible for the majority of us to work and also to have energy left for our families, friends and even sports and outdoor life. The effectiveness of the vaccine has been proven in a double blind scientific study.
“However the vaccine is not produced anymore and most of us have been forced back to illness life. We have thus come to an absurd situation where there exists a treatment of ME/CFS, which could dramatically reduce symptoms and make life much better for millions of people all over the world."
So if the vaccine is not available any more, are there alternative options? The answer is 'yes'. This is how I currently approach the treatment of Staph Toxin Illness. In general, results have been very good.
1. Be aware of the possible conditions that may have turned on the Staph toxin production in the first place and, if possible, rectify these conditions. There may still be some Staph on the body that have not yet started producing toxins.
We have already mentioned low sodium or osmolality as being a trigger for toxin production (McGregor, Doctoral Thesis p. 189) and that antibiotics, especially prolonged courses, can be a trigger (ibid. p. 217). So avoid drinking too much water or having unnecessary antibiotic courses. Regarding water, don't make this an excuse to drink too little. About 35ml/kg/day is about right for most adults.
Another thesis has been done on the subject we are discussing: Fairhead, H., The Regulation of Toxin Production in Staph Aureus, Doctoral Thesis, University of Nottingham, June 1998.
In this study she gives evidence as follows:
Page 38: “In S. aureus, it has been found that deficiency of iron up-regulates activity of the accessory gene regulator and production of alpha- haemolysin”.
Page 40: “In S. aureus high salt concentrations (1.2 M NaCl) resulted in a 16-fold decrease in production of enterotoxin C (Regassa and Betley, 1993)” See also page 89 and 90 where high salt concentrations inhibited toxin production.
Page 93. Low calcium or magnesium levels cause an increase in toxin production.
So we need to try and avoid low iron, low serum sodium or osmolality (don't overdue your water intake - 35ml/kg is a good general figure for adults), low calcium and low magnesium. I recommend having blood tests to check the levels of these minerals. Also, we should only take antibiotics when we really have to and try and avoid long antibiotic courses in particular. Antibiotics should never be used for just common colds and viruses. If results are equivalent, lyme treatments that avoid long antibiotic courses should be used in preference to ones that do.
2. Decide if you are going to try and eradicate Staph from the nose and sinuses or just neutralize or reduce toxin production in these areas.
It must be emphasised that the approaches below are quite firmly experimental as no large scale, double-blind, placebo controlled, randomised, multi-centre trial has been conducted on the use of nose spray of xylitol, coconut oil and water, combination antibiotics or L. plantarum culture in the safe and effective eradication or control of nasal Staphylococcus aureus. So, anyone wishing to try these methods must do so at their own risk (under supervision, of course, of a suitable and agreeable health care professional) or else wait until they are proven by clear, non-biased scientific studies.
For an eradication program, I recommend a gentle five step program to try and avoid severe herxing. Let me make it plain: these nasal Staph can cause major herxing if they are aggressively killed.
- Step One is using Xylitol nose spray for four weeks. I recommend making it in order to avoid confusing issues from other ingredients that are added to proprietary products. Xylitol crystals are obtainable from a health food shop or on line. I think the variety made from spruce is probably better than the one from corn. Add 1/4 to 1/2 teaspoon to a 20 or 30 ml nose spray bottle. Add clean water. Warm water makes it easier to dissolve. Shake before use. Use 2-3 sprays both sides twice a day. Keep in the fridge and make up a fresh batch about every four days as it does not have any preservative in it. If it really can't be made then purchase a proprietary brand such as Xlear or Fess Frequent Flyer. Xylitol acts as a biofilm digester. Biofilm is a jelly-like mucous that the bugs live in for protection. Use of the Xylitol spray can sometimes cause some Herx reactions by enhancing your bodies natural defence system and so killing some Staph (Zabner J, et al., The osmolyte xylitol reduces the salt concentration of airway surface liquid and may enhance bacterial killing, PNAS October 10, 2000, vol. 97 no. 21)
- Step Two is using a coconut oil and water mixture for four weeks. If you are sensitive or allergic to Xylitol then you can move straight to this step but use only about 1/8 tsp of coconut oil per spray bottle to make a weaker mixture. Use high quality, cold-pressed, virgin coconut oil (I suggest 1/8 to 1/2 tsp of coconut oil in a 30ml spray bottle). Use clean warm water in the spray bottle with the oil or use cold and then warm it up. It must be warm enough to melt the oil but NOT hot. Shake well to turn it into a water/oil mix and spray 2-3 doses each side while gently breathing in through your nose. Repeat twice a day. You will need to warm up the bottle each time you use it (unless you live in the tropics) to avoid the coconut oil solidifying. I suggest putting it in a container with warm water to melt the coconut oil (do NOT make it too hot!). For a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. I understand these are 20ml bottles, so you would only need 1/8 to 1/4 tsp of oil. You can also buy empty spray bottles online - try Ebay for example. I do NOT recommend trying to push lumps of pure coconut oil up the nose or using a neti pot with pure liquid oil in it! This is dangerous. You may accidentally inhale enough oil into your lungs to cause pneumonia. Coconut oil and water mixture keeps quite well. I would suggest a fresh preparation each fortnight.
If you are sensitive or allergic to coconut oil then an alternative is liquid sunflower lecithin. This is an oily liquid not granules! It can be bought it capsule form. It is used in the same way and must be warmed each time. A fresh batch should be made up at least every week. I suggest sunflower lecithin because less folk are sensitive to sunflower than they are to soy. But you could use soy lecithin instead if you wanted to.
Some relevant studies on coconut oil and lecithin:
In Fairhead's thesis (references above) she mentions on page 97 that Glycerol monohydrate reduced production of alpha-toxin. Glycerol monohydrate is found in coconut oil.
Also there is another relevant study showing that lauric acid (found abundantly in coconut oil) inhibits Staph toxins or turns off their production. Ruzin A, Novick RP, Equivalence of Lauric Acid and Glycerol Monolaurate [GML] as Inhibitors of Signal Transduction in Staphylococcus aureus, Journal of Bacteriology , May 2000, p. 2668–2671: “We found that indeed lauric acid at an equimolar concentration mimics the inhibitory effect of GML on the induction of staphylococcal beta-lactamase activity and, like GML, blocks expression of protein A and TSST-1 in S. aureus. Thus, we currently hypothesize that lauric acid might be responsible for all of the inhibitory effects of GML described so far, although GML might be active as well.”
Lauric acid and GML also inhibit Staph biofilms: Hess DJ et al., The Natural Surfactant Glycerol Monolaurate Significantly Reduces Development of Staphylococcus aureus and Enterococcus faecalis Biofilms, Surg Infect (Larchmt), 2015 Oct;16(5):538-42. doi: 10.1089/sur.2014.162. Epub 2015 Jun 25.
Please note that coconut oil also has some antifungal properties (Bergsson G, et al., In Vitro Killing of Candida albicans by Fatty Acids and Monoglycerides, Antimicrob Agents Chemother. 2001 Nov; 45(11): 3209–3212). So if you had fungal or yeast colonisation in the nose or sinuses you might get a Herxhiemer reaction from coconut oil killing it off.
Regarding lecithin, McGregor in his Doctoral Thesis mentions a study showing that the delta toxin is inhibited by lecithin (namely, Rogolsky, M. Nonenteric toxins of Staphylococcus aureus. Microbiol Rev 1979; 43:320-360) McGregor, Doctoral Thesis p. 190.
- Step Three. Use Mupirocin 0.2% EDTA 0.1% MAPG 15% nose spray for four weeks. Mupirocin is the active ingredient in Bactroban. It is a pharmaceutical antibiotic active against most Staph. EDTA is a biofilm digester. MAPG stands for MucoAdhesive Polymer Gel and it makes the antibiotics stick to the lining of your nose for longer. You will need a prescription for this item and it will need to be made up at a compounding pharmacy. I no longer recommend use of Gentamicin as in 'BEG' spray because Gentamicin can cause the development of tinnitus in susceptible people. This tinnitus can be very hard to treat. Gentamicin can also cause candida to flare up in the mouth or gut as some of the spray gets swallowed. If you really want to risk Gentamicin then use only 0.025%. If desired this Mupirocin/EDTA nose spray can be made stronger by adding in a simultaneous colloidal silver nose spray. If you can't get a script organised for this spray then you could move directly to Step Four. But I recommend trying to do this third step, if at all possible.
- Step Four. Finish off the Staph by using either a stronger antibiotic spray or inoculation with a strong anti-Staph friendly bacteria, namely, Lactobacillus plantarum. This is a six week course. For the stronger antibiotic, I would recommend 'BER' nose spray, which has to be got on prescription. The formula I use is Mupirocin (Bactroban) 0.2%; EDTA 0.1%; Rifampicin 0.025%; MAPG 15%. You spray two sprays both sides twice a day. For details on how to make the L. plantarum nose spray, please refer to my Bio page. I have found that this L. plantarum culture can be quite powerful and cause major herxing. This is one reason why the previous three steps are recommended to do first.
- Step Five. Maintenance. You will want to stop Staph from coming back into your nose from somewhere else on your body, or perhaps from someone else (less likely). You can either use Xylitol nose spray twice a day, coconut oil and water nose spray twice a day or the L. plantarum nose spray twice a day. I use a combination with mainly coconut oil and water and occassionally resting from this and using Xylitol or the L. plantarum culture. Interestingly, I have noticed on myself and with many patients that the coconut oil/water nose spray seems to protect from getting colds or viruses.
After being on Step Five for at least five weeks you should have a repeat nose swab to make sure that the Staph has gone. If it has not gone, we recommend redoing step three and four, but doing step four for 8 weeks and combining the antibiotic nose spray (morning and evening doses) along with the L. plantarum (a midday dose).
For a reduction/neutralisation program:This is aimed at reducing the number of Staph and reducing the amount of active toxin and neutralising the remaining toxin. It involves simply using steps one and two above and then continuing a combination of either xylitol or coconut oil/water nose spray indefinitely.
I have found that using coconut oil/water nose spray has a great side effect - it greatly reduces the tendency to catch colds and similar infections. This is one reason why I continue to use it regularly.
3. Other considerations: In some cases it is possible that Staph needs to be treated on the skin or in the vagina. One option is to rub coconut oil all over after each shower and ladies use a warm water and coconut oil douche twice or three times a week. I used L. plantarum coconut yoghurt on my skin to reduce Staph activity. A yoghurt could also be used as a kind of douche. Based on preliminary research taking L. plantarum orally may reduce inflammation caused by Staph via an immune modulating effect. By the way, this probiotic is often found in saurkraut.
For my personal experience with getting rid of MARCoNS and the use of cultures of B subtils and L plantarum, please refer to my Bio page.
There is some very relevant research on CoNS and its toxins. Nasal carriage of this bug may or may not produce local symptoms. Also there may be generalised symptoms. The fullest published symptom list that I have seen comes from Table 5.1 of a thesis done by Niel McGregor referenced later in this page. I believe this list relates to any one with Staph Toxin Illness and that it is not a complete list of possible symptoms:
Musculoskeletal symptoms
Jaw muscle pain
TMJ (jaw joint) clicking or locking
Neck/Shoulder pain or tenderness
Arm pain or tenderness
Sciatica (nerve pain down the leg)
Arthritis/Painful or stiff joints
Infectious symptoms
Swollen or tender cervical and/or axilliary lymph nodes
Night sweats
Sore throat
Recurrent sinusitis
Aphthous ulceration (mouth ulcers)
Hyperaesthesia/Paraesthesia
Clenching or grinding of the teeth
Earaches and Tinnitus
Headache and Migraine headaches
Hair loss
Irritable bowel and abdominal symptoms
Diarrhoea
Palpitations
Blood pressure problems
Faintness / dizziness
Muscle fatigue
Generalised lethargy and sleep disturbance
I diagnose Staph Toxin Illness based on history, a nasal swab showing Staph and a therapeutic trial of treatment. A standard nasal swab done by most big labs where they perform a 2-3 day culture is inadequate. Some types of Staph can apparently be slow growing and a two week culture is necessary. In Australia you can call the private test company called Nutripath and order a swab test kit. You can also contact the US company www.microbiologydx.com directly (this is the lab that Nutripath refers their specimens to). The advantage of using Nutripath is a slightly easier postage experience.
Staph bugs are considered to be a normal part of body colonization. I have read that they are found on about 55% of the population. In most people they appear to cause no trouble unless certain conditions cause the Staph to get nasty. In relation to fatigue and associated symptoms the issue is the Staph being triggered to produce toxins. Such toxins can produce a large array of symptoms including fatigue and fibromyalgia. If you have Staph in your nose with fatigue or fibro but no evidence of CIRS then in my opinion you may well have toxin activation going on.
Let us consider some of the evidence that the triggering of Staph toxin production can lead to CFS and/or Fibromyalgia. The following studies have associated a type of Staph toxin with chronic facial and muscle pain:
Butt Hl et al., An association of membrane-damaging toxins from coagulase-negative staphylococci and chronic orofacial muscle pain, Journal of Medical Microbiology 1998; 47:577-584
McGregor NR et al., Coagulase-negative staphylococcal membrane-damaging toxins, pain intensity, and metabolic changes in temporomandibular disorder patients with chronic muscle pain, J Orofac Pain. 2003 Spring;17(2):125-32.
Niel McGregor, lead author of the above study did a whole thesis on chronic face pain and its association with Staph (McGregor Niel Roland, CHRONIC FACE PAIN/TMD: BIOCHEMISTY AND MICROBIOLOGY, A Thesis submitted to the Faculty of Dentistry, University of Sydney for the degree of Doctor of Philosophy, esp. pages 227-228 in the original work or pages 226-227 of the Sydney Uni archive file (dated 1999). The Sydney University URL for the thesis is: http://ses.library.usyd.edu.au/handle/2123/369.)
In this thesis McGregor provides evidence for many interesting things, including:
CFS appears to be associated with delta and beta Staph toxins (p. 206).
On p. 189 he mentions that part of the Staph chromosome called the 'Accessory Gene Regulator” (arg) is responsible for toxin production and can be turned on or off by certain environmental stimulii. He mentions “Importantly a reduction in osmolarity (low sodium levels) in the medium is associated with an increase in toxin production and arg-associated RNA whilst an increase in extracellular sodium results in inhibition of arg expression (Regassa & Betley, 1993).” The reference for Regassa and Betley is: Regassa LB, Betley MJ. High sodium chloride concentrations inhibit staphylococcal enterotoxin C gene (sec) expression at the level of sec mRNA. Infect Immun 1993; 61:1581-1585.
It is interesting to study the various things that can cause a low sodium level or low osmolality. If you want to study the topic check out SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone).
On p. 204 he mentions an association of toxin production with antibiotic use at the time of onset of temporomandibular pain syndrome and on page 217 he states that antibiotic use, especially prolonged antibiotic use, is associated with higher levels of delta Staph toxins. In addition on page 229 he comments that antibiotic use may select for more toxicogenic Staph species.
So, what about treatments for this Staph toxin illness causing face pain and CFS?
On page 229 of his thesis McGregor tells us that toxins produced by Staph have a low antigenicity, so the body's immune system does not readily produce antibodies against these toxins. This is why we would need a Staph toxoid vaccine enabling the body to produce antitoxin.
Has such a vaccine been tried? Yes, with very good results. See the following studies and thesis:
Andersson M, et al., Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome, Eur J Pain, 1998; 2(2):133-142.
Zachrisson O, et al., Immune modulation with a staphylococcal preparation in fibromyalgia/chronic fatigue syndrome: relation between antibody levels and clinical improvement. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):98-105. Epub 2004 Jan 20.
http://www.ncbi.nlm.nih.gov/pubmed/14735403
Zachrisson O, et al., Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue syndrome--a randomised controlled trial. Eur J Pain. 2002;6(6):455-66.
http://www.ncbi.nlm.nih.gov/pubmed/12413434
Thesis (in English) by Olof Zachrisson, Fibromyalgia Chronic Fatigue Syndrome - Aspects on biology, treatment, and symptom evaluation. Doctoral thesis from institute of clinical neuroscience, section of psychiatry, Gteborg University, Sweden, 2002. ISBN 91-628-5386-4.
Gottfries C, et al., Long-Term Treatment with a Staphylococcus Toxoid Vaccine in Patients with Fibromyalgia and Chronic Fatigue Syndrome, Journal of Chronic Fatigue Syndrome Vol. 13, Issue 4, 2006.
These studies all sound wonderful, but the vaccine is, to my knowledge, not available at the time of this article being written (July, 2016). Please read Dr. Lars Lagerstrand (MD, PhD) personal testimony which I found at the meassociation.org.uk web site, dated Sept. 2009 (and also keep reading this page to understand alternative options):
Dr. Lagerstrand's personal testimony: “I am a medical doctor and associate professor working at the Karolinska University Hospital in Stockholm and a member of the committee of the Swedish Association for ME patients in Stockholm. However, I am also a patient with ME/chronic fatigue syndrome since 14 years and have been successfully treated with a vaccine against staphylococcus during the last 8 years.
“A Swedish research group has developed a treatment against ME/CFS that reduces symptoms significantly. In Sweden we have about one hundred and fifty patients with ME/CFS that have been successfully treated with a vaccine against staphylococcus. The vaccine has been given to us monthly during 5-10 years without any adverse effects. The treatment has made it possible for the majority of us to work and also to have energy left for our families, friends and even sports and outdoor life. The effectiveness of the vaccine has been proven in a double blind scientific study.
“However the vaccine is not produced anymore and most of us have been forced back to illness life. We have thus come to an absurd situation where there exists a treatment of ME/CFS, which could dramatically reduce symptoms and make life much better for millions of people all over the world."
So if the vaccine is not available any more, are there alternative options? The answer is 'yes'. This is how I currently approach the treatment of Staph Toxin Illness. In general, results have been very good.
1. Be aware of the possible conditions that may have turned on the Staph toxin production in the first place and, if possible, rectify these conditions. There may still be some Staph on the body that have not yet started producing toxins.
We have already mentioned low sodium or osmolality as being a trigger for toxin production (McGregor, Doctoral Thesis p. 189) and that antibiotics, especially prolonged courses, can be a trigger (ibid. p. 217). So avoid drinking too much water or having unnecessary antibiotic courses. Regarding water, don't make this an excuse to drink too little. About 35ml/kg/day is about right for most adults.
Another thesis has been done on the subject we are discussing: Fairhead, H., The Regulation of Toxin Production in Staph Aureus, Doctoral Thesis, University of Nottingham, June 1998.
In this study she gives evidence as follows:
Page 38: “In S. aureus, it has been found that deficiency of iron up-regulates activity of the accessory gene regulator and production of alpha- haemolysin”.
Page 40: “In S. aureus high salt concentrations (1.2 M NaCl) resulted in a 16-fold decrease in production of enterotoxin C (Regassa and Betley, 1993)” See also page 89 and 90 where high salt concentrations inhibited toxin production.
Page 93. Low calcium or magnesium levels cause an increase in toxin production.
So we need to try and avoid low iron, low serum sodium or osmolality (don't overdue your water intake - 35ml/kg is a good general figure for adults), low calcium and low magnesium. I recommend having blood tests to check the levels of these minerals. Also, we should only take antibiotics when we really have to and try and avoid long antibiotic courses in particular. Antibiotics should never be used for just common colds and viruses. If results are equivalent, lyme treatments that avoid long antibiotic courses should be used in preference to ones that do.
2. Decide if you are going to try and eradicate Staph from the nose and sinuses or just neutralize or reduce toxin production in these areas.
It must be emphasised that the approaches below are quite firmly experimental as no large scale, double-blind, placebo controlled, randomised, multi-centre trial has been conducted on the use of nose spray of xylitol, coconut oil and water, combination antibiotics or L. plantarum culture in the safe and effective eradication or control of nasal Staphylococcus aureus. So, anyone wishing to try these methods must do so at their own risk (under supervision, of course, of a suitable and agreeable health care professional) or else wait until they are proven by clear, non-biased scientific studies.
For an eradication program, I recommend a gentle five step program to try and avoid severe herxing. Let me make it plain: these nasal Staph can cause major herxing if they are aggressively killed.
- Step One is using Xylitol nose spray for four weeks. I recommend making it in order to avoid confusing issues from other ingredients that are added to proprietary products. Xylitol crystals are obtainable from a health food shop or on line. I think the variety made from spruce is probably better than the one from corn. Add 1/4 to 1/2 teaspoon to a 20 or 30 ml nose spray bottle. Add clean water. Warm water makes it easier to dissolve. Shake before use. Use 2-3 sprays both sides twice a day. Keep in the fridge and make up a fresh batch about every four days as it does not have any preservative in it. If it really can't be made then purchase a proprietary brand such as Xlear or Fess Frequent Flyer. Xylitol acts as a biofilm digester. Biofilm is a jelly-like mucous that the bugs live in for protection. Use of the Xylitol spray can sometimes cause some Herx reactions by enhancing your bodies natural defence system and so killing some Staph (Zabner J, et al., The osmolyte xylitol reduces the salt concentration of airway surface liquid and may enhance bacterial killing, PNAS October 10, 2000, vol. 97 no. 21)
- Step Two is using a coconut oil and water mixture for four weeks. If you are sensitive or allergic to Xylitol then you can move straight to this step but use only about 1/8 tsp of coconut oil per spray bottle to make a weaker mixture. Use high quality, cold-pressed, virgin coconut oil (I suggest 1/8 to 1/2 tsp of coconut oil in a 30ml spray bottle). Use clean warm water in the spray bottle with the oil or use cold and then warm it up. It must be warm enough to melt the oil but NOT hot. Shake well to turn it into a water/oil mix and spray 2-3 doses each side while gently breathing in through your nose. Repeat twice a day. You will need to warm up the bottle each time you use it (unless you live in the tropics) to avoid the coconut oil solidifying. I suggest putting it in a container with warm water to melt the coconut oil (do NOT make it too hot!). For a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. I understand these are 20ml bottles, so you would only need 1/8 to 1/4 tsp of oil. You can also buy empty spray bottles online - try Ebay for example. I do NOT recommend trying to push lumps of pure coconut oil up the nose or using a neti pot with pure liquid oil in it! This is dangerous. You may accidentally inhale enough oil into your lungs to cause pneumonia. Coconut oil and water mixture keeps quite well. I would suggest a fresh preparation each fortnight.
If you are sensitive or allergic to coconut oil then an alternative is liquid sunflower lecithin. This is an oily liquid not granules! It can be bought it capsule form. It is used in the same way and must be warmed each time. A fresh batch should be made up at least every week. I suggest sunflower lecithin because less folk are sensitive to sunflower than they are to soy. But you could use soy lecithin instead if you wanted to.
Some relevant studies on coconut oil and lecithin:
In Fairhead's thesis (references above) she mentions on page 97 that Glycerol monohydrate reduced production of alpha-toxin. Glycerol monohydrate is found in coconut oil.
Also there is another relevant study showing that lauric acid (found abundantly in coconut oil) inhibits Staph toxins or turns off their production. Ruzin A, Novick RP, Equivalence of Lauric Acid and Glycerol Monolaurate [GML] as Inhibitors of Signal Transduction in Staphylococcus aureus, Journal of Bacteriology , May 2000, p. 2668–2671: “We found that indeed lauric acid at an equimolar concentration mimics the inhibitory effect of GML on the induction of staphylococcal beta-lactamase activity and, like GML, blocks expression of protein A and TSST-1 in S. aureus. Thus, we currently hypothesize that lauric acid might be responsible for all of the inhibitory effects of GML described so far, although GML might be active as well.”
Lauric acid and GML also inhibit Staph biofilms: Hess DJ et al., The Natural Surfactant Glycerol Monolaurate Significantly Reduces Development of Staphylococcus aureus and Enterococcus faecalis Biofilms, Surg Infect (Larchmt), 2015 Oct;16(5):538-42. doi: 10.1089/sur.2014.162. Epub 2015 Jun 25.
Please note that coconut oil also has some antifungal properties (Bergsson G, et al., In Vitro Killing of Candida albicans by Fatty Acids and Monoglycerides, Antimicrob Agents Chemother. 2001 Nov; 45(11): 3209–3212). So if you had fungal or yeast colonisation in the nose or sinuses you might get a Herxhiemer reaction from coconut oil killing it off.
Regarding lecithin, McGregor in his Doctoral Thesis mentions a study showing that the delta toxin is inhibited by lecithin (namely, Rogolsky, M. Nonenteric toxins of Staphylococcus aureus. Microbiol Rev 1979; 43:320-360) McGregor, Doctoral Thesis p. 190.
- Step Three. Use Mupirocin 0.2% EDTA 0.1% MAPG 15% nose spray for four weeks. Mupirocin is the active ingredient in Bactroban. It is a pharmaceutical antibiotic active against most Staph. EDTA is a biofilm digester. MAPG stands for MucoAdhesive Polymer Gel and it makes the antibiotics stick to the lining of your nose for longer. You will need a prescription for this item and it will need to be made up at a compounding pharmacy. I no longer recommend use of Gentamicin as in 'BEG' spray because Gentamicin can cause the development of tinnitus in susceptible people. This tinnitus can be very hard to treat. Gentamicin can also cause candida to flare up in the mouth or gut as some of the spray gets swallowed. If you really want to risk Gentamicin then use only 0.025%. If desired this Mupirocin/EDTA nose spray can be made stronger by adding in a simultaneous colloidal silver nose spray. If you can't get a script organised for this spray then you could move directly to Step Four. But I recommend trying to do this third step, if at all possible.
- Step Four. Finish off the Staph by using either a stronger antibiotic spray or inoculation with a strong anti-Staph friendly bacteria, namely, Lactobacillus plantarum. This is a six week course. For the stronger antibiotic, I would recommend 'BER' nose spray, which has to be got on prescription. The formula I use is Mupirocin (Bactroban) 0.2%; EDTA 0.1%; Rifampicin 0.025%; MAPG 15%. You spray two sprays both sides twice a day. For details on how to make the L. plantarum nose spray, please refer to my Bio page. I have found that this L. plantarum culture can be quite powerful and cause major herxing. This is one reason why the previous three steps are recommended to do first.
- Step Five. Maintenance. You will want to stop Staph from coming back into your nose from somewhere else on your body, or perhaps from someone else (less likely). You can either use Xylitol nose spray twice a day, coconut oil and water nose spray twice a day or the L. plantarum nose spray twice a day. I use a combination with mainly coconut oil and water and occassionally resting from this and using Xylitol or the L. plantarum culture. Interestingly, I have noticed on myself and with many patients that the coconut oil/water nose spray seems to protect from getting colds or viruses.
After being on Step Five for at least five weeks you should have a repeat nose swab to make sure that the Staph has gone. If it has not gone, we recommend redoing step three and four, but doing step four for 8 weeks and combining the antibiotic nose spray (morning and evening doses) along with the L. plantarum (a midday dose).
For a reduction/neutralisation program:This is aimed at reducing the number of Staph and reducing the amount of active toxin and neutralising the remaining toxin. It involves simply using steps one and two above and then continuing a combination of either xylitol or coconut oil/water nose spray indefinitely.
I have found that using coconut oil/water nose spray has a great side effect - it greatly reduces the tendency to catch colds and similar infections. This is one reason why I continue to use it regularly.
3. Other considerations: In some cases it is possible that Staph needs to be treated on the skin or in the vagina. One option is to rub coconut oil all over after each shower and ladies use a warm water and coconut oil douche twice or three times a week. I used L. plantarum coconut yoghurt on my skin to reduce Staph activity. A yoghurt could also be used as a kind of douche. Based on preliminary research taking L. plantarum orally may reduce inflammation caused by Staph via an immune modulating effect. By the way, this probiotic is often found in saurkraut.
For my personal experience with getting rid of MARCoNS and the use of cultures of B subtils and L plantarum, please refer to my Bio page.
Images and content © D. Bird 2017
