Update July 2020
Since the first edition 5/2019 was published, I have received a lot of positive feedback, and I would like to take this opportunity to thank you for it. As hoped, the website and the book are increasingly found by those affected, and in many cases the treating doctors are open-minded and ready to deal with this topic. Diagnosis and therapy are discussed in detail in the book, and I look forward to working with interested colleagues at any time.
Of course the work in the practice continues, and difficult courses of diseases have to be deciphered. In my research into these cases, I come across other findings and therapeutic options. Chapter 7, in which other possible causes of illness and infections are discussed, will therefore be extended in a new edition (which is currently still a long way off). One addition is so essential that I would like to report on it here.
We are talking about Chlamydia infections, which I could identify as a cause or additional factor of the disease in some difficult cases.
Chlamydia are very small bacteria that live within our cells and hide there; in this respect they are similar to toxoplasmas. It is known that some strains of these bacteria can cause persistent infections of the respiratory tract, and it is also suspected that chronic chlamydial disease can lead to vascular occlusion and joint inflammation similar to rheumatic diseases. Another strain is one of the most common sexually transmitted pathogens and causes infections of the genital organs. This often goes unnoticed, but it can also lead to inflammation of the urethra, painful abdominal inflammation and infertility.
It is less well known, however, that chlamydia can apparently also trigger longterm chronic diseases with a wide range of symptoms such as fatigue, coughing, chronic sinus infections, visual disturbances and burning eyes, pains of joints, spine and tendons. Internal organs can also be affected, resulting in a burning sensation in the stomach area and heart stitches. Anyone looking for "Brockmann" and "Chlamydia" online will quickly find an interesting article by Dr. Silke Brockmann with a detailed description of the symptoms. As with toxoplasmosis, it is not individual symptoms that are decisive for diagnosing the disease, but their combination. The following additional list is based Silke Brockmann's observations and has proven to be useful. The download is free of charge.
The frequency of infections with chlamydia increases with age, for Chlamydophila pneumonia it is around 60%. It is unknown how often this leads to a chronic illness. The clinical picture is less common among my patients and a bit less aggressive than chronic active toxoplasmosis, but it can imitate some of the symptoms and thus make the diagnosis more difficult or interfere with the success of the treatment. As with toxoplasmas, the importance of chronic chlamydia infections has been underestimated so far.
In chlamydia infections of the respiratory tract the antibody determinations are more reliable than in chronically active toxoplasmosis. A special feature, however, is that an active infection is often not characterized by increased IgM, but by increased IgA. It should also be noted that in people with congenital IgA deficiency (frequency about 1: 500) it is not possible to reliably rule out a chlamydia infection that requires treatment by estimating IgA antibodies. Here LTT testing (see below) can be helpful. In case of active chlamydial infections, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) were mostly detected in our practice.
For the chlamydia strain that is sexually transmitted (Chlamydia trachomatis), direct evidence, e.g. a smear, is more reliable. As is so often the case, there is unfortunately a certain error rate, so that this disease can sometimes not be confirmed with certainty, but it is also difficult to exclude securely. The LTT is also available for chlamydia, and costs around € 90 per test of one chlamydia strain.
Fortunately, the treatment is less complicated than in the case of toxoplasmosis, standard antibiotics such as clarithromycin 2x500 mg or doxycycline 2x100 mg over 20 days work reliably, even more so if they are combined. In other cases, antibiotics can also be combined according to the "Wheldon Protocol" (doxycycline 2x100 mg + azithromycin 1x250 up to 500mg on every second day).
As with the treatment of chronically active toxoplasmosis, there may be a temporary increase in symptoms during the first few days of treatment, but this is in some respect also a positive sign as the therapy is usually effective in these cases.
If a chronically active toxoplasmosis and a chronically active chlamydial infection are present at the same time, it is advisable to treat the chlamydial infection first. The reason is that Chlamydia cause far fewer relapses than Toxoplasma. During the first Chlamydia therapy, only a few chlamydia-specific symptoms such as coughing, burning eyes or tendon pain will probably improve at first, the remaining symptoms will then improve as a result of the Toxoplasmosis therapy. I would like to urgently recommend this treatment sequence - if Toxoplasmosis is treated first while the immune system is still weakened by both diseases, a Toxoplasmosis relapse may occur early, perhaps already during the following Chlamydia therapy.
Ultimately, in the case of chronic infections, it makes sense to take into account that a weakened immune system may not only lose control over one pathogen, but also over several. An immune system may initially be weakened by toxoplasmosis, but it can subsequently also lose control over other germs such as chlamydia or herpes viruses, e.g. CMV or EBV. As a result, the clinical picture may widen, the disease intensity may increase and a successful therapy becomes more difficult - but in many cases it is still possible.
I'm still working on convincing a university clinic to conduct a clinical study on chronically active toxoplasmosis. Although meanwhile I have been granted appropriate funding, this remains a difficult task, as many doctors still underestimate the significant threat to our health that results from this disease.
Additional Checklist Chlamydia