Correlation between immune system against infections (cytokines) and the patient's psyche / behavior?
Amati et al.
[Relationship of Job Satisfaction, Psychological Distress and
Stress-Related Biological Parameters among Healthy Nurses: A
Longitudinal Study
J Occup Health 2010; 52:31-38, PDF
] examined whether there was a relationship between cytokines and number of
different immune defense cells and job-related stress and psychosocial
support.
People who were exposed to job-wise stress and the lack of support /
understanding was relatively reduced immune defense risk profile:
increased lymphocytes, increased CD8 + T suppressor cells, CD8 +-CD57 +
activated T cells (NB CD3-CD57 + subset that is found low in chronic
Lyme disease, tuberculosis, were not measured in this work!) and CD56 +
NK cells, reduced CD4 + helper T cells and low CD4 + / CD8 + ratio
- Reverse was great
job satisfaction and high levels of social support associated with
reduced CD8 + - CD57 + T cells, supporting that social support is
important for protecting against immune deficiency under stress!
CD57+ T cells seem of particular importance.
Reactive microenvironment infiltrated with CD57+ T cells are
associated with a higher incidence of adverse reactions, suggesting that
CD57 is a marker of general immune dysfunction.
CD57 + antigen is normally expressed only in a small proportion (16%)
of CD8 + T lymphocytes, but the proportion increases during chronic
immune activation and with increasing age *
* Increase of chronic immune activation with increasing age could
reflect people up through life infected with various microbes - viruses,
bacteria, parasites - with potential for lifelong persistence and later
reactivation; including various virus in herpes family (ex HHV6, EBV,
CMV) - intracellular microbes - all of which are associated with
activation of NFkB - my mini review on NFkB
focusing on intracellular microbes associated with chronic disease -
including some of the tick borne bacteria Borrelia, Ehrlichia, rickettia
Others
bacteria - which can cause dysregulation of the immune system precisely
to create the possibility of persistence and reactivation; infections,
all of which can flare up later when the immune system is reduced ...
Expression of CD57+ makes cells sensitive to activation-induced cell death by apoptosis (TNF effect?).
NK
cells and subsets plays an important role in the host defense against
viral / parasitic (intracellular) infections and in protecting against
tumor growth (cancer).
Long-term stress is associated with reduced NK cell activity,
number of NK cells decreased by depersonaliserings score of Maslach
Burn-out Inventory (MBI) among office workers, associated with job
stress, overwork - but stress can also increase the number of NK cells.
This article was high job satisfaction and high social suppport
associated with reduced NK CD56 + cells, while it was higher in people
who felt stressed.
There seems to be inter-individual differences in the effect of circulating lymphocytes during stress exposure .
Stricker CD57+ NK cell fraction is
often found low in chronic Borreliosis of longer than 1 year
duration; healing is correlated with an increase in CD57-NK cell
fraction up to normal range (>100)
Number of circulating NK CC or demonstrating high in depression. Persons
having increased their job satisfaction exhibited reduced levels of
inflammatory cytokines such as IL-1beta, IL-6, and CD8 + CD57 +
activated T-cells, which supports the hypothesis that there is a change
in the immunological / inflammatory response in terms of job
satisfaction and psycho social stress.
More
free download available reading material on the link between infection /
cytokines, mental / cognitive disorders, behavioral changes, decreased
blood flow in the brain, etc.: * Depression in medical illness ( PDF ) * Cytokines and the Brain: Implications for Clinical Psychiatry ( PDF )
* Synergistic Effects of interleukin-1beta, interleukin-6, and tumor
necrosis factor-alpha: central monoamine, corticosterone, and behavioral
variation. ( PDF ) * Relief of psychiatric symptoms in a patient with Crohn's disease after metronidazole therapy. (P213 in PDF ) * Successful Treatment of Lyme Encephalopathy with Intravenous Ceftriaxone. ( PDF ) * Cerebral perfusion in chronic fatigue syndrome and depression. ( PDF ) * Neurological and psychological symptoms after the severe acute neuroborreliosis. ( PDF )
* The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study. ( PDF not OA) * Functional brain imaging and neuropsychological testing in Lyme disease. ( PDF ) * A controlled study of cognitive deficits in children with chronic Lyme disease. ( PDF ) * A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. PMID: 17928580 MKs comment in DanInfekt ) * Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy. PMID: 19414715
* Vance Spence lecture in Sheffield 2005 Lyme conf. which is about "why research in vascular?"
It
is always important to see any revival / reactivation of chronic
persistent infection and subsequent development of chronic disease,
depression etc. in relation to the patient's living conditions and not
only focus on the individual microbes role, but also assess the
patient's lifestyle, whether there are significant stressors in the
patient's life that may contribute to immunosuppression, which allows
the resurgence of infections as the immune system usually can hold it in
check?!
- And if it turns out that a patient do
not thrive in his job, the marriage etc., there good reason to do
something about it, as it can result in immune suppression and risk of
development or exacerbation of chronic disease and revival of hitherto
latent infections if the stress continues!
But
one thing is certain - it is not always ENOUGH to maintain a
good health, that you live as healthy as you possibly can!
Even relatively young and before reasonably healthy-living and healthy patients,
can "break" down completely after they acquire Borrelia infection, etc., and
some of them fortunately get back on track - as the infection is gunned down by antibiotic therapy.
A fairly typical story is that the inoculating tickbite and possibly also an erythema migrans rash, initially went unnoticed, i.e. pt.
- the patient are not aware and do not not contact doctor shortly after
the bite, but gradually over months to years develop an increasing
array of multi-organ symptoms,that puzzles the doctor as well as the patient - Borrelia is, as syphilis, for good reason called the great imitator.
The disease is recurrent- remitting episodes with flu-like symptoms (chills and sweats) of approx.
2-5 days in a weekly or monthly recurrence pattern, fatigue, migraine-like
headaches, nausea/vomiting, joint and muscle pain plus various cognitive disorders (sound and light sensitivity,
touch sensitivity, touch trigger longer-term strong burning sensations
in the skin, impaired short-term memory, impaired concentration. etc.)
- because of the long interval the patient does not connect previous tickbite or rash with later occuring symptoms,
and if the doc forget to ask the key questions about tickexposure and
eventual rashes in the past, the infection may go unnoticed for many
years, despite the patient sees many different doctors ...
The doctor may or may not be aware that the in Denmark commonly used
Borrelia antibody test has been shown to be published FALSE SERUM
ANTIBODY NEGATIVE in 50% or more of late (> 3 months duration) Lyme
disease cases detected by direct examination methods:
Culture is the microbiological gold standard diagnostic method see Reed 2002, PDF
PCR (genetic testing) for example. a few publ with several well-studied cases from Europe: Oksi 1995 ( PDF ), Strle 2006 ( PDF )
- many more late / persistent despite antibiotics therapy borrelia reports are listed in persistent borreliosis ...
When
/ if there is an underlying immunodeficiency then unfortunately only a
few remaining microbes after stopping antibiotic treatment, can
easily quickly flourish again and cause major relapse, again and
again. If sick people -
develop cognitive and behavioral problems - it can be very difficult to
understand why it is necessary, and to implement life style change that
reduce stress (changing jobs, separation from partner in bad
relationship or similar), if the patient continues to get toxins, such
as tobacco, alcohol in large quantities, various medicines (especially,
of course, known immunosuppressive drugs, cytostatics, corticosteroids
(prednisone, etc..) and certain NSAIDs prep. reduce IgG antibody prod
by up to 50% ( PDF
); malnutrition (poor appetite, inappropiate diet tried due to suspected food
reactions, so that the body may appear to be missing important building
blocks?
-
or a latent borrelia infection can flare up, when / if the patient
later is exposed to severe stressors, for example death of
illness in the immediate family, operations/ anaestesis, etc. -
the immune supression caused by stress may precipitate a relapse of
infection(s) that were under control! .. we know that an old "incapsulated" TB can fluorish in old age or immune depression of various causes.
It
is important to evaluate the whole patient for if there are
immunosuppressive factors, that should be addressed and changed if
possible - maybe it is enough to regain control to remove stressors and the pt. may not have a need for antibiotics? - which should be reserved for very disabled cases.
But
often the patient is too sick to change anything and looking into
lifestyle must wait until the patient have improved on treatment;
patients who improve much on first treatment think they are cured, and
are often not motivated to make any lifestyle changes ... it take more
relapses, before the patient understand the necessity of looking into
causes of immune depression.
Borrelia grows so slowly that a conventional antibiotic treatment of 10 days barely break a single growth cycle; the 80-90% of Borrelia patients
that do recover after short treatment, are usually those who
seroconvert and develop a mature IgG antibody response early, and the
cure achieved are probably more because their well-functioning immune system, than due to the antibiotic treatment?
People
that are not cured easily usually have only IgM or no measurable
antibodies (they do not develop immune memory), some express
fluctuating IgMs, but do not develop IgG when measured with old
commercial serology test ...
These of people with known / serological evidence Borrelia
infection do not need the extended evaluation or treatment unless they
experience a relapse!
PEOPLE WITH RECURRENT RELAPSE / CHRONIC ILLNESS FROM BORRELIA > 1
year has IMMUNE IMPAIRMENT and should be evaluated for other
tick-borne infectious - especially the types that infect immune cells,
Anaplasma, Ehrlichia, Coxiella? - plus CMV, EBV may reactivate too and
play a role?
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