To @Lassesen
Dr.Igor Markov, Markov clinic, Kyiv, Ukraine, replies to Lassesen’s review “Is ME/CFS a case of CBIS?” on 11:31 AM June 1, 2021:
https://cfsremission.com/2021/06/01...YCha_kDA1Bp2OXPTo_lRF_vmkPf5NNMybovk23fOlTQCs or
https://cfsremission.com/2021/06/01/is-me-cfs-a-case-of-cbis/
on a paper “Chronic bacterial intoxication syndrome under the mask of CFS/ME” that is now being discussed on Phoenix Rising (Dr.Markov CBIS Theory of ME/CFS - General Discussion | Page 25 | Phoenix Rising ME/CFS Forums: https://forums.phoenixrising.me/thr...ry-of-me-cfs-general-discussion.84566/page-25 and
ME/CFS is a mystery no more! Under ME/CFS hides Chronic Bacterial Intoxication Syndrome (CBIS) — [This Thread ONLY for Posting Questions to Dr Markov] | Phoenix Rising ME/CFS Forums
https://forums.phoenixrising.me/thr...nly-for-posting-questions-to-dr-markov.84158/ )
Dear Lassesen!
I thought for a long time about your review at “CFSRemission.com”: is ME/CFS a case of CBIS? on 11:31 AM June 1, 2021:
I could not decide to whom I would answer: to a specialist and a scientist, who, according to the existing theories of the origin of CFS, cannot believe what is written in our articles. Or to a patient who is periodically in despair that "often reduces critical analysis." Finally I decided. The main dominant of therapeutical medicine is clinical practice, with its simple motto, written over 25 years on the first page of our clinic's website https://vitacell.com.ua : "It is good treated that what is correctly diagnosed." Therefore, I will answer you, firstly as to a patient, for whom a critical approach to what has been written only helps, and, secondly as to a specialist, for whom a critical approach helps to develop the correct professional opinion.
During 12 long years we kept complete silence: a minimum of words, information, no scientific publications. We could not believe ourselves that it would finally be possible to move this heavy block/wodge of CFS/ME (CFS, ME/CFS) from its place. Moreover, at the very beginning we did not intend to do this: because infectious diseases specialists practically did not pay attention to CFS, which in the classifiers of diseases and diagnoses was referred to neurological diseases. I dealt with one of my “favorite” infections: the Epstein-Barr virus, which for a long time was considered almost as the main cause of the emergence and progression of CFS. And this path led me to a dead end. This is how the terms Nephrodysbacteriosis and Chronic Bacterial Intoxication Syndrome (CBIS) appeared, which there were not and are not in the classifiers of diagnoses and diseases. But about that a little later.
Not believing ourselves, we decided to believe our patients who came to us with varying degrees of despair: from mild pessimism to openly suicidal thoughts and actions (28%, Report 2, Table 1, p.54 of “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Reports 1-6: Clinical Diagnosis” published in the proceedings of the 8th International Congress on Infectious Diseases (Febr.15-16, 2021, London, UK):
https://www.longdom.org/proceedings...n-syndrome-under-the-mask-of-cfsme-59051.html , pdf./HTML, p.32-116). And after treatment, sooner or later, they returned to their normal life, which they lived before the disease of CFS and before their difficult decision to interrupt these tortures and this hopelessness (the same link: Report 4, Example 5, page 81-82).
And on February 14-15, 2021, the first 6 Reports on “CBIS under the mask of CFS/ME. Clinical diagnossis” were published, just the same 85 pages of text that you refer to and which we are discussing. And what? Over the past 5 months, you are the first professional specialist who has not only read all 85 pages, but also expressed your critical comments. Thank you very much for that. Although I understand that only a personally interested person could have done this, i.e. just the patient. Do you know what do almost all the scientific critics and experts in the field of CFS/ME, to whom we appealed with a proposal to evaluate our work, say? Too much text, couldn’t it be simpler? Thus, there was no the effect of the exploding bomb, which the authors of these 85 pages hoped for. It's the same as if a jet fighter flew over Kiyv, over Paris, over London or Washington etc. directly over the heads of passers-by, but no one heard the roar of its engines. Well, at least criticism. But so nothing at all. A dead rubber wall that cannot be holed by the authors. It's a shame, of course.
So thanks again for your response and your assessment of our paper, that is now being discussed on Phoenix Rising, given on CFSRemission.com. Now, in essence.
As for emotions, sensations and the degree of despair.
We can fully agree with you regarding the despair, that patients with CBIS-CFS/ME are experiencing, and the changes in their emotional sphere. One of the typical external manifestations of the intoxication effect on the organism of patients with CBIS is amimia, which was more often noted in adults (1427/2340 or 61%) and in school-age children (279/870 or 32%). Previously cheerful, friendly, affable, always with a smile and a play of different emotions on their faces, people seemed to be wearing either a mournful, or an indifferent, or a tragic mask, like Pierrot from the fairy tale about Pinocchio (Report 2, p. 58-59). The face constantly remained inactive and no longer reflected any emotions or any feelings. One might get the impression that such a person is not at all interested in everything that is happening around him, and they are indifferent to everything. Because they seem to know or feel something that others do not know. This is how one of our patients, a public person who had been ill with CBIS for almost 3 long years, commented on what happened to his face before and after treatment: “Doctor, during the last year of my illness I almost never smiled, so bad I felt myself, I was so exhausted. Although before my illness, my smile was my hallmark/business card, by which I was recognized. Thank you for giving me back not only my smile, but also my real life."
Phobias of varying severity and depression often with panic attacks are experienced by 73-74% of adults (Report 2, Table 1, p.54). The most typical feeling is apathy, experienced by 82% of adults and 14% of schoolchildren. The patients themselves describe their state as an extreme degree of indifference to everything that happens around, to their relatives and friends (Report 4, p.80).
About the research model and “Is ME/CFS a case of CBIS?”
Clinically and in a treatment plan, CBIS-CFS/ME for me is a book I have read. I think I learned this disease as a multiplication table. I want to and it's time to move on. In this regard, our clinical observations in the field of chronic bacterial and viral infections are very interesting and informative.
Already literally over the past six months, we have formed a new vision of the problem of CBIS-CFS/ME. If back in February 2021 we wrote that CBIS=CFS/ME, then today it has become quite obvious to us that the concept of Nephrodysbacteriosis [so we’ve designated the primary formation of a local clinically asymptomatic (without signs of inflammatory process) long-term focus of chronic bacterial infection in the kidneys, which is usually formed in an ascending way and can lead to severe bacterial endotoxicosis with the subsequent development of distant from the kidneys clinical manifestations of CBIS] / CBIS is much broader and includes, apart from CFS/ME, such diagnoses and pathological states as Fibromyalgia/FM (Report 4, p.78-79), Isolated syndrome of increased sweating with a sharp/pungent smell of sweat (Report 3, p.64-65), disorders of the genital sphere with decreased libido and potency, erectile dysfunctions, which were detected in 23% of men with CBIS and which almost completely disappeared after treatment with bacterial autovaccines (Report 3, Example 1, p.66-67).
To the relatively independent intoxication manifestations of Nephrodysbacteriosis in 45-65% of children and 76% of adults can be attributed prolonged subfebrile state, in 29-38% and 24%, respectively - febrile attacks (Report 2, Table 1, p.51-52), which “came without a declaration of war and left without declaring capitulation"- that is outwardly completely without a reason. The origin of such temperature anomalies, despite numerous examinations and consultations, remained unidentified for years (often decades). Such intoxicational manifestations of CBIS as ticoid disorders (Report 3, p.67), especially in children, require separate study. There was established a direct etiological connection of Tourette's syndrome, which is considered as a genetically determined disorder of the central nervous system, with Nephrodysbacteriosis/CBIS in a 10-year-old child with multiple motional ("motor") and phonic ("vocal") tics with coprolalia (Report 3, Example 2, p.67-68). The complete recovery of this child after treatment with bacterial autovaccines can impugn/question only the "genetic" origin of Tourette's syndrome and, possibly, many others with an unknown etiological cause. Today we are monitoring a child with a very rare also genetically determined Hallerman-Streif’s oculo-mandibulo-facial syndrome, associated with congenital cytomegalovirus (CMV) infection, the etiological role of which in the origin of this rare syndrome requires additional study. The child was also diagnosed with concomitant Nephrodysbacteriosis with latent formation of chronic sluggish pyelonephritis. It should be noted that Nephrodysbacteriosis is detected in almost all children with congenital CMV infection, especially with various delays in physical, motor (motional) and psycho-speech development in preschool age. It is extremely interesting that after the treatment of Nephrodysbacteriosis with bacterial vaccines, that leads to the interruption of intoxicational syndrome, the development of children noticeably improves and accelerates.
The relationship between Nephrodysbacteriosis/CBIS and such typical manifestations as skin lesions - bacterial toxicoderma, which we have established, deserves a separate additional study (Report 5, p.90-91).
Bacterial toxicodermas were one of the most frequent manifestations of CBIS and they were noted in more than a third of adults and almost half of children. If some say that the tongue is the mirror of the gastrointestinal tract, then there is such a clear impression that the skin is the mirror of the kidneys. Clinical dermatological diagnoses, which were diagnosed in patients with Nephrodysbacteriosis/CBIS, included such more often nosologically separate diseases as toxicoderma itself, atopic dermatitis and other variants of dermatitis, erythema, urticaria, local asymmetric Quincke's edema, usually on the face (lips, eyelids), eczema, psoriasis, erysipelas. That is all these diagnostically established diseases were considered as various clinical variants of bacterial toxicoderma, which arose on the background of Nephrodysbacteriosis/pyelonephritis and was only one of the manifestations of CBIS-CFS/ME, and often was simply chronic intoxication without the classic signs of CFS/ME. Such an unusual look at the nature of these skin diseases, many of which are usually considered genetically determined and/or hereditary, that is, read - incurable, has made it possible to change the strategy and tactics of their treatment. Namely: there were treated not the skin and allergies, but Nephrodysbacteriosis/pyelonephritis. This approach to the treatment of these various skin lesions and their treatment as much as possible without the use of antiallergic, hormonal drugs and antibiotics with the prescription of bacterial vaccines made it possible to achieve the effectiveness of treatment in children, in particular, such diseases as atopic dermatitis, eczema, psoriasis at the level of 80-100%. In adults who have lived with these diagnoses their almost whole lives, the most that could be expected was the achievement of a more or less stable remission. Although in cases of beginning of treatment in adults with up to 3 years of illness, the results were also significantly better.
Moreover, it was found that in the etiological and pathogenetic basis of such seemingly independent diseases of a viral nature as genital herpes and herpes zoster, an important, if not dominant, role is played just by intoxication caused by bacterial toxins at Nephrodysbacteriosis/CBIS (as written in the fully ready for publication “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Bacteriological Diagnosis”, Report 7, p.9-10). Taking into consideration the carried out examinations, it was assumed that just certain bacterial toxins, some part of which, according to the clinical signs of their action, could be considered as neurotropic, in patients with Nephrodysbacteriosis/CBIS are just the main trigger factor, which, on the one hand, provokes relapses of genital herpes and herpes zoster, and on the other hand, can inhibit the immunological response to treatment with herpes vaccines. On the other hand, taking into consideration the frequency of detection of Nephrodysbacteriosis/pyelonephritis in patients with recurrent genital and herpes zoster (90.7% and 95.5%, respectively), these diseases to a certain extent can be indirectly considered as a clinical marker of undiagnosed Nephrodysbacteriosis/pyelonephritis.
Separately it is necessary to consider such a serious disease as reactive arthritis (ReA), which was considered as a result of the action of arthromyotropic toxins of bacteria in patients with Nephrodysbacteriosis/pyelonephritis (Report 5, pp. 91, 92-93).
Currently, to ReA are attributed inflammatory non-purulent diseases of the joints that develop due to immune disorders after acute intestinal infection (in 1.5-4% of cases) and more often, according to established concepts, caused by toxins of such enterobacteria as Yersinia, Salmonella and Shigella, as well as by toxins of urogenital infections, sexually transmitted (1-3%), among which 80% of cases are connected with Chlamydia trachomatis, explaining this by the "chlamydiosis pandemic in the world." Neither in the available medical literature, nor in the Internet, nor in previous and modern classifications of reactive arthritis, nor in WHO materials, there are no reports that the focus of the primary infection, which is the triggering factor for the secondary development of reactive arthritis, may be in the kidneys. Not a word was also found that the causative agents of ReA can be ordinary naturally symbiotic and saprophytic enterobacteria and enterococci, which live for life in the human intestine, as well as pathogenic staphylococci and streptococci, in cases where these bacteria form a focus of chronic bacterial infection in the kidneys.
During 12 years (since 2009) under our observation and treatment there were 770/4500 (17.1%) patients with CBIS on the background of Nephrodysbacteriosis/pyelonephritis with reactive non-purulent inflammation of the joints, dominating in the clinical picture of the disease. There were 540/2340 (23%) adults, 157/870 (18%) schoolchildren, and 73/750 (9.7%) aged 3 to 7 years. Usually, diagnoses of joint lesions were established yet at the previous stages of examination and treatment: reactive arthritis - in 560/770 (72.7%) cases (in another 70/770 or 9.1% of cases, the diagnosis of ReA was initially established in our clinic), as well as rheumatoid arthritis (RA) – 70/770 (9.1%), including juvenile RA in 9 children (1.1%); as well as arthritis on the background of gout - 45/770 (5.8%) cases, psoriasis - 15/770 (1.9%) and joint lesions, which were on the background of borreliosis (Lyme disease) - in 10 patients (1.3%) that in general totaled also 70/770 (9.1%) cases.
An example of effective treatment with bacterial vaccines of a patient with gout, whose polyarthritis for 10 years did not respond to the standard treatment in such cases, and therefore his doctors were already going to prescribe him therapy with cytostatic drugs, is given in Report 3, Example 1, pp.66-67. After several cycles of treatment with bacterial vaccines, the gout, of course, remained, but the pain in the joints disappeared and did not recur again not once during 4 years of observation. And the patient never again took pain relievers and non-steroidal anti-inflammatory drugs, which before he had uselessly swallowed for 10 long years.
In 12/2340 (0.5%) adults (women-8, men-4) with typical clinical manifestations of CBIS, due to the effect of psychotropic toxins, there was additionally observed the emergence of a special mental state, known as depersonalization/derealization syndrome (Report 4, p.82-83).
We are absolutely sure that the etiopathogenetic role of Nephrodysbacteriosis will be established more additionally in a significant list of diagnoses and syndromes, which still remain etiologically uncertain.
About terminology. Not only the term "Nephrodysbacteriosis" is not found in databases of PubMed, but also MEDLINE, PsycINFO, EMBASE, Cochrane, in classifiers of diseases and diagnoses, in special literature, etc. Still not found. Because before such a term did not exist at all. Apart from the term Nephrodysbacteriosis, which just we have so “designated”, there are defined more additionally three terms: “Chronic bacterial intoxication syndrome”, “febrile attack” and “pain attack” (Report 2, p.49). Just so the authors have designated that what during 12 years they had observed in the clinic of these interconnected diagnoses and pathological states. For these terms, there was received a "Certificate of Copyright Registration No.98661" issued by the State Intellectual Property Service of Ukraine on July 15, 2020.
About that “what it’s necessary to predict in connection with chronic infection in kidneys”.
Our article is really single in this field, since the medical community did not yet face this diagnosis and, accordingly, did not study its consequences. Preliminary data on the outcomes of asymptomatic infection in the kidneys are given in our paper (Report 5, pp.99-100). The development of CBIS did not depend on the presence of an inflammatory process in the kidneys. So, among 2340 adults with a diagnosis of Nephrodysbacteriosis with the development of CBIS, clinical mentions, laboratory and/or ultrasound confirmation of the diagnosis of pyelonephritis had at the time of visiting our clinic only 281/2340 (12%) patients, and among 2160 children - 173 (8%). Meanwhile, more additionally in 585/2340 (25%) adults and 411/2160 (19%) children, despite the absence of any data of anamnesis and clinical manifestations of chronic pyelonephritis, in the general urine analyzes there were for the first time detected microscopic signs of latent formation of chronic sluggish inflammatory process in the kidneys with a different level of increase of protein, leukocytes, with the appearance of cylinders and bacteria, less often - erythrocytes. That is, in 63% of adult patients and 73% of children at the moment of their diagnosing with CBIS, they had Nephrodysbacteriosis in a "pure" form without any signs of an inflammatory process in the kidneys.
In a result of follow-up observation for 700 patients (adults - 420, children - 280) with a diagnosis of Nephrodysbacteriosis, who either did not pass at all, or underwent only 1-2 courses of treatment with bacterial autovaccines, without having achieved the complete sanitation of the focus in the kidneys, there was established the following. In more than a third of cases (in 157/420 or 37.4% of adults and 110/280 or 39.2% of children), the debut of pyelonephritis has developed in a period from several hours (casuistic cases) to several years (sometimes 8-10 years) after the initial clinical diagnosing and/or bacteriological confirmation of their diagnosis Nephrodysbacteriosis.
In connection with such an almost total isolation of bacteria from the urine of patients with different diagnoses, there were examined two control groups of healthy children and adults (Report 7, p. 11). Among infants, Nephrodysbacteriosis was found in 110/205 cases (53.7%), that could be regarded as a kind of "payment for diapers", and among adults - in 5/70 (7.1%) cases.
Thus, it can be assumed that very often under the future construction of CBIS-CFS/ME with all its diverse clinical manifestations the etiopathogenetic basis in the form of Nephrodysbacteriosis is laid yet in childhood. And children, treated with bacterial vaccines against Nephrodysbacteriosis, will never in their adult life suffer from CBIS-CFS/ME. Although this preliminary thesis needs further study.
About irony (remark). Firstly, the respected reviewer in vain "skipped" patients’ diseases histories, cited by the authors, ironically noting, how “many pages devoted to individual stories”. Unfortunately, modern doctors pay too much attention to various mathematical models of diseases, the results of instrumental examinations, diagnostic and treatment algorithms, forgetting about Her Majesty the Clinic, about the need to collect anamnesis, very often - just talking with their patients. So taught me, a young clinician, 45 years ago my teacher, an outstanding Kyiv’s infectious diseases clinician, Professor Boris Leontyevich Ugryumov, and he, a young doctor in the 30s of the last century, was taught by his teacher, an infectious diseases academician Georgy Pavlovich Rudnev. The correct "model" of clinical diagnosis has been preserved in memory for all my life: "As in a drop of water the whole surrounding world is refracted, so in one clinical case of the disease a whole problem can be reflected." Just so I teach today my son, a young infectious diseases clinician.
And, secondly, the lenient in a few lines irony of the reputable reviewer that the toxicological study of blood was carried out "not with an ordinary test", but with the use of the Toxicon diagnostic system, "developed by a group of Ukrainian scientists", is hardly appropriate at all [I.M. - I give this answer to a specialist, not a patient]. This system was developed by a Kyiv’s scientist, a doctor for toxicology-resuscitation professor Boris Semyonovich Sheiman. The Toxicon system has been used many times for a long time for various models of the characteristics of toxic damage to organs and systems of the organism of children and adults, including by us - at Nephrodysbacteriosis/CBIS. The results of studies of the gene response to the effect of various etiological factors made it possible to establish that the emergence of various "toxic proteomes" in the bloodstream is the regularity of this response.
The Toxicon system, thanks to its complex toxicometry, allows to establish the parameters of toxemia with the definition of the characteristics of "toxic proteomes." Just to "toxic proteomes" it’s possible to attribute the terms "endotoxin" or "toxin", which are widely used in the medical literature. In all 818 children and adults with the diagnosis CBIS, examined by the Toxicon system, without exception all indicators of the cytolytic activity of toxic proteomes, which were tested, significantly exceeded the norm. Proteomic analysis was also previously used to determine the pathophysiology of ME/CFS (Sweetman, E., Kleffmann, T., Edgar, C. et al. A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction. J Transl Med 18 365 (2020). https://doi.org/10.1186/s12967-020-02533-3).
About the role and contribution of Ukrainian scientists to the world science and medical practice it’s hardly necessary to remind. It is already well known, regardless of the personal opinion of the reputable reviewer.
About inattentiveness. The reputable reviewer notes, quoting the incorrect Google-translation from Ukrainian to English, that “Bacteria that had to live naturally in our intestines and work there productively … apparently by mistake, but purposefully settled in the kidneys. Most often they were enterococci … and others, in no single cases – Staphylococcus and Streptococcus, …”, i.e. that the cause of Nephrodysbacteriosis "in no case" were Staphylococcus and Streptococcus.
Firstly, the correct translation has to be: “…in not single cases (= not in isolated cases) - Staphylococcus and Streptococcus,…” [i.e. Staphylococcus and Streptococcus there were in many cases!].
Secondly, the authors propose to read Report 7, pp.5-6 and Table 1, which literally say the following: “Staphylococci and streptococci made up a large group of bacteria isolated from urine in patients with CBIS: in total 15% or 1012 strains, isolated from 22.5% of patients. Namely, Staphylococci (675/6750 or 10%): Staphylococcus aureus - 398/675 or 59% and Staphylococcus haemolyticus - 277/675 or 41% strains, and Streptococci: Streptococcus pyogenes - 5% or 337/6750 strains (from 7.5% of patients). Staphylococci and Streptococci in total according to the detection rates were second only after enterococci and Escherichia coli ...”.
Once again about the model and the personal interest of the authors.
It is possible to debate for a long time about the conformity or inconsistency of that, is the CBIS a variant of the ME/CFS? To infinity. Patients with these diagnoses do not have time to wait for the end of the scientific debates of scientists and experts about the chosen model. Moreover, it is not necessary. The only thing the authors of this pioneering report want is a professional answer to the question: everything written is true, or a fiction of the authors. The answer to this question can be obtained in two ways. Firstly, to organize multicenter studies, adhering to the concept of diagnostics and treatment, developed by the authors, without distorting its essence. As the reviewer correctly noted, "the lack of replication too often leads to the slow death of theories." It may turn out to be correct, but a long way to go. Shorter, more direct and efficient way, possibly parallel, in our opinion is the following. To select according to the judgement of the created medical-patient commission 100, 50 and at least 20 patients with different periods of the disease: 25% - up to 5 years, another 25% - from 6 to 10 years, 25% - 11-20 years and 25% - more 20 years. And send them to Kyiv for examination and treatment. The cost of diagnostics and preparation of bacterial autovaccines is 1.5-2 thousand dollars per person, and the same amount, or less (depending on distance to Kyiv), for transfer, accommodation and nutrition for 2 weeks (the time required for bacterial tests and preparation of autovaccines). This budget is, in our opinion, ridiculous for the possibility of solving the problem of CFS/ME, taking into account the billions of dollars that the world community needs annually to solve this problem.
Now about personal interest. We did not set ourselves the goal of fundraising "to continue research", therefore it can be no talk of any "bravado and bias". For 12 years, we have carried out all the studies confirming our clinical, diagnostic and therapeutic concept at the expense of our own budget of our 2 private clinics. Now we will go further in the study of the above clinical variants of Nephrodysbacteriosis/CBIS. And various companies and funds that have been financing the study of the CFS/ME problem for decades, have 3 options for further actions. 1) It is simply not to notice our study and findings and to continue formally to search for answers to questions, being on a knowingly wrong way that runs into a dead end ("ecologically homogeneous group; common DNA; common diet; common history of vaccination", etc.). 2) To organize multicenter studies to confirm or refute our concept of CFS/ME origin. 3) To diagnose and treat a limited number of patients with typical diagnoses of CFS/ME in Kyiv.
Once again about antibiotics (remark).
"Someone is on soap box describing a popular demon." Unfortunately, antibiotics from a simple demon have long turned into a ruthless executioner. As for the "soap box", a reputable reviewer (as a specialist) might be more modest. The conclusion of the authors is based on the study of the anamnesis and follow-up observation of 4500 patients with Nephrodysbacteriosis/CBIS. In 4050 (90.0%) cases, it was found that patients were prescribed and they usually more than once took earlier antibiotics of various groups. Herewith, in almost 2/3 of adults the first overload of the organism with antibiotics occurred in childhood more often in connection with constant colds and their purulent-inflammatory complications caused by Staphylococcal infection. In almost a third of cases, the emergence or exacerbation of symptoms of CBIS also occurred after taking just antibiotics the days before (from several weeks to 1-2 months) (as written in the fully ready for publication “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Treatment”, Report 9, p.3). The reviewer is modestly silent about his experience in studying this question.
About the misunderstood (remark).
“A vaccine against a kidney bacteria will also have direct impact on the same bacteria in the gut microbiome. On the flip side, appropriate antibiotics would also impact the same bacteria in the Jadin’s protocol using antibiotics will also impact kidney infections.“
However: 1) We do not use bacterial autovaccines to treat intestinal dysbiosis (disorders of the intestinal microbiome). Vaccines on enterobacteria in the intestine do not have any effect, since the evolutionary relationships of the intestinal mucous membranes and the bacteria which form its enteromicrobiome, phylogenetically cannot enter into antagonistic contradictions; 2) Antibiotics are in principle not suitable for the treatment of Nephrodysbacteriosis, since dysbacteriosis/dysbiosis of any localization, in principle, cannot be "cured" with antibiotics. This is nonsense and delusion, in which, unfortunately, many practicing doctors continue to be.
“There is one important difference: vaccines have a longer life of action (typically a year or more) than an antibiotics. Also be aware that the study cited that up to 10 courses of vaccines were needed with some. This sounds a bit like 10 rounds of antibiotics!!”
It is professionally incorrect to compare antibiotics and vaccines in this way. Hardly anyone doubts the "benefits" of antibiotics. This is just that treatment which shortens a person's life. But almost every day patients come to our clinic, for whom antibiotics were prescribed in multiple courses, often lasting several months, sometimes continuously. This is a direct path to complete disability of patients. Bacterial vaccines are currently the only way to break this vicious circle of continuous antibiotic therapy. And if the treatment of any focus of chronic bacterial infection (including Nephrodysbacteriosis) with antibiotics in all cases leads to a reduction of the "bright" intervals between the necessary courses of treatment, then the use of bacterial vaccines, on the contrary, always increases these intervals. Bacterial autovaccines and antibiotics are antagonistically not matching/different methods of treatment, about which cannot be said "slightly similar."
Once again about the model (to p.82). "… excessive growth of multiple bacteria…" cannot be defeated with "…antibiotics, phages, diet and supplement changes." Bacterial vaccines are the only real and more than once tested/proven means to change the level of the immunological response of the mucous membranes, on which the "uninvited guests" have settled, and to restore the barrier level of local immunity. And this is not simply a replica. This is a clinical experience that has been tested many times over in comparison. And this is just a cure, NOT simply a "remission." Even if it is necessary in some cases to repeat it every year, while remaining clinically healthy. Everything else is either cheese in a mousetrap (antibiotics), or "dancing at the fire and tambourine fight" (diet and nutritional supplements). The authors insist on this categorically.
About reviewer’s error. The thesis that “until vaccines become available”, the use of “appropriate multiple courses of the right antibiotics is available today” is madness, the payment for which is the patient's lifelong cabala near the doctor's chair. Those who do not use antibiotics to treat CFS/ME have a chance even without vaccines to get out of this situation to freedom. Those, who give up and allow antibiotic treatment, don't have that chance.
About gratitude. The authors express their deep gratitude to the reviewer (thank you, Lassesen!) for the final thesis, said also earlier on Phoenix Rising, that "their results are creditable, their treatment is creditable." The choice of a model for verifying the results of the authors' 12-year study – this is already a technical issue of the choice for the medical and patient community.
Kindly yours, Dr.-med.Igor Markov, Kyiv, Ukraine.
Dr.Igor Markov, Markov clinic, Kyiv, Ukraine, replies to Lassesen’s review “Is ME/CFS a case of CBIS?” on 11:31 AM June 1, 2021:
https://cfsremission.com/2021/06/01...YCha_kDA1Bp2OXPTo_lRF_vmkPf5NNMybovk23fOlTQCs or
https://cfsremission.com/2021/06/01/is-me-cfs-a-case-of-cbis/
on a paper “Chronic bacterial intoxication syndrome under the mask of CFS/ME” that is now being discussed on Phoenix Rising (Dr.Markov CBIS Theory of ME/CFS - General Discussion | Page 25 | Phoenix Rising ME/CFS Forums: https://forums.phoenixrising.me/thr...ry-of-me-cfs-general-discussion.84566/page-25 and
ME/CFS is a mystery no more! Under ME/CFS hides Chronic Bacterial Intoxication Syndrome (CBIS) — [This Thread ONLY for Posting Questions to Dr Markov] | Phoenix Rising ME/CFS Forums
https://forums.phoenixrising.me/thr...nly-for-posting-questions-to-dr-markov.84158/ )
Dear Lassesen!
I thought for a long time about your review at “CFSRemission.com”: is ME/CFS a case of CBIS? on 11:31 AM June 1, 2021:
I could not decide to whom I would answer: to a specialist and a scientist, who, according to the existing theories of the origin of CFS, cannot believe what is written in our articles. Or to a patient who is periodically in despair that "often reduces critical analysis." Finally I decided. The main dominant of therapeutical medicine is clinical practice, with its simple motto, written over 25 years on the first page of our clinic's website https://vitacell.com.ua : "It is good treated that what is correctly diagnosed." Therefore, I will answer you, firstly as to a patient, for whom a critical approach to what has been written only helps, and, secondly as to a specialist, for whom a critical approach helps to develop the correct professional opinion.
During 12 long years we kept complete silence: a minimum of words, information, no scientific publications. We could not believe ourselves that it would finally be possible to move this heavy block/wodge of CFS/ME (CFS, ME/CFS) from its place. Moreover, at the very beginning we did not intend to do this: because infectious diseases specialists practically did not pay attention to CFS, which in the classifiers of diseases and diagnoses was referred to neurological diseases. I dealt with one of my “favorite” infections: the Epstein-Barr virus, which for a long time was considered almost as the main cause of the emergence and progression of CFS. And this path led me to a dead end. This is how the terms Nephrodysbacteriosis and Chronic Bacterial Intoxication Syndrome (CBIS) appeared, which there were not and are not in the classifiers of diagnoses and diseases. But about that a little later.
Not believing ourselves, we decided to believe our patients who came to us with varying degrees of despair: from mild pessimism to openly suicidal thoughts and actions (28%, Report 2, Table 1, p.54 of “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Reports 1-6: Clinical Diagnosis” published in the proceedings of the 8th International Congress on Infectious Diseases (Febr.15-16, 2021, London, UK):
https://www.longdom.org/proceedings...n-syndrome-under-the-mask-of-cfsme-59051.html , pdf./HTML, p.32-116). And after treatment, sooner or later, they returned to their normal life, which they lived before the disease of CFS and before their difficult decision to interrupt these tortures and this hopelessness (the same link: Report 4, Example 5, page 81-82).
And on February 14-15, 2021, the first 6 Reports on “CBIS under the mask of CFS/ME. Clinical diagnossis” were published, just the same 85 pages of text that you refer to and which we are discussing. And what? Over the past 5 months, you are the first professional specialist who has not only read all 85 pages, but also expressed your critical comments. Thank you very much for that. Although I understand that only a personally interested person could have done this, i.e. just the patient. Do you know what do almost all the scientific critics and experts in the field of CFS/ME, to whom we appealed with a proposal to evaluate our work, say? Too much text, couldn’t it be simpler? Thus, there was no the effect of the exploding bomb, which the authors of these 85 pages hoped for. It's the same as if a jet fighter flew over Kiyv, over Paris, over London or Washington etc. directly over the heads of passers-by, but no one heard the roar of its engines. Well, at least criticism. But so nothing at all. A dead rubber wall that cannot be holed by the authors. It's a shame, of course.
So thanks again for your response and your assessment of our paper, that is now being discussed on Phoenix Rising, given on CFSRemission.com. Now, in essence.
As for emotions, sensations and the degree of despair.
We can fully agree with you regarding the despair, that patients with CBIS-CFS/ME are experiencing, and the changes in their emotional sphere. One of the typical external manifestations of the intoxication effect on the organism of patients with CBIS is amimia, which was more often noted in adults (1427/2340 or 61%) and in school-age children (279/870 or 32%). Previously cheerful, friendly, affable, always with a smile and a play of different emotions on their faces, people seemed to be wearing either a mournful, or an indifferent, or a tragic mask, like Pierrot from the fairy tale about Pinocchio (Report 2, p. 58-59). The face constantly remained inactive and no longer reflected any emotions or any feelings. One might get the impression that such a person is not at all interested in everything that is happening around him, and they are indifferent to everything. Because they seem to know or feel something that others do not know. This is how one of our patients, a public person who had been ill with CBIS for almost 3 long years, commented on what happened to his face before and after treatment: “Doctor, during the last year of my illness I almost never smiled, so bad I felt myself, I was so exhausted. Although before my illness, my smile was my hallmark/business card, by which I was recognized. Thank you for giving me back not only my smile, but also my real life."
Phobias of varying severity and depression often with panic attacks are experienced by 73-74% of adults (Report 2, Table 1, p.54). The most typical feeling is apathy, experienced by 82% of adults and 14% of schoolchildren. The patients themselves describe their state as an extreme degree of indifference to everything that happens around, to their relatives and friends (Report 4, p.80).
About the research model and “Is ME/CFS a case of CBIS?”
Clinically and in a treatment plan, CBIS-CFS/ME for me is a book I have read. I think I learned this disease as a multiplication table. I want to and it's time to move on. In this regard, our clinical observations in the field of chronic bacterial and viral infections are very interesting and informative.
Already literally over the past six months, we have formed a new vision of the problem of CBIS-CFS/ME. If back in February 2021 we wrote that CBIS=CFS/ME, then today it has become quite obvious to us that the concept of Nephrodysbacteriosis [so we’ve designated the primary formation of a local clinically asymptomatic (without signs of inflammatory process) long-term focus of chronic bacterial infection in the kidneys, which is usually formed in an ascending way and can lead to severe bacterial endotoxicosis with the subsequent development of distant from the kidneys clinical manifestations of CBIS] / CBIS is much broader and includes, apart from CFS/ME, such diagnoses and pathological states as Fibromyalgia/FM (Report 4, p.78-79), Isolated syndrome of increased sweating with a sharp/pungent smell of sweat (Report 3, p.64-65), disorders of the genital sphere with decreased libido and potency, erectile dysfunctions, which were detected in 23% of men with CBIS and which almost completely disappeared after treatment with bacterial autovaccines (Report 3, Example 1, p.66-67).
To the relatively independent intoxication manifestations of Nephrodysbacteriosis in 45-65% of children and 76% of adults can be attributed prolonged subfebrile state, in 29-38% and 24%, respectively - febrile attacks (Report 2, Table 1, p.51-52), which “came without a declaration of war and left without declaring capitulation"- that is outwardly completely without a reason. The origin of such temperature anomalies, despite numerous examinations and consultations, remained unidentified for years (often decades). Such intoxicational manifestations of CBIS as ticoid disorders (Report 3, p.67), especially in children, require separate study. There was established a direct etiological connection of Tourette's syndrome, which is considered as a genetically determined disorder of the central nervous system, with Nephrodysbacteriosis/CBIS in a 10-year-old child with multiple motional ("motor") and phonic ("vocal") tics with coprolalia (Report 3, Example 2, p.67-68). The complete recovery of this child after treatment with bacterial autovaccines can impugn/question only the "genetic" origin of Tourette's syndrome and, possibly, many others with an unknown etiological cause. Today we are monitoring a child with a very rare also genetically determined Hallerman-Streif’s oculo-mandibulo-facial syndrome, associated with congenital cytomegalovirus (CMV) infection, the etiological role of which in the origin of this rare syndrome requires additional study. The child was also diagnosed with concomitant Nephrodysbacteriosis with latent formation of chronic sluggish pyelonephritis. It should be noted that Nephrodysbacteriosis is detected in almost all children with congenital CMV infection, especially with various delays in physical, motor (motional) and psycho-speech development in preschool age. It is extremely interesting that after the treatment of Nephrodysbacteriosis with bacterial vaccines, that leads to the interruption of intoxicational syndrome, the development of children noticeably improves and accelerates.
The relationship between Nephrodysbacteriosis/CBIS and such typical manifestations as skin lesions - bacterial toxicoderma, which we have established, deserves a separate additional study (Report 5, p.90-91).
Bacterial toxicodermas were one of the most frequent manifestations of CBIS and they were noted in more than a third of adults and almost half of children. If some say that the tongue is the mirror of the gastrointestinal tract, then there is such a clear impression that the skin is the mirror of the kidneys. Clinical dermatological diagnoses, which were diagnosed in patients with Nephrodysbacteriosis/CBIS, included such more often nosologically separate diseases as toxicoderma itself, atopic dermatitis and other variants of dermatitis, erythema, urticaria, local asymmetric Quincke's edema, usually on the face (lips, eyelids), eczema, psoriasis, erysipelas. That is all these diagnostically established diseases were considered as various clinical variants of bacterial toxicoderma, which arose on the background of Nephrodysbacteriosis/pyelonephritis and was only one of the manifestations of CBIS-CFS/ME, and often was simply chronic intoxication without the classic signs of CFS/ME. Such an unusual look at the nature of these skin diseases, many of which are usually considered genetically determined and/or hereditary, that is, read - incurable, has made it possible to change the strategy and tactics of their treatment. Namely: there were treated not the skin and allergies, but Nephrodysbacteriosis/pyelonephritis. This approach to the treatment of these various skin lesions and their treatment as much as possible without the use of antiallergic, hormonal drugs and antibiotics with the prescription of bacterial vaccines made it possible to achieve the effectiveness of treatment in children, in particular, such diseases as atopic dermatitis, eczema, psoriasis at the level of 80-100%. In adults who have lived with these diagnoses their almost whole lives, the most that could be expected was the achievement of a more or less stable remission. Although in cases of beginning of treatment in adults with up to 3 years of illness, the results were also significantly better.
Moreover, it was found that in the etiological and pathogenetic basis of such seemingly independent diseases of a viral nature as genital herpes and herpes zoster, an important, if not dominant, role is played just by intoxication caused by bacterial toxins at Nephrodysbacteriosis/CBIS (as written in the fully ready for publication “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Bacteriological Diagnosis”, Report 7, p.9-10). Taking into consideration the carried out examinations, it was assumed that just certain bacterial toxins, some part of which, according to the clinical signs of their action, could be considered as neurotropic, in patients with Nephrodysbacteriosis/CBIS are just the main trigger factor, which, on the one hand, provokes relapses of genital herpes and herpes zoster, and on the other hand, can inhibit the immunological response to treatment with herpes vaccines. On the other hand, taking into consideration the frequency of detection of Nephrodysbacteriosis/pyelonephritis in patients with recurrent genital and herpes zoster (90.7% and 95.5%, respectively), these diseases to a certain extent can be indirectly considered as a clinical marker of undiagnosed Nephrodysbacteriosis/pyelonephritis.
Separately it is necessary to consider such a serious disease as reactive arthritis (ReA), which was considered as a result of the action of arthromyotropic toxins of bacteria in patients with Nephrodysbacteriosis/pyelonephritis (Report 5, pp. 91, 92-93).
Currently, to ReA are attributed inflammatory non-purulent diseases of the joints that develop due to immune disorders after acute intestinal infection (in 1.5-4% of cases) and more often, according to established concepts, caused by toxins of such enterobacteria as Yersinia, Salmonella and Shigella, as well as by toxins of urogenital infections, sexually transmitted (1-3%), among which 80% of cases are connected with Chlamydia trachomatis, explaining this by the "chlamydiosis pandemic in the world." Neither in the available medical literature, nor in the Internet, nor in previous and modern classifications of reactive arthritis, nor in WHO materials, there are no reports that the focus of the primary infection, which is the triggering factor for the secondary development of reactive arthritis, may be in the kidneys. Not a word was also found that the causative agents of ReA can be ordinary naturally symbiotic and saprophytic enterobacteria and enterococci, which live for life in the human intestine, as well as pathogenic staphylococci and streptococci, in cases where these bacteria form a focus of chronic bacterial infection in the kidneys.
During 12 years (since 2009) under our observation and treatment there were 770/4500 (17.1%) patients with CBIS on the background of Nephrodysbacteriosis/pyelonephritis with reactive non-purulent inflammation of the joints, dominating in the clinical picture of the disease. There were 540/2340 (23%) adults, 157/870 (18%) schoolchildren, and 73/750 (9.7%) aged 3 to 7 years. Usually, diagnoses of joint lesions were established yet at the previous stages of examination and treatment: reactive arthritis - in 560/770 (72.7%) cases (in another 70/770 or 9.1% of cases, the diagnosis of ReA was initially established in our clinic), as well as rheumatoid arthritis (RA) – 70/770 (9.1%), including juvenile RA in 9 children (1.1%); as well as arthritis on the background of gout - 45/770 (5.8%) cases, psoriasis - 15/770 (1.9%) and joint lesions, which were on the background of borreliosis (Lyme disease) - in 10 patients (1.3%) that in general totaled also 70/770 (9.1%) cases.
An example of effective treatment with bacterial vaccines of a patient with gout, whose polyarthritis for 10 years did not respond to the standard treatment in such cases, and therefore his doctors were already going to prescribe him therapy with cytostatic drugs, is given in Report 3, Example 1, pp.66-67. After several cycles of treatment with bacterial vaccines, the gout, of course, remained, but the pain in the joints disappeared and did not recur again not once during 4 years of observation. And the patient never again took pain relievers and non-steroidal anti-inflammatory drugs, which before he had uselessly swallowed for 10 long years.
In 12/2340 (0.5%) adults (women-8, men-4) with typical clinical manifestations of CBIS, due to the effect of psychotropic toxins, there was additionally observed the emergence of a special mental state, known as depersonalization/derealization syndrome (Report 4, p.82-83).
We are absolutely sure that the etiopathogenetic role of Nephrodysbacteriosis will be established more additionally in a significant list of diagnoses and syndromes, which still remain etiologically uncertain.
About terminology. Not only the term "Nephrodysbacteriosis" is not found in databases of PubMed, but also MEDLINE, PsycINFO, EMBASE, Cochrane, in classifiers of diseases and diagnoses, in special literature, etc. Still not found. Because before such a term did not exist at all. Apart from the term Nephrodysbacteriosis, which just we have so “designated”, there are defined more additionally three terms: “Chronic bacterial intoxication syndrome”, “febrile attack” and “pain attack” (Report 2, p.49). Just so the authors have designated that what during 12 years they had observed in the clinic of these interconnected diagnoses and pathological states. For these terms, there was received a "Certificate of Copyright Registration No.98661" issued by the State Intellectual Property Service of Ukraine on July 15, 2020.
About that “what it’s necessary to predict in connection with chronic infection in kidneys”.
Our article is really single in this field, since the medical community did not yet face this diagnosis and, accordingly, did not study its consequences. Preliminary data on the outcomes of asymptomatic infection in the kidneys are given in our paper (Report 5, pp.99-100). The development of CBIS did not depend on the presence of an inflammatory process in the kidneys. So, among 2340 adults with a diagnosis of Nephrodysbacteriosis with the development of CBIS, clinical mentions, laboratory and/or ultrasound confirmation of the diagnosis of pyelonephritis had at the time of visiting our clinic only 281/2340 (12%) patients, and among 2160 children - 173 (8%). Meanwhile, more additionally in 585/2340 (25%) adults and 411/2160 (19%) children, despite the absence of any data of anamnesis and clinical manifestations of chronic pyelonephritis, in the general urine analyzes there were for the first time detected microscopic signs of latent formation of chronic sluggish inflammatory process in the kidneys with a different level of increase of protein, leukocytes, with the appearance of cylinders and bacteria, less often - erythrocytes. That is, in 63% of adult patients and 73% of children at the moment of their diagnosing with CBIS, they had Nephrodysbacteriosis in a "pure" form without any signs of an inflammatory process in the kidneys.
In a result of follow-up observation for 700 patients (adults - 420, children - 280) with a diagnosis of Nephrodysbacteriosis, who either did not pass at all, or underwent only 1-2 courses of treatment with bacterial autovaccines, without having achieved the complete sanitation of the focus in the kidneys, there was established the following. In more than a third of cases (in 157/420 or 37.4% of adults and 110/280 or 39.2% of children), the debut of pyelonephritis has developed in a period from several hours (casuistic cases) to several years (sometimes 8-10 years) after the initial clinical diagnosing and/or bacteriological confirmation of their diagnosis Nephrodysbacteriosis.
In connection with such an almost total isolation of bacteria from the urine of patients with different diagnoses, there were examined two control groups of healthy children and adults (Report 7, p. 11). Among infants, Nephrodysbacteriosis was found in 110/205 cases (53.7%), that could be regarded as a kind of "payment for diapers", and among adults - in 5/70 (7.1%) cases.
Thus, it can be assumed that very often under the future construction of CBIS-CFS/ME with all its diverse clinical manifestations the etiopathogenetic basis in the form of Nephrodysbacteriosis is laid yet in childhood. And children, treated with bacterial vaccines against Nephrodysbacteriosis, will never in their adult life suffer from CBIS-CFS/ME. Although this preliminary thesis needs further study.
About irony (remark). Firstly, the respected reviewer in vain "skipped" patients’ diseases histories, cited by the authors, ironically noting, how “many pages devoted to individual stories”. Unfortunately, modern doctors pay too much attention to various mathematical models of diseases, the results of instrumental examinations, diagnostic and treatment algorithms, forgetting about Her Majesty the Clinic, about the need to collect anamnesis, very often - just talking with their patients. So taught me, a young clinician, 45 years ago my teacher, an outstanding Kyiv’s infectious diseases clinician, Professor Boris Leontyevich Ugryumov, and he, a young doctor in the 30s of the last century, was taught by his teacher, an infectious diseases academician Georgy Pavlovich Rudnev. The correct "model" of clinical diagnosis has been preserved in memory for all my life: "As in a drop of water the whole surrounding world is refracted, so in one clinical case of the disease a whole problem can be reflected." Just so I teach today my son, a young infectious diseases clinician.
And, secondly, the lenient in a few lines irony of the reputable reviewer that the toxicological study of blood was carried out "not with an ordinary test", but with the use of the Toxicon diagnostic system, "developed by a group of Ukrainian scientists", is hardly appropriate at all [I.M. - I give this answer to a specialist, not a patient]. This system was developed by a Kyiv’s scientist, a doctor for toxicology-resuscitation professor Boris Semyonovich Sheiman. The Toxicon system has been used many times for a long time for various models of the characteristics of toxic damage to organs and systems of the organism of children and adults, including by us - at Nephrodysbacteriosis/CBIS. The results of studies of the gene response to the effect of various etiological factors made it possible to establish that the emergence of various "toxic proteomes" in the bloodstream is the regularity of this response.
The Toxicon system, thanks to its complex toxicometry, allows to establish the parameters of toxemia with the definition of the characteristics of "toxic proteomes." Just to "toxic proteomes" it’s possible to attribute the terms "endotoxin" or "toxin", which are widely used in the medical literature. In all 818 children and adults with the diagnosis CBIS, examined by the Toxicon system, without exception all indicators of the cytolytic activity of toxic proteomes, which were tested, significantly exceeded the norm. Proteomic analysis was also previously used to determine the pathophysiology of ME/CFS (Sweetman, E., Kleffmann, T., Edgar, C. et al. A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction. J Transl Med 18 365 (2020). https://doi.org/10.1186/s12967-020-02533-3).
About the role and contribution of Ukrainian scientists to the world science and medical practice it’s hardly necessary to remind. It is already well known, regardless of the personal opinion of the reputable reviewer.
About inattentiveness. The reputable reviewer notes, quoting the incorrect Google-translation from Ukrainian to English, that “Bacteria that had to live naturally in our intestines and work there productively … apparently by mistake, but purposefully settled in the kidneys. Most often they were enterococci … and others, in no single cases – Staphylococcus and Streptococcus, …”, i.e. that the cause of Nephrodysbacteriosis "in no case" were Staphylococcus and Streptococcus.
Firstly, the correct translation has to be: “…in not single cases (= not in isolated cases) - Staphylococcus and Streptococcus,…” [i.e. Staphylococcus and Streptococcus there were in many cases!].
Secondly, the authors propose to read Report 7, pp.5-6 and Table 1, which literally say the following: “Staphylococci and streptococci made up a large group of bacteria isolated from urine in patients with CBIS: in total 15% or 1012 strains, isolated from 22.5% of patients. Namely, Staphylococci (675/6750 or 10%): Staphylococcus aureus - 398/675 or 59% and Staphylococcus haemolyticus - 277/675 or 41% strains, and Streptococci: Streptococcus pyogenes - 5% or 337/6750 strains (from 7.5% of patients). Staphylococci and Streptococci in total according to the detection rates were second only after enterococci and Escherichia coli ...”.
Once again about the model and the personal interest of the authors.
It is possible to debate for a long time about the conformity or inconsistency of that, is the CBIS a variant of the ME/CFS? To infinity. Patients with these diagnoses do not have time to wait for the end of the scientific debates of scientists and experts about the chosen model. Moreover, it is not necessary. The only thing the authors of this pioneering report want is a professional answer to the question: everything written is true, or a fiction of the authors. The answer to this question can be obtained in two ways. Firstly, to organize multicenter studies, adhering to the concept of diagnostics and treatment, developed by the authors, without distorting its essence. As the reviewer correctly noted, "the lack of replication too often leads to the slow death of theories." It may turn out to be correct, but a long way to go. Shorter, more direct and efficient way, possibly parallel, in our opinion is the following. To select according to the judgement of the created medical-patient commission 100, 50 and at least 20 patients with different periods of the disease: 25% - up to 5 years, another 25% - from 6 to 10 years, 25% - 11-20 years and 25% - more 20 years. And send them to Kyiv for examination and treatment. The cost of diagnostics and preparation of bacterial autovaccines is 1.5-2 thousand dollars per person, and the same amount, or less (depending on distance to Kyiv), for transfer, accommodation and nutrition for 2 weeks (the time required for bacterial tests and preparation of autovaccines). This budget is, in our opinion, ridiculous for the possibility of solving the problem of CFS/ME, taking into account the billions of dollars that the world community needs annually to solve this problem.
Now about personal interest. We did not set ourselves the goal of fundraising "to continue research", therefore it can be no talk of any "bravado and bias". For 12 years, we have carried out all the studies confirming our clinical, diagnostic and therapeutic concept at the expense of our own budget of our 2 private clinics. Now we will go further in the study of the above clinical variants of Nephrodysbacteriosis/CBIS. And various companies and funds that have been financing the study of the CFS/ME problem for decades, have 3 options for further actions. 1) It is simply not to notice our study and findings and to continue formally to search for answers to questions, being on a knowingly wrong way that runs into a dead end ("ecologically homogeneous group; common DNA; common diet; common history of vaccination", etc.). 2) To organize multicenter studies to confirm or refute our concept of CFS/ME origin. 3) To diagnose and treat a limited number of patients with typical diagnoses of CFS/ME in Kyiv.
Once again about antibiotics (remark).
"Someone is on soap box describing a popular demon." Unfortunately, antibiotics from a simple demon have long turned into a ruthless executioner. As for the "soap box", a reputable reviewer (as a specialist) might be more modest. The conclusion of the authors is based on the study of the anamnesis and follow-up observation of 4500 patients with Nephrodysbacteriosis/CBIS. In 4050 (90.0%) cases, it was found that patients were prescribed and they usually more than once took earlier antibiotics of various groups. Herewith, in almost 2/3 of adults the first overload of the organism with antibiotics occurred in childhood more often in connection with constant colds and their purulent-inflammatory complications caused by Staphylococcal infection. In almost a third of cases, the emergence or exacerbation of symptoms of CBIS also occurred after taking just antibiotics the days before (from several weeks to 1-2 months) (as written in the fully ready for publication “Chronic bacterial intoxication syndrome under the mask of CFS/ME. Treatment”, Report 9, p.3). The reviewer is modestly silent about his experience in studying this question.
About the misunderstood (remark).
“A vaccine against a kidney bacteria will also have direct impact on the same bacteria in the gut microbiome. On the flip side, appropriate antibiotics would also impact the same bacteria in the Jadin’s protocol using antibiotics will also impact kidney infections.“
However: 1) We do not use bacterial autovaccines to treat intestinal dysbiosis (disorders of the intestinal microbiome). Vaccines on enterobacteria in the intestine do not have any effect, since the evolutionary relationships of the intestinal mucous membranes and the bacteria which form its enteromicrobiome, phylogenetically cannot enter into antagonistic contradictions; 2) Antibiotics are in principle not suitable for the treatment of Nephrodysbacteriosis, since dysbacteriosis/dysbiosis of any localization, in principle, cannot be "cured" with antibiotics. This is nonsense and delusion, in which, unfortunately, many practicing doctors continue to be.
“There is one important difference: vaccines have a longer life of action (typically a year or more) than an antibiotics. Also be aware that the study cited that up to 10 courses of vaccines were needed with some. This sounds a bit like 10 rounds of antibiotics!!”
It is professionally incorrect to compare antibiotics and vaccines in this way. Hardly anyone doubts the "benefits" of antibiotics. This is just that treatment which shortens a person's life. But almost every day patients come to our clinic, for whom antibiotics were prescribed in multiple courses, often lasting several months, sometimes continuously. This is a direct path to complete disability of patients. Bacterial vaccines are currently the only way to break this vicious circle of continuous antibiotic therapy. And if the treatment of any focus of chronic bacterial infection (including Nephrodysbacteriosis) with antibiotics in all cases leads to a reduction of the "bright" intervals between the necessary courses of treatment, then the use of bacterial vaccines, on the contrary, always increases these intervals. Bacterial autovaccines and antibiotics are antagonistically not matching/different methods of treatment, about which cannot be said "slightly similar."
Once again about the model (to p.82). "… excessive growth of multiple bacteria…" cannot be defeated with "…antibiotics, phages, diet and supplement changes." Bacterial vaccines are the only real and more than once tested/proven means to change the level of the immunological response of the mucous membranes, on which the "uninvited guests" have settled, and to restore the barrier level of local immunity. And this is not simply a replica. This is a clinical experience that has been tested many times over in comparison. And this is just a cure, NOT simply a "remission." Even if it is necessary in some cases to repeat it every year, while remaining clinically healthy. Everything else is either cheese in a mousetrap (antibiotics), or "dancing at the fire and tambourine fight" (diet and nutritional supplements). The authors insist on this categorically.
About reviewer’s error. The thesis that “until vaccines become available”, the use of “appropriate multiple courses of the right antibiotics is available today” is madness, the payment for which is the patient's lifelong cabala near the doctor's chair. Those who do not use antibiotics to treat CFS/ME have a chance even without vaccines to get out of this situation to freedom. Those, who give up and allow antibiotic treatment, don't have that chance.
About gratitude. The authors express their deep gratitude to the reviewer (thank you, Lassesen!) for the final thesis, said also earlier on Phoenix Rising, that "their results are creditable, their treatment is creditable." The choice of a model for verifying the results of the authors' 12-year study – this is already a technical issue of the choice for the medical and patient community.
Kindly yours, Dr.-med.Igor Markov, Kyiv, Ukraine.
