Dr. Cècile Jadin-The Rickettsial Approach
Jan van Roijen
Voor: HELP M.E. - CIRCLE, donderdag 22 juni 2000
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[JvR: Omdat ik wat vragen kreeg over het verband Rickettsia en ME,
stuur ik, voor een beter begrip, de komende dagen nog wat meer
artikelen over dit microorganisme.
Het volgende artikel is van dr. Cecile Jadin op de Sydney
Conferentie in 1999.
Because I got some questions about the relationship between
Rickettsia and ME/CFS, I will send some more articles about
this subject in the next days.
The following paper is from Dr. Cecile Jadin at the Sydney
Conference 1999.
Dr. Cecile Jadin is bereikbaar:
How to contact Dr. Cecile Jadin:
Mail address: Dr. C.L.Jadin.
Postnet Suite 182,
Private Bag X3,
North Riding 2162,
Republic of South Africa
Fax no. + 27 11 794 3370
Tel no. + 27 11 460 1670 from 06.30am – 07.00am and from
06.30pm – 07.00pm (local time)
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Dr. Cecile Jadin`s paper at the Sydney Conference:
The Rickettsial Approach
Presented by Dr. Cècile Jadin Johannesburg, South Africa
at the CFS Conference in Sydney, February 1999.
The Rickettsial Approach and treatment of patients presenting with CFS,
Fibromyalgia, Rheumatoid Arthritis and Neurological Dysfunction.
Good Day. I am Cécile Jadin. I am originally from Belgium, but I have
been practising in South Africa for the last 17 years. I am a surgeon by
profession; in South Africa, in addition to practising as a surgeon, I
also assisted my husband in his general practice. For the last 7 years,
I have been focusing on the subject of my paper and my approach has
naturally been that of a clinician, and it is in this context that I am
presenting my paper.
I wish to explain something of my background, so that you understand why
I took the Rickettsial approach. I was born in the then Belgian Congo,
because my father was Professor JB Jadin, who undertook the
groundbreaking research on Rickettsial infection, first in the Pasteur
lnstitute of Tunisia, as disciples of Professor Charles Nicolle, (who
himself was a disciple of Louis Pasteur)- then in Central Africa with
Professor Paul Giroud. So you might say, I was familiar with this
research from an early age and I am presenting here the results of
teamwork through the last 100 years.
8 years ago, one of my friends became unable to walk and was diagnosed
as having ME. For 4 years I suggested the diagnosis of Rickettsial
lnfection, therefore the Weil- Felix test was performed several times in
South Africa and the results were negative. One day, she came to see me
with an acute appendicitis. After I removed her appendix, upon her
request, I sent her serum to my father to test for Rickettsiae, and it
was positive. I treated her with Tetracyclines and 3 weeks later, she
was riding her horse again. I was sceptical. But this case brought me a
couple of 100 patients and the publicity surrounding an investigation of
my methodology by the South African Medical Council brought several
thousand more.
Research on Rickettsioses was originally developed by French, Polish and
Russian scientists. They followed Charles Nicolle's (Pasteur lnstitute,
winner of the Nobel Prize for medicine in 1933) hypothesis, which is
that o c c u l t d e s e a s e s are a reality and their cohabitation
in the same host will lead to the bankruptcy of the immune system (8).
By occult disease Charles Nicolle implies the a s y m p t o m a t i c
stage of the disease, where the agent is present in the host, but
dormant. The emergence of a virus, bacteria, stress or pollution can
activate this agent, which leads to the s y m p t o m a t i c stage.
An example of this cohabitation is the infant mortality rate described
by J.B. Jadin in Central Africa. Neonates diagnosed with malaria and
Coxielia Burnetti all died as opposed to those with malaria only (20).
The numerous publications of these authors are unfortunately all in
French, so their circulation was limited. They also, as academics,
excluded the media. Therefore the r e a l i m p o r t a n c e o f t
h e i r d i s c o v e r y i s s t i l l t o b e m a d e w i d e
l y k n o w n.
The fairly recently recognised entity of C F S gives us a perfect
opportunity to try the etiological route to understand this disease.
Along this route we will automatically enter other medical fields,
inviting us to consider an infectious etiology in cardiology
(4,5,9,11,12), in psychiatry (3,17), in neurology (3,29) and in
rheumatology (28), rather than describing the symptoms and gathering
them into syndromes (20, 40).
Obviously one germ can cause many diseases depending on a selective
topicality for one or more particular tissues as well as one disease can
be caused by different germs alone or simultaneously. Therefore we would
like to concentrate on the causative agent rather than on the name of
the disease.
There are many reasons suggesting the infectious etiology and, more
specifically, Rickettsial-like organisme of CFS. Amongst those reasons:
1. Consider the following -.
- CFS was first reported in lncline, Nevada in 1984 (1) and
developed into epidemic proportions.
- Rocky Mountain Spotted Fever originated from the same place in
1916 (9,29).
- The spirochete Borrelia Duttoni, first blamed for causing the
recurrent Malgache fever described in the journals written by Drury in
1702 (24) in Madagascar, then by Scheltz in the Belgian Congo in 1933,
by Palakov in Cape Town in 1944, by Heisch in Kenya in 1950.
- Lyme Disease appeared (or reappeared?) more recently in Lyme,
Connecticut in 1975 (Borrelia Burgdorferi) (25).
Could these be new names for an old disease?
All of the above highlights the life of a germ as an individual
emerging and disappearing in a wave pattern epidemically and
historically. Like us, germs have to adapt, producing new
variations of themselves, (not new species), that may or may not
survive on their own, with or without the help of another germ.
This is circumstance-dependent, and these particular
circumstances will never reoccur. Some of those variations will
acquire specific and consistant characteristics. This is their
'civilisation'. We only see them when they succeed, and only then
do new avenues of investigation open up, while others are abandoned.
2. A link has been established between Florence Nightingale disease and
CFS (21). The fact that she was working surrounded by lice, fleas
and ticks, treating soldiers with wounds and with epidemic typhus
during the Crimean war, could be a logical explanation as to why
she was terribly tired during the last 2 decades of her life; and
possibly has relevance to Gulf War illnesses (13). Zinsser has
developed the same concept in his classic book "Rats, Lice and
History". He contends:
"Soldiers have rarely won wars. Typhus and other infectious
diseases have decided the outcome of more military campaigns than
Caesar, Hannibal, Napoleon and all generals in history. Depending
on the outcome for each warring faction, either the epidemics were
blamed for defeat, or the generals were credited with victory." (2).
More examples of this phenomenon were reported by JB Jadin (29).
3. Lymphocyte studies conducted on sheep with tick-borne diseases (14),
CFS patients (15,16), and patients with Q Fever endocarditis (11) are
showing amazingly similar results.
4. Coincidentally, the new name suggested in the Lancet for CFS is PQFS
(Post Q Fever Syndrome) in April 1996 edition (22).
5. During the First World War an estimated 25 million Russians
contracted Louse- borne epidemic typhus, resulting in 3 million
deaths. Why not before or after? lt could suggest that the stress
factor reactivates the virulence of Typhus Prowazeki. In the
medical history of CFS patients, stress has often been described
as the start of the illness.
6. The symptoms displayed by CFS, Fibromyalgia, RA, and even
neurological patients as MS, show the same diversity of symptoms
as Rickettsial patients. How many scientists blamed the diversity of
symptoms for misleading unprepared practitioners in the diagnosis
of chronic Rickettsial infection (30)? That same diversity could have
contributed to the delay in recognising CFS. French authors
(Giroud, Jadin, Legag) attribute those multiple aspects to a
generalized micro-vascular invasion. They widely demonstrated the
persistence of Rickettsiae in the vessels (4), (18). The suggestion
here is that the well-known, well-documented entity of Rickettsial
disease, showing the same symptoms as the newly arrived
CFS, might simply, partially or totally be caused by the same agent.
7. The last, but not the least reason, is the success rate of the
Rickettsia treatment, Tetracycline. Dr Phillipe Bottero on 100
patients, Dr Peter Tableton on 300 patients (17) and myself on a
much larger number of patients, maintain an 84% - to 96%
recovery rate.
Patients and Method
3,400 patients presented with CFS, Fibromyalgia, RA, depression and MS
have been
diagnosed as suffering from Chronic Rickettsial lnfection (CRI) after
eliminating other
diseases as a cause (diabetes, cancer etc.).
The majority of my patients report a flu-like infektion with often an
elevated
temperature and severe headaches. This lasts for a few days, disappear
or reoccur,
and then leave them with a chronic condition of CFS, Fibromyalgia etc as
mentioned
above.
Diagnosis of CRI is established by Giroud's Micro-Agglutination test
against five
strains of Rickettsiae:
R. Prowazeki
R. Mooseri
R. Gonori
Coxielia Burnetti
Neo Rickettsia Chiamydiae (18)
A high reading means a high serological level of antibodies - a negative
reading in
endemic areas reflects the poverty of the immune system (24).
Agglutination happens
or does not - therefore there is no possibility of personal
interpretation. Test quality
depends on Antigen quality (3). Positive tests can be found in people
who display no
symptoms (Giroud, Jadin; 26% according to Drancourt (39)).
Rickettsiae are transmitted by arthropodes (36), except for Q Fever,
which does not
really need vectors,
- they are resistant to humidity and to dryness
- they will stay virulent for 60 days in milk,
- 4 months in sand,
- 6 months in meat,
- and 7 - 9 months in cotton. (4).
They are spread by rodents and birds. Through the centuries, bird
migration has been
responsible for changing the geographical distribution of disease (27) -
but this is
nothing compared to effect of the explosive disease distribution by
present day air
traffic (26).
Equally the transport of insects compared to the import and export of
livestock - as in
the case of the import of 10,000 parrots from Paraguay to Belgium when
some 2,000
died, leaving the virus well and alive behind them (27), (identified by
my father as Neo-
Rickettsia Bedsonia).
This world distribution does not include Antarctica, where they do not
survive.
Fish also share this disease, as Erlichioses is, according to breeders,
a common
problem (31).
However, the Micro-Agglutination test of Giroud is not our only tool to
establish the
diagnosis of Rickettsial infections. We find the following blood tests
most relevant:
- - LFT- the hepatoxicity of Rickettsiae has been reported as early as
1937 by
errick in Q Fever (19, 29), followed by many others (Giroud, Lenette,
Legag,
Brezina, Perron, Kelly, Raoult, etc. In these cases, Tetracyclines
are improving
liver function.
- - Iron study (50%of abnormalities corrected with Tetracyclines only
and when
necessary with a short course of iron supplement).
- - Thyroid AB rather than TFT, although the TFT show abnormalities in
3% of
patients, the thyroid AB are elevated in 28% of cases and improve or
normalise
rapidly with treatment.
- - CRP, RF, ANF, WR resulted in 53% (39) and also improved with
treatmnent
- - Mycoplasma (only researched after the Manly conference).
The patients symptoms most commonly exhibited are:
- Tiredness
- Myalgia, arthralgia migrating
- Headaches, retroorbital and temporal, worst after prolonged
horizontal position
or mental effort (4).
- Memory and concentration deficit (4).
- Psychological and neurological disorders(4,5,18,29,30)
- Chest pain, palpitations (8,12)
- Vision abnormalities (3,29)
- Nausea (8,9,18)
- Loss of balance (29)
- Recurrent sore throat (23)
- Bruising (4)
- Sweats, low grade fever (4)
- Raynaud syndrome (18)
We find a constant guideline in the Physical examination, which often
shows
- An inflamed throat
- Multiple adenopathies
- Heart abnormalities (vascular (4,12,30) and valvular impact
(2, 39))
- RIF tenderness (chlamydiae 18 in appendix (23))
After establishing those 3 cornerstones (symptoms, physical examination
and blood
tests), a treatment has been administered, guided by our predecessor,
(Giroud, Jadin,
Legag etc.), refined by our contemporaries, (Bottero and Raoult) and my
own daily,
private lesson (each patient is one).
The treatment consists of 7 to 12 days per month of a specific
Tetracycline used as
follows..
1. A h i g h d o s a g e is required (4,5) with the limitation of:
- S a f e t y (32)
Goodman et al (33) highlights irreversible hepatotoxicity in intravenous
administration only. Our experience was that when liver functions were
normal to start with, they stay normal. lf they were abnormal, they will
improve during treatment and generally return to normal. Cases
of fatty acid depots (as shown by liver scan, before and after 6 months
to1 year of treatment) have disappeared (1 MS, 4 ME). This
confirms the fact that Rickettsiae are more hepatotoxic than
Tetracyclines.
- T o l e r a n c e
a) The gastric intolerance will be successfully prevented by using a
gastric pump inhibitor during and if necessary before and after the
administration of the Tetracyclines.
b) The tolerance of the treatment is directly related to the Herxheimer
reaction (4, 6, 26, 37) is a reactivation of old symptoms and/or
exacerbation of present symptoms that occurs on
antibiotherapy. Its presence has a very important diagnosis and
prognosis value. They might or might not be parallel to a
serological reactivation. lt will fade with the number of treatments
received. When very severe, the HR is treated with Probenecid.
2. The Tetracyclines are a l t e r n a t e d because:
a) A patient is frequently contaminated by many strains of Rickettsiae
(5) and
different Rickettsiae have different sensitivity to different
Tetracyclines. (4).
b) A patient might build resistance to each Tetracycline (4, 17).
c) Patients show individual sensitivity to different Tetracyclines or
combinations and is very often a previliged reaction to a specific
treatment.
3. The Tetracyclines are c o m b i n e d with Quinolones, Macrolides
or Metronidazole (7), because Rickettsiae present a wide
heterogenicity of
susceptibility of different drugs (4).
4. The treatment is often l o n g due to:
a) The chronicity of the germ
b) The multiple foci of Rickettsiae
c) The fact that Rickettsiae have a slow evolution and some foci are
dormant, encapsulated and therefore protected from antibiotherapy. Only
when they become active can they be treated (5).
d) Each treatment will allow the immune system to produce and maintain a
proper
and efficient level of antibodies. This happens each time the antigen
Rickettsiae are released from the cell to the blood stream while on
antibiotherapy (4).
e) The length of the disease should logically imply a lengthy treatment.
In our experience, this point is not always true. Patients, ill for many
years, may recover after a few months treatment.
5. Antimalaria has been found efficient to improve Rheumatoid symptoms
and Rheumatoid biological findings (see patients' files).
6. Adjuvants such as Vitamin B complex and acidobacillus are also used.
7. Cortisone is avoided as much as possible as it is known to weaken the
Immune
System (3) and also to reactivate the disease in experiments on
guinea-pigs (39).
8. Exercise is recommended, for the following 3 reasons:
- Rickettsiae is a vascular disease
- The fact that strains of Rickettsiae grow better in vitro
when maintained in a C02 enriched atmosphere (34).
- The suggestion that Rickettsiae grow best when the
metabolism of the host cell is low (38).
9. Hot baths are important to eliminate toxins produced by Rickettsiae
antigens when liberated in the bloodstream by antibiotherapy.
10. Reinfection may obviously oceur. Reactivation (called so rather than
relapse) may also happen due to the interaction of bacteria, virus,
stress,
pollution, etc. causing the Rickettsiae forms' change to active from
dormant.
Measurement of Progress
Patients are seen monthly to judge progress on:
1. Symptoms
2. Activity increase (From bedridden to back to exercise or back to
work)
3. From being treated by painkillers, antidepressants, sedatives,
cortisone to none
4. Medical examination
5. Biological investigation: from having:
- - LFT )
- - RF, CRP, ANF )
- - KFT ) To normal or nearly so
- - Thyroid antibodies )
- - Iron )
Based on the assessment, the treatment is prolonged or stopped (3 months
to 2 years
- - 8 months on average). However, as previously mentioned, the length
of treatment is
not directly correlated to the length of illness:
Patients can be divided into 2 categories:
1. Fast progress - their illness was mainly Rickettsia
2. Slow progress - their illness was Rickettsia plus other factors (20)
At the end of the last page is a drawing of a balloon named "The Immune
Balloon" with sacks on board named with different diseases. The
balloonist throw a sack named "Rickettsia" overboard. With the drawing
is the following text: "Controlling Rickettsia is a suggested way to
repair an immune system quickly or slowly".
and the page end with the following :
"La santé est cornme une mongolfiére: il faut parfois lâcher du lest"
CFS – Rickettsial Infection: Sources of References.
Presented by DR. Cècile Jadin, Johannesburg, South Africa, February 1999
(Copied by MW)
R e f e r e n c es A u t h or s
1) CFS in Incline Village 1991 Mauf & Gon RSA
2) Annals New York Academy of Sciences 1990 Preface
3) Acta Mediterranea di Patologia Infectiva e Tropicale 1984 Vol3 J.B.
Jadin P213
1986 Vol5 1987Vol6 no 3
4) Bulletin Societè de Pathologie Exotique 1963 J. Gear P588
Monteiro P680
S. Nicolau P691-714
J.G. Bernard P758-793
N.R. Grist P684-687
A. MasBernard P714-724
Roche P724-740
5) Clinique de la Rèsidence du Parc 986 MS P.Le Gag
Relationship between protozoa, virus & bacteria J.B. Jadin
Psychopathies Ph. Bottero Buerger Disease C. Bourde & Delanonoï
Dermatology Aymard
6) Extrait Bull. Acad. Nat Médecine Vol 158 No 1 P. Giroud & J. Jadin
7) European Journal of Epidemiology 1991 D. Raoult P276
8) Academie Royale des Sciences d`Outre Mer 1963 No 6 J.B. Jadin
P1128-1129
9) Ann. Soc. Belge Med. Tropic. 1962 Vol 3 J. Jadin P321
Au Sujet des Maladies Rickettsiennes
10) Infectious Diseases and Medical Microbiology 2nd Ed. Braude
P810-814
11) Arch. int. Med.: Chronic Q Fever March 8 1993 Vol 153 T. Brouqui et
al. P643
12a) Department of Pathology SA April 1992 Allan Shore?
12b) Update: Nov. 1997 P. Welsby P15 Does Infection Cause Coronary
Disease
13) International Journal of Medicine Garth Nicholson
14) Res. Vet. Scient.: July 1991 Woldehiwet Lympho. Subpopulations in
Pheripheral
Blood of Sheep Experimentally infected with Tick-Borne Disease
15) Journal of Clinical Immunology (US): Jan. 1993 13 (1) Strauss et al
P30
Lymphocytes Phenotype and Function in the C.F.S.
16) S. Maryland Clin Immunol. Jan 93 13 (1) P30-40
17) Affidavit: "To Whom it May Concern" to January 1995 Dr. P.
Tarbleton
SA Medical Council
18) Bulletin Acadèmie Nationale de No 6 Masson Paul Giroud P163 Mèdècine
1979 Ed. Paris
19) Maladies Infectieuses 1976 CH 41 J. Orfila
20) Arch. Inst. Pasteur Tunis: Les 1986 Vol 63 P. Giroud P97-99
Infections Superposèes Sont à & J.B. Jadin la Base des Faillites
de L´Humanitè
21) Study Annales Internal Med. 1994 – 121 T. Hennessy P953-959
CFS: May 12: F. Nightingale`s Birthday Comprehensive Approach
22) Lancet Vol 347, P977,978 April 1996
23) Bulletin Acadamie Nationale Medicine Vol 163 No 6 1979
24) Bulletin Societè Pathologie Exotique January 1952
25) Lyme Disease CDC
26) Rickettsia and Rickettsia Diseases 1973 Brezina
27) Bulletin Societè Pathologie Exotique 1969 J.B. Jadin
28) Annales of International Medicine January 1995
29) ASBMT Vol 3 1952 J.B. Jadin
30) EEG report of 18 year old Epilectic February C.L.Jadin 1998
31) An Emerging Group of Pathogens 1997 Oregon JL Fryer M Manuel in
Fish S U,
Synopsis
32) SAMJ Tetracycline in ME – fad or fact? Vol 82 1992 Bettina Schön
33) Pharmalogical Basis of Therapeutics 1991 Goodman et al
34) In vitro susceptibilities of Rickettsia 1997 University of NC
35) Relation entre Protozoaires, Virus 1984 J.B. Jadin et Bacteries
36) Arthropodes
37) Martindale 6th Ed 1995 P314-318
38) Rickettsial Disease . Review of Ch 21 1980 Jawetz Medical Biology
39) 8th Congress of American 1990 M. Drancourt Rickettsioses Society &
P. Levy
40) Acadèmie Royale des Science 1991 J.B. Jadin d`Outre-Mer
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Ashleigh Olivier
My name is Ashleigh I am 30 years old and I am a single mother of a daughter she is 9years old. I do work still, i am a invoicing clerk. I have primary progressive Multi Sclerosis and I am begging for help. I am getting worse everyday and i do not have a medical aid. I will pay cash but there must be a way that I can pay off the amount.
The reception lady said just to gee Dr Ceceila will cost me R14000.00. So i am very desperate to get answers and a better understanding of what is happening.
Kindest regards