with C. pneumoniae (including Multiple Sclerosis)
I first encountered this strange mental state in a 32 year old woman with very severe MS. She was completely immobile and required constant nursing help. Her family had completely abandoned her; she never had visitors. Yet, at the same time, she seemed very content with life. Every morning I would ask her how she felt: she would invariably reply "I'm very well, thank you."
Not everyone with MS comes
to have this syndrome; it seems only to occur prior to and during
an actively progressive phase. It cannot be accounted for by
primary autoimmune myelinopathy. I believe it likely to be a
toxic state due to bacterial metabolites; there is some indirect
evidence for this. Let's look at this more deeply.
Indeed, recent research shows that specific volatiles (tentatively hexanal and 5-methyl undecane) are found in the breath of persons with MS [Ionescu R et al. Detection of multiple sclerosis from exhaled breath using bilayers of polycyclic aromatic hydrocarbons and single-wall carbon nanotubes. ACS Chem Neurosci. 2011 Dec 21;2(12):687-93. Epub 2011 Sep 22.] Hexanal (hexanaldehyde) is a molecule associated with lipid peroxidation; it has a sweet 'springtime' odour, and is used as such by the fragrance industry. The human nose is very sensitive to hexanal, and can detect it in minute amounts (less than one part per billion). Now, I found that, while kissing, I could detect a very unusual sweet smell on Sarah's breath. It vanished with treatment.
Three Case Histories illustrate the nature of stereotypical psychological changes in persons with chronic C. pneumoniae brain infection.
1) A young woman in her early 20s came to see me. She had severe, very aggressive MS, almost certainly early Secondary Progressive disease. She was unable to walk, and entered the office in a wheelchair pushed by her fiancé. Despite the rapidly progressive nature of her illness, she was euphoric and lacked reason. On seeing me she laughed, and shouted: 'Here I come with my loyal retinue!' Behind her stood her mother and her fiancé, both looking exhausted and alarmed. She made a good but not complete recovery with antimicrobial treatment; she was able to return to part-time work.
2) I advised on a woman in her early 40s, a financier. She had bizarre mental symptomatology and was quite irrational. She had no insight into her illness. An MRI scan showed multiple white-matter hyperintensities typical of severe MS, though she had no motor or sensory signs or symptoms. She might be said to have had a forme fruste of MS. A C. pneumoniae specific IgA Elisa was morbidly raised (SeroCPquant: Savyon Diagnostics, Israel). Interestingly, she had a long history of Crohn's Disease for which she underwent a complete colectomy. She refused treatment and lost contact. Incidentally, a number of studies have linked Inflammatory Bowel Disease with white-matter hyperintensities in the brain. See [Chen M, Lee G et al. Cerebral white matter lesions in patients with Crohn's disease. J Neuroimaging. 2012 Jan;22(1):38-41.]
3) A girl of 12 presented with profound mental changes with hallucinations and short-term memory loss. She was failing at school. Her premorbid personality was one of high intelligence and thoughtfulness. Interestingly, a few months before the onset of symptoms her class had taken part in reaction-time testing. The class had been divided into pairs, the tester and the tested. The tester held a metre ruler by one end and released it; the pupil tested had to catch it. This girl's reaction time was the slowest in the class by a factor of ten. A C. pneumoniae specific IgA Elisa was morbidly raised (SeroCPquant: Savyon Diagnostics, Israel) as was the MIF. The girl was treated along the lines given on this site. She made a complete recovery with the return of her former intelligent and compassionate nature. She is now studying for a higher degree.