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Streptococcus
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== SIBO and Gut Dysbiosis == Streptococcus is often implicated in a condition called [[small intestinal bacterial overgrowth (SIBO)]], characterized by excessive bacteria in small intestines. SIBO is commonly found in ME/CFS, where symptoms often improve after treatment.<ref name=":2">{{Cite journal | last = Pimentel | first = Mark | last2 = Hallegua | first2 = David | last3 = Chow | first3 = Evelyn J. | last4 = Wallace | first4 = Daniel | last5 = Bonorris | first5 = George | last6 = Lin | first6 = Henry C. | date = 2000-04-01 | title = Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study|url=https://www.gastrojournal.org/article/S0016-5085(00)83765-8/abstract|journal=Gastroenterology|language=English|volume=118|issue=4|pages=A414|doi=10.1016/S0016-5085(00)83765-8|issn=0016-5085}}</ref><ref>{{Cite journal | last = Pimentel | first = M | last2 = Wallace | first2 = D | last3 = Hallegua | first3=D | last4 = Chow | first4 = E | last5 = Kong | first5 = Y | last6 = Park | first6 = S | last7 = Lin | first7 = H | date = Apr 2004 | title = A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754959/|journal=Annals of the Rheumatic Diseases|volume=63|issue=4|pages=450–452|doi=10.1136/ard.2003.011502|issn=0003-4967|pmc=1754959|pmid=15020342|quote=|access-date=|via=}}</ref><ref>{{Cite journal | last = Lin | first = Henry C. | date = 2004-08-18 | title = Small Intestinal Bacterial Overgrowth|url=https://jamanetwork.com/journals/jama/fullarticle/199251|journal=JAMA|language=en|volume=292|issue=7 | pages = 852|doi=10.1001/jama.292.7.852|issn=0098-7484}}</ref> The most common bacterial species linked to SIBO include: ''Streptococcus'', ''[[Escherichia coli]]'', ''[[Lactobacillus]]'' and Bacteroides.<ref>{{Cite journal | last = Bouhnik | first = Y. | last2 = Alain | first2 = S. | last3 = Attar | first3=A. | last4 = Flourié | first4 = B. | last5 = Raskine | first5 = L. | last6 = Sanson-Le Pors | first6 = M.J. | last7 = Rambaud | first7 = J.C. | date = Jun 1999 | title = Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome|url=https://pubmed.ncbi.nlm.nih.gov/10235214/|journal=The American Journal of Gastroenterology|volume=94|issue=5|pages=1327–1331|doi=10.1111/j.1572-0241.1999.01016.x|issn=0002-9270|pmid=10235214|pmc=|quote=|access-date=|via=}}</ref> SIBO is a manifestation of [[Dysbiosis|microbiome dysbiosis]] (or ''gut dysbiosis''), an imbalance of bacteria in the gut often accompanied by increased levels of [[aerobic bacteria]]<ref name=":1" />, in particular ''Enterococcus'' and ''Streptococcus'' species. === Symptom improvement === A 2015 study found significant symptom and overall sleep quality improvements among ME/CFS patients by treating Streptococcus and microbiota dysbiosis with Erythromycin.<ref name=":3">{{Cite journal | last= Jackson | first = Melinda L. | last2 = Butt | first2 = Henry | last3 = Ball | first3 = Michelle | last4 = Lewis | first4 = Donald P. | last5 = Bruck | first5 = Dorothy | date = Nov 2015 | title = Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study|url=https://pubmed.ncbi.nlm.nih.gov/26779319/|journal=Sleep Science (Sao Paulo, Brazil)|volume=8|issue=3|pages=124–133|doi=10.1016/j.slsci.2015.10.001|issn=1984-0659|pmc=4688574|pmid=26779319|quote= | last6 = | first6 = | authorlink = Melinda Jackson | author-link2 = Henry Butt|access-date= | authorlink3 = Michelle Ball | author-link4 = Donald Lewis | author-link5 = Dorothy Bruck|via=}}</ref> A 2018 study including 44 adult ME/CFS patients ('''all''' with significant ''Streptococcus'' counts) showed improvements in total symptoms, some sleep, and cognitive symptoms following a 4-week Erythromycin + [[Probiotic|probiotic treatment]]. The [[Antibiotics|antibiotic treatment]] was used to target the overgrowth of Streptococcus bacteria found in [[Microbiome|microbiota]] of ME/CFS patients. The idea was based on previous studies linking lactic acidosis and gut dysbiosis with symptoms of ME/CFS. And that d-lactic acid producing bacteria play a large role in both. Results showed antimicrobial and probiotic treatment yielded concurrent reduction in enteric Streptococcus counts and improvement in some neurological symptoms.<ref name=":4">{{Cite journal | last = Wallis | first = Amy | last2 = Ball | first2 = Michelle | last3 = Butt | first3=Henry | last4 = Lewis | first4 = Donald P. | last5 = McKechnie | first5 = Sandra | last6 = Paull | first6 = Phillip | last7 = Jaa-Kwee | first7 = Amber | last8 = Bruck | first8 = Dorothy | date = 2018-02-06 | title = Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801817/|journal=Journal of Translational Medicine|volume=16|doi=10.1186/s12967-018-1392-z|issn=1479-5876|pmc=5801817|pmid=29409505}}</ref>
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