From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Streptococcus is a genus of gram-positive bacterium[1][2] belonging to the phylum firmicutes and the order lactobacillales (lactic acid bacteria). Streptococcus is a d-lactic acid producing bacteria. Excessive production of d-lactic acid can lead to lactic acidosis.[3]

Strep throat (streptococcal pharyngitis) is caused by group A Streptococcus, with common symptoms including sore throat, fever, and swollen lymph nodes in the neck.[4] Strep throat typically resolves in just 1-2 weeks, often without treatment.

In ME/CFS, studies have found microbiota overgrowth of Streptococcus species, as well as conditions resulting from this bacterial imbalance (e.g. SIBO, acidosis, dysbiosis), in patients with CFS symptoms.[3][5][6][7]

D-Lactic Acidosis[edit | edit source]

Streptococcus and Enterococcus are two aerobic Gram positive intestinal bacteria that produce D-lactate. Elevated levels of D-lactic acid can lead to Lactic acidosis, characterized by the buildup of lactic acid in the bloodstream.[4][3]

CFS symptoms[edit | edit source]

In a 2009 study, a significant increase of Gram positive facultative anaerobic faecal microorganisms were found in 108 CFS patients as compared to 177 control subjects, including Enterococcus faecalis and Streptococcus sanguinis.

Results suggest that when Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the resulting excess D-lactic acid alters the pH and gut integrity, and heightens intestinal permeability, allowing the acid into the body. This in turn could explain neurocognitive and mitochondrial dysfunction symptoms in ME/CFS.[3]

SIBO and Gut Dysbiosis[edit | edit source]

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.[5][8][9]

The most common bacterial species linked to SIBO include: Streptococcus, Escherichia coli, Lactobacillus and Bacteroides.[10]

SIBO is a manifestation of microbiome dysbiosis (or gut dysbiosis), an imbalance of bacteria in the gut often accompanied by increased levels of aerobic bacteria[3], in particular Enterococcus and Streptococcus species.

Symptom improvement[edit | edit source]

A 2015 study found significant symptom and overall sleep quality improvements among ME/CFS patients by treating Streptococcus and microbiota dysbiosis with Erythromycin.[6]

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 treatment. The antibiotic treatment was used to target the overgrowth of Streptococcus bacteria found in 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.[7]

Guttate Psoriasis[edit | edit source]

Guttate psoriasis is a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots. Streptococcal infection is one of the most common triggers of guttate psoriasis, specifically group A streptococcus. [11]

In a large 2020 study, CFS patients with Human Leukocyte Antigen (HLA) risk alleles were found to share the following autoimmune diseases, ordered by frequency:[12]

  1. Hashimoto's thyroiditis/hypothyreosis,
  2. Psoriasis
  3. Rheumatoid arthritis
  4. Alopecia areata
  5. Crohn’s disease or ulcerative colitis

EBV Reactivation[edit | edit source]

Group A streptococci activate B cells via TLR2 and can trigger lytic reactivation of Epstein-Barr virus (EBV) in tonsils. [13]

Diagnosis[edit | edit source]

An Antistreptolysin O (ASO) blood test can be used to test for Group A Streptococcus (Streptococcus pyogenes) infection. This test will measure the amount of antibody ASO in the blood. An elevated titer for ASO could indicate active Streptococcus infection.

Treatment[edit | edit source]

Erythromycin Streptococcus A Resistance
The percent of invasive group A Streptococcus (GAS) infections that are resistant to erythromycin has nearly tripled in 8 years. CDC Fact Sheet, 2019

Some ME/CFS patients can improve symptoms by clearing their treatable bacterial infections. There are also viable treatment options for many conditions caused by these infections.

Streptococcus Infection[edit | edit source]

  • Erythromycin
  • Probiotics
  • Azithromycin
  • Penicillin
  • Amoxicillin
  • Clindamycin
  • Clarithromycin

Resistance to certain antibiotics is well-documented for group A strep. In many cases, Streptococcus resistance is getting stronger. Be sure to check for the latest updates regarding the effectiveness of specific antibiotics.

D-lactic acidosis[edit | edit source]

  • Intravenous bicarbonate
  • Clindamycin
  • Probiotics
  • Vancomycin
  • Neomycin 
  • Tetracycline

SIBO[edit | edit source]

  • Rifaximin
  • Neomycin
  • Metronidazole
  • Probiotics

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. "Streptococcal Infections - Infectious Diseases". MSD Manual Professional Edition. Retrieved August 23, 2020.
  2. Patterson, Maria Jevitz (1996). Baron, Samuel (ed.). Streptococcus. Galveston (TX): University of Texas Medical Branch at Galveston. ISBN 978-0-9631172-1-2. PMID 21413248.
  3. 3.0 3.1 3.2 3.3 3.4 Sheedy, John R.; Wettenhall, Richard E.H.; Scanlon, Denis; Gooley, Paul R.; Lewis, Donald P.; Mcgregor, Neil; Stapleton, David I.; Butt, Henry L.; Meirleir, Kenny L. De (July 1, 2009). "Increased D-Lactic Acid Intestinal Bacteria in Patients with Chronic Fatigue Syndrome". In Vivo. 23 (4): 621–628. ISSN 0258-851X. PMID 19567398.
  4. 4.0 4.1 "Group A Strep | Strep Throat | For Clinicians | GAS | CDC". Centers for Disease Control and Prevention. April 19, 2019. Retrieved August 21, 2020.
  5. 5.0 5.1 Pimentel, Mark; Hallegua, David; Chow, Evelyn J.; Wallace, Daniel; Bonorris, George; Lin, Henry C. (April 1, 2000). "Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study". Gastroenterology. 118 (4): A414. doi:10.1016/S0016-5085(00)83765-8. ISSN 0016-5085.
  6. 6.0 6.1 Jackson, Melinda L.; Butt, Henry; Ball, Michelle; Lewis, Donald P.; Bruck, Dorothy (November 2015). "Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study". Sleep Science (Sao Paulo, Brazil). 8 (3): 124–133. doi:10.1016/j.slsci.2015.10.001. ISSN 1984-0659. PMC 4688574. PMID 26779319.
  7. 7.0 7.1 Wallis, Amy; Ball, Michelle; Butt, Henry; Lewis, Donald P.; McKechnie, Sandra; Paull, Phillip; Jaa-Kwee, Amber; Bruck, Dorothy (February 6, 2018). "Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons". Journal of Translational Medicine. 16. doi:10.1186/s12967-018-1392-z. ISSN 1479-5876. PMC 5801817. PMID 29409505.
  8. Pimentel, M; Wallace, D; Hallegua, D; Chow, E; Kong, Y; Park, S; Lin, H (April 2004). "A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing". Annals of the Rheumatic Diseases. 63 (4): 450–452. doi:10.1136/ard.2003.011502. ISSN 0003-4967. PMC 1754959. PMID 15020342.
  9. Lin, Henry C. (August 18, 2004). "Small Intestinal Bacterial Overgrowth". JAMA. 292 (7): 852. doi:10.1001/jama.292.7.852. ISSN 0098-7484.
  10. Bouhnik, Y.; Alain, S.; Attar, A.; Flourié, B.; Raskine, L.; Sanson-Le Pors, M.J.; Rambaud, J.C. (June 1999). "Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome". The American Journal of Gastroenterology. 94 (5): 1327–1331. doi:10.1111/j.1572-0241.1999.01016.x. ISSN 0002-9270. PMID 10235214.
  11. "Guttate psoriasis: MedlinePlus Medical Encyclopedia". Retrieved August 21, 2020.
  12. Lande, Asgeir; Fluge, Øystein; Strand, Elin B.; Flåm, Siri T.; Sosa, Daysi D.; Mella, Olav; Egeland, Torstein; Saugstad, Ola D.; Lie, Benedicte A. (March 24, 2020). "Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Scientific Reports. 10 (1): 1–8. doi:10.1038/s41598-020-62157-x. ISSN 2045-2322.
  13. Ueda, Seigo; Uchiyama, Satoshi; Azzi, Tarik; Gysin, Claudine; Berger, Christoph; Bernasconi, Michele; Harabuchi, Yasuaki; Zinkernagel, Annelies S.; Nadal, David (January 15, 2014). "Oropharyngeal Group A Streptococcal Colonization Disrupts Latent Epstein-Barr Virus Infection". The Journal of Infectious Diseases. 209 (2): 255–264. doi:10.1093/infdis/jit428. ISSN 0022-1899.