Intestinal staphylococcal small colony variants: a cause of medically unexplained physical symptoms?

Intestinal staphylococcal small colony variants: a cause of medically unexplained physical symptoms? I rritable bowel syndrome (IBS) is often associated with food intolerances, fibromyalgia, and chronic fatigue (1), a symptom cluster commonly denoted as medically unexplained physical symptoms. We here present three cases which may give new thoughts concerning the etiology of the condition. Case 1: A male veterinarian, age 57. At age 38, he was treated with several long-lasting courses of antibiotics due to epididymitis. He thereafter developed IBS and subsequently musculoskeletal pain and chronic fatigue. Following an open knee injury complicated with chronic infection with antibiotic-resistant Staphylococcus epidermidis at age 55, his systemic complaints deteriorated, forcing him to restrict his veterinary practice considerably. He himself had discovered similar bacterial growth from swabs of his own rectal mucosa as from the mucinous secretion of his injured knee. Case 2: A male physician, age 60. At age 21, he got severe IBS following several courses of antibiotics due to recurrent airways infections. Subsequently, he gradually developed musculoskeletal pain and chronic fatigue which forced him to reduce his workload to less than the half. Some hearing loss and a slight aortic valve insufficiency were also diagnosed. Case 3: A female physician, age 55. At age 35, she developed mild IBS following multiple courses of antibiotics for nasal sinusitis. Subsequently, she gradually developed mild mental fatigue and facial rosacea. At age 54, following an episode of acute gastroenteritis combined with stress related to the death of a near family member, she developed severe IBS. Simultaneously, she experienced worsening of her mental fatigue and the rosacea as well as having additional symptoms (such as joint stiffness). With considerable efforts, she maintains full job. Common to all three cases is a normal routine physical and laboratory examination and no apparent cause of their abdominal and systemic complaints which also included food intolerances. Upper endoscopy was unremarkable. However, duodenal biopsies showed increased (but within normal limits) counts of intraepithelial lymphocytes (IELs), and the patients had all growth of numerous pinpoint clear staphylococcal small colony variants (SCVs) in virtually pure culture, when brush samples from the duo-denum were plated directly on mannitol salt agar. In a supplementary investigation, we examined 50 patients with similar symptomatology with brush samples from deep in the nasal cavity and from the rectal mucosa 3Á4 cm above the anal sphincter. From these locations, all patients had growth of coagulase-negative staphylococci (CNS) …