The idea that many hard-to-treat diseases are caused by polymicrobial disease teams (PDTs) is pretty complicated. I only stumbled onto it in June, so the explanation below is pretty thin. I keep finding new information to support the PDT idea. I hope to be able to show how PDTs cause multiple sclerosis (MS) within a couple of months.
Polymicrobial Diseases
Genes, lifestyle, and environmental poisons all complicate explanations of why we get sick, but I still agree with Paul Ewald (en.wikipedia.org⁄wiki⁄Paul_W._Ewald) that most diseases must be caused by microbes.
Hiding in Plain Sight
If Ewald is right, and most "noninfectious" diseases are in fact caused by infections, then we have to ask why it has been so hard to identify the guilty microbes. I've been puzzling over this for more than ten years, and I think I have figured it out. The idea is so simple and so obvious that other people must have figured it out years ago, but so far I haven't been able to find any published descriptions of it.
In June I read a paper by Fellerhoff and Wank. They found that people with schizophrenia, bipolar disorder, and depression were infected with Chlamydophila pneumoniae (CPN) more often than chance would predict. But it was clear that CPN could not be the sole cause of any of those disorders.
I have a friend with bipolar disorder, and I was wondering what practical benefit my friend might get from the Fellerhoff and Wank paper. After a while I asked myself: "What if bipolar disorder is caused by several microbes working together, and CPN is just another member of the team? What if other germs could fill CPN's position on the team?"
The more I thought about it, the surer I became that bipolar disorder and many other diseases were caused by polymicrobial disease teams (PDTs). The germs that cause bipolar disorder, multiple sclerosis, and other "noninfectious" diseases have been hiding in plain sight.
Note
I had a neighbor who was a genuine, psychiatrist-certified, bona fide schizophrenic. His ideas were preposterous, but he never had any doubts about them. I'm full of doubts about a lot of things, but not the PDT idea. I'm so sure it's right that I wonder if I'm losing my marbles. You will have to judge for yourself. :-)
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Teamwork
I think PDTs act very much like ball teams. Just as ball teams have positions that must be filled to play the game, PDTs have positions that must be filled in order to cause diseases. Each germ on a PDT performs some function that cannot be performed by the other germs on the team.
On of the most obvious difference between PDTs and ball teams is intentionality. Even a bunch of kids playing stickball in the street pick the players on each team and play to win. The players in a PDT come together by chance and have no goals. The germs playing in each position change with time, place, and luck of the draw, so it has been maddeningly difficult to identify any of them as the causes of a disease.
Germs that are able to cause diseases by themselves, such as the measles and mumps viruses, are able to suppress the immune system and make us sick. Even so, the immune system usually wins in the end and measles and mumps disappear.
My guess is that the germs that play on PDTs can't do both, or they can't do both very well. Consequently, they only cause disease when chance brings them together. I don't know what all of the positions are on PDTs, but I think each PDT must have at least one enabler and one effector. Enablers suppress the immune system and effectors make us sick.
Just as there are 1st-, 2nd-, and 3rd-string players on ball teams, there must be 1st-, 2nd-, and 3rd-string germs on PDTs. If we assume that the worst forms of a disease occur when all of the positions are filled with 1st-string players, then we can assume that milder versions of the disease will occur when only the 2nd- and 3rd-string germs are present.
Syndromes
The diseases caused by 2nd and 3rd string players will not just be milder, they will be different than diseases caused by 1st string players.
Say CPN is the 1st-string "quarterback" on a PDT. If CPN isn't available, the team might still play with another germ as "quarterback." The other germ wouldn't play exactly like CPN, so the disease the team caused would not be exactly like the disease that would have occurred if CPN was playing. The disease would be similar enough to be grouped with the CPN-related disease, but it would really be a separate disease.
Consider multiple sclerosis (MS). There are at least two recognized forms of MS, and there are diseases that are so similar to MS that only experts can only tell them apart (www.ncbi.nlm.nih.gov⁄mesh⁄68020278). One type of MS is closely linked to CPN, and CPN is often found in the diseases that resemble MS. If CPN isn't available, one of the other germs frequently found in MS patients must step in and take CPN's position.
I think that each of the different types of MS, and each of the diseases that closely resemble MS, is caused by a different PDT. Consequently, each one will have to be treated a little differently than the others.
MS was one of the first disorders that I thought of, but I knew of dozens of "noninfectious" diseases that were associated with multiple microbes more often than chance would predict. A few examples would include asthma, autism, chronic obstructive pulmonary disease, rheumatoid arthritis, and atherosclerosis. Since June I've found hundreds of such diseases--you can find them listed in Appendix I.
Polymicrobial Teams Have Their Own Rules
Unlike players on ball teams, microbes can play on many teams at one time. That's why people tend to have clusters of associated diseases, e.g., obesity, diabetes, and heart disease. There are lots more clusters waiting to be discovered in the Appendices, and still more in PubMed.
CPN plays on many teams. It has been linked to 100+ diseases, but it is not the sole cause of any of them. Not surprisingly, many of the diseases associated with CPN are associated with each other (see Appendix III).
Not all of the players have to be playing all of the time--some can play their role and disappear. For example, reactive arthritis and atrial fibrillations appear after Campylobacter jejuni organisms have been cleared from the body.
T. cruzi and other intracellular germs take years to produce heart disease. I believe that it takes so long because it takes a long time for chance to bring together all of the members of T. cruzi- or CPN-based heart-disease teams.
Diseases like diabetes and arthritis appear to be noninfectious because it's so hard to catch all of the team members together at one time.
Key Players
I believe that each polymicrobial team has a few key players, like the quarterback in American football. Without these key players the teams cannot function. I think cytomegalovirus, Chlamydophila pneumoniae, Mycoplasma, and Trypanosoma cruzi are key players on most of the teams they are on, and eradicating them will cure many of the diseases they contribute to.