Sarcoidosis: A Bacterial Infection?

Sarcoidosis, a disease of inflammation, was first described in 1877 by Jonathan Hutchinson. While it is considered a 'rare' disease by some, sarcoidosis symptoms often develop very gradually which makes it difficult to pinpoint just how many people are afflicted. In the US, the incidence is highest among black African-Americans and second highest in white people with Northern European ancestry.

Associated symptoms are often vague and include fatigue, blurry vision, and aches and pains. Despite these vague symptoms, 90% of sarcoidosis cases primarily affect the patient's lungs. According to the American Lung Association, half of all cases are brief and heal without treatment, but between 20 and 30% of patients are left with permanent lung damage.

The most common treatment is steroid administration to reduce inflammation.

Sarcoidosis inflammation specifically displays as granulomas, small areas of inflammation formed by the body's immune system. The granulomas are comprised of mostly immune cells. In some other diseases these granulomas first form, then die but in the case sarcoidosis the granuloma will heal into scar tissue.

Until very recently, the consensus was that sarcoidosis was probably an auto-immune disease because no infectious agent had been found in the diseased tissue. In other diseases involving granulomas, fungus or bacteria infections were associated with the granulomas; this is logical because granulomas formed as a response to the infection. When the immune system activates without an infectious trigger, the disease is classified as an auto-immune disorder. This auto-immune classification of sarcoidosis is now being challenged.

In 2002, a group of Swedish researchers found the bacteria Rickettsia helvetica inside the granulomas of 26 people with sarcoidosis. As the granulomas are made of immune system cells, these living, replicating bacteria showed that there was something wrong with the immune system.

Even before that, in 1989 a group of researchers at the Columbia University Eye Institute found a different bacteria (Cell Wall Deficient bacteria) in the affected eye tissue of sarcoidosis patients.

Despite this and other very leading evidence, many doctors continue to prescribe steroids for sarcoidosis, which treats the inflammation symptom, but not the cause. If bacterial infection is, indeed, the cause of sarcoidosis, antibiotics would seem to be indicated.

The Marshall protocol, named for Trevor Marshall, Ph.D. addresses the not only the bacterial infection at the root of sarcoidosis, but also the cause of the immune system's inability to successfully combat the infection. Marshall, a sarcoidosis sufferer since 1978, believes that a malfunction in the body's manufacture/maintainence of vitamin-D is what makes that person develop sarcoidosis in the presence of bacterial infections.

The greater medical community is slow to adopt new information, and this has been true of its treatment of sarcoidosis patients. While the Marshall protocol doesn't call for any dangerous treatments, many physicians are wary of applying it to their sarcoidosis patients. In the malpractice-happy environment of the US, it isn't difficult to understand why doctors would hesitate to step outside the approved treatments.

Even so, many patients willing to work hard enough eventually find a physician willing to administer the Marshall protocol and find themselves getting better, slowly but surely.