AHMF: 98 Conference: McGregor

Toxic Coagulase Negative Staphylococci are Associated with Changes in Urinary Organic and Amino Acid Excretion in Chronic Facial Muscle Pain Patients

NR McGregor, HL Butt [1], RH Dunstan, TK Roberts, M Zerbes, IJ Klineberg.

Collaborative Pain Research Unit:
Department of Biological Sciences
The University of Newcastle
Callaghan
NSW 2308, Australia.
Neurobiology Research Unit
Centre for Oral Health Research
University of Sydney
Westmead Hospital
Westmead
NSW 2084, Australia.
1 Division of Microbiology and Infectious Diseases
Hunter Area Pathology Service
John Hunter Hospital
Newcastle
NSW 2305, Australia.

CFS patients have an increased prevalence of chronic facial muscle pain. This study of 35 chronic facial muscle pain patients (MP) and 34 age and sex matched control subjects assessed carriage of staphylococcal species, symptoms and changes in urinary excretion of amino and organic acids.

The MP patients had an increase in the carriage of toxic coagulase negative species (TCoNS) ( &LT; 0.0004) which produced either d-toxin ( &LT; 0.002) or both d-toxin and horse-toxin (P &LT; 0.004). The carriage of TCoNS was associated with increases in pain severity (VAS), irritable bowel, palpitations, muscle fatigue and recurrent low-grade fever consistent with the symptom profile of fibromyalgia. The carriage of TCoNS was inversely correlated with the reduced excretion of leucine, which is an important modulator of proteolysis. The carriage of TCoNS was positively associated with increased excretions of tyrosine and 3-methylhistidine, which were indicative of increased non-fibrillar and fibrillar proteolysis respectively. Other anomalies were also associated with the carriage of TCoNS including, increased excretions of the urea cycle intermediate, ornithine; the citric acid cycle intermediate, aconitic acid; the connective tissue amino acids, hydroxyproline and proline; and the excitatory amino acid, aspartic acid. There was an increased excretion of total amino acids suggestive of a low-grade aminoaciduria.

These data indicate that toxic coagulase negative Staphylococcus spp were strongly correlated with anomalies in proteolysis and other aspects of metabolism, and implicate that these organisms may have a major role in the aetiology of chronic muscle pain.