What is Multiple Antibiotic Resistant Coagulase Negative Staph (MARCoNS)
Frequently folks with mold related illness or chronic inflammatory response syndrome (CIRS) may have a staph colonization deep in the nose. It is caused by biofilm-forming microorganisms that live deep in the nose without causing nasal symptoms. These microorganisms create compounds that can affect genetic expression by turning on certain genes. They also lower MSH which is normally low in mold patients. It appears MARoNS is creating a toxin that is a neurotoxin, but not enough is known about this yet. Dr. Ritchie Shoemaker was the person who discovered this association of CIRS patients and this Staph infection.
He found that if a patient did not respond to the Cholestyramine as he expected, one of the things he needed to rule out was these coagulase-negative staph bacteria. They can be tested for with an API-STAPH isolation technique on a deep nasal culture. Usually the MSH level will still be low after treatment if the person has MARCoNS. MSH can be low for other reasons, but if you treat with Cholestyramine and they do not feel better in a month and you test MSH and it is low, they may have MARCoNS.
Now, I should mention here, there are other things that you should look for if someone is not responding, not just MARCoNS. Look for heavy metals, parasties, other bacteria besides MARCoNS, viruses, and other toxins.
How To Take A Sample
This is not a comfortable procedure. You have to put a swab about four inches back into the nasal pharynx. You are swabbing the nasopharynx(back of the throat area). You don't go through the mouth to do it as you do not want to pick up the bacteria in the mouth which will cloud the picture. The idea is to gently rub the cotton swab against the back of your throat/nose. We are looking for the presence of unusual coagulase negative staph germs that are uncommonly found in anyone except those with low MSH. The lab used for this test must use an API-STAPH isolation technique. This is not a “routine nasal culture”. Be sure you are getting the correct test from the lab.
It is very difficult to do a nasal culture on yourself but not impossible. I have done my own. Sometimes you will need to have the kit sent to patients who can't come to your office. They are usually able to do it. You have to decide if they are capable or not. If you have not done a deep nasal culture you can look up videos online. Here are general directions but you will need to tweak them for the individual patient who's culture you are taking. I also suggest you look online if this is your first time at this procedure or you do not remember it from medical school. The culture swab is held by the end cap. The patient should be seated, with head held erect and chin parallel to the floor. Tell them to breathe through their mouth prior to starting and tell them to continue breathing through their mouth until finished. Let them know what you will be doing and that it will be uncomfortable and that their eyes may tear up and they may want to take their head away but they should not. The cotton swab is slowly and gently introduced into the left(usually left nose and right hand but can be on right side too if you are left handed), move along the middle part of the nose. If you meet resistance, simple alter your angle very slightly to find an opening past the turbinates. Do not shove. Always be gentle. As the swab is introduced further, usually 2-3 inches, many patients will become uncomfortable. Their eyes will tear, they may get flushed and try to pull away from the culture. Gently request the patient continue to breathe through open mouth, permitting swabbing of the far back wall of the nose for 3-5 seconds. The distance to the back of the throat will usually be the same as the distance from the edge of the nose to the front of the ear. This is about 4 inches.
Where To Get A Swab Kit
The swab kit can be ordered from Diagnostic Lab Medicine. Physicians can set up an account there and order kits. Make sure they know you want to do a MARCoNS test and not a regular nasal swab test. Do not use alginate swabs. You only need to test on one side. Send it to the lab immediately as it is only stable in the culturette for one week. This is considered an experimental lab procedure currently and insurance will not pay for it as far as I know.
Another place to order MARCoNS testing is at Microbiology DX.
The fee for biofilm testing is $100.00 US. The turn-around time for a biofilm result is approximately one week. The testing availability will be starting May 16, 2016. They can differentiate a weak biofilm response from a negative.
When To Consider MARCoNS
It is really nice to know if the person has MARCoNS in the beginning so you can treat it after a month of cholestyramine. However, if you have not checked for it and your patient is not responding to Cholestyramine after a month of treatment, consider MARCoNS. It is best to treat it after a month of Cholestyramine as mycotoxins keep MSH low and MSH will keep MARCoNS in check. If you have low MSH as do most CIRS patients, the MARCoNS is not kept in check by it. As long as you have a mycotoxin load MARCoNS has an easier time taking over. MARCoNS itself keeps MSH low. Staph biofilms have also been shown to lower CD4+CD25+
The person has to have coagulase negative staph that is resistant to more than one class of antibiotics to be positive and treated for MARCoNS.
The treatment suggested by Dr. Shoemaker which is BEG nasal spray. Two sprays each nostril three times per day, for one month.Then test again.
Other agents used are Berberis spp., in conjunction with colloidal silver. Berberis added to BEG spray may also work since it does not always do the trick. There are numerous herbs that are beneficial in fighting biofilm-forming bacteria. Another mix that is used by some practitioners is colloidal silver with EDTA. Another choice is essential oils such as oregano and the herb constituent artemisinin. Please realize essential oils are strong and can be very irritating to sensitive tissues such as nasal mucosa.
When treated, the die-off of the MARCoNS will cause a rise in C4a as they seem to keep the C4a lower than you would normally expect in a person with CIRS. (If they have really high C4a in the beginning it is unlikely they have MARCoNS although if they have Lyme's you can not assume this.) Additionally, if you have them check their VCS you will see a fall on the VCS scores in row E and then D. Also MMP9 will rise within two days of the die off symptoms onset. If, this happens, stop and pretreat with High fish oil, tumeric and no amylose diet for 5 days before returning to BEG spray or whatever treatment you are using. (You can also use other antinflammatory agents you like or your patient responds well to.)
Specific doses to use for die-off reaction
Omega 3s (2-3 grams EPA/day & 1.5-2 grams/day DHA).
High does of turmeric or curcumin such as Meriva-500 (1-2 caps 2-3 times per day)
No-amylose diet for five days before returning to BEG spray or alternative treatment.
The person should be tested to make sure the treatment has worked. If they have dogs in their environment, it appears they may be able to be reinoculated from their animal. They can have a vet test their animal or the can live in a more sanitary fashion. This would include not letting the animal sleep on their bed. Washing their hands after handling their animals is especially helpful. Cats do not seem to have MARCoNS.
An additional area that MARCoNS has been found is in dental cavitations.
An additional issue I would like to mention is rhinosinusitis due to fungi. Aspergillus, Chaetomium, Fusarium, Penicillium, and Trichoderma has been associated with chronic rhinosinusitis. Many of these have the potential to produce mycotoxins. One research article notes that both those with sinusitis and controls have equal prevalence of fungal organisms and that essentially everyone has nasal fungi. However, mycotoxins were not found in nasal washings from healthy controls, though they were in those previously exposed to a moldy environment. CIRS patients with nasal problems other than MARCoNS are usually cleared up by treating for CIRS. Symptomatic treatment with Oregon Grape and colloidal silver has been very useful.
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