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Sarcoidosis is a chronic, progressive, systemic disease that gradually reduces the quality of life and can even kill (NFL-star Reggie White and movie-star Bernie Mac died from sarcoidosis). See Symptoms of Sarcoidosis.

Why Does the Body Make Granulomas?

Dr. Gary Kaiser, microbiology professor at the Community College of Baltimore County, explains how and why the immune system produces granulomas:

"The formation of granuloma in infections such as tuberculosis, leprosy, histoplasmosis, and coccidioidomycosis is a cytokine-mediated cellular response. Because macrophages have difficulty in removing the microbes that cause these infections, there is a continuous secretion of cytokines and chemokines that leads to an accumulation of densely packed macrophages around the microbes. The macrophages release fibrogenic cytokines such as TNF (tumor necrosis factor) and IL-1 (interleukin) that lead to the formation of granulation tissue and scar tissue. The resulting mass is called a granuloma and is an attempt by the body to ‘wall-off’ or localize the infection."

In tuberculosis, for example, a macrophage can usually engulf the tuberculosis bacterium, but then apparently the bacterium has a means for preventing it own death. If the macrophage is not ‘activated’ by paracrines from a specific immune response, the bacteria may remain alive for long periods within the macrophage. In this circumstance, other macrophages surround and wall off the infected macrophages, forming a type of chronic inflammation called a granuloma.

What Goes Wrong?

Macrophages are a type of white blood cell which kill bacterial invaders. Macrophages are also called phagocytes, or ‘eating cells’. In fact, the word ‘macrophage’ means they are the ‘big eaters’.

In sarcoidosis, macrophages are highly activated, but not completely effective, so other macrophages surround and wall off the infected macrophages (the ones with bacteria inside them), joining together their cell material to form multi-nucleated giant cells with little or no dead material (necrosis) because the bacteria are still alive.

Macrophages

Successful macrophages have to die to kill the engulfed enemy bacteria and complete the phagocytic process. Otherwise, bacteria may be able to live and even replicate safely inside the macrophage and the human host will still be ill.

This could be disastrous, considering that the life span of a macrophage may be months or even years. Bacteria can continue living and replicating inside macrophages within granulomas. Even slowly-reproducing bacteria might establish a stronghold by living inside macrophages.

Etiology

Recent research has revealed that sarcoidosis may be caused by Th1/Th17 inflammation as a result of immune system dysfunction due to a chronic intracellular bacterial infection. See Infectious Etiology of Sarcoidosis

Diagnosis

Diagnosis rarely occurs early in the disease process and many symptoms are attributed to other causes (e.g., arthritis, fibromyalgia, chronic fatigue syndrome, migraines, etc.). See Diagnosing Sarcoidosis

Myths

The failure to recognize the extent of this disease process accounts for the myth of automatic remission:
See Myths About Sarcoidosis.

Treatment

Conventional treatment is postponed as long as possible because the drugs used have many adverse effects and relapse usually occurs following cessation of treatment. See Conventional Treatments for Sarcoidosis.

Inflammation Therapy

The FDA has designated two drugs, Minocycline and Clindamycin, as orphan products for the treatment of sarcoidosis. Both these drugs are used in Inflammation Therapy which has proven very effective at reducing or resolving many of the symptoms associated with sarcoidosis. See Overview of InflammationTherapy 

References:
Professor Eishi's work documents how a harmless, endogenous bacteria is found in sarcoid granuloma.
https://www.nature.com/articles/s41598-017-15710-0

Professor Eishi explains that sarcoidosis is an allergic endogenous infection.
Etiologic Aspect of Sarcoidosis as an Allergic Endogenous Infection Caused by Propionibacterium acnes
https://www.hindawi.com/journals/bmri/2013/935289/

Updated December 2, 2017