Summary The aim of the current study was to examine the biochemical defects in key components of the 2′,5′-oligoadenylate (2-5A) synthe-tase/RNase L antiviral pathway in an extended cohort of patients with chronic fatigue syndrome (CFS) from two sites. CFS patients, who met the CDC criteria for CFS, and matched controls were assessed with respect to their general health, depression, and pain. Biochemical assays were completed for three blood draws over a period of one year. Analysis of the mean values for bioactive 2-5A, RNase L activity, low molecular weight (LMW) RNase L in CFS PBMC extracts confirmed the statistically significant upregulation of the 2-5A synthetase/RNase L pathway compared to control PBMC extracts (p = .001, .002, and .007, respectively). Clinical correlates to the biochemical findings included a negative correlation between Karnofsky Performance Score and bioactive 2-5A (p = .025) or RNase L activity (p = .002) and positive correlation between Metabolic Screening Questionnaire and RNase L activity (p = .01) and between interferon- and LMW RNase L (p = .05). The evidence presented in this study more firmly establishes the dysregulation of the 2-5A synthetase/RNase L pathway in CFS.
Abstract Chronic fatigue syndrome is a condition characterized by unexplained, persistent fatigue in conjunction with other generalized symptoms. However, the patients as a group are more likely to have objective abnormalities of the immune system than control subjects. We measured the frequency of certain HLA antigens in a representative group of 35 patients. We restricted our analysis to class II molecules as these appear to be more specific predictors of susceptibility to immunologically-based disorders. The frequency of the HLA-DQ1 antigen was increased in patients compared to general population Caucasian controls. This association between chronic fatigue syndrome and the HLA-DQ1 antigen translates into a relative risk of 3.2. This association has not been reported previously in chronic fatigue syndrome. Differences in the ethnic sub-grouping of patients in this study and in previous studies also could have contributed to the difference between our findings and those of previous investigators. Conversely, this study did not find HLA associations that have been reported by previous studies. The sample size of this study could have led to type II statistical errors and a failure to recognize certain HLA associations as significant.
Objective: The current study examined cognitive function, major depressive disorder (MDD), and apathy construct symptoms in a large multi-site surveillance study of chronic fatigue syndrome conducted by the Centers for Disease Control and Prevention. Method: Subjects underwent neuropsychological testing and were administered the Diagnostic Interview Schedule to establish psychiatric diagnoses. Questions in the Beck Depression Inventory relating to motivation were used to develop an apathy construct. Results: Neuropsychological test results showed impairment in multiple cognitive domains in over 25% of the cohort, and raised proportions of outliers in motor and executive function. Memory complaints were not associated with tests of memory function. The apathy construct rather than MDD was associated with impaired cognition. Conclusions: Impaired cognition in chronic fatigue does not appear to be associated with MDD but rather with endorsement of construct symptoms. Similar associations were reported in medical conditions with known etiologies. These results suggest a potential biological basis for apathy construct symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Summary A multiplex polymerase chain reaction (PCR) was used to detect mycoplasma infection in human DNA samples of patients with CFS and related illnesses. One set of oligonucleotide primers which are specific for a highly conserved region among all members of the genus Mycoplasma along with three other primer sets which are specific for Mycoplasma fermentans, M. hominis, and M. penetrans species were used in this assay. The sensitivity of detection was determined by adding known mycoplasma DNA copy numbers to 1 μg of genomic DNA from healthy subjects. Each sample was subjected to 40 cycles of amplification. The detection level was determined to be 7, 7, 9, and 15 mycoplasma DNA copies per μg of human genomic DNA for M. genus, M. fermentans, M. hominis, and M. penetrans, respectively. The assay was applied to DNA extracted from the PBMCs of individuals suffering from chronic fatigue syndrome (CFS) (n = 100), fibromyalgia (FMS) (n = 40), rheumatoid arthritis (RA) (n = 60), and gulf war syndrome (GWS) (n = 60) and compared to age- and sex-matched healthy individuals (n = 160). The percentage of M. genus infection detected in CFS, FMS, RA, and GWS was 52,54, 49, and 55%, respectively. M. fermentans was detected in 32, 35, 23, and 36%, M. hominis was detected in 9, 8,11, and 5%, and M. penetrans was detected in 6, 4, 7, and 3% of CFS, FMS, RA, and GWS patients, respectively. M. genus, M. fermentans, M. hominis, and M. penetrans were detected in 15, 8, 3, and 2% of healthy matched controls. This assay provides a rapid and cost efficient procedure to screen clinical samples for the presence of three potentially pathogenic species of Mycoplasma with a high level of sensitivity and specificity.
Examined the physical, behavioral, and psychological factors related to the occurrence of chronic fatigue syndrome (CFS). The study included 20 patients (mean age 41 yrs) who fulfilled the CFS case definition and 20 matched-controls. All Ss completed a self-administered questionnaire. The greatest difference between cases and controls was the reported level of stress from any of 5 sources in the 5 yrs prior to onset of illness (95% vs 55%). The risk of CFS was significantly related to the number of sources of stress, especially 3 or more. Other significant risk factors included a history of PMS, a history of eczema, loss of interest in daily activities, and panic attacks. The results suggest that stress may be one of the factors related to the development of CFS. The possibility remains that the observed relationship resulted from a biased recollection of events preceding the illness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
ABSTRACT Background: Chronic pain and fatigue represent major reasons for seeking medical treatments, however, the mechanisms are poorly understood. Onset of these disorders has been associated with events (infections, trauma, stress) which initiate a host response requiring increased energy demands. Objectives: To investigate the biochemical mechanisms of chronic pain and fatigue. Methods: Data will be presented from 4 separate investigations of CFS and myofascial pain syndrome (MFPS) patients, and from age/ sex-matched controls, using metabolite profiling techniques. Results: Several types of chronic pain and fatigue disorders were discerned on the basis of their biochemistry. The metabolic events associated with chronic pain were distinct from those associated with chronic fatigue. The investigations have shown that chronic pain was associated with reductions in serum sodium, changes in urinary volume and output of amino and organic acids, increases in levels of markers of tissue damage (ALT, AST), and increases in the tyrosine: leucine ratio, which represents alterations in protein turnover. Fatigue was associated with alterations in urine excretion of amino and organic acids associated with tricarboxylic acid cycle (TCA) function. Levels of RNase-L were correlated with the expression of chronic fatigue related symptoms and were a good marker for CFS. Increased carriage of toxin-producing coagulase negative staphylococci was evident in MFPS and CFS patients, and this carriage was correlated with increased tyrosine: leucine ratios and pain severity. The toxin producing staphylococci appear to be a co-morbid pathogen that contributes to CFS patient morbidity. Conclusion: These studies indicated that changes in nitrogen ho-meostasis were associated with pain and fatigue symptoms and carriage of certain pathogens may sustain or exaggerate the chronic disorder.
Investigated the relationship between immunologic status and physical symptoms in Chronic Fatigue Syndrome (CFS) patients. 27 27–73 yr olds diagnosed with CFS and 46 17–61 yr old control Ss were included. Ss completed a questionnaire including selected subscales of the Sickness Impact Profile, the Cognitive Difficulties Scale and frequency and severity of CFS-related physical symptoms. Cellular immune markers measured included number and percent of T-helper/inducer cells, T-cytotoxic/suppressor cells (CD3+CD8+), activated T-lymphocytes, activated T cytotoxic/suppressor cells (CD38+HLA-DR+CD8+), and CD4/CD8 ratio. Results show significant associations between a number of immunologic measures and severity of illness suggesting that the degree of cellular immune activation was associated with the severity of CFS-related physical symptoms, cognitive complaints, and perceived impairment secondary to CFS. Elevations in T helper/inducer cells, activated T-cells, activated cytotoxic/suppressor T-cells, and CD4/CD8 ratio were associated with greater severity of several symptoms. Reductions in T-suppressor/cytotoxic cells also appeared related to greater severity of some CFS-related physical symptoms and illness burden. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the sociocultural influences that affect chronic fatigue syndrome (CFS) patients as well as their treating clinicians. These sociocultural factors include: (1) the preexisting cultural climate toward disease, (2) cultural intolerance of ambiguity, (3) cultural intolerance of chronic vs acute illness, (4) the ongoing psyche–soma duality among health care providers, and (5) initial disease illegitimacy and subsequent enculturation. The author suggests that these specific influences, as well as the patient's medical status, need to be carefully considered in the assessment and treatment of CFS patients and their families. The traumatogenic effects of these sociocultural influences on CFS patients are discussed and specific treatment strategies suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
ABSTRACT Accurate diagnosis of Chronic Fatigue Syndrome (CFS) is greatly complicated by the vague wording of many of the major diagnostic criteria (i.e., substantial reductions in previous levels of occupational, educational, social, or personal activities) and the absence of guidelines for health care professionals to follow. The lack of operationally explicit criteria has forced health care professionals to rely heavily on their own clinical judgement, which may be biased by personal and highly idiosyncratic factors. Thus, in the case of CFS, the lack of consensus among clinicians regarding the interpretation and application of the diagnostic criteria has likely produced problems in diagnostic reliability. Data from a recent community based epidemio-logic study are presented to illustrate these problems and provide recommendations for improving criterion reliability.
Developed and evaluated a screening instrument and 2nd-stage medical assessment to estimate the prevalence of chronic fatigue syndrome (CFS). The instrument is a combination of existing and new measures, including demographic items, the Fatigue Scale, and a list of symptoms associated with CFS. Ss were 4 groups of 15 Ss: patients with CFS (mean age 42.8 yrs), lupus (mean age 43.7 yrs), or multiple sclerosis (MS), and a healthy control group. Ss were interviewed twice over a 2-wk period with the new CFS screening questionnaire. The results showed the instrument had excellent test–retest and interrater reliability, and therefore has utility for CFS community-based epidemiologic research. However, while the instrument differentiated patients with CFS from healthy Ss, it was less likely to distinguish CFS from other autoimmune diseases, especially lupus. Thus, future community-based CFS prevalence studies should encompass both a screening and a medical examination to adequately differentiate CFS from other illnesses with overlapping symptomatology. The authors recommend a 2-stage research design with both a screening instrument with good sensitivity and medical assessments of CFS positives from stage I to deal with the specificity problem. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Surveyed a group of 67 Ss (80% female, aged 18–57 yrs) seeking relief from the incapacitating symptoms of chronic fatigue syndrome (CFS) concerning their feelings of stigma and perceptions of physician attributions of CFS symptoms to psychological causes as a contributor to CFS-related stigma. Most Ss scored high on measures of stigma: 95% had feelings of estrangement, 70% believed that others attributed their CFS symptoms to psychological causes, 77% coped by using an educational strategy (disclosure), and 39% saw a need to be secretive about their symptoms in some circumstances. Most Ss (77%) were labeled as "psychological cases" by one or more of the physicians consulted, but of the 4 stigma measures, only disclosure was related to physician labeling. Such factors as duration of illness and unemployment, dissatisfaction with spouse, and symptom severity correlated significantly with measures of stigma. That many physicians were reportedly ignorant or skeptical of CFS (males more so than females) may influence attempts of CFS patients to legitimize their symptoms by disclosure and lead to high rates of health care system use. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Abstract Review of the literature indicated the lack of disease specific measures for assessing activity limitations and participation restriction in patients with Chronic Fatigue Syndrome. Retrospective analysis of Karnofsky Performance Status questionnaires and Activities of Daily Living questionnaires (a Dutch version of the Barthel index, modified for CFS) of 141 subjects was performed to create a new questionnaire. Data analysis resulted in the following item selection, based on most frequently reported activity limitations and participation restriction; cleaning, washing dishes and returning them to cupboard, iron, do the wash, gardening, replace light bulb, walking, climb one flight of stairs, stand one hour, sit two hours, doing groceries, thirty minutes of computer work, carrying heavy objects, write a full page letter, use a screwdriver, hammer a nail, make one bed, reading, social activities, doing sports, studying, driving a car, going to school/working, preparing meals and caring for a child. These data were used to create the CFS-Activities and Participation Questionnaire (CFS-APQ). The reliability and different aspects of validity of this new measure still need to be established.
Evaluated the role of multi-convergent therapy (MCT) in the management of 27 19–76 yr olds with heterogeneous Chronic Fatigue Syndrome (CFS). This study was undertaken to assess whether MCT is effective in the treatment of CFS and to examine whether a more extensive investigation is warrented. Due to heterogeneity of symptoms, outcome measures were established on the basis of a shared decision-making process between patient and therapist. Results show that all patients achieved significant recoveries. 12 patients recorded a mean improvement on baseline symptoms of 61%, 8 patients who completed a Quality of Life questionnaire demonstrated a mean change from 2.4 to 6.3 (out of 10). Five patients reported a return to full normal function and two patients returned to school or work and regular exercise. At followup 9 mo–1 yr later, all 18 patients who responded reported either continued improvements or maintenance of a well state. It is concluded that these findings of this study support the use of MCT in the management of patients with Chronic Fatigue Syndrome and justify the implementation of a major clinical trial. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Chronic fatigue syndrome (CFS) is a disease whose exact cause is unknown. The focus of this study was to examine the effects of massage therapy (MT) on the well-being of patients with CFS. MT was expected to reduce depression, anxiety, and stress hormones, as it has previously been shown to do in other groups of depressed individuals. 20 Ss with CFS (mean age 47 yrs) were randomly assigned either to the massage therapy or an attention control (SHAM TENS) group, 10 to a group. The results suggest greater improvement in self-report measures and biochemical values in those receiving MT vs SHAM TENS. Depression, anxiety, and pain not only decreased immediately after receiving the 1st massage, but continued to decrease over the 5-wk treatment period. MT helped alleviate not only fatigue symptoms but other somatic symptoms associated with CFS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Abstract 1. POOL EXERCISE COMBINED WITH AN EDUCATION PROGRAM FOR PATIENTS WITH FIBROMYALGIA SYNDROME. A PROSPECTIVE, RANDOMIZED STUDY.Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. JRheumatol2000; 27:2473-81. 2. SIX- AND 24-MONTH FOLLOW-UP OF POOL EXERCISE THERAPY AND EDUCATION FOR PATIENTS WITH FIBROMYALGIA. Mannerkorpi K, Ahlmen M, Ekdahl C. Scand J Rheumatol 2002; 31:306-10.
The chronic fatigue syndrome comprises one of the most challenging issues in contemporary medicine. The condition remains distressing for patients and perplexing to medical science. Clinicians face a management path which has no ''gold standard'' of investigational mileposts; and are locked into a progression where the extremes of either undertreatment or over-investigation may lead to iatrogenic disaster. The themes of investigation, diagnosis and management of patients with the chronic fatigue syndrome remain controversial. This condition joins in historical perspective a series of other diseases such as pink disease, post-traumatic stress disorder (by a variety of names), the Royal Free disease, Q Fever, Ross River disease and chronic ciguateraall of which have occupied windows of historical time in the twentieth century during which their genesis remained an enigma. In some cases, they still do. New and puzzling diseases will undoubtedly arise in the future. Both patients and medical science are best served if the formal discipline of differential diagnosis is followed unswervingly under these circumstances or ''new'' diseases. The rigour of this discipline -the rank listing of formal possibilities after the clinical history and objective signs have been elicited-forms the pivot of best-practice contemporary medicine. An example of its power is no more dramatically illustrated by the example of a ''new'' enigmatic disease, chronic ciguatera, which ''reappeared'' in the 1950s. Ciguatoxins are some of the most potent biological substances known. Their neurotropic effects produce a protean array of symptoms which are distressing in the acutephase syndrome and which are enervating throughout the often-prolonged progression of convalescence. It is now appreciated that such effects are due to sodium channel activation and subsequent dysfunction at the receptor sites on the cell surface of all excitable tissues. Dr. A. Melvin Ramsay, the Honorary Consultant Physician in Infectious Diseases at the Royal Free Hospital in London, was at the clinical epicentre of the presentation of another new disease in July 1955. His approach to its diagnosis, in the best traditions of differential diagnosis, is an exemplar of the objective response to the appearance of a new or enigmatic disease; and especially to that type in which experience has not generated sufficient case familiarity to define syndrome barriers or to establish pathogenesis. Under such conditions, the correct diagnostic paradigm is to follow the discipline of differential diagnosis, an evolved phenomenon of the last one hundred years of medicine. This paper traces the evolution of the process of differential diagnosis, in the perspective of the enigma of chronic fatigue, which remains an unmet challenge today.
Organ cells of the body retain an Immune Activity System comparable to protozoa. The cells' immunity memory templates are latent proteins, microbes, their toxins and chemicals (latentees). Excess latentees are detected and excreted by latency therapy. Their excretion induces immediate and/or delayed symptoms and signs recognized by the patient. Foreign latent materials (latentors) enter the body and bypass the natural immune system to be taken up selectively by organ cell groups. Active infection/disease and allergens (antigens) involve the natural immune system antibodies. Latent infection/disease and allergens (latentors) involve the Organ Cell Immunity as intracellu-lar latentees. Clinical laboratory testing is inappropriate.
This Clinical Anecdotal Study compiles 297 patients who obtained little or no relief from conventional and alternative medicine (duration: 63% > three years). Patients provoked symptoms to two or more of 16 viruses, in particular Epstein Barr Virus. Latency therapy (heat, saunas, massage, tolerated exercise and sweating during sleep, the auto-sauna) dilutions stimulated excretion until symptoms/signs cleared. The principals were Epstein Barr Virus 67.3%, 200 patients; 13 individual viruses 30.0%, 89 patients; non-viral 2.6%, 8 patients. Latency therapy < 50% improvement = 16.5%; 50% to 80% = 26.6%; 80% to 100% = 46.7%; failures = 11%. Fourteen patients gave positive Epstein Barr Virus serology. A latency immunity concept explains affected subjective symptoms and illnesses and offers a treatment which complements related medical therapies.
Purpose: To compare the outcome of treatment of chronic fatigue syndrome measured by a validated outcome instrument to patients' perception of outcome based on simple questioning.
Subjects and Methods: Results of a single self-report question (“Are you much better, better, about the same, worse or much worse?”) at the end of approximately one year of treatment of 45 patients were compared to results of the Short Form 36 obtained at the beginning and end of that year.
Results: There was no correlation between the results of the single self-report question and the interval change in the Short Form 36 summary scales and 7 of 8 component scales.
Conclusions: Appropriate outcomes measurements can increase reliability of clinical practice results as well as treatment trials. Studies based only on answers to simple self-report questions may yield unreliable results.
Objectives: To investigate fatty acid and sterol homeostasis in patients with CFS. Methods: Plasma samples were collected from CFS and control subjects and analyzed for lipid composition by GC-MS metabolic profiling techniques. Results: CFS patients had significantly different profiles of fatty acids and sterols compared with control subjects. The 1st and 2nd most important factors discriminating the CFS patients from the controls, were a decrease in elaidic acid (trans-9-octadecenoic acid) and an increase in stearic acid (octadecanoic acid), respectively. The CFS patients also had lower levels of cholesterol, which has potential impact on membrane integrity and function, steroid hormone synthesis, energy metabolism and bile production. The CFS patients could also be subdivided into subgroups based on their fatty acid and sterol composition. The results of cluster analyses and multivariate analyses revealed that several types of homeostasis exist in different types of CFS patients, whereas the control group was largely homogeneous. Viral infections can contribute to the nature of the lipid-based anomalies in CFS patients and lipid profiles from patients with prior viral infections could be differentiated from those without viral histories. Conclusions: The assessment of fatty acids and sterols in fasting plasma samples can indicate essential fatty acid deficits, suggest appropriate types of essential fatty acid oils for formulations, indicate potential cholesterol deficit-associated anomalies, provide evidence for mitochondrial dysfunction and categorize CFS patients into biochemical subgroups. These evaluations provide a basis for devising individually tailored patient management protocols.
Objective: The development of a score for severity of Chronic Fatigue Syndrome (CFS), the correlation of CFS with parameters of immune activation and the association with pathogens. Methods: Five hundred five patients with suspicion of Chronic Fatigue Syndrome and no other definitive diagnosis were checked by a 45-criteria-score, basic laboratory programs and immunological profiles. In most of the patients further tests concerning complement system, immune activation markers, hormones and serology of herpesviruses, Chlamydia and Borrelia could be evaluated. Comparison of the symptoms of CFS patients with healthy controls lead to a 30-criteria-score and this score was correlated with laboratory parameters (Spearman rank-correlation-coefficient rs, ties corrected). Results: Three hundred eighty-five patients fulfilling stronger criteria according to the Centers for Disease Control (CDC) definition showed significant differences to 53 healthy controls in 40 of the 45 criteria (p < 0.001, twitches and food allergies p < 0.05). Thirteen symptoms corresponding to CDC criteria were all significant (p < 0.001), 17 further significant criteria of descending precision were added: respiratory infections, palpitations, dizziness, dyspepsia, dryness of mouth/eyes, allergies, nausea, paresthesia, loss of hair, skin alterations, dyscoordination, chest pain, personality changes, eczema, general infections, twitches, urogenital infections. A correlation between the 30-criteria-score and immunological parameters could be evaluated in 472 of the 505 patients. Significant positive correlation with the 30-criteria-score was found in numbers of CD8+ T-lymphocytes, HLA-DR+ T-lymphocytes, gamma globulins, IgM, IgG, and for the number of types of autoantibodies (mainly ANA, ACA, antithyroid and antiparietal cell antibodies). Significant negative correlation was found in albumin-globulin-ratio, eosinophils and IgE. Most of these parameters also correlated with one another. On the other hand, in subgroups of the 505 patients the Frequency of positivity in serological tests for HHV-6 (49.9%), EBV (35.4%), HSV (29.2%), CMV (12.5%) and Chlamydia (35.0%) was striking. Borrelia Western blots showed 3 or more specific IgG-bands in 54 of 131 patients (41.2%). In some cases infection with EBV, HHV-6 and CMV, respectively, was confmed by DNA-PCR-test and antigen detection. Summary: In increasingly larger groups of patients with CFS and related constellations we often see clinical signs and longer anamnesis of other symptoms besides the classical criteria of CFS, especially a high prevalence of local and general susceptibility to infections and hints to prolonged inflammation processes. Together with other results, the data confirm the hypothesis that a reduced or unstable immune control or delayed immune reaction to persisting viruses or bacterial intracellular pathogens, possibly triggered by common infections or other environmental factors, can lead to a chronic neuroimmune activation state and auto-immune disorders. Hypersensitivity symptoms of the patients might not be mediated by classical allergies alone but also result from a type-lV-hypersensitivity.
Chronic faligue syndrome (CFS) in children and adolescents presents unique challenges and opportunities to researchers. Issues specific to research conducted on children and adolescents with CFS ate discussed. Such issues include the importance of utilizing a consistent definition of CFS and ascertaining that all participants meet the criteria, the need for attention to wording of questions regarding fatigue, and the significance of medical evaluations as part of a research study. Considerations pertaining to research with minors, such as confidentiality and assent, are explored. Finally, suggestions for future research on children are made.
It has been a common occurrence that children with chronic, unexplained fatigue receive no specific diagnosis because of difficulties posed by the 1988 research criteria for chronic fatigue syndrome (CFS). The lack of a specific diagnosis creates medical uncertainty and may lead to increased psychosocial and educational disruption. With the recent publication of new research criteria these problems may be improved as the new criteria are less restrictive. In the process of developing new research criteria, data was collected for children who presented for evaluation of chronic unexplained fatigue over a two year period. Diagnosis of CFS was based upon the 1988 CDC criteria or clinical criteria based upon activity limitation and the associated symptom complex. Comparison of these two groups showed differences in symptom severity and degree of activity limitation, while demographics, psychosocial variables, and symptom pattern were similar. These results would suggest that chronic fatigue syndrome exists in a continuum of severity and that definition based solely upon severity of fatigue is arbitrary. While severe and debilitating fatigue should remain the basis of any research definition, clinical criteria based upon the symptom pattern of CFS may improve long term management by providing a working clinical diagnosis.
Chronic fatigue syndrome is a severe, often disabling disorder with prevalence as high as 422 cases per 100,000 in the United States. Aside from the adverse effects to patients' quality of life, sequela of the disorder include a negative impact on the economy as well as a burden on public health care costs. Some avenues of current research into the possible genesis of the syndrome are neurally mediated hypotension, viral pathogen, immunological disorders, lymphocyte enzyme system abnormalities, or a purely psychological root. This paper is a review of the literatures as to a neuroendocrinologic cause, namely dysfunction of the hypothalamic-pituitary-adrenal axis.
The purpose of this investigation was to identify significant quality-of-life issues for two women previously diagnosed with chronic fatigue syndrome (CFS), and their families. Both women were participants in a cost-recovery, clinical trial of the antiviral and immuno-modulatory drug, Ampligen.
A qualitative, case study approach was adopted to access information not normally available from clinical trials. Specifically, semi-structured, in-depth interviews were conducted with the CFS patients, and their spouses, to discover if these families perceived any changes in their patterns of daily living contingent with participation in the Ampligen trial. Patient diaries were also analyzed for the purpose of triangulation.
Content analysis of the interview transcripts and diary entries revealed a number of significant quality of life improvements for the women and their families, for which they perceived the drug therapy responsible. After an initial acclimation period, and with the exception of the day when the drug was administered, both women reported a reduction in pain, increased energy levels, and improved cognitive functioning. They each cited numerous cases to illustrate their improvement.
Forty-six patients with chronic fatigue syndrome (CFS) were matched with two control groups: one chosen on the basis of relatively good physical health (N = 92) and the other without regard to physical health (N = 46). All patients were from the same psychiatric practice. The groups were compared on 20 anomalous brain conditions or phenomena (ABCP) used as markers of patterns of brain organization.
The results suggest that psychiatric patients who subsequently develop CFS have a higher number of pre-CFS ABCP, of both childhood and adult onset, than psychiatric patients who have not developed this condition.
Full blood counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haematinics and markers for oxidative stress were measured on thirty-three patients diagnosed with chronic fatigue syndrome (CFS) and twenty-seven age and sex matched controls. The CFS patients had increased prevalence of symptoms of temporomandibular dysfunction (TMD). Jaw muscle pain was associated with increases in methaemoglobin (P < .002), ferritin (P < .02) and malondialdehyde (P < .007) whilst temporomandibular joint (TMJ) clicking and/or locking was associated with increases in methaemoglobin (P < .001), malondialdehyde (P < .05) and vitamin B12 (P < .02) levels. Multiple regression analysis found methaemoglobin to be the principle component associated with TMD symptoms in the CFS patients. Increases in scalar severity responses to jaw muscle pain and TMJ clicking and/or locking were positively correlated with methaemoglobin by multiple regression. These data indicate that oxidative stress due to excess free radical formation was associated with jaw muscle pain in CFS patients and suggest that these symptoms were likely to be associated with a pathogen-associated aetiology.
The cause of the tiredness and depression, may be due to a virus in the acute or recuperative phase, but in the long-term fatigue must be due to other mechanisms.
As varied as are our size, shape, skin and eye colour so are the more subtle nuances of antibodies and enzymes which each cell produces.
It is postulated that it is mostly atopic patients who will also react abnormally to certain foods, inhalants and skin applications.
Sugars (refined foods) play a major role in leading to fatigue by their chemical, physiological, pharmacological and glycosylogical properties.
Bread plays a major role in provoking the symptoms of depression in the chronic fatigue syndrome.
What is suggested is that in a genetically predisposed group of people food intolerance causes symptoms akin to both the major and minor criteria of CFS.
Context: Patients with Chronic Fatigue Syndrome and their physicians are often in conflict about the etiology and treatment of CFS.
Objectives: 1. Survey the literature regarding physician's attitudes towards CFS; 2. Examine the contributing factors to physician's attitude towards the disorder; and 3. Suggest solutions.
Data Sources: The relevant medical and psychological literature (years 1988-2000) was searched using the search term “Chronic Fatigue Syndrome.” This was supplemented with papers from the bibliographies of the retrieved papers, additional related literature, and clinical experience.
Data Synthesis: Forty-six to ninety percent of GPs accept CFS as a discrete clinical entity and 30-82% are willing to make the diagnosis in qualifying patients.
Conclusions: CFS is a heterogeneous, multifactorial host response disorder that is inadequately described by the biomedical model. Despite substantial evidence of multisystemic physical abnormality in CFS, the lack of pathognomic tests and the female gender predominance cause some physicians to continue to treat CFS as a psychosocial disorder. This leads to conflict between patients and physicians. CFS challenges physicians to think beyond current disease models, to tolerate diagnostic and therapeutic uncertainty, and to work collaboratively with patients rather than taking the role of expert.
The investigation of the growth hormone (GH)-IGF-J. axis in patients with chronic fatigue syndrome (CFS) may be important for different reasons. Some of the disturbances of the hypothalamic-pituitary-adrenal axis and central serotonincrgic (5-HT) function in CFS will be reviewed, before elaborating on three hypotheses that may explain the role of a disturbed GH axis activity in CFS. Firstly, the disturbed central 5-HT receptor activity may be the cause of GH axis dysfunction. Secondly, CFS may be considered as a “stress-related illness,” in which the disturbed central 5-HT function is a result rather than the cause of impaired neuroendocrine stress responses. Finally, by analogy with fibromyalgia, sleep abnormalities in CFS may impair nocturnal GH secretion. Whether the disturbed GH axis activity is a primary or secondary phenomenon in the pathogenesis of CFS, should be elucidated by future clinical investigations.
Benzalkonium salts comprise a group of positively charged surface-active alkylamine biocides with the general formula alkyldi-methylbenzylammonium chloride or bromide. They interact with guanine nucleotide triphosphate-binding proteins (G proteins), thereby affecting signal transduction in a variety of cell types and processes. The present report reviews the known and potential basic science research and clinical applications and manifestations of benzalkonium salts. Benzalkonium salts have antiproliferative effects on a variety of cells (including T cells) through G-protein-dependent pathways, affect cytokine gene expression (downregulate tumor necrosis factor expression), and are also effective bactericidal, fungicidal, and virucidal agents with multisite (direct and immunologically-mediated) inhibitory activity against many pathogens, including the human immunodeficiency virus (HIV), papillomavirus, and herpesviruses. Therefore, benzalkonium salts not only appear to be effective as disinfectants and spermicides but may also prove useful in the prevention and treatment of several diseases, particularly those linked to viruses and originating at the skin or mucosal surface. The untoward effects of benzalkonium salts are also discussed as a paradigm for chemical-induced diseases.
A literature search identified all papers published on chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) in the British Medical Journal between 1995 and 2000. Analysis of the findings revealed a bias towards the views of one school of thought and a lack of papers on the immunological or virological aspects of CFS. This contrasts with the mainstream American journals, which generally covered a much wider range of subjects and views. We examine the arguments for and against covert editorial policies, and summarise the results of discussions with the relevant individuals and organisations. (Journal no longer published so see supp resources for text.)