Clinical, Epidemiologic, and Virologic Studies in Four Clusters of the Chronic Fatigue Syndrome

Levine, Paul H.

doi:10.1001/archinte.1992.00400200049009

Cited by 71 publications

(29 citation statements)

References 37 publications

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“…Such anecdotes are suggestive of infectious agents, particularly viruses. Historically, “clusters” or “outbreaks” of ME/CFS have been frequently linked to known outbreaks of viral illnesses, particularly polio in the 1950s case of the Royal Free Hospital Group , or Epstein-Barr virus in the surge of ME/CFS diagnoses in Lake Tahoe in the late 1980s [4]. This hypothesis has been empirically investigated by a prospective study of 256 patients diagnosed with Epstein-Barr virus, Q fever or Ross River virus disease, which concluded that 11% of the cohort developed ME/CFS, with similar symptomatology, within 12 months of infection [5].…”

Section: Introductionmentioning

confidence: 99%

Weighting of orthostatic intolerance time measurements with standing difficulty score stratifies ME/CFS symptom severity and analyte detection

Lewis

Kita²,

Ludlow

et al. 2018

J Transl Med

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BackgroundMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is clinically defined and characterised by persistent disabling tiredness and exertional malaise, leading to functional impairment.MethodsThis study introduces the weighted standing time (WST) as a proxy for ME/CFS severity, and investigates its behaviour in an Australian cohort. WST was calculated from standing time and subjective standing difficulty data, collected via orthostatic intolerance assessments. The distribution of WST for healthy controls and ME/CFS patients was correlated with the clinical criteria, as well as pathology and cytokine markers. Included in the WST cytokine analyses were activins A and B, cytokines causally linked to inflammation, and previously demonstrated to separate ME/CFS from healthy controls. Forty-five ME/CFS patients were recruited from the CFS Discovery Clinic (Victoria) between 2011 and 2013. Seventeen healthy controls were recruited concurrently and identically assessed.ResultsWST distribution was significantly different between ME/CFS participants and controls, with six diagnostic criteria, five analytes and one cytokine also significantly different when comparing severity via WST. On direct comparison of ME/CFS to study controls, only serum activin B was significantly elevated, with no significant variation observed for a broad range of serum and urine markers, or other serum cytokines.ConclusionsThe enhanced understanding of standing test behaviour to reflect orthostatic intolerance as a ME/CFS symptom, and the subsequent calculation of WST, will encourage the greater implementation of this simple test as a measure of ME/CFS diagnosis, and symptom severity, to the benefit of improved diagnosis and guidance for potential treatments.Electronic supplementary materialThe online version of this article (10.1186/s12967-018-1473-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Weighting of orthostatic intolerance time measurements with standing difficulty score stratifies ME/CFS symptom severity and analyte detection

Lewis

Kita²,

Ludlow

et al. 2018

J Transl Med

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“…as a triggering agent has been suspected before [81], and a prodromal phase of gastroenteritis has been documented [13]. New intolerances to foods, alcohol and sensory stimuli have also been reported previously [13, 82] as have periods of hypersomnia [83] and a fluctuating pattern [13].…”

Section: Discussionmentioning

confidence: 95%

From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults’ experiences of the illness trajectory

2017

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BackgroundMunicipal drinking water contaminated with the parasite Giardia lamblia in Bergen, Norway, in 2004 caused an outbreak of gastrointestinal infection in 2500 people, according to the Norwegian Prescription Database. In the aftermath a minor group subsequently developed post-infectious fatigue syndrome (PIFS). Persons in this minor group had laboratory-confirmed parasites in their stool samples, and their enteritis had been cured by one or more courses of antibiotic treatment. The study’s purpose was to explore how the affected persons experienced the illness trajectory and various PIFS disabilities.MethodsA qualitative design with in-depth interviews was used to obtain first-hand experiences of PIFS. To get an overall understanding of their perceived illness trajectory, the participants were asked to retrospectively rate their functional level at different points in time. A maximum variation sample of adults diagnosed with PIFS according to the international 1994 criteria was recruited from a cohort of persons diagnosed with PIFS at a tertiary Neurology Outpatient Clinic in Western Norway. The sample comprised 19 women and seven men (mean age 41 years, range 26–59). The interviews were fully transcribed and subjected to a qualitative content analysis.ResultsAll participants had been living healthy lives pre-illness. The time to develop PIFS varied. Multiple disabilities in the physical, cognitive, emotional, neurological, sleep and intolerance domains were described. Everyone more or less dropped out from studies or work, and few needed to be taken care of during the worst period. The severity of these disabilities varied among the participants and during the illness phases. Despite individual variations, an overall pattern of illness trajectory emerged. Five phases were identified: prodromal, downward, turning, upward and chronic phase. All reached a nadir followed by varying degrees of improvement in their functional ability. None regained pre-illness health or personal and professional abilities.ConclusionsThe needs of persons with this condition are not met. Early diagnosis and interdisciplinary rehabilitation could be beneficial in altering the downward trajectory at an earlier stage, avoiding the most severe disability and optimising improvement. Enhanced knowledge among health professionals, tailored treatment, rest as needed, financial support and practical help would likely improve prognosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0614-4) contains supplementary material, which is available to authorized users.

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“…The initial study which used PCR amplification of HTLV-2 proviral sequences followed by probe hybridization assays to find an association of HTLV-2 infection to CFS was followed by only a few negative studies [16-18]. Even though this technique is highly specific and sensitive, amplification by nested PCR may be superior when detection of low levels of infection and/or virus variants is pursued.…”

Section: Discussionmentioning

confidence: 99%

“…Even though this technique is highly specific and sensitive, amplification by nested PCR may be superior when detection of low levels of infection and/or virus variants is pursued. In addition none of the three negative studies that followed the initial one included more than 30 patient blood samples [16-18], and therefore further investigation including larger cohorts of patients was at need.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to XMRV screening studies, evaluation of HTLV-2 in different cohorts of FM/CFS patients has been scarce [16-18]. This latter retrovirus, closely related to the HTLV-1 virus causing adult T-cell leukemia and lymphoma and the demyelinating disease called myelopathy/Tropical spastic paraparesis (HAM/TSP) has not yet been clearly associated with any disease.…”

Section: Introductionmentioning

confidence: 99%

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Lack of evidence for retroviral infections formerly related to chronic fatigue in Spanish Fibromyalgia patients

Oltra

García-Escudero

Mena-Duran

et al. 2013

Virol J

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BackgroundThe etiology of fibromyalgia and chronic fatigue syndrome (FM/CFS) is currently unknown. A recurrent viral infection is an attractive hypothesis repeatedly found in the literature since it would explain the persistent pain and tiredness these patients suffer from. The initial striking link of two distinct orphan retroviruses: the gamma retroviruses murine leukemia virus (MLV)-related virus and the delta retrovirus T-lymphotropic virus type 2 (HTLV-2) to chronic fatigue have not been confirmed to date.ResultsGenomic DNA (gDNA) from 75 fibromyalgia patients suffering from chronic fatigue and 79 age-matched local healthy controls were screened for the presence of MLV-related and HTLV-2 related proviral sequences. The XMRV env gene was amplified in 20% of samples tested (24% patients/15% healthy controls). Unexpectedly, no PCR amplifications from independent gDNA preparations of the same individuals were obtained. None of the positive samples showed presence of contaminating murine sequences previously reported by other investigators, neither contained additional regions of the virus making us conclude that the initial env amplification came from spurious air-driven amplicon contaminants. No specific HTLV-2 sequences were obtained at any time from any of the 154 quality-controlled gDNA preparations screened.ConclusionsPrevious associations between MLV-related or HTLV-2 retrovirus infection with chronic fatigue must be discarded. Thus, studies showing positive amplification of HTLV-2 sequences from chronic fatigue participants should be revised for possible undetected technical problems.To avoid false positives of viral infection, not only extreme precautions should be taken when nested-PCR reactions are prepared and exhaustive foreign DNA contamination controls performed, but also consistent amplification of diverse regions of the virus in independent preparations from the same individual must be demanded.The fact that our cohort of patients did not present evidence of any of the two types of retroviral infection formerly associated to chronic fatigue does not rule out the possibility that other viruses are involved in inciting or maintaining fibromyalgia and/or chronic fatigue conditions.

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Clinical, Epidemiologic, and Virologic Studies in Four Clusters of the Chronic Fatigue Syndrome

Cited by 71 publications

References 37 publications

Weighting of orthostatic intolerance time measurements with standing difficulty score stratifies ME/CFS symptom severity and analyte detection

Weighting of orthostatic intolerance time measurements with standing difficulty score stratifies ME/CFS symptom severity and analyte detection

From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults’ experiences of the illness trajectory

Lack of evidence for retroviral infections formerly related to chronic fatigue in Spanish Fibromyalgia patients

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