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====== Chronic fatigue syndrome (myalgic encephalomyelitis) ====== | ====== Chronic fatigue syndrome (myalgic encephalomyelitis) ====== | ||
- | <relatedarticle> [[home: | + | <relatedarticles> [[home: |
===== Introduction ===== | ===== Introduction ===== | ||
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Chronic fatigue syndrome (CFS) is the most common name given to a variably debilitating disorder or disorders generally defined by persistent fatigue unrelated to exertion, not substantially relieved by rest and accompanied by the presence of other specific symptoms for a minimum of six months. | Chronic fatigue syndrome (CFS) is the most common name given to a variably debilitating disorder or disorders generally defined by persistent fatigue unrelated to exertion, not substantially relieved by rest and accompanied by the presence of other specific symptoms for a minimum of six months. | ||
[[https:// | [[https:// | ||
- | Almost every aspect of CFS is the subject of disagreement and uncertainty(({{pubmed> | + | Almost every aspect of CFS is the subject of disagreement and uncertainty(({{pmid> |
- | < | + | < |
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- | The absence of well-defined biomarkers coupled with inability to point to a single somatic cause (e.g. an infectious process) has had a devastating effect on the way patients with CFS/ME are diagnosed, treated and regarded. Even though CFS/ME is now widely regarded as a " | + | The absence of well-defined biomarkers coupled with inability to point to a single somatic cause (e.g. an infectious process) has had a devastating effect on the way patients with CFS/ME are diagnosed, treated and regarded. Even though CFS/ME is now widely regarded as a " |
- | Three types of overlap occur among the disease states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common symptoms. | + | Three types of overlap occur among the disease states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common symptoms. |
An infectious etiology of chronic fatigue syndrome has long been suspected. Today, scientific evidence provides a growing, if not conclusive, link between infectious agents and CFS. For example, a 2011 study detected hundreds of unique proteins in the cerebrospinal fluid of patients with CFS as compared to healthy controls. | An infectious etiology of chronic fatigue syndrome has long been suspected. Today, scientific evidence provides a growing, if not conclusive, link between infectious agents and CFS. For example, a 2011 study detected hundreds of unique proteins in the cerebrospinal fluid of patients with CFS as compared to healthy controls. | ||
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Had the agency done nothing in response to this epidemic, patients would now be better off. The name functioned as a kind of social punishment. Patients were branded malingerers by families, friends, journalists and insurance companies, and were denied medical care. (It’s no coincidence that suicide is among the three leading causes of death among sufferers.) Soon the malady came to be widely considered a personality disorder or something that sufferers brought upon themselves. A recent study financed by the C.D.C. suggested that childhood trauma or sexual abuse, combined with a genetic inability to handle stress, is a key risk factor for chronic fatigue syndrome. | Had the agency done nothing in response to this epidemic, patients would now be better off. The name functioned as a kind of social punishment. Patients were branded malingerers by families, friends, journalists and insurance companies, and were denied medical care. (It’s no coincidence that suicide is among the three leading causes of death among sufferers.) Soon the malady came to be widely considered a personality disorder or something that sufferers brought upon themselves. A recent study financed by the C.D.C. suggested that childhood trauma or sexual abuse, combined with a genetic inability to handle stress, is a key risk factor for chronic fatigue syndrome. | ||
- | //**Hillary Johnson**, [[http:// | + | //**Hillary Johnson**, [[https:// |
- | However, CFS is a serious disease. The gentleness of its name barely suggests how debilitating the affliction is, and the use of the term " | + | However, CFS is a serious disease. The gentleness of its name barely suggests how debilitating the affliction is, and the use of the term " |
=====Diagnosis and testing===== | =====Diagnosis and testing===== | ||
- | In the U.S., the most commonly used diagnostic criteria and definition of CFS/ME for research and clinical purposes were published by the United States Centers for Disease Control and Prevention (CDC).(({{pubmed> | + | In the U.S., the most commonly used diagnostic criteria and definition of CFS/ME for research and clinical purposes were published by the United States Centers for Disease Control and Prevention (CDC).(({{pmid> |
- A new onset (not lifelong) of unexplained, | - A new onset (not lifelong) of unexplained, | ||
- Four or more of the following symptoms that last six months or longer: impaired memory or concentration; | - Four or more of the following symptoms that last six months or longer: impaired memory or concentration; | ||
- | There are no characteristic laboratory abnormalities to diagnose CFS/ME,(({{pubmed> | + | There are no characteristic laboratory abnormalities to diagnose CFS/ME,(({{pmid> |
The absence of clear laboratory markers affects not only how CFS is diagnosed, but whether or not it is viewed as fundamentally psychological illness, and how it is treated. | The absence of clear laboratory markers affects not only how CFS is diagnosed, but whether or not it is viewed as fundamentally psychological illness, and how it is treated. | ||
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==== Research ==== | ==== Research ==== | ||
- | There is considerable evidence that mitochondrial dysfunction is present in some CFS patients. (({{pubmed> | + | There is considerable evidence that mitochondrial dysfunction is present in some CFS patients. (({{pmid> |
- | This work contributes key elements to the development of ME/CFS diagnostics, | + | This work contributes key elements to the development of ME/CFS diagnostics, |
- | Disturbances in fatty acid and lipid metabolism | + | Disturbances in fatty acid and lipid metabolism |
+ | |||
+ | Selenium and iodine are essential for thyroid hormone synthesis and function. (({{pmid> | ||
| | ||
- | Altered composition of the gut microbiome | + | Altered composition of the gut microbiome |
- | A decisive infectious trigger may then lead to immunization against autoantigens involved in aerobic energy production and/or hormone receptors and ion channel proteins, producing postexertional malaise and ME/CFS, affecting both muscle and brain.(({{pubmed> | + | A decisive infectious trigger may then lead to immunization against autoantigens involved in aerobic energy production and/or hormone receptors and ion channel proteins, producing postexertional malaise and ME/CFS, affecting both muscle and brain.(({{pmid> |
- | NK cells are a necessary component of the immunological process and aberrations in their functional processes, including equivocal levels of NK cells and cytotoxic activity pre-empts recurrent viral infections, autoimmune diseases and altered inflammatory responses. NK cells are implicated in a number of diseases including chronic fatigue syndrome (CFS)(({{pubmed> | + | NK cells are a necessary component of the immunological process and aberrations in their functional processes, including equivocal levels of NK cells and cytotoxic activity pre-empts recurrent viral infections, autoimmune diseases and altered inflammatory responses. NK cells are implicated in a number of diseases including chronic fatigue syndrome (CFS)(({{pmid> |
- | Patients with CFS showed abnormalities in 20 metabolic pathways. (({{pubmed> | + | Patients with CFS showed abnormalities in 20 metabolic pathways. (({{pmid> |
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< | < | ||
- | //**Nancy Klimas, M.D.,** [[http:// | + | //**Nancy Klimas, M.D.,** [[https:// |
The systematic use of stimulants to manage symptoms of fatigue is not recommended. | The systematic use of stimulants to manage symptoms of fatigue is not recommended. | ||
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===== Metabolic evidence ===== | ===== Metabolic evidence ===== | ||
- | As reported in The Economist " Robert Naviaux of the University of California, San Diego, and his colleagues published evidence(({{pubmed> | + | As reported in The Economist " Robert Naviaux of the University of California, San Diego, and his colleagues published evidence(({{pmid> |
in 2016, "Dr Naviaux and his team collected and analysed blood samples from 45 people who had been diagnosed with CFS, and also from 39 controls who were free of any CFS-related symptom. They then trawled through those samples looking at the levels of 612 specific chemicals, known as metabolites, | in 2016, "Dr Naviaux and his team collected and analysed blood samples from 45 people who had been diagnosed with CFS, and also from 39 controls who were free of any CFS-related symptom. They then trawled through those samples looking at the levels of 612 specific chemicals, known as metabolites, | ||
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- | In October 2009, we reported the first direct isolation of infectious xenotropic murine leukemia virus-related virus (XMRV). In that study, we used a combination of biological amplification and molecular enhancement techniques to detect XMRV in more than 75% of 101 patients with chronic fatigue syndrome (CFS).(({{pubmed> | + | In October 2009, we reported the first direct isolation of infectious xenotropic murine leukemia virus-related virus (XMRV). In that study, we used a combination of biological amplification and molecular enhancement techniques to detect XMRV in more than 75% of 101 patients with chronic fatigue syndrome (CFS).(({{pmid> |
+ | [[https:// | ||
===== Impairment of immune function ===== | ===== Impairment of immune function ===== | ||
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< | < | ||
- | An infectious etiology of Chronic Fatigue Syndrome has long been suspected and investigated, | + | An infectious etiology of Chronic Fatigue Syndrome has long been suspected and investigated, |
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- | In a 2011 study appearing in //PLoS One//, Schutzer and colleagues analyzed spinal fluid samples from three groups — 11 healthy people, 43 diagnosed with chronic fatigue syndrome and 25 previously treated for Lyme disease but who were still experiencing cognitive problems and fatigue.(({{pubmed> | + | In a 2011 study appearing in //PLoS One//, Schutzer and colleagues analyzed spinal fluid samples from three groups — 11 healthy people, 43 diagnosed with chronic fatigue syndrome and 25 previously treated for Lyme disease but who were still experiencing cognitive problems and fatigue.(({{pmid> |
On its most basic level, this study offers strong evidence of a biological component for Lyme and CFS. The presence of so many unique proteins suggests that these are proteins are either created directly by microbes or are the results of microbes acting on the human genome. | On its most basic level, this study offers strong evidence of a biological component for Lyme and CFS. The presence of so many unique proteins suggests that these are proteins are either created directly by microbes or are the results of microbes acting on the human genome. | ||
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==== XMRV ==== | ==== XMRV ==== | ||
- | In 2009, researchers published a paper in the journal //Science// announcing that in 67% of the samples of 101 chronic fatigue syndrome patients (as compared to 3.7% of 218 healthy controls), they had found a retrovirus called XMRV: xenotropic murine leukemia virus-related virus.(({{pubmed> | + | In 2009, researchers published a paper in the journal //Science// announcing that in 67% of the samples of 101 chronic fatigue syndrome patients (as compared to 3.7% of 218 healthy controls), they had found a retrovirus called XMRV: xenotropic murine leukemia virus-related virus.(({{pmid> |
- | For many scientists, the inability of other labs to confirm the results raised questions about the validity of the retroviral finding. Others such as W. Ian Lipkin [[http:// | + | For many scientists, the inability of other labs to confirm the results raised questions about the validity of the retroviral finding. Others such as W. Ian Lipkin [[https:// |
==== Enterobacteria and enteroviruses ==== | ==== Enterobacteria and enteroviruses ==== | ||
- | A number of studies have detected enterobacteria in the gut of patients with CFS. Maes //et al.// found that the prevalences in response to the presences and median values for serum IgA against the lipopolysaccharides of enterobacteria are significantly greater in patients with CFS.(({{pubmed> | + | A number of studies have detected enterobacteria in the gut of patients with CFS. Maes //et al.// found that the prevalences in response to the presences and median values for serum IgA against the lipopolysaccharides of enterobacteria are significantly greater in patients with CFS.(({{pmid> |
- | Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach.(({{pubmed> | + | Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach.(({{pmid> |
==== Mycoplasma ==== | ==== Mycoplasma ==== | ||
- | Nijs //et al.// found a high prevalence of // | + | Nijs //et al.// found a high prevalence of // |
==== Other infections ==== | ==== Other infections ==== | ||
- | Certain other infectious illnesses, such as Q fever and viral meningitis are associated with a greater risk of developing CFS, but many people have no evidence of viral infection, and there is no evidence of persistent infection.(({{pubmed> | + | Certain other infectious illnesses, such as Q fever and viral meningitis are associated with a greater risk of developing CFS, but many people have no evidence of viral infection, and there is no evidence of persistent infection.(({{pmid> |
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There are several reports of CFS outbreaks, one prominent example of which is Incline Village. | There are several reports of CFS outbreaks, one prominent example of which is Incline Village. | ||
- | < | + | < |
Some very common infections seem to set off C.F.S. and lead to several theories about the disease. My favorite theory is that any infection that can activate the immune system in a profound way could allow a hidden latent virus or viruses to reactivate and perpetuate a chronic illness. Anything that suppresses the immune system, like some treatments for cancer, might do the same thing, causing profound fatigue in some “recovered” cancer patients years after chemotherapy. | Some very common infections seem to set off C.F.S. and lead to several theories about the disease. My favorite theory is that any infection that can activate the immune system in a profound way could allow a hidden latent virus or viruses to reactivate and perpetuate a chronic illness. Anything that suppresses the immune system, like some treatments for cancer, might do the same thing, causing profound fatigue in some “recovered” cancer patients years after chemotherapy. | ||
- | //**Nancy Klimas, M.D.**, [[http:// | + | //**Nancy Klimas, M.D.**, [[https:// |
</ | </ | ||
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CFS/ME patients' | CFS/ME patients' | ||
- | * **unnecessarily seek medical care** – One study found CFS patients consulted their physician more frequently in the 15 years before development of their condition.(({{pubmed> | + | * **unnecessarily seek medical care** – One study found CFS patients consulted their physician more frequently in the 15 years before development of their condition.(({{pmid> |
- | * **participate in social networks** – A lack of support or the reinforcement of " | + | * **participate in social networks** – A lack of support or the reinforcement of " |
- | * **display " | + | * **display " |
- | * **display high levels of " | + | * **display high levels of " |
- | * **engage in catastrophizing** – A euphemism for fearing the worst.(({{pubmed> | + | * **engage in catastrophizing** – A euphemism for fearing the worst.(({{pmid> |
- | * **engage in avoidance behaviour** – A pervasive pattern of social inhibition.(({{pubmed> | + | * **engage in avoidance behaviour** – A pervasive pattern of social inhibition.(({{pmid> |
==== Cognitive explanations ==== | ==== Cognitive explanations ==== | ||
- | According to a 2006 //Lancet// paper, " | + | According to a 2006 //Lancet// paper, " |
- | * **perceive symptoms inaccurately** – Prins summed up the literature when she said there are discrepancies between perceived and actual cognitive performance, | + | * **perceive symptoms inaccurately** – Prins summed up the literature when she said there are discrepancies between perceived and actual cognitive performance, |
- | * **fixate on a physical cause for symptoms** or when exercise is avoided.(({{pubmed> | + | * **fixate on a physical cause for symptoms** or when exercise is avoided.(({{pmid> |
- | * **are neurotic and introverted**(({{pubmed> | + | * **are neurotic and introverted**(({{pmid> |
- | * **fail to self-regulate** – Deary has hypothesized that in CFS/ME, the health threat is no longer the illness, but anything that threatens to disrupt a precarious accommodation to it.(({{pubmed> | + | * **fail to self-regulate** – Deary has hypothesized that in CFS/ME, the health threat is no longer the illness, but anything that threatens to disrupt a precarious accommodation to it.(({{pmid> |
- | * **engage in somatization** – So called " | + | * **engage in somatization** – So called " |
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==== Therapy based on the cognitive-behavioral model of disease ==== | ==== Therapy based on the cognitive-behavioral model of disease ==== | ||
- | Cognitive behavioral therapy (CBT), graded exercise therapy (GET) and other interventions for CFS/ME are predicated on the profoundly flawed cognitive-behavioral model for the disease. They also suffer from bias. For example, because many of the CBT and GET studies required patients to visit a clinic, severely affected patients may have been excluded.(({{pubmed> | + | Cognitive behavioral therapy (CBT), graded exercise therapy (GET) and other interventions for CFS/ME are predicated on the profoundly flawed cognitive-behavioral model for the disease. They also suffer from bias. For example, because many of the CBT and GET studies required patients to visit a clinic, severely affected patients may have been excluded.(({{pmid> |
* **cognitive behavioral therapy** – CBT is a form of psychological therapy in which patients are taught to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, | * **cognitive behavioral therapy** – CBT is a form of psychological therapy in which patients are taught to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, | ||
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< | < | ||
- | //**F.N. Twisk**, et al.//(({{pubmed> | + | //**F.N. Twisk**, et al.//(({{pmid> |
</ | </ | ||
- | As of November 2010, the top three treatments for CFS on the [[http:// | + | As of November 2010, the top three treatments for CFS on the [[https:// |
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===== Other treatments ===== | ===== Other treatments ===== | ||
- | * **Rituximab** – In 2011, a Norwegian study published in //PLoS One// studied the effect of Rituximab – a monoclonal antibody otherwise used in cancers and anti-rejection treatment for organ transplants – on patients with CFS. In the 25-week study period, fatigue improved significantly in 10 out of 15 patients versus 2 out of 15 controls.(({{pubmed> | + | * **Rituximab** – In 2011, a Norwegian study published in //PLoS One// studied the effect of Rituximab – a monoclonal antibody otherwise used in cancers and anti-rejection treatment for organ transplants – on patients with CFS. In the 25-week study period, fatigue improved significantly in 10 out of 15 patients versus 2 out of 15 controls.(({{pmid> |
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chronic fatigue syndrome (CFS), multiple chemical sensitivity | chronic fatigue syndrome (CFS), multiple chemical sensitivity | ||
- | Read the [[http:// | + | Read the [[https:// |
< | < | ||
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chronic fatigue syndrome (CFS), depression, food sensitivities | chronic fatigue syndrome (CFS), depression, food sensitivities | ||
- | Read the [[http:// | + | Read the [[https:// |
< | < | ||
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autism, ADHD, depression, severe anxiety, chronic fatigue syndrome (CFS) | autism, ADHD, depression, severe anxiety, chronic fatigue syndrome (CFS) | ||
- | Read the [[http:// | + | Read the [[https:// |
< | < | ||
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sarcoidosis, | sarcoidosis, | ||
- | Read the [[http:// | + | Read the [[https:// |
< | < | ||
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- | [[http:// | + | [[https:// |
Interviews of patients with other diseases are [[home: | Interviews of patients with other diseases are [[home: | ||
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===== Read more ===== | ===== Read more ===== | ||
- | * [[http:// | + | * [[https:// |
- | * [[http:// | + | * [[https:// |
- | * [[http:// | + | * [[https:// |
- | * [[http:// | + | * [[https:// |
==== Recent research ==== | ==== Recent research ==== | ||
- | < | + | < |
To determine whether a signature of serum cytokines could be associated with ME/CFS and correlated with disease severity and fatigue duration, cytokines of 192 ME/CFS patients and 392 healthy controls were measured using a 51-multiplex array on a Luminex system. Each cytokine’s preprocessed data were regressed on ME/CFS severity plus covariates for age, sex, race, and an assay property of newly discovered importance: nonspecific binding. On average, TGF-β was elevated (P = 0.0052) and resistin was lower (P = 0.0052) in patients compared with controls. Seventeen cytokines had a statistically significant upward linear trend that correlated with ME/CFS severity: CCL11 (Eotaxin-1), | To determine whether a signature of serum cytokines could be associated with ME/CFS and correlated with disease severity and fatigue duration, cytokines of 192 ME/CFS patients and 392 healthy controls were measured using a 51-multiplex array on a Luminex system. Each cytokine’s preprocessed data were regressed on ME/CFS severity plus covariates for age, sex, race, and an assay property of newly discovered importance: nonspecific binding. On average, TGF-β was elevated (P = 0.0052) and resistin was lower (P = 0.0052) in patients compared with controls. Seventeen cytokines had a statistically significant upward linear trend that correlated with ME/CFS severity: CCL11 (Eotaxin-1), | ||
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[[https:// | [[https:// | ||
- | Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function. | + | Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function. |
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+ | < | ||
===== Notes and comments ===== | ===== Notes and comments ===== | ||
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cardiac insufficiency | cardiac insufficiency | ||
- | * **sensitization** – the process by which an organism is repeatedly exposed to a stimulus, progressively amplifying the response. Nijs //et al.// argue unconvincingly that elevated levels of nitric oxide (which coincidentally play a key role in host defense) sensitize the central nervous system to stimuli.(({{pubmed> | + | * **sensitization** – the process by which an organism is repeatedly exposed to a stimulus, progressively amplifying the response. Nijs //et al.// argue unconvincingly that elevated levels of nitric oxide (which coincidentally play a key role in host defense) sensitize the central nervous system to stimuli.(({{pmid> |
< | < | ||
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A new paper confirms my concerns about the Whittemore Peterson Institute using cell-cultures as part of their XMRV assay: | A new paper confirms my concerns about the Whittemore Peterson Institute using cell-cultures as part of their XMRV assay: | ||
- | http:// | + | https:// |
Note also that we have explained how important it is to select the correct primers for a nested-PCR analysis, something that many research groups do not yet seem to fully appreciate. It is on page 20 of our recent book chapter: | Note also that we have explained how important it is to select the correct primers for a nested-PCR analysis, something that many research groups do not yet seem to fully appreciate. It is on page 20 of our recent book chapter: | ||
- | http:// | + | https:// |
..Trevor.. | ..Trevor.. | ||
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FYI, | FYI, | ||
- | http:// | + | https:// |
..Trevor.. | ..Trevor.. | ||
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From: Dr Trevor Marshall | From: Dr Trevor Marshall | ||
Date: 2010-12-20 10:44:36 | Date: 2010-12-20 10:44:36 | ||
- | Reply: | + | Reply: |
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- | http:// | + | https:// |
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< | < | ||
- | Reply: | + | Reply: |
Why wouldn' | Why wouldn' | ||
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From: Bane | From: Bane | ||
Date: 2011-05-04 15:41:39 | Date: 2011-05-04 15:41:39 | ||
- | Reply: | + | Reply: |
Chronic Fatigue Syndrome Is Not Related to XMRV Retrovirus, Comprehensive Study Finds | Chronic Fatigue Syndrome Is Not Related to XMRV Retrovirus, Comprehensive Study Finds | ||
- | http:// | + | https:// |
“Our investigation found no trace of XMRV in any of the blood samples taken from patients we obtained ourselves, or from patients previously tested in the 2009 Science study,” Singh said. “Because of our findings, we believe chronic fatigue syndrome patients should reconsider the merit of taking antiretroviral agents to alleviate their symptoms.” | “Our investigation found no trace of XMRV in any of the blood samples taken from patients we obtained ourselves, or from patients previously tested in the 2009 Science study,” Singh said. “Because of our findings, we believe chronic fatigue syndrome patients should reconsider the merit of taking antiretroviral agents to alleviate their symptoms.” | ||
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From: Phillyguy | From: Phillyguy | ||
Date: 2011-05-04 20:51:51 | Date: 2011-05-04 20:51:51 | ||
- | Reply: | + | Reply: |
The patients on the CFS boards are very angry about the interpretation of these results. However, what they dont realize is that this is good news. Retroviruses can be really, really nasty and difficult to treat. | The patients on the CFS boards are very angry about the interpretation of these results. However, what they dont realize is that this is good news. Retroviruses can be really, really nasty and difficult to treat. | ||
</ | </ | ||
- | ===== References ===== | + | ===== References =====</ |