Category: Diagnosis

Clinical spectrum of postviral fatigue syndrome

Abstract:

Many different neurological and psychiatric syndromes follow viral infections, but their clinical pictures and pathogeneses are poorly understood. The syndromes include acute disseminated encephalomyelitis (post-infectious encephalomyelitis), the Guillain-Barre syndrome (post-infectious neuritis) and Reye’s syndrome.

Recently, attention has been focused on another common postviral neurological syndrome, i.e. the postviral fatigue syndrome (PVFS)–termed myalgic encephalomyelitis (ME) and a host of other designations. PVFS occurs both sporadically and in epidemics, with cases being reported from all over Europe, the United States, Australasia and South Africa.

It is difficult to make the diagnosis and this has meant, in the past, that it is not until an epidemic has occurred that random cases which presented in the preceding years are realised to represent the same condition. With renewed interest in the syndrome and greater attention from physicians, however, diagnosis of sporadic cases is now becoming more common.

 

Source: Behan PO, Bakheit AM. Clinical spectrum of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):793-808. http://www.ncbi.nlm.nih.gov/pubmed/1794085

 

Antibodies to Epstein-Barr virus in patients with chronic fatigue

Abstract:

To clarify the role of Epstein-Barr virus (EBV) infection and the value of EBV antibody testing in evaluating patients with chronic fatigue, we studied 200 consecutive patients with chronic fatigue (mean duration, 9 years).

Complete EBV serologic panels were obtained for 154 patients, 35 (23%) of whom met serologic or clinical criteria for chronic or reactivated EBV infection. We compared these patients with chronic EBV infection (CEBV cases) to 35 age- and sex-matched patients who were selected from the same cohort of fatigued patients but who did not meet the criteria (CEBV control subjects).

We found few differences between groups in demographic characteristics, clinical features, and symptoms; CEBV cases were more likely to meet criteria for the proposed chronic fatigue syndrome (14% vs 0%), and to report that they suffered from an influenza-like illness at the onset of their fatigue syndrome (34% vs 12%), that they lost their job because of their fatigue (37% vs 11%), and that their fatigue was improved by recreational activity (26% vs 3%).

Physical examination and laboratory testing showed few abnormalities in either group. Psychiatric morbidity was common in both groups, including mood disorders (63% of CEBV cases vs 54% of CEBV controls), anxiety (11% vs 9%) and somatization disorder (9% in each group).

We conclude that EBV serologic patterns have little clinical usefulness in evaluating patients with chronic fatigue.

 

Source: Matthews DA, Lane TJ, Manu P. Antibodies to Epstein-Barr virus in patients with chronic fatigue. South Med J. 1991 Jul;84(7):832-40. http://www.ncbi.nlm.nih.gov/pubmed/1648795

 

Antibody to Coxsackie B virus in diagnosing postviral fatigue syndrome

Abstract:

OBJECTIVE: To study the association between coxsackie B virus infection and the postviral fatigue syndrome and to assess the immunological abnormalities associated with the syndrome.

DESIGN: Case-control study of patients with the postviral fatigue syndrome referred by local general practitioners over one year.

SETTING: General practitioner referrals in Dunbartonshire, Scotland.

PATIENTS: 254 Patients referred with the postviral fatigue syndrome (exhaustion, myalgia, and other symptoms referable to postviral fatigue syndrome of fairly recent onset–that is, several months) and age and sex matched controls obtained from same general practitioner; 11 patients were rejected because of wrong diagnoses, resolution of symptoms, and refusal to participate, leaving 243 patients and matched controls.

MAIN OUTCOME MEASURES: Detailed questionnaire (patients and controls) and clinical examination (patients) and blind analysis of blood sample at entry and after six months for determination of coxsackie B virus IgM and IgG antibodies and other variables (including lymphocyte protein synthesis, lymphocyte subsets, and immune complexes).

RESULTS: Percentage positive rates for coxsackie B virus IgM at entry were 24.4% for patients and 22.6% for controls and for coxsackie B virus IgG 56.2% and 55.3% respectively; there were no significant differences between different categories of patients according to clinical likelihood of the syndrome nor any predictive value in a fourfold rise or fall in the coxsackie B virus IgG titre in patients between entry and review at six months. The rates of positive antibody test results in patients and controls showed a strong seasonal variation. Of the numerous immunological tests performed, only a few detected significant abnormalities; in particular the mean value for immune complex concentration was much higher in 35 patients and 35 controls compared with the normal range and mean value for total IgM was also raised in 227 patients and 35 controls compared with the normal range.

CONCLUSIONS: Serological tests available for detecting coxsackie B virus antibodies do not help diagnose the postviral fatigue syndrome. Percentage positive rates of the antibodies in patients simply reflect the background in the population as probably do the raised concentrations of total IgM and immune complexes.

 

Source: Miller NA, Carmichael HA, Calder BD, Behan PO, Bell EJ, McCartney RA, Hall FC. Antibody to Coxsackie B virus in diagnosing postviral fatigue syndrome. BMJ. 1991 Jan 19;302(6769):140-3. http://www.ncbi.nlm.nih.gov/pubmed/1847316

 

A supplemental interview for forms of “affective spectrum disorder”

Abstract:

OBJECTIVE: Recent evidence suggests that a number of psychiatric and medical conditions may be members or candidate members of a larger family of conditions, which we have termed “affective spectrum disorder (ASD).” In order to facilitate further research into this concept, we drafted seven interview modules, using the format of the Structured Clinical Interview for DSM-III-R (SCID), designed to diagnose the following psychiatric and medical disorders: irritable bowel syndrome, narcolepsy, Tourette’s disorder, migraine, fibromyalgia, chronic fatigue syndrome, and kleptomania.

METHOD: Published operational diagnostic criteria for these seven disorders were sought in the literature. Questions in SCID format were then drafted in accordance with these operational criteria. Draft modules were then sent to experts familiar with each of the disorders and suggestions and revisions from these experts incorporated into the final modules.

RESULTS: The complete supplemental interview is presented with this report. Preliminary experience with this interview in more than 100 patients tentatively suggests that it is reliable for diagnosing the disorders in question; however, a formal test-retest reliability assessment is still required.

CONCLUSIONS: It is hoped that this supplemental interview, used in conjunction with the SCID, will be helpful in further studies of the epidemiology, pathogenesis, and treatment of these possible forms of affective spectrum disorder.

 

Source: Pope HG Jr, Hudson JI. A supplemental interview for forms of “affective spectrum disorder”. Int J Psychiatry Med. 1991;21(3):205-32. http://www.ncbi.nlm.nih.gov/pubmed/1955274

 

Primary fibromyalgia and the chronic fatigue syndrome

Abstract:

Thirty-three primary fibromyalgia patients were investigated for chronic fatigue syndrome symptoms. Significant fatigue was reported by 21/33 patients (63.6%), and patients reported various flulike symptoms, yet only 7/33 patients (21.2%) fulfilled criteria for the chronic fatigue syndrome. Only one patient reported painful lymph glands and four patients reported fever. Thus, symptoms of painful glands or fever might serve as clinical indicators, distinguishing between fibromyalgia and the chronic fatigue syndrome.

 

Source: Wysenbeek AJ, Shapira Y, Leibovici L. Primary fibromyalgia and the chronic fatigue syndrome. Rheumatol Int. 1991;10(6):227-9. http://www.ncbi.nlm.nih.gov/pubmed/2041979

 

Symptoms and signs of chronic fatigue syndrome

Abstract:

This review summarizes the symptoms and signs seen in patients with chronic fatigue syndrome (CFS). It is based on the authors’ experience with two cohorts of approximately 510 patients with chronic debilitating fatigue and on the reported experience of other investigators with similar patients.

The most characteristic symptoms of CFS are the sudden onset of an infectious-type illness, the subsequent chronic and debilitating fatigue, and postexertional malaise; many patients also have recurrent fevers, pharyngitis, adenopathy, myalgias, sleep disorders, and cognitive impairment.

 

Source: Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S8-11. http://www.ncbi.nlm.nih.gov/pubmed/2020806

 

Chronic fatigue syndrome: issues in the diagnosis and estimation of incidence

Abstract:

This article critiques the current working definition of chronic fatigue syndrome. The concerns raised about the current working definition are the following: prolonged or excessive exertion is not addressed explicitly; duration and quality of bed rest are not specified; a socioeconomic ascertainment bias is present; data from history and physical findings are not clearly separated and are relegated to minor criteria; and the rigor of neurologic and psychiatric evaluations is not specified.

We propose a flow chart that addresses the possible modes of evolution of chronic fatigue syndrome for patients; this chart may yield more homogeneous subgroups of individuals with this syndrome or enable some patients to avert the syndrome.

 

Source: Armon C, Kurland LT. Chronic fatigue syndrome: issues in the diagnosis and estimation of incidence. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S68-72. http://www.ncbi.nlm.nih.gov/pubmed/2020804

 

Postviral syndrome

Note: This comment appeared in the Journal of the Royal Society of Medicine, Volume 83, October 1990 in reference to The diagnosis of postviral syndrome. [J R Soc Med. 1990]

 

Postviral syndrome Dr D J D Perrins writes (June 1990 JRSM, p 413) of the difficulty in making a definitive diagnosis of postviral syndrome (myalgic encephalomyelitis, ME) echoing the paper by Dr Bowman et aL (December 1988 JRSM, p 712) and goes on to affirm ‘the clinical pattern of ME has much in common with multiple sclerosis (1). No neurologist of experience would agree with this statement. Dr Perrins admits that some of the patients he himself reported upon may in fact have had MS. Seven out of 10 MS patients will tell you the diagnosis if you listen carefully (the late Henry Miller); ‘a blind neurologist is better than a deaf one’ (Mumenthaler, Berne). The clinical course of ME and MS is usually quite different, though occasional ‘difficult’ similarities may be met with.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292897/pdf/jrsocmed00131-0089b.pdf

 

Source:  E. J. Field. Postviral syndrome. J R Soc Med. 1990 Oct;83(10):675-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292897/

 

Chronic fatigue syndrome

Abstract:

Reports on conditions of chronic fatigue associated with other somatopsychic symptoms after acute viral infections have led to the hypothesis of a “chronic fatigue syndrome” (CFS). Historical disease descriptions, like e.g. “myalgic encephalomyelitits”, were updated by means of modern virological diagnostic techniques and data analysis.

Several viral agents like enteroviruses, Epstein-Barr virus, Human-Herpesvirus 6 and other herpesviruses have been implicated for possible underlying infections. A preliminary disease definition by the Center for Disease Control (CDC) seeks to provide a rational basis for further etiological studies. In fact, there is growing consensus that the syndrome comprises various separate disease entities and causative agents.

Today we can tentatively differentiate a “chronic mononucleosis” after infection with Epstein-Barr virus, an etiologically undetermined “postviral fatigue syndrome” and a fatigue syndrome of the myalgic type after Coxsackie-B virus infection. Furthermore, a valid diagnosis of CFS must be based on the exclusion of defined other diseases and the awareness of dealing with a hypothetical concept. As a result, current knowledge does not yet allow specific therapeutic recommendations.

 

Source: Ewig S, Dengler HJ. Chronic fatigue syndrome. Klin Wochenschr. 1990 Aug 17;68(16):789-96. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/2170741

 

The chronic fatigue syndrome: a return to common sense

The chronic fatigue syndrome has become one of the past decade’s causes celebres, vying with ecological issues for a place in the public perception of real and imagined threats to society and the individual. Perhaps this interest is a manifestation of the malaise of fin de siecle which in other ages has led to outbursts of anarchy’ or increased eschatological preoccupation. Fortunately, the passing of time-and the cathartic benefits of publication have restored a more reasoned view of chronic fatigue and its attendant problems. Chronic fatigue first became prominent as one of the features of myalgic encephalomyelitis or the ‘ME syndrome’ and has subsequently been the subject of intense debate. (2’5) In truth, fatigue is a symptom with many causes and is thus comparable with dyspnoea or dyspepsia. However, in some patients it is the dominant complaint, thereby defining chronic fatigue as a syndrome sui generis in the minds of some observers.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429649/pdf/postmedj00163-0004.pdf

 

Source: Denman AM. The chronic fatigue syndrome: a return to common sense. Postgrad Med J. 1990 Jul;66(777):499-501. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429649/