Category: Etiology

Alleged link between hepatitis B vaccine and chronic fatigue syndrome

I thought it fitting that Mr. Andrew House’s letter “Alleged link between  and chronic fatigue syndrome” saw the light of day in your Apr. 1 issue (page 1145), sharing space with “Psychopharmacology of lycanthropy.”

It was an appropriate debut for a letter that unblushingly ridiculed sick human beings. The disparaging tone and point of view reminded me of the way psychiatric patients used to be discussed in the bad old days.

You can read the full comment as well as the author’s reply here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336231/pdf/cmaj00257-0021c.pdf

 

Source: O’Sullivan SJ. Alleged link between hepatitis B vaccine and chronic fatigue syndrome. CMAJ. 1992 Aug 15;147(4):399, 402. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336231/

 

Clinical, epidemiologic, and virologic studies in four clusters of the chronic fatigue syndrome

Abstract:

BACKGROUND: The purpose of this study is to provide a case definition of chronic fatigue syndrome in an outbreak occurring in the Nevada-California region to evaluate candidate etiologic agents and observe the natural history of the illness.

METHODS: Patients diagnosed as having chronic fatigue syndrome were studied by repeated interviews, questionnaires, and blood collection over a 3-year period. Serum samples were tested for antibodies to Epstein-Barr virus, human herpesvirus-6, and human T-lymphotropic viruses I and II. Leukocytes from typical cases were also assayed for human T-lymphotropic viruses I and II.

RESULTS: Cases were defined as persons who had: (1) severe persistent fatigue following an acute illness appearing in an individual with no previous physical or psychological symptoms; (2) presenting signs and symptoms of an acute infection; (3) severe and persistent headache and/or myalgias; and (4) abrupt change in cognitive function or the appearance of a new mood disorder. After 3 years of follow-up, almost all study subjects were able to return to pre-illness activity. None of the viruses evaluated–human T-lymphotropic viruses I and II, Epstein-Barr virus, or human herpesvirus-6–could be etiologically linked to these outbreaks.

CONCLUSION: Clinical features of outbreaks of chronic fatigue syndrome differ sufficiently to suggest different etiologic agents. Giardiasis appears to have precipitated one of the four clusters in this study but the cause(s) of the other three outbreaks is as yet uncertain. The overall prognosis ofchronic fatigue syndrome is usually favorable.

Comment in: Human herpesvirus type 6 and chronic fatigue syndrome. [Arch Intern Med. 1993]

 

Source: Levine PH, Jacobson S, Pocinki AG, Cheney P, Peterson D, Connelly RR, Weil R, Robinson SM, Ablashi DV, Salahuddin SZ, et al. Clinical, epidemiologic, and virologic studies in four clusters of the chronic fatigue syndrome. Arch Intern Med. 1992 Aug;152(8):1611-6. http://www.ncbi.nlm.nih.gov/pubmed/1323246

 

Alleged link between hepatitis B vaccine and chronic fatigue syndrome

Comment on: Alleged link between hepatitis B vaccine and chronic fatigue syndrome. [CMAJ. 1992]

 

It was with great interest that I read this article in the Jan. 1, 1992, issue of CMAJ (146: 37-38). As a 4th-year medical student at the University of Ottawa I was pleased to read of a possible medical (albeit iatrogenic) explanation for my complaints of fatigue and ill health.

You see, in my first year of medical school I was engaged in an elective in general surgery and, as a precaution, received complete hepatitis B prophylaxis. Now, some 3 years later, I find that I can hardly drag myself out of bed every morning at dawn, and it is a struggle to keep my eyes open to read Harrison’s every night, not to mention the nearly impossible task of stifling yawns and the embarrassment of nodding off at rounds and lectures after a 36-hour shift.

I also find it fascinating that most of my classmates (who have also received the hepatitis B vaccination series) have similar complaints of excessive daytime somnolence, lack of energy and listlessness as they too struggle to complete a work week in excess of 70 hours.

I am sure that the Nightingale Research Foundation would find this information very useful in its attempt to link hepatitis B vaccination with chronic fatigue syndrome. I wonder how many other medical students, interns and residents, family physicians and specialists who have received the vaccine are suffering as I am. Our voices must be heard!

~Andrew House University of Ottawa Ottawa, Ont.

 

Source: House A. Alleged link between hepatitis B vaccine and chronic fatigue syndrome. CMAJ. 1992 Apr 1;146(7):1145. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488336/

Note: You can read the full letter here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488336/pdf/cmaj00296-0011a.pdf

 

Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects and patients with major depression

Abstract:

The chronic fatigue syndrome (CFS) is characterized by severe persistent fatigue and neuropsychiatric symptoms. It has been proposed that the abnormalities in cell-mediated immunity which have been documented in patients with CFS may be attributable to a clinical depression, prevalent in patients with this disorder.

Cell-mediated immune status was evaluated in patients with carefully defined CFS and compared with that of matched subjects with major depression (non-melancholic, non-psychotic) as well as healthy control subjects.

Patients with CFS demonstrated impaired lymphocyte responses to phytohaemagglutinin (PHA) stimulation, and reduced or absent delayed-type hypersensitivity (DTH) skin responses when compared either with subjects with major depression or with healthy control subjects (P less than 0.05 for each analysis).

Although depression is common in patients with CFS, the disturbances of cell-mediated immunity in this disorder differ in prevalence and magnitude from those associated with major depression. These observations strengthen the likelihood of a direct relationship between abnormal cell-mediated immunity and the etiology of CFS.

 

Source: Lloyd A, Hickie I, Hickie C, Dwyer J, Wakefield D. Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects and patients with major depression. Clin Exp Immunol. 1992 Jan;87(1):76-9. http://www.ncbi.nlm.nih.gov/pubmed/1733640

Note : You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1554231/

 

Alleged link between hepatitis B vaccine and chronic fatigue syndrome

In 1989, 3456 cases of hepatitis B were reported in Canada. It is generally accepted that the true incidence of the disease is about 10 times the reported incidence.

Hepatitis B virus is a major cause of acute and chronic hepatitis, cirrhosis and primary hepatocellular carcinoma. Chronic hepatitis may develop in 10% of infected adults and 90% of infected infants and may progress to cirrhosis and hepatocellular carcinoma. In its acute form hepatitis B is fatal in a small number of cases. The disease is transmitted through sexual contact and infected blood and other body fluids. Carriers frequently show no symptoms until later in life and may therefore infect others unknowingly.

Hepatitis B vaccine has been used in populations that have an established risk of infection with known consequences (e.g., health care workers, male homosexuals and injection drug users).

Recent attention in the Canadian press has focused on the possible association between hepatitis B vaccination and chronic fatigue syndrome (CFS).

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488229/pdf/cmaj00290-0039.pdf

 

Source: [No authors listed] Alleged link between hepatitis B vaccine and chronic fatigue syndrome. CMAJ. 1992 Jan 1;146(1):37-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488229/

 

Psychiatric perspectives: an overview

Abstract:

This chapter reviews the evidence concerning the importance of psychological and social factors in the aetiology and pathogenesis of chronic fatigue syndrome. The diagnosis is often offered to doctors by patients; and we consider attribution, stigma, collusion between doctor and patient, and abnormal illness behaviour in this context. We then give a brief description of a model for common mental disorders, and show how chronic fatigue syndrome relates to this model. It emerges that there are special vulnerability factors in these patients’ personalities before the viral illness, but the disorder is seen as being released by the viral illness. By the time the disorder becomes established the original causal nexus is seen as no longer so important, and the disorder can be seen as a form of abnormal illness behaviour maintained by special factors. The implications for treatment are then considered.

 

Source: Woods TO, Goldberg DP. Psychiatric perspectives: an overview. r Med Bull. 1991 Oct;47(4):908-18. http://www.ncbi.nlm.nih.gov/pubmed/1794090

 

Fibromyalgia and parvovirus infection

Abstract:

An infectious cause of fibromyalgia (FM) has been hypothesized based upon the observed similarity of this entity and chronic fatigue syndrome. Three patients developed symptoms of FM after documented episodes of acute parvovirus B19 infections. B19 antibody determinations were obtained approximately 1 month after the symptoms began; both IgM and IgG titers were positive at that time. All 3 patients met criteria for FM. Polysomnography performed on 2 of the patients revealed profound alpha-wave intrusion throughout nonrapid eye movement sleep. A more careful search for viral infections in FM patients whose symptoms appear following a “flu-like” illness appears warranted.

 

Source: Leventhal LJ, Naides SJ, Freundlich B. Fibromyalgia and parvovirus infection. Arthritis Rheum. 1991 Oct;34(10):1319-24. http://www.ncbi.nlm.nih.gov/pubmed/1657005

 

Postviral fatigue syndrome

Comment on: Postviral fatigue syndrome. [BMJ. 1991]

 

SIR, In his letter Dr Anthony Knudsen comments (1) on the recent paper by Dr J W Gow and colleagues on the postviral fatigue syndrome.(2) Dr Knudsen refers to the fact that the aetiology of the syndrome has not been established and to the dearth of definitive pathological findings. Though he does not directly express an opinion, he mentions “the view held by some that the condition is stress related and of psychological origin.”

The body of opinion that holds that the postviral fatigue syndrome has a physical, organic origin seems often to be criticised because it cannot produce “the evidence.” Yet these critics seem quite sanguine about putting forward the hypothesis that the syndrome is of psychological or psychiatric origin without a hint of an opinion regarding the basis of this hypothesis, far less evidence to support it.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1669836/pdf/bmj00125-0065d.pdf

 

Source: M L Sweeney. Postviral fatigue syndrome. BMJ. 1991 May 11; 302(6785): 1153–1154. PMCID: PMC1669836 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1669836/

 

Retroviral sequences related to human T-lymphotropic virus type II in patients with chronic fatigue immune dysfunction syndrome

Abstract:

Chronic fatigue immune dysfunction syndrome (CFIDS) is a recently recognized illness characterized by debilitating fatigue as well as immunological and neurological abnormalities [Straus, S.E. (1988) J. Inf. Dis. 157, 405-412]. Once thought to be caused by Epstein-Barr virus, it is now thought to have a different but unknown etiology.

We evaluated 30 adult and pediatric CFIDS patients from six eastern states for the presence of human T-lymphotropic virus (HTLV) types I and II by Western immunoblotting, polymearse chain reaction, and in situ hybridization of blood samples.

The majority of patients were positive for HTLV antibodies by Western blotting and for HTLV-II gag sequences by polymerase chain reaction and in situ hybridization. Twenty nonexposure healthy controls were negative in all assays. These data support an association between an HTLV-II-like virus and CFIDS.

 

Source: DeFreitas E, Hilliard B, Cheney PR, Bell DS, Kiggundu E, Sankey D, Wroblewska Z, Palladino M, Woodward JP, Koprowski H. Proc Natl Acad Sci U S A. 1991 Apr 1;88(7):2922-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC51352/ (Full article)

 

Cognitive and mood-state changes in patients with chronic fatigue syndrome

Abstract:

In this paper the cognitive and psychiatric impairments associated with chronic fatigue syndrome (CFS) and related disorders are reviewed. It is concluded that while acute mononucleosis and infection with Epstein-Barr virus occasionally result in impaired cognition, such changes have not yet been objectively verified in patients with CFS.

However, when patients with CFS are carefully studied, concurrent or premorbid psychiatric disorders are revealed at a greater than chance level. Finally, some suggestions are offered regarding improved neuropsychological assessment of fatigue, concentration, and attention for patients with CFS. The findings to date, while suggesting that psychological predisposition may play a role in the expression of CFS, are still inconclusive regarding the etiology of CFS.

 

Source: Grafman J, Johnson R Jr, Scheffers M. Cognitive and mood-state changes in patients with chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S45-52. http://www.ncbi.nlm.nih.gov/pubmed/1850543