Category: Etiology

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

 

Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases

Abstract:

After seven pediatric cases of chronic fatigue syndrome (CFS) were diagnosed in a farming community in upstate New York, a questionnaire regarding symptoms and potential risk factors of CFS was distributed to all students enrolled in the same school district.

Twenty-one students with symptoms of CFS were identified. Two controls per case matched for age and sex were randomly selected from questionnaire respondents. Health status was verified for all subjects by telephone, and diagnosis of CFS was confirmed by a physician.

Information was collected on the following factors: symptoms of CFS among other family members; history of allergy/asthma; consumption of raw milk, raw eggs, raw cheese, or raw meat; water supply; exposure to animals; home heating source; proximity to farmland/orchards; tick bite; blood transfusion; camping; and appendicitis.

Logistic-regression analyses indicated that the best model (characterized by symptoms among other family members, recent ingestion of raw milk, and history of allergy/asthma) produced significant estimates of relative risk (P less than .05) of 35.9, 44.3, and 23.3, respectively, for the three factors (corrections were made for the effect of the other covariates).

These data suggest that a combination of host and environmental factors, including an infectious agent or agents, are involved in the etiology of CFS.

 

Source: Bell KM, Cookfair D, Bell DS, Reese P, Cooper L. Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S32-8. http://www.ncbi.nlm.nih.gov/pubmed/2020801

 

Chronic fatigue syndrome: thoughts on pathogenesis

Abstract:

Studies have shown that a proportion of patients with severe chronic infection due to Epstein-Barr virus (EBV) lack antibody to a component of EBV nuclear antigen. However, it is not clear whether this circumstance is one of cause or effect in regard to the pathogenesis of chronic fatigue syndrome (CFS); it is clearly not pathognomonic since it also occurs in persons infected with the human immunodeficiency virus and–rarely–in those with other EBV-related conditions. Stress and depression may be other pathogenetic mechanisms that could reactivate EBV and lead to CFS; examples of this phenomenon are given. The syndrome might also follow certain other viral infections as part of a process that has been called postinfectious neurasthenia. Currently, the cause(s) and cure of CFS, a common and distressing syndrome, are enigmatic and require multidisciplinary study.

 

Source: Evans AS. Chronic fatigue syndrome: thoughts on pathogenesis. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S56-9. http://www.ncbi.nlm.nih.gov/pubmed/1850544

 

Serologic and immunologic responses in chronic fatigue syndrome with emphasis on the Epstein-Barr virus

Abstract:

Although patients with chronic fatigue syndrome (CFS) can be diagnosed by clinical criteria, the lack of specific laboratory criteria delays or prevents the diagnosis and contributes to the quasi-disease status of the syndrome.

A resurgence of interest in the syndrome has followed reports suggesting that CFS may be associated with chronic active infection due to the Epstein-Barr virus. Analysis of reports to date shows that the mean titers of antibodies to viral capsid antigen and to early antigen are greater for patients with CFS than for healthy individuals; this is particularly evident in cases for which serial samples were tested.

However, these differences do not prove the cause of CFS. Cell-mediated immune responses in patients with CFS vary from study to study, and the number and function of natural killer cells in those patients are the most variable factors. Rates of isolation of virus from saliva do not differ, but in one comparison study with a large number of subjects, more lymphocytes that contained virus were isolated from patients than from controls.

Other viruses, such as the Coxsackie B virus, have been implicated as causes of CFS in studies from Great Britain. The use of a working definition of CFS and standardized tests to address abnormalities revealed by laboratory tests among homogeneous populations should allow determination of useful tests for the diagnosis of CFS and studies of its mechanisms.

 

Source:  Jones JF. Serologic and immunologic responses in chronic fatigue syndrome with emphasis on the Epstein-Barr virus. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S26-31. http://www.ncbi.nlm.nih.gov/pubmed/1850541

 

Analysis of clinical, epidemiologic, and laboratory data on chronic fatigue syndrome

Abstract:

Much of the research conducted on chronic fatigue syndrome (CFS) is exploratory. The researchers’ overall goal is to use clinical, epidemiologic, and laboratory data to provide clues about the etiology of this syndrome. In preparation for this symposium, a review of numerous publications on CFS has indicated that the literature generally does not reflect the application of optimal statistical methods for exploration of data.

Whenever the researchers’ aim is to generate hypotheses, modern methods designed specifically for exploratory data analysis are likely to provide greater insights into any patterns of data than are the traditional approaches to hypothesis testing. In addition, the use of formal methods of data synthesis for ongoing and future research on CFS is a means of strengthening collaborative efforts and of improving the ability of researchers to interpret the evidence available that relates to specific etiologic factors. The inclusion on the research team of experienced biostatisticians, who would oversee the statistical methods and the development of innovative analyses, is recommended.

 

Source: Redmond CK. Analysis of clinical, epidemiologic, and laboratory data on chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S90-3. http://www.ncbi.nlm.nih.gov/pubmed/1826967