Chronic fatigue syndrome after Q fever

Abstract:

BACKGROUND: Q fever is a common and acute but rare chronic zoonosis caused by Coxiella burnetii. Its acute form manifests as atypical pneumonia, flu-like syndrome, or hepatitis. Some authors observed symptoms of chronic fatigue in a small number of patients after the acute phase of Q fever; in many cases serological assay confirmed the activity of Coxiella burnetii infection. The effect of antibiotic therapy on post-Q-fever fatigue syndrome has not been studied in south-east Europe thus far.

CASE REPORTS: Three patients are presented with post-Q-fever fatigue syndrome. All fulfilled the CDC criteria for chronic fatigue syndrome. IgA antibodies to phase I of the growth cycle of Coxiella burnetii were positive in two patients and negative in one. Two patients were treated with doxycycline for two weeks in the acute phase of illness and one with a combination of erythromycin and gentamycin. After 4-12 months they developed post-Q-fever fatigue syndrome and were treated with intracellular active antibiotics (fluoroquinolones and tetracycline) for 3-12 months. Efficacy of the treatment was observed in two patients, but in one patient the results were not encouraging.

CONCLUSIONS: These results suggest the possibility of the involvement of Coxiella burnetii infection in the evolution of chronic fatigue syndrome. This is the first report on post-Q-fever fatigue syndrome in Mediterranean countries. Evidence of IgA antibodies to phase I of the growth cycle of Coxiella burnetii is not a prerequisite for establishing a diagnosis of CFS. The recommendation of antibiotic treatment in post-Q-fever fatigue syndrome requires further investigation.

 

Source: Ledina D, Bradarić N, Milas I, Ivić I, Brncić N, Kuzmicić N. Chronic fatigue syndrome after Q fever. Med Sci Monit. 2007 Jul;13(7):CS88-92. https://www.ncbi.nlm.nih.gov/pubmed/17599032

 

Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome

Abstract:

There is evidence for a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in a proportion of the patients with chronic fatigue syndrome (CFS), despite the negative studies and methodological difficulties. In this review, we focus on challenge studies and on the role of the HPA axis in the pathogenesis of CFS. Mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids are the main findings. Several underlying mechanisms have been proposed. Currently, it is a matter of debate whether these disturbances have a primary role in the pathogenesis of CFS. However, even if the HPA axis dysfunctions are secondary to other factors, they are probably a relevant factor in symptom propagation in CFS.

 

Source: Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ. Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology. 2007;55(2):112-20. Epub 2007 Jun 27. http://www.karger.com/Article/FullText/104468 (Full article)

 

Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue

Abstract:

Haemodynamic abnormalities have been documented in the chronic fatigue syndrome (CFS), indicating functional disturbances of the autonomic nervous system responsible for cardiovascular control. This study was designed to explore the pathophysiology in adolescent CFS-patients by analysing RR-interval (RRI) variability and diastolic blood pressure (DBP) variability during mild orthostatic stress, using an algorithm which accounts for non-stationary biosignals.

A total of 27 adolescents with CFS and 33 healthy control subjects having equal age- and sex distribution underwent 15 min of 20 degrees head-up tilt (HUT). The spectral power densities of RRI and DBP were computed in the low-frequency (LF) band (0.04-0.15 Hz) and the high-frequency (HF) band (0.15-0.4 Hz) using an adaptive autoregressive algorithm to obtain a time-varying spectrum. RMSSD, a time domain index of RRI variability, was also computed. At rest, all indices of variability were similar in the two groups. During tilt, CFS patients had a larger increase in the LF/HF ratio (P<or=0.001) and normalized LF power of RRI (P<or=0.01), and a larger decrease in normalized HF power (P<or=0.01) of RRI than controls. CFS patients also had trends towards a larger decrease in absolute HF power of RRI and a larger increase in normalized LF power of DBP.

These findings suggest that adolescents with CFS have sympathetic predominance of cardiovascular regulation during very mild orthostatic stress. Possible underlying mechanisms are moderate hypovolemia, abnormalities of reflex control or physical de-conditioning.

 

Source: Wyller VB, Saul JP, Amlie JP, Thaulow E. Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue. Clin Physiol Funct Imaging. 2007 Jul;27(4):231-8. https://www.ncbi.nlm.nih.gov/pubmed/17564672

 

School phobia and childhood chronic fatigue syndrome (CCFS)

Abstract:

Chronic fatigue occurring in previously healthy children and adolescents is a vexing problem encountered by pediatric practitioners and the impact of fatigue in youngsters should not be underestimated. In its severe form, it is often associated with mood disorders. Findings in children and adolescent cases suggest that severe unexplained fatigue might precede the development of fatigue-related illness, such as childhood chronic fatigue syndrome (CCFS). This is a disabling condition characterized by severe disabling fatigue and a combination of symptoms, the prominent features being self-reported impairments in concentration and short-term memory, sleep disturbances and autonomic symptoms that cannot be explained by medical or psychiatric illness. We have encountered such patients with these complaints; their major symptoms include: general fatigue, fever, headache (not migraine), and memory disturbance. From our clinical experience, we have inferred that patients with CCFS might experience changes in brain function levels, which induce an autonomic imbalance and engender symptoms such as general fatigue, higher-order level cognitive dysfunction, and memory disturbance.

 

Source: Tomoda A. School phobia and childhood chronic fatigue syndrome (CCFS). Nihon Rinsho. 2007 Jun;65(6):1121-33. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561707

 

Autonomic function and child chronic fatigue syndrome

Abstract:

It is postulated that child chronic fatigue syndrome (CFS) involves the autonomic nervous system, although the precise mechanism has not been clearly indicated. This paper reviews recent reports focusing the role of the autonomic nervous system which plays in CFS. Many of the method for measuring autonomic function have appeared in the clinical setting in parallel with advancing computer technology, but these are limited when applied in children. In these blood pressure and heart rate changes during orthostatic stress and these variability are favorably used. As a result, one third of children with CFS showed abnormal cardiovascular adjustment during posture change (orthostatic dysregulation: OD) which is characterized by instantaneous orhthostatic hypotension, postural tachycardia or neurally-mediated syncope. Most of the studies using power spectral analysis of heart rate variability showed sympathetic activation, however no consistent finding has been obtained. In conclusion, autonomic function might be partly involved in CFS such as OD, but its priority in causing CFS is unclear.

 

Source: Tanaka H. Autonomic function and child chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1105-12. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561705

 

Childhood chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome in childhood and adolescents(CCFS) is a complex and debilitation with severe morbidity and confusion. It is common condition with up to 3-5% of children and adolescents showing strange fatigue and confusion for more than 30 days. In this condition, four major symptoms are important: sleep disorders, easy fatigability, disturbed learning and memorization and immunological problems. Routine laboratory studies are similar to adult CFS, although abnormalities can be seen on serum pyruvic acid level, OGTT pattern, deep body temperature rhythm, hormonal secretion rhythm, and cerebral blood flow. For a diagnosis of CCFS, a research group supported by Japanese ministry of health, labor and welfare developed CCFS case definition on 2004. Treatment focused to correct disrupted circadian rhythms and supply of energy.

 

Source: Miike T. Childhood chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1099-104. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561704

 

A new treatment: thermal therapy for chronic fatigue syndrome

Abstract:

Thermal therapy using far-infrared ray dry sauna was performed for patients with chronic fatigue syndrome (CFS). Symptoms such as fatigue, pain, and low-grade fever were dramatically improved on two patients. And prednisolone administration was discontinued and became socially rehabilitated 6 months after discharge. On other 11 patients with CFS, physical symptoms such as fatigue and pain improved, too. Furthermore, we reported that repeated thermal therapy had relaxation effect and diminishes appetite loss and subjective complaints in mildly depressed patients. These results suggest that repeated thermal therapy may be a promising method for the treatment of CFS.

 

Source: Masuda A, Munemoto T, Tei C. A new treatment: thermal therapy for chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1093-8. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561703

 

Considerations for the treatment of chronic fatigue syndrome

Abstract:

The etiology of chronic fatigue syndrome(CFS) is still unknown and under active discussion, but involvement of psychosocial factors appear to be essential for the onset and clinical course of CFS. As CFS patients complain of many stress-related physical and psychological symptom, it is important to understand the CFS from psychosomatic point of view. Not only for the pharmaceutical treatment, attentive consideration is required for treatment of exhaustion of body and mind of CFS patients. Use of anti-depressants or oriental herb medicine is often effective to relieve the anxiety and depressive condition. Furthermore to augment the self-healing potential, psychosomatic approach is important to modify the life style and behavioral characteristics.

 

Source: Murakami M. Considerations for the treatment of chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1089-92. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561702

 

Overview of psychiatric therapy for chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is recognized as a special condition based on abnormality of psycho-neuro-endocrine-immunological system, which is caused by several cytokines and autoantibodies. For CFS diagnosis, it is required to exclude psychiatric diseases which could cause chronic fatigue. On the other hand, recent studies proved the effectiveness cognitive behavioral therapy(CBT) for CFS. Distorted cognition relevant to CFS includes the characteristics such as over adaptation, perfectionism, avoidance and so on. In the CBT for CFS, it is important to quit seeking physical causes, to accept the pathological state as it is, to monitor daily activity and recognize the cognitive and behavioral patterns which might prolong fatigue, to maintain a constant activity level and to make planned increases in activity.

 

Source: Yamadera W, Itoh H. Overview of psychiatric therapy for chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1082-6. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561701

 

Overview of medical treatment and management of chronic fatigue syndrome

Abstract:

A tailor-made management plan that includes various combinations of non-pharmacologic and pharmacologic therapy for patients withchronic fatigue syndrome (CFS) is important. We present an overview of four aspects of our medical treatment and management for CFS: introduction of our medical management system, summary of our management strategy, non-pharmacologic therapy, and pharmacologic therapy; according to foreign guidelines and the latest studies. The main non-pharmacologic therapies for CFS are rehabilitation and lifestyle guidance. Using a graded exercise therapy, we have constructed a broad management strategy for CFS. Herein we introduce our graded exercise therapy. If the symptoms continue despite careful management of the program by the physician, consultation with a psychiatrist or psychosomatic medicine specialist is necessary.

 

Source: Yoshihara K, Kubo C. Overview of medical treatment and management of chronic fatigue syndrome. Nihon Rinsho. 2007 Jun;65(6):1077-81. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/17561700