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

 

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

 

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

 

Physiologic measurement of exercise and fatigue with special reference to chronic fatigue syndrome

Abstract:

Oxidative metabolism is the major source of energy for muscle activity, and maximal oxygen uptake (VO2max), the product of maximal cardiac output and maximal arteriovenous oxygen difference, indicates individual capacity for oxidative metabolism and performance of exercise by the large muscles.

Strength, a function of muscle cross-sectional area, motor-unit recruitment, and neuromuscular coordination, is the ability to develop force in a single, brief, maximal-effort voluntary contraction of rested muscle. Weakness is a diminished ability of rested muscle to exert maximal force. Fatigue is a loss of maximal force-generating capacity that develops during muscular activity, likely originates within muscle itself, and persists until muscle is fully recovered. Individual perception of motor effort can be determined with standardized rating scales.

These concepts are discussed in detail, their relevance to the pathophysiology of exercise in chronic fatigue syndrome is analyzed, and a general strategy of exercise evaluation pertinent to chronic fatigue syndrome is presented.

 

Source: Lewis SF, Haller RG. Physiologic measurement of exercise and fatigue with special reference to chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S98-108. http://www.ncbi.nlm.nih.gov/pubmed/2020810

 

Validation of biologic markers for use in research on chronic fatigue syndrome

Abstract:

Unresolved aspects of chronic fatigue syndrome can be addressed by research involving biologic markers. These may be any molecular, biochemical, physiological, or other biologic parameter obtainable from biologic specimens. The use of biologic markers in research requires their validation as dependent or independent variables. Additionally, other characteristics of markers such as reliability of assays, background level, confounding factors, interpretations, and legal and ethical implications should be considered before the use of markers in research. A checklist is provided for evaluating a biologic marker before its inclusion in research.

 

Source: Schulte PA. Validation of biologic markers for use in research on chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S87-9. http://www.ncbi.nlm.nih.gov/pubmed/2020808

 

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

 

Issues and problems in the conduct of epidemiologic research on chronic fatigue syndrome

Abstract:

The epidemiologic research approach is perhaps most appropriate for initial studies of chronic fatigue syndrome since the syndrome is vaguely defined, scientific knowledge about it is limited, and an infectious etiology is suspected.

Several priority needs appropriate for epidemiologic research are identified, including a refinement of diagnostic criteria; a greater understanding of the natural history of the syndrome; basic incidence, prevalence, and mortality statistics; information on whether asymptomatic cases exist; etiologic studies of possible heterogeneity of cases; investigations of clusters of cases; and determinations of whether patients with the syndrome have an increased risk of malignancy.

Because of the lack of cogent etiologic hypotheses regarding the syndrome, case-control studies are identified as a high priority for research. The many difficulties encountered in conducting such research are discussed and approaches to dealing with these problems are suggested.

 

Source: Grufferman S. Issues and problems in the conduct of epidemiologic research on chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S60-7. http://www.ncbi.nlm.nih.gov/pubmed/2020803

 

Defining the chronic fatigue syndrome

Abstract:

The recently published working definition of the chronic fatigue syndrome (CFS) is a necessary first step toward a consistent effort to research this controversial illness. Before this definition was developed, cases often were defined vaguely, according to the perceptions and biases of the individual researchers, so that the results of some studies were unclear. However, few specific diagnostic parameters for CFS exist, and the new definition may not delineate a single clinicopathologic entity.

Future efforts at researching this illness should be aimed at identifying parameters that differentiate CFS from psychiatric conditions such as major depression and from other defined chronic diseases. Because CFS may be the result of multiple disease processes, the separate study of well-defined subgroups of patients with CFS is appropriate.

Such subgroups of patients are probably more likely to have common pathogenetic features than are patients with CFS as a whole group.

 

Source: Holmes GP. Defining the chronic fatigue syndrome. Rev Infect Dis. 1991 Jan-Feb;13 Suppl 1:S53-5. http://www.ncbi.nlm.nih.gov/pubmed/2020802