Tag: 1990

A cluster of cases of chronic fatigue and chronic fatigue syndrome: clinical and immunologic studies

Chronic fatigue syndrome (CFS) is characterized by unexplained, persistent fatigue and other symptoms including arthralgias, myalgias, cognitive impairment, and depression [1, 2]. It has been postulated that infectious agents play a role in both sporadic cases and clustered cases of CFS [3- 5].

We were notified of a cluster of CFS cases that occurred in a women’s residential facility; these cases were associated with an influenza-like outbreak in February 1990. We conducted a study of these events in 1993. Between 1990 and 1993,36 women had lived in the facility. Sixteen of these residents reported fatigue that lasted more than or equal to1 month during the 3-year study interval. Two of the residents who entered the facility before 1990 already had fatigue. Five residents stated that the onset of fatigue corresponded to the outbreak of the influenza-like illness. Nine women described no temporal relationship between their fatigue and the “flu” outbreak. The fatigue resolved in two of these nine women after several weeks, while it persisted in the other seven. Evaluations were performed for these seven residents, and diagnoses including lupus, ulcerative colitis, or hyperparathyroidism were considered for three, but no cause for the fatigue was established for the other four.

You can read the rest of this article here: http://cid.oxfordjournals.org/content/23/2/408.long

 

Source: Levine PH, Dale JK, Benson-Grigg E, Fritz S, Grufferman S, Straus SE. A cluster of cases of chronic fatigue and chronic fatigue syndrome: clinical and immunologic studies. Clin Infect Dis. 1996 Aug;23(2):408-9. http://www.ncbi.nlm.nih.gov/pubmed/8842294

 

Life insurance MDs sceptical when chronic fatigue syndrome diagnosed

Comment on: Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. [CMAJ. 1990]

 

As a physician with chronic fatigue syndrome (CFS) since the early days of the Lake Tahoe, Calif., outbreak, in 1984, I read Olga Lechky’s report (Can MedAssoc J 1990; 143: 413- 415) with particular interest. It was refreshing to hear Dr. Richard Proschek, assistant medical director of Mutual Life of Canada, admit that the industry’s attitude to CFS is one of hostility. Unfortunately for the thousands of severely debilitated patients with the condition this scepticism and hostility are not restricted to that industry, which in many instances has behaved with compassion and responsibility toward its clients. The hostile viewpoint is also widely prevalent in the medical profession and is often freely communicated to patients.

To hold that CFS is not a real disease it is necessary to imagine that in 1984 people of all ages began to manufacture a condition with clearly defined symptoms that begins as a flu-like illness, persists and evolves. How many diseases fit this description? When, before 1984, did depression present so? Can it be true that thousands of our brightest citizens, including children, Olympic aspirants, several members of some families, alarming numbers of teachers, 50% of a symphony orchestra and 10% of the population of Incline Village, Nev., abruptly and concurrently elected to drop out of life, then continued to complain in the face of widespread scepticism, hostility, marital breakdown and, frequently, isolation? What, other than an infectious agent, could cause this?

Proschek’s bias arises from his position. Physicians in practice, however, see many CFS patients who have no insurance or are quite wealthy. The degree to which imagination must extend to accommodate a diagnosis of secondary gain in these people is beyond belief. Many physicians lament the lack of a blood test for CFS. What, pray, is the test for malingering, a diagnosis we seem to have no difficulty making?

You can read the rest of this letter here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452931/pdf/cmaj00229-0013.pdf

 

Source: Sean J. O’Sullivan, MD. Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. CMAJ. 1990 Dec 15;143(12):1283-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452931/

 

Is chronic fatigue syndrome synonymous with effort syndrome?

Abstract:

Chronic fatigue syndrome (CFS), including myalgic encephalomyelitis (ME) and postviral syndrome (PVS), is a term used today to describe a condition of incapacity for making and sustaining effort, associated with a wide range of symptoms. None of the reviews of CFS has provided a proper consideration of the effort syndrome caused by chronic habitual hyperventilation.

In 100 consecutive patients, whose CFS had been attributed to ME or PVS, the time course of their illness and the respiratory psychophysiological studies were characteristic of chronic habitual hyperventilation in 93.

It is suggested that the labels ‘CFS’, ‘ME’ or ‘PVS’ should be withheld until chronic habitual hyperventilation – for which conventional rehabilitation is available – has been definitively excluded.

 

Source: Rosen SD, King JC, Wilkinson JB, Nixon PG. Is chronic fatigue syndrome synonymous with effort syndrome? J R Soc Med. 1990 Dec;83(12):761-4. http://www.ncbi.nlm.nih.gov/pubmed/2125315

 

Hyperventilation disorders

Hyperventilation syndrome falls into the shadowy hinterland between physiology, psychiatry, psychology and medicine. In this respect it joins a long list of syndromes from the past of which effort syndrome is just one example. Myalgic encephalomyelitis (ME) and postviral fatigue syndrome are recent attempts to impose a unitary definition on what is probably a complex interaction between many different organic and psychological factors. The recent introduction of terms such as somatization disorder recognize this aetiological heterogeneity (1).

The symptoms of hypocapnia induced by voluntary overbreathing were first described by Haldane in 1908, the first case of spontaneous hyperventilation by Goldman in 1922 (2), and the term Hyperventilation Syndrome was first used by Dalton, Kerr and Gliebe in 1937 to describe patients with symptoms both of hypocapnia and anxiety (3). Since then, many different interpretations of this term have appeared in the literature encompassing patients with widely different aetiologies. Much research in this area is bedevilled by failure to define clearly the detailed characteristics of the patients studied; by the assumption of definitions for which there is no universal agreement; and by the presentation of scientifically unsound data lacking in rigorous quantitative proof and with perpetuation of circular arguments. The papers in this issue of the journal make a commendable attempt to reintroduce the reader to the historical perspectives of this subject and to clarify some of the issues, but unfortunately also have some of the shortcomings common to so many of the studies in this very difficult field.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292944/pdf/jrsocmed00129-0005.pdf

 

Source: Gardner W. Hyperventilation disorders. J R Soc Med. 1990 Dec;83(12):755-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292944/

 

The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities

Abstract:

The chronic fatigue syndrome is a poorly defined symptoms complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including psychological symptoms, sore throat, lymph node pain, headache, myalgia, arthralgias. Psychological disturbances, ranging from mild depression or anxiety to severe behavioral abnormalities, are always present. Chronic fatigue syndrome is the name that more accurately describes this symptom complex of unknown cause.

A viral aetiology has long been hypothesized: many viruses are potential candidates, including any of the 23 Coxsackie A or 6 Coxsackie B viruses, herpes viruses, particularly Epstein-Barr virus and varicella. These studies, though interesting, remain unconvincing because of methodological flaws such as a poor case definition and inadequate control groups.

This syndrome may represent an infection by a yet unidentified virus. It is more likely due to an abnormal immune response toward different intracellular pathogens. There is no treatment to ameliorate the chronic fatigue syndrome. Epidemiological studies are essential with explicit operational case definition before progress can be made in the management of this distressing disorder.

 

Source: Pinardi G, Scarlato G. The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities. Recenti Prog Med. 1990 Dec;81(12):773-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/2075278

 

Tired, weak, or in need of rest: fatigue among general practice attenders

Abstract:

OBJECTIVES: To determine the prevalence and associations of symptoms of fatigue.

DESIGN: Questionnaire survey.

SETTING: London general practice.

PARTICIPANTS: 611 General practice attenders.

MAIN OUTCOME MEASURES: Scores on a fatigue questionnaire and reasons given for fatigue.

RESULTS: 10.2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome.

CONCLUSIONS: Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress.

Comment in

Chronic fatigue syndrome. [BMJ. 1991]

Fatigue among general practice attenders. [BMJ. 1991]

 

Source: David A, Pelosi A, McDonald E, Stephens D, Ledger D, Rathbone R, Mann A. Tired, weak, or in need of rest: fatigue among general practice attenders. BMJ. 1990 Nov 24;301(6762):1199-202. http://www.ncbi.nlm.nih.gov/pubmed/2261560

Note: You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664364/

 

Aerobic work capacity in chronic fatigue syndrome

Comment on Aerobic work capacity in patients with chronic fatigue syndrome. [BMJ. 1990]

SIR,

The data of Dr Marshall S Riley and colleagues (1) are consistent with our findings (2) that most patients referred with the chronic fatigue syndrome have the effort syndrome-that is, chronic hyperventilation as a consequence of excessive effort and distress.(3)

May we draw attention to three points. Dr Riley and colleagues concluded that the patients could not be hyperventilating because their values of end-tidal partial pressure of carbon dioxide at rest and at peak exercise did not differ significantly from those of the controls.

In our opinion the values published for the controls (35 8 mmHg at rest and 36-3 mmHg at peak exercise) are too low to be accepted as normal. The finding that the patients reached their anaerobic threshold far quicker than did the controls is consistent with the early acidosis on exertion known to occur in chronic hyperventilation. This is a consequence of the depletion of the body’s buffer base reserves,(4) brought about by renal compensation for chronic respiratory alkalosis.(5)

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664329/pdf/bmj00207-0055b.pdf

 

Source: Rosen SD, King JC, Wilkinson JB, Nixon PG. Aerobic work capacity in chronic fatigue syndrome. BMJ. 1990 Nov 24;301(6762):1217. [Comment] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664329/

 

Prevalence of chronic fatigue syndrome in an Australian population

Abstract:

An epidemiological study was undertaken to provide the first reported estimate of the point prevalence of chronic fatigue syndrome in an Australian community.

After a pilot study in a separate location, the population of the Richmond Valley, New South Wales, was sampled using a structured case-finding technique, which included notification from local medical practitioners, the use of a screening questionnaire and standardised interviews conducted by a physician and psychiatrist. In addition, investigations were performed to exclude alternative diagnoses and to assess cell-mediated immunity.

Forty-two patients with chronic fatigue syndrome, with a female:male ratio of 1.3:1.0, were detected in a population of 114,000. The mean age at onset of symptoms was 28.6 years (SD, 12.3 years), and the median duration of symptoms from onset to sampling date was 30 months. The social status of the patients was distributed in accordance with that of the remainder of the population sampled, with no bias towards the middle or upper social classes. The disorder was causing considerable incapacity, with 43% of patients unable to attend school or work.

The conservative estimate from this study suggests a prevalence on June 30 1988 of 37.1 cases per 100,000 (95% confidence interval [CI], 26.8-50.2). Chronic fatigue syndrome is an important disorder in this Australian community that affects young individuals from all social classes and causes considerable ill health and disability.

 

Source:  Lloyd AR, Hickie I, Boughton CR, Spencer O, Wakefield D. Prevalence of chronic fatigue syndrome in an Australian population. Med J Aust. 1990 Nov 5;153(9):522-8. http://www.ncbi.nlm.nih.gov/pubmed/2233474

 

Postviral fatigue syndrome

This is a syndrome that may or may not follow what appears to be an acute infectious illness, and may occur in epidemic or sporadic forms consisting of persisting or relapsing ‘fatigue’ or easy fatiguability of at least six months’ duration, for which no other cause is apparent. It is associated with a number of other variable features including mild fever, sore throat, painful lymph nodes, headaches, muscle pain, migratory arthralgia, photophobia, forgetfulness, irritability, concentration difficulties, depression, and sleep disturbance. It has been recognised since the early 1930s and known by a wide variety of names including Iceland disease, Royal Free disease, epidemic neuromyasthenia, myalgic encephalomyelitis, postviral syndrome, and more recently chronic fatigue syndrome.( 1 )

Although predominantly a disorder of young adults, it has been recognised in children with either an acute or insidious onset. At least 10-15 cases of the sporadic form are seen each year at the Hospital for Sick Children, Great Ormond Street, with lethargy, headache, abdominal pain, and subjective muscular weakness being the most common manifestations. Abnormal physical findings are usually conspicuous by their absence but occasionally pharyngeal injection, tender cervical lymph nodes, and muscle tenderness are present. A proportion of patients have an ‘atypical’ lymphocytosis, increased plasma creatine phosphokinase activity, circulating immune complexes, minor changes on electroencephalography and electromyelography, increased serum Epstein-Barr and Coxsackie B antibody titres, and VPI antigen in serum. Some workers have demonstrated enteroviral RNA in muscle biopsy material.(2 )Although an infective aetiology has been invoked, however, the full nature of the illness remains obscure and is probably a mixture of an initial infective insult followed by or associated with an important psychological component.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1792622/pdf/archdisch00656-0012.pdf

 

Source:  Lask B, Dillon MJ. Postviral fatigue syndrome. Arch Dis Child. 1990 Nov;65(11):1198. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1792622/

 

A controlled trial of intravenous immunoglobulin G in chronic fatigue syndrome

Abstract:

PURPOSE: Currently, there is no established therapy for chronic fatigue syndrome (CFS), a recently defined illness that has been associated with a variety of immunologic abnormalities. Based on the hypothesis that a chronic viral infection or an immunoregulatory defect is involved in the pathogenesis of CFS, the therapeutic benefit of intravenous immunoglobulin G (IV IgG) was evaluated in a group of patients with CFS. Additionally, serum immunoglobulin concentrations and peripheral blood lymphocyte subset numbers were measured at the outset of the study, and the effect of IV IgG therapy on IgG subclass levels was determined.

PATIENTS AND METHODS: Thirty patients with CFS were enrolled in a double-blind, placebo-controlled trial of IV IgG. The treatment regimen consisted of IV IgG (1 g/kg) or intravenous placebo (1% albumin solution) administered every 30 days for 6 months. Participants completed a self-assessment form prior to each of the six treatments, which was used to measure severity of symptoms, functional status, and health perceptions. Patients were also asked to report adverse experiences defined as worsening of symptoms occurring within 48 hours of each treatment.

RESULTS: Twenty-eight patients completed the trial. At baseline, all 28 patients complained of moderate to severe fatigue, and measures of social functioning and health perceptions showed marked impairment. Low levels of IgG1 were found in 12 (42.9%), and 18 (64.3%) had low levels of IgG3. At the end of the study, no significant therapeutic benefit could be detected in terms of symptom amelioration or improvement in functional status, despite restoration of IgG1 levels to a normal range. Major adverse experiences were observed in 20% of both the IV IgG and placebo groups.

CONCLUSION: The results of this study indicate that IV IgG is unlikely to be of clinical benefit in CFS. In addition to the ongoing need for placebo-controlled trials of candidate therapies for CFS, an expanded research effort is needed to define the etiology and pathogenesis of this disorder.

Comment in:

Intravenous immunoglobulin treatment for the chronic fatigue syndrome. [Am J Med. 1990]

 

Source: Peterson PK, Shepard J, Macres M, Schenck C, Crosson J, Rechtman D, Lurie N. A controlled trial of intravenous immunoglobulin G in chronic fatigue syndrome. Am J Med. 1990 Nov;89(5):554-60. http://www.ncbi.nlm.nih.gov/pubmed/2239975