Tag: 1992

Serum levels of lymphokines and soluble cellular receptors in primary Epstein-Barr virus infection and in patients with chronic fatigue syndrome

Abstract:

The immunopathology in primary Epstein-Barr virus (EBV) infections and in chronic fatigue syndrome was studied by examining serum levels of interleukins (IL) and of soluble T cell receptors in serum samples.

Serum samples were from patients during and 6 months after primary EBV-induced infectious mononucleosis and from patients with chronic fatigue syndrome and serologic evidence of EBV reactivation. Markers for T lymphocyte activation (soluble IL-2 and CD8) and for monocyte activation (neopterin) were significantly elevated during acute infectious mononucleosis but not in patients with chronic fatigue syndrome.

Interferon-alpha, IL-1 beta, and IL-6 levels were not significantly increased in any patient group but inferferon-gamma levels were significantly increased during the acute phase of infectious mononucleosis. The levels of IL-1 alpha were significantly higher than in controls both in patients with infectious mononucleosis and in those with chronic fatigue syndrome. In the latter, the lack of most markers for lymphocyte activation found in patients with infectious mononucleosis makes it less likely that EBV reactivation causes symptoms.

 

Source: Linde A, Andersson B, Svenson SB, Ahrne H, Carlsson M, Forsberg P, Hugo H, Karstorp A, Lenkei R, Lindwall A, et al. Serum levels of lymphokines and soluble cellular receptors in primary Epstein-Barr virus infection and in patients with chronic fatigue syndrome. J Infect Dis. 1992 Jun;165(6):994-1000. http://www.ncbi.nlm.nih.gov/pubmed/1316417

 

ME: is it a genuine disease?

Abstract:

Myalgic encephalomyelitis (ME) is a postviral syndrome whose dominant clinical features are exercise-induced muscle fatigue, disturbances in cognitive functioning and symptoms of overactivity of the autonomic nervous system. The syndrome tends to affect previously fit young adults between the ages of 20 and 40 but no age group is excluded. One recent epidemiological survey suggested a prevalence rate of 1.3 per 1000 adults, with females outnumbering males by 1.8:1. ME is currently the subject of intense medical (and media) debate, especially over its pathophysiology and management. It has also become known as the postviral/chronic fatigue syndrome (PVFS/CFS).

Comment in: It could be ME. [Health Visit. 1992]

 

Source: Shepherd C, Lees H. ME: is it a genuine disease? Health Visit. 1992 May;65(5):165-7. http://www.ncbi.nlm.nih.gov/pubmed/1624312

 

Chronic fatigue syndrome. Recent advances in diagnosis and treatment

Abstract:

Chronic fatigue syndrome is a chronic debilitating illness that is marked in the majority of cases by sudden onset of fatigue and flulike symptoms. Symptoms subsequently relapse and remit and may persist for years. Physical examination typically reveals relatively minor, nonspecific abnormalities in an apparently well patient. Although immunologic abnormalities are associated with chronic fatigue syndrome, tests for these features are expensive, nonspecific, and generally reserved for research purposes. The diagnosis is made on the basis of new onset of severe fatigue, a characteristic pattern of symptoms, and exclusion of other illnesses. Treatment is aimed at alleviating symptoms and helping patients adjust to the debilitating and chronic nature of the illness.

 

Source: Bell DS. Chronic fatigue syndrome. Recent advances in diagnosis and treatment. Postgrad Med. 1992 May 1;91(6):245-52. http://www.ncbi.nlm.nih.gov/pubmed/1579531

 

Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome

Abstract:

OBJECTIVE: To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.

DESIGN: Prospective comparison of patients with postviral fatigue syndrome with two control groups.

SETTING: Department of neurology, University of Glasgow, Southern General Hospital; department of psychiatry, St James’s Hospital, Dublin.

SUBJECTS: 15 patients with postviral fatigue syndrome, 13 age and sex matched healthy subjects, and 13 patients with primary depression.

MAIN OUTCOME MEASURES: Serum prolactin concentrations before and one, two, and three hours after administration of buspirone.

RESULTS: Because of the effects of sex hormones on prolactin secretion data for men and women were analysed separately. There was no significant difference in baseline prolactin concentrations between patients with postviral fatigue syndrome and healthy subjects or those with primary depression. However, the percentage difference between peak and baseline values was significantly higher in patients with postviral fatigue syndrome than the control groups (one way analysis of variance: women, p = 0.003; men, p = 0.004).

CONCLUSIONS: The results suggest upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome but not in those with primary depression. The buspirone challenge test may therefore be useful in distinguishing these two conditions. Larger studies are required to explore the potential value of drugs acting on central 5-hydroxytryptamine receptors in the treatment of patients with the postviral fatigue syndrome.

Comment in:

Postviral fatigue syndrome. [BMJ. 1992]

Postviral fatigue syndrome. [BMJ. 1992]

Postviral fatigue syndrome. [BMJ. 1992]

Postviral fatigue syndrome. [BMJ. 1992]

 

Source: Bakheit AM, Behan PO, Dinan TG, Gray CE, O’Keane V. Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.BMJ. 1992 Apr 18;304(6833):1010-2. http://www.ncbi.nlm.nih.gov/pubmed/1586780

Note: You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881733/

 

Comorbidity of fibromyalgia with medical and psychiatric disorders

Abstract:

PURPOSE: Patients with fibromyalgia have been reported to display high rates of several concomitant medical and psychiatric disorders, including migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. To test further these and other possible associations, we assessed the personal and family histories of a broad range of medical and psychiatric disorders in patients with fibromyalgia.

PATIENTS AND METHODS: Subjects were 33 women (mean age 42.1 years) who each met American College of Rheumatology criteria for fibromyalgia and presented to a rheumatologist at a tertiary referral center. They received the Structured Clinical Interview for DSM-III-R (SCID); a supplemental interview, in SCID format, for other medical and psychiatric disorders, including migraine, irritable bowel syndrome, and chronic fatigue syndrome; and an interview for family history of medical and psychiatric disorders.

RESULTS: Patients with fibromyalgia displayed high lifetime rates of migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. They also exhibited high rates of familial major mood disorder.

CONCLUSIONS: The finding that migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder are frequently comorbid with fibromyalgia is consistent with the hypothesis that these various disorders may share a common physiologic abnormality.

 

Source: Hudson JI, Goldenberg DL, Pope HG Jr, Keck PE Jr, Schlesinger L. Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med. 1992 Apr;92(4):363-7. http://www.ncbi.nlm.nih.gov/pubmed/1558082

 

Chronic fatigue syndrome

Abstract:

Chronic Fatigue Syndrome appears to represent a spectrum of disorders in which a variety of pathophysiological mechanisms may operate. While the initiating event in the majority of patients is a pyrexial illness, possibly due to enterovirus infection, evidence of persisting infection or inflammatory changes in muscle and/or brain remain unconvincing.

CFS patients display a definite reduced aerobic work capacity compared to normal control subjects, but this may reflect a state of deconditioning resulting from prolonged physical inactivity. They also have an altered perception of their level of exertion and premorbid fitness.

The characteristic fluctuation in symptoms, with periods of relapses and partial remissions, may indicate that some central disorder of sensory perception is operational. It may be that a primary sleep disorder results in a reduced sensory threshold for afferent stimuli from muscle. This could well account for many of the subjective symptoms which patients experience. Much more research is clearly necessary if we are to achieve a better understanding of this distressing and at present enigmatic disorder.

 

Source: McCluskey DR, Riley MS. Chronic fatigue syndrome. Compr Ther. 1992 Apr;18(4):13-6. http://www.ncbi.nlm.nih.gov/pubmed/1628478

 

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS), which is characterized by devastating fatigue, mild fever, lymphadenopathy, headache, myalgia, insomnia and neuropsychiatric disorders, now has drawn much attentions from many physicians, researchers and even peoples in general society world wide. The pathogenesis of CFS is still remains to be clarified and clinico-pathological difference between CFS and mood disorder is controversial. In this paper, CFS would be reviewed in detail.

 

Source: Matsuda J. Chronic fatigue syndrome. Nihon Rinsho. 1992 Apr;50(4):887-91. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/1619775

 

The epidemiology of fatigue: more questions than answers

Fatigue syndromes, though recognised for some time, have recently attracted a variety of new diagnostic labels, as well as both professional and media controversy. However, most of the arguments surround the interpretation of small hospital based case-control studies using highly selected groups of patients.’ There is relative silence on population based studies, which perhaps contributes to the lack of concensus. This paper reviews the epidemiology of fatigue in the general population and in primary care and examines potential sources of bias in hospital based studies

You can read the rest of this article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1059513/pdf/jepicomh00209-0006.pdf

 

Source: Lewis G, Wessely S. The epidemiology of fatigue: more questions than answers. J Epidemiol Community Health. 1992 Apr;46(2):92-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1059513/

 

Fibromyalgia, chronic fatigue, and myofascial pain syndromes

Abstract:

During the past year many studies have been published on fibromyalgia and chronic fatigue syndromes. Randomized clinical trials using current operational diagnostic criteria were reported, but no single therapy has been highly effective in either condition. The working case definition of chronic fatigue syndrome has been criticized and suggestions for a new case definition have been made. Further understanding of the overlap of these three common disorders will also require that uniform diagnostic criteria be tested in chronic fatigue syndrome and myofascial pain syndrome.

 

Source: Goldenberg DL. Fibromyalgia, chronic fatigue, and myofascial pain syndromes. Curr Opin Rheumatol. 1992 Apr;4(2):247-57. http://www.ncbi.nlm.nih.gov/pubmed/1581154

 

Illness perception and symptom components in chronic fatigue syndrome

Abstract:

Two-hundred and eight patients with chronic fatigue syndrome (post-viral fatigue syndrome) completed a questionnaire which dealt both with their illness in general and with the extent to which they experienced specific symptoms. A factor analysis of the symptom data yielded four components: emotional distress; fatigue; somatic symptoms; and cognitive difficulty.

Emotional disturbance is a common feature of the disorder and its role has been widely debated. When the symptom components were considered independently, fatigue, somatic symptoms and cognitive difficulty were associated with questionnaire items relating to general illness severity, but emotional distress was not.

Thus negative emotions did not contribute directly to patients’ perception of illness severity. They were, however, correlated with the other symptom components. It is argued that this correlation reflects a reciprocal influence, with negative emotions exacerbating fatigue and other key symptoms and the debilitating nature of these symptoms enhancing emotional vulnerability.

 

Source: Ray C, Weir WR, Cullen S, Phillips S. Illness perception and symptom components in chronic fatigue syndrome. J Psychosom Res. 1992 Apr;36(3):243-56. http://www.ncbi.nlm.nih.gov/pubmed/1564677