Tag: 1993

Inability of retroviral tests to identify persons with chronic fatigue syndrome, 1992

Abstract:

Chronic fatigue syndrome (CFS) is characterized by prolonged, debilitating fatigue. Although the cause of CFS unknown, CDC and researchers in other organizations have been investigating whether infection with a previously unidentified retrovirus might be an etiologic factor. Based on reports suggesting that retroviral infection with a human T-lymphotropic virus type 2 (HTLV-II)-like retrovirus or a spumavirus might be associated with CFS, some research and commercial laboratories developed assays to test specimens from persons with CFS. Even though the hypothesized association between infection with retroviruses and CFS has not been confirmed, these tests are used commonly to evaluate patients with CFS. This report summarizes the findings of a controlled, blinded study conducted in 1992 to determine whether three retroviral tests can distinguish serologically between patients with CFS (i.e., case-patients) and healthy controls.

 

Source: Centers for Disease Control and Prevention (CDC). Inability of retroviral tests to identify persons with chronic fatigue syndrome, 1992. MMWR Morb Mortal Wkly Rep. 1993 Mar 19;42(10):183, 189-90. http://www.ncbi.nlm.nih.gov/pubmed/8446093

 

Service delivery for people with chronic fatigue syndrome: a pilot action research study

Abstract:

Chronic fatigue syndrome (CFS) is a symptom complex which while mild in some cases is severely debilitating in others. Long-term ill health leads to greater use of resources but in the case of long-term CFS the anecdotal evidence suggested a low compliance with the available options and a high level of both patient and general practitioner dissatisfaction.

This pilot study sought through repeated action research cycles to start to identify culturally and contextually sensitive forms of language and models for service delivery suitable for people with CFS in a general practice setting. It worked through a number of action research cycles, to initiate the identification of conceptual models acceptable to both doctors and to patients suffering from CFS, self-management options which encouraged the body’s ability to heal itself and services and delivery mechanisms which met patient needs within health provider options.

 

Source: Denz-Penhey H, Murdoch JC. Service delivery for people with chronic fatigue syndrome: a pilot action research study. Fam Pract. 1993 Mar;10(1):14-8. http://www.ncbi.nlm.nih.gov/pubmed/8477887

 

Abnormal arginine-vasopressin secretion and water metabolism in patients with postviral fatigue syndrome

Abstract:

Water metabolism and the responses of the neurohypophysis to changes in plasma osmolality during the water loading and water deprivation tests were studied in nine patients with postviral fatigue syndrome (PVFS) and eight age and six-matched healthy control subjects. Secretion of arginine-vasopressin (AVP) was erratic in these patients as shown by lack of correlation between serum and urine osmolality and the corresponding plasma AVP levels. Patients with PVFS had significantly low baseline arginine-vasopressin levels when compared with healthy subjects. Patients with PVFS as a group also showed evidence of increased total body water content. These results may be indicative of hypothalamic dysfunction in patients with PVFS.

 

Source: Bakheit AM, Behan PO, Watson WS, Morton JJ. Abnormal arginine-vasopressin secretion and water metabolism in patients with postviral fatigue syndrome. Acta Neurol Scand. 1993 Mar;87(3):234-8. http://www.ncbi.nlm.nih.gov/pubmed/8475696

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Operational diagnostic criteria for fibromyalgia were applied to most clinical studies during the past year. Similar diagnostic criteria for chronic fatigue syndrome are being revised, but criteria for myofascial pain have not been agreed on or tested. Intense research efforts focused on the role of neurohormones and the hypothalamic-pituitary-adrenal axis in fibromyalgia and chronic fatigue syndrome over the past year.

 

Source: Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1993 Mar;5(2):199-208. http://www.ncbi.nlm.nih.gov/pubmed/8452771

 

Information processing efficiency in chronic fatigue syndrome and multiple sclerosis

Abstract:

OBJECTIVE: To compare the cognitive performance of subjects with chronic fatigue syndrome (CFS), multiple sclerosis (MS), and healthy controls. All subjects were matched for age, education, and verbal intelligence, as previous neuropsychological studies of CFS had not used appropriate control groups.

DESIGN: Case-control design. All subjects were given a neuropsychological battery and the test scores were compared among the groups.

SETTING: Subjects with CFS and subjects with MS were recruited from private and institutional practice and from the community. Healthy subjects were recruited from the community.

PATIENTS/OTHER PARTICIPANTS: Twelve subjects (all female) with CFS participated in the study. Chronic fatigue syndrome was diagnosed in these patients in accordance with the requirements outlined by the Centers for Disease Control as modified subsequently to not exclude patients with concurrent depression and/or anxiety. All subjects with CFS were referred for a neuropsychological examination to assess persistent cognitive complaints. Eleven subjects (10 female, one male) with the diagnosis of clinically stable MS were chosen from clinics and the community because of complaints of mild to moderate cognitive impairment. The subjects with MS and 11 healthy volunteers (10 female, one male) were matched to the group with CFS by age, education, and estimated verbal intelligence (based on the Vocabulary subtest of the Wechsler Adult Intelligence Scale-Revised). The subjects with MS had a mean Kurtzke Expanded Disability Status Scale score of 4.95 (SD, 1.95; range, 2.0 to 7.5). As a result of the matching procedure, there were no differences among the three groups in age (F[2,31] = 0.32), education (F[2,31] = 0.80), and verbal intelligence (F[2,31] = 0.31).

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: These measures included the Beck Depression Inventory (BDI), the Paced Auditory Serial Addition Test (PASAT), Digit Span Test, and the Similarities Test of Verbal Abstract Reasoning.

RESULTS: The mean number of correctly identified responses collapsed across the four PASAT trials was significantly different across groups (F[2,31] = 4.03; P < .05). While the CFS and MS groups did not differ from each other, subjects with CFS (SEM, 124.2 +/- 6.4) and subjects with MS (SEM, 112.9 +/- 10.9) scored significantly below controls (SEM, 146.4 +/- 6.4) (Fisher’s Protected Least Significant Difference test; P < .05). There were significant differences among the three groups on mean Digit Span Test performance (F[2,31] = 5.5; P < .01). While the CFS and MS group did not differ significantly from each other, only the CFS group was significantly lower than control (Fisher’s Protected Least Significant Difference test; P < .05). Mean performance on the Similarities test did not differ among the three groups (F = 0.58). In addition, there were significant differences among the three groups in mean BDI scores (F[2,31] = 7.6; P < .01). The CFS and MS groups did not differ significantly from each other, and both groups showed a statistically significantly elevated mean BDI score relative to the control group (Fisher’s Protected Least Significant Difference test; P < .05). No significant correlations were found between BDI scores and PASAT total scores (CFS, r = -.21; MS, r = .13; control, r = .27), or between BDI and Digit Span Test (CFS, r = -.32; MS, r = -.40; control, r = -.19). Results of the PASAT and Digit Span Test were significantly correlated in the CFS group (r = .71; P < .01), but not in the MS (r = .06) or control groups (r = .49).

CONCLUSIONS: These results indicate that subjects with CSF and subjects with MS show significant impairment on a test of complex concentration when compared with appropriate controls. The data suggest that subjects with CFS and subjects with MS have difficulty on tasks that require the simultaneous processing of complex cognitive information. Selective impairment in information processing efficiency may lie at the root of other cognitive complaints made by patients with CFS.

 

Source: DeLuca J, Johnson SK, Natelson BH. Information Processing Efficiency in Chronic Fatigue Syndrome and Multiple Sclerosis.Arch Neurol. 1993;50(3):301-304. doi:10.1001/archneur.1993.00540030065016. http://archneur.jamanetwork.com/article.aspx?articleid=592247

 

Complications of sarcoidosis. Chronic fatigue syndrome

Abstract:

Well-recognised complications are pulmonary fibrosis, cor pulmonale, glaucoma, cataract and nephrocalcinosis causing failure of lungs, heart, vision and kidneys. Less well-recognised is the post-sarcoidosis chronic fatigue syndrome.

The afflicted join sarcoidosis patients’ associations because of their profound symptoms of myalgia, fatigue, sleep reversal and low-spiritedness. The symptoms are out of proportion to the lack of physical signs and the absence of objective evidence of sarcoidosis.

Management includes unremitting sympathy and replenishment of essential neurochemicals.
Comment in: Complications of sarcoidosis. Chronic fatigue syndrome. [Sarcoidosis. 1993]

 

Source: James DG. Complications of sarcoidosis. Chronic fatigue syndrome. Sarcoidosis. 1993 Mar;10(1):1-3. http://www.ncbi.nlm.nih.gov/pubmed/8134708

 

Fatigue, depression, and social adjustment in chronic fatigue syndrome

Abstract:

The aims of this study were to determine the characteristics and perceived levels of fatigue and the prevalence of depression in children with chronic fatigue syndrome and to assess the effects of illness on schooling and social functioning.

Twelve children with chronic fatigue syndrome were compared with a matched group of children with cystic fibrosis and matched healthy controls. Levels of fatigue (fatigue questionnaire), depression (children’s depression inventory), and social adjustment (semistructured interview with parents) were compared between groups.

Children with chronic fatigue syndrome had significantly higher median scores for physical and mental fatigue and depressive symptomatology than either comparison group and five children scored as depressed on the children’s depression inventory.

Schooling and social functioning were seriously disrupted. Children with chronic fatigue syndrome reported high levels of fatigue affecting both physical and mental functioning, the association with depression found in adult studies was confirmed, and social adjustment was poor.

 

Source: Walford GA, Nelson WM, McCluskey DR. Fatigue, depression, and social adjustment in chronic fatigue syndrome. Arch Dis Child. 1993 Mar;68(3):384-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793898/ (Full article)

 

Assessment of a retrovirus sequence and other possible risk factors for the chronic fatigue syndrome in adults

Abstract:

OBJECTIVE: To assess whether the human T-lymphotropic virus type II (HTLV-II) gag gene sequence, a purportedly new laboratory marker of the chronic fatigue syndrome (CFS), and other possible risk factors for CFS, particularly those associated with retroviral transmission, are associated with well-characterized CFS.

DESIGN: Two matched case-control studies.

SETTING: The metropolitan Atlanta area.

PATIENTS: Twenty-one patients with CFS who were identified by the Centers for Disease Control and Prevention CFS surveillance system; 21 CDC employee controls (laboratory study) and 42 neighborhood controls (risk-factor study) who were matched to patients by age, race, and gender.

MEASUREMENTS: Peripheral blood lymphocytes and leukocytes were assayed for the HTLV-II gag gene sequence by polymerase chain reaction and specific Southern blot hybridization. Questionnaires elicited demographic and clinical information and a history of exposures associated with retrovirus transmission (for example, blood transfusions, sexual practices, intravenous drug use).

RESULTS: All patients were white and 86% were female. The median age at illness onset was 34 years (range, 16 to 51 years). The HTLV-II gag gene sequence was not identified in the blood of any patient or control under conditions in which the appropriate assay controls were positive. No statistical differences were observed between patients and controls in frequency of blood transfusions (10% compared with 7%), median number of sex partners before illness (3 compared with 3), bisexual or homosexual behavior (14% compared with 7%), intravenous drug use (0% compared with 0%), and other factors associated with retroviral infection.

CONCLUSIONS: The HTLV-II gag gene sequence was not a marker for CFS in this small study of well-defined patients, nor did other characteristics of the patients and controls support the hypothesis that a retrovirus, transmitted by usual modes, was a cause of CFS.

 

Source: Khan AS, Heneine WM, Chapman LE, Gary HE Jr, Woods TC, Folks TM, Schonberger LB. Assessment of a retrovirus sequence and other possible risk factors for the chronic fatigue syndrome in adults. Ann Intern Med. 1993 Feb 15;118(4):241-5. http://www.ncbi.nlm.nih.gov/pubmed/8420441

 

The chronic fatigue syndrome

Sir, Although many doctors equate chronic fatigue syndrome (Oxford definition) with what we call myalgic encephalomyelitis (ME), there are some noteworthy differences.

Firstly, in Britain, chronic fatigue syndrome is an umbrella term covering a number of different conditions including neurasthenia, effort syndrome and fibromyalgia. ME is a more specific entity (see the ‘ 10, 1992) and unlike the above, has been closely linked to a persistent infection and immune system activation.

Secondly, while profound fatigue is undeniably the most common symptom of ME, it is rather different from the type of tiredness which people normally experience after exertion. For example, it is often accompanied by feelings of illness which are so unlike anything which people have had before that patients frequently say they cannot describe it. Some have referred to the latter as a severe ‘flu-like’ malaise, others have likened it to being poisoned. Regrettably, having subsumed ME under a general heading of chronic fatigue syndrome, this important and disabling aspect of ME will almost certainly be overlooked.

You can read the rest of this letter here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399627/pdf/postmedj00050-0083a.pdf

 

Source: Macintyre A, Hume MC. The chronic fatigue syndrome. Postgrad Med J. 1993 Feb;69(808):164. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399627/

 

Chronic fatigue syndrome. A fresh look at an old problem

Abstract:

Chronic fatigue syndrome (CFS), an organic disease of unexplained origin, affects about three people in 100,000. Symptoms last approximately 2 1/2 years, and most CFS patients return to normal health. Diagnosis of CFS is by exclusion. No single remedy has yet proven consistently beneficial. Family physicians can help by providing medical validation of disability to persons who might otherwise be seen as malingerers.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/pdf/canfamphys00108-0118.pdf

 

Comment in: Disagreeing on how to treat CFS patients. [Can Fam Physician. 1993]

 

Source: McSherry J. Chronic fatigue syndrome. A fresh look at an old problem. Can Fam Physician. 1993 Feb;39:336-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/