Tag: 2022

Exposure-response relationship between K. brevis blooms and reporting of upper respiratory and neurotoxin-associated symptoms

Abstract:

In southwest Florida, Karenia brevis (K. brevis) blooms occur frequently, can be very intense and persist over several years. Individuals living in coastal communities around the Gulf of Mexico are particularly vulnerable to brevetoxins released by K. brevis in seawater and carried inland within marine aerosol. Exposure to K. brevis occurs during residential, recreational, and occupational activities and has been associated with upper respiratory tract (URT) symptoms in healthy and medically vulnerable individuals. Additionally, ingestion of brevetoxin-contaminated seafood causes neurotoxic shellfish poisoning (NSP), and severe headaches prompting emergency department visits which occur in excess during K. brevis blooms.

The current study examined a dose-response relationship between K. brevis in coastal waters and URT and NSP-like symptoms and headaches among southwest Florida residents. Data on past medical history (PMH) and medical symptoms were collected from the participants (n = 258) in five southwest Florida counties between June 2019 to August 2021. A dose-response relationship was observed between K. brevis blooms and reporting of URT and NSP-like symptoms and headaches. Reporting of NSP-like symptoms was higher among participants with a PMH of migraines, chronic fatigue syndrome (CFS) and mild memory loss, while the association of headaches with K. brevis blooms was accentuated among individuals with a PMH of migraines.

These results suggest further investigations into the threshold of aerosolized brevetoxin dose required to elicit URT, headaches and/or NSP-like symptoms. These symptoms ultimately cause significant public health safety concerns, primarily among vulnerable populations with preexisting neurological conditions.

Source: Abdullah L, Ferguson S, Niedospial D, Patterson D, Oberlin S, Nkiliza A, Bartenfelder G, Hahn-Townsend C, Parks M, Crawford F, Reich A, Keegan A, Kirkpatrick B, Mullan M. Exposure-response relationship between K. brevis blooms and reporting of upper respiratory and neurotoxin-associated symptoms. Harmful Algae. 2022 Aug;117:102286. doi: 10.1016/j.hal.2022.102286. Epub 2022 Jul 12. PMID: 35944953. https://pubmed.ncbi.nlm.nih.gov/35944953/

Phenotypic characteristics of peripheral immune cells of Myalgic encephalomyelitis/chronic fatigue syndrome via transmission electron microscopy: A pilot study

Abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex chronic multi-systemic disease characterized by extreme fatigue that is not improved by rest, and worsens after exertion, whether physical or mental. Previous studies have shown ME/CFS-associated alterations in the immune system and mitochondria.

We used transmission electron microscopy (TEM) to investigate the morphology and ultrastructure of unstimulated and stimulated ME/CFS immune cells and their intracellular organelles, including mitochondria. PBMCs from four participants were studied: a pair of identical twins discordant for moderate ME/CFS, as well as two age- and gender- matched unrelated subjects-one with an extremely severe form of ME/CFS and the other healthy.

TEM analysis of CD3/CD28-stimulated T cells suggested a significant increase in the levels of apoptotic and necrotic cell death in T cells from ME/CFS patients (over 2-fold). Stimulated Tcells of ME/CFS patients also had higher numbers of swollen mitochondria. We also found a large increase in intracellular giant lipid droplet-like organelles in the stimulated PBMCs from the extremely severe ME/CFS patient potentially indicative of a lipid storage disorder. Lastly, we observed a slight increase in platelet aggregation in stimulated cells, suggestive of a possible role of platelet activity in ME/CFS pathophysiology and disease severity.

These results indicate extensive morphological alterations in the cellular and mitochondrial phenotypes of ME/CFS patients’ immune cells and suggest new insights into ME/CFS biology.

Source: Jahanbani F, Maynard RD, Sing JC, Jahanbani S, Perrino JJ, Spacek DV, Davis RW, Snyder MP. Phenotypic characteristics of peripheral immune cells of Myalgic encephalomyelitis/chronic fatigue syndrome via transmission electron microscopy: A pilot study. PLoS One. 2022 Aug 9;17(8):e0272703. doi: 10.1371/journal.pone.0272703. PMID: 35943990. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272703 (Full text)

Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in Australian primary care patients: only part of the story?

Abstract:

Background: ME/CFS is a disorder characterized by recurrent fatigue and intolerance to exertion which manifests as profound post-exertional malaise. Prevalence studies internationally have reported highly variable results due to the 20 + diagnostic criteria. For Australia, the prevalence of ME/CFS based on current case definitions is unknown.

Objectives: To report prevalence of ME/CFS in patients aged ≥ 13 years attending Australian primary care settings for years 2015-2019, and provide context for patterns of primary care attendance by people living with ME/CFS.

Methodology: Conducted in partnership with the Patient Advisory Group, this study adopted a mixed methods approach. De-identified primary care data from the national MedicineInsight program were analyzed. The cohort were regularly attending patients, i.e. 3 visits in the preceding 2 years. Crude prevalence rates were calculated for years 2015-2019, by sex, 10-year age groups, remoteness and socioeconomic status. Rates are presented per 100,000population (95% confidence intervals (CI)). Qualitative data was collected through focus groups and in-depth 1:1 interview.

Results: Qualitative evidence identified barriers to reaching diagnosis, and limited interactions with primary care due to a lack of available treatments/interventions, stigma and disbelief in ME/CFS as a condition. In each year of interest, crude prevalence in the primary care setting ranged between 94.9/100,000 (95% CI: 91.5-98.5) and 103.9/100,000 population (95%CI: 100.3-107.7), equating to between 20,140 and 22,050 people living with ME/CFS in Australia in 2020. Higher rates were observed for age groups 50-59 years and 40-49 years. Rates were substantially higher in females (130.0-141.4/100,000) compared to males (50.9-57.5/100,000). In the context of the qualitative evidence, our prevalence rates likely represent an underestimate of the true prevalence of ME/CFS in the Australian primary care setting.

Conclusion: ME/CFS affects a substantial number of Australians. Whilst this study provides prevalence estimates for the Australian primary care setting, the qualitative evidence highlights the limitations of these. Future research should focus on using robust case ascertainment criteria in a community setting. Quantification of the burden of disease can be used to inform health policy and planning, for this understudied condition.

Source: Orji N, Campbell JA, Wills K, Hensher M, Palmer AJ, Rogerson M, Kelly R, de Graaff B. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in Australian primary care patients: only part of the story? BMC Public Health. 2022 Aug 9;22(1):1516. doi: 10.1186/s12889-022-13929-9. PMID: 35945527. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13929-9 (Full text)

Post-acute COVID-19 syndrome and gut dysbiosis linger beyond 1 year after SARS-CoV-2 clearance

We recently published in Gut to show that gut dysbiosis persisted for at least 6 months in patients with post-acute COVID-19 syndrome (PACS).1 Murine and human studies have also reported microbial alterations associated with different PACS symptoms.2 3 With the pandemic entering its third year, PACS could potentially affect recovered individuals for over 1 year.4 It remains unknown whether PACS-associated gut dysbiosis would also linger for such a long time.

Here, we conducted a prospective study to determine long-term alterations in the gut microbiome of patients with COVID-19 using shotgun metagenomic sequencing (online supplemental materials). A total of 155 patients with COVID-19 in Hong Kong were followed up for an average of 14 months after SARS-CoV-2 viral clearance, and 155 age-matched, sex-matched and body mass index-matched subjects without COVID-19 were recruited as controls. Patients with COVID-19 were infected with the original or earlier variants of SARS-CoV-2 from January 2020 to February 2021. Consistent with previous finding that 76.4% of patients had PACS 6 months after recovery from acute COVID-19,1 we found that the prevalence of PACS was 78.7% at an average of 14-month (IQR 11–18 months) follow-up. The three most common symptoms were fatigue (50.9%), memory problems (44.5%) and difficulty in sleeping (35.5%, figure 1A). Gut dysbiosis in these patients did not fully recover. Both bacteria diversity (p=0.0036, figure 1B) and richness (p=0.00032, figure 1C) of patients with COVID-19 were still significantly lower than that of controls. Principal coordinates analysis of beta diversity also showed distinct separation of patients with COVID-19 from controls (F=8.3822, p<0.001, figure 1D). These observations suggest persistent gut dysbiosis beyond 1 year in patients with PACS

Read the rest of this article HERE.

Source: Su Q, Lau RI, Liu Q, Chan FKL, Ng SC. Post-acute COVID-19 syndrome and gut dysbiosis linger beyond 1 year after SARS-CoV-2 clearance. Gut. 2022 Aug 8:gutjnl-2022-328319. doi: 10.1136/gutjnl-2022-328319. Epub ahead of print. PMID: 35940857. https://gut.bmj.com/content/early/2022/08/08/gutjnl-2022-328319 (Full text)

Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study

Abstract:

Background: Patients often report various symptoms after recovery from acute COVID-19. Previous studies on post-COVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of long-term symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.

Methods: This study is based on data collected within Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician’s diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls.

Findings: 76 422 participants (mean age 53·7 years [SD 12·9], 46 329 [60·8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5·5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90-150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90-150 days after COVID-19 diagnosis or matched timepoint.

Interpretation: To our knowledge, this is the first study to report the nature and prevalence of post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required.

Funding: ZonMw; Dutch Ministry of Health, Welfare, and Sport; Dutch Ministry of Economic Affairs; University Medical Center Groningen, University of Groningen; Provinces of Drenthe, Friesland, and Groningen.

Source: Ballering AV, van Zon SKR, Olde Hartman TC, Rosmalen JGM; Lifelines Corona Research Initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022 Aug 6;400(10350):452-461. doi: 10.1016/S0140-6736(22)01214-4. PMID: 35934007. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fulltext (Full text)

Mechanism of acupuncture and moxibustion in treatment of chronic fatigue syndrome from perspective of intestinal flora

Abstract:

in English, Chinese

Intestinal flora dysbiosis may play an important role in the occurrence and development of chronic fatigue syndrome (CFS), which may induce the inflammatory response and metabolic disturbance of patients with CFS. Acupuncture and moxibustion may achieve anti-fatigue effect by affecting the diversity and quantity of intestinal flora, improving intestinal barrier function, and regulating brain-gut peptides.

Source: Li CR, Sun ZR, Wang YL, Yang Y, Sun WB, Qu YY, Wang QY, Yang TS. [Mechanism of acupuncture and moxibustion in treatment of chronic fatigue syndrome from perspective of intestinal flora]. Zhongguo Zhen Jiu. 2022 Aug 12;42(8):956-60. Chinese. doi: 10.13703/j.0255-2930.20210829-k0003. PMID: 35938342. https://pubmed.ncbi.nlm.nih.gov/35938342/ [Article in Chinese]

2022 IACFS/ME Conference – Days 3 & 4

August 2, 2022:
IACFS/ME 2022 Virtual Medical and Scientific Conference July  27 – 30, 2022 

Day 3 (29 July 2022) of the IACFS/ME Annual Conference provided a continuous stream of fascinating and illuminating talks and presentations. The final two days of the conference had a particular focus on the immunology and management of Long-Covid with relevance to ME/CFS.

Dr. Daiki Takewaki at the National Institute of Science Japan talked about clearly identifiable gut dysbiosis (imbalance of gut microbiota involving the loss of beneficial microbial input or signal and an expansion of pathogenic microbes – pathobionts) that correlate with symptoms and immune markers in ME/CFS patients. A number of speakers provided patient case work from clinical practice, including Melissa Siller and Susan Levine MD, Lucina Bateman MD talked on follow-up of identical twins and the risk of family members also developing ME/CFS, and Leigh Jerome PhD on the care and management of Long-Covid patients.

One of the stand-out talks was given by Akiko Iwasaki PhD, a Professor of Immunobiology and Molecular, Cellular and Developmental Biology at Yale Medical School. Dr. Iwasaki provided an especially insightful talk on the biochemical signatures of Long-Covid syndrome. Dr. Iwasaki stated that it was fairly easy to differentiate Long-Covid sufferers simply by examining their symptom profiles on simple symptom surveys, and that Long-Covid was a female dominant illness, just like ME/CFS; symptoms were largely the same as in ME/CFS, with some exceptions, such as breathlessness being more prevalent in Long-Covid but post-exertional malaise (PEM), brain-fog, sleep disturbances, and fatigue all being dominant features of Long-Covid.

Treatments Explored to Ease Post-Viral Symptoms of ME/CFS and Long COVID

August 5, 2022:

By Miriam Tucker

A variety of treatments, most already commercially available, are
under investigation for treating the constellation of overlapping
symptoms associated with myalgic encephalomyelitis/chronic fatigue
syndrome (ME/CFS), “long COVID,” and dysautonomia.

At the virtual annual meeting of the International Association for
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME),
speakers presented data for a variety of approaches to ease symptoms
common across post-viral conditions, such as extreme fatigue,
post-exertional malaise (“crash”), cognitive dysfunction (“brain
fog”), orthostatic intolerance including postural orthostatic
tachycardia syndrome (POTS), and chronic pain. Most of the modalities
are already commercially available for other indications, although
some are costly and not covered by payers for these conditions.
—

Treatments discussed in the article are:

•Pyridostigmine (Mestinon, Others)
•Oxaloacetate (benaGene)
•Inspiritol
•Stellate Ganglion Block
•Transcutaneous Auricular Vagus Nerve Stimulation

Read the full article HERE.

2022 IACFS/ME Conference – Days 1 & 2

IACFS/ME 2022 Virtual Medical and Scientific Conference July  27 – 30, 2022 

The annual International Association of CFS/ME (IACFS/ME) conference opened this week with an introduction by its Director, Professor Fred Friedberg. 58 speakers, 20 posters, almost 300 attendees, many early-stage researchers, are due to ‘attend’ the conference. The growth in numbers attending reflects a growing interest in ME/CFS among scientists and health professionals internationally.

The conference focuses on the biomedical, behavioural, and public health aspects of ME/CFS and associated comorbidities with a portion of the conference to be devoted to COVID-19 and its relevance to ME/CFS research and clinical care.

Read the rest of this report HERE.