Autonomic Dysfunction in Patients with Acute Infection with Coxiella burnetii

Abstract:

Background: Coxiella burnetii is a common zoonotic pathogen that can lead not only to acute or chronic Q fever but also to post-infectious syndromes, where autonomic nervous system (ANS) dysfunction has been suggested as a contributing mechanism. This study aimed to assess autonomic function in patients presenting with polymorphic symptoms, dysautonomia, or ME/CFS who had serological evidence of acute infection with Coxiella burnetii.

Methods: A total of 156 participants were evaluated, including 100 seropositive patients and 56 matched controls. All subjects underwent standardized cardiovascular reflex tests (CART), beat-to-beat analysis of heart rate and blood pressure with baroreflex indices, 24 h Holter ECG with HRV assessment, and, in the Coxiella group, head-up tilt testing (HUTT).

Results: A significantly higher prevalence of autonomic dysfunction was observed in the Coxiella group, predominantly affecting parasympathetic regulation, with abnormal CART scores, reduced LF power and baroreflex effectiveness, and a high rate of positive HUTT findings characterized by extreme blood pressure variability. Although long-term HRV measures did not differ significantly between groups, short-term indices consistently indicated ANS impairment.

Conclusions: These findings suggest that Coxiella burnetii infection may trigger persistent autonomic dysfunction, potentially contributing to the development of ME/CFS and syncope in affected individuals. Further longitudinal studies are needed to clarify pathophysiological mechanisms and clinical implications.

Source: Milovanović B, Marković N, Ristanović E, Atanasievska Kujović S, Đorđevski N, Petrovic M, Milošević M, Bulatovic S, Bojić M. Autonomic Dysfunction in Patients with Acute Infection with Coxiella burnetii. Pathogens. 2025 Dec 19;15(1):3. doi: 10.3390/pathogens15010003. PMID: 41598987. https://www.mdpi.com/2076-0817/15/1/3 (Full text)

How post-infection status could lead to the increasing risks of chronic fatigue syndrome and the potential mechanisms: A 17-year population based Cohort study

Abstract:

Background: Serological studies have suggested that viruses and atypical pathogens are associated with CFS, but no study has focused on typical and common pathogens. This study aims to assess the association of infections with a variety of common pathogens with the risk of CFS and provide evidence for the hypothesis that infection triggers CFS.

Methods: The nested case-control study identified 2,000,000 adult patients from a nationwide population-based health insurance claims database from January 1, 2000, to December 31, 2017. Each case with a diagnosis of infection by pathogens was matched with one control using a propensity score. Patients with more than one potential pathogen, younger than 20 years old, or with a history of CFS or infection with certain pathogens before the index date were excluded. Univariate and multivariate Cox proportional hazard models were applied to estimate the HR, aHR, and corresponding 95% CI. The multivariate analysis had adjustments for age, sex, comorbidities, and medication confounders.

Results: A total of 395,811 cases with 1: 1 matched controls were included (58.2% female; mean age [standard deviation], 44.15 [17.02]). Among these, the aHR of the pathogen cohort was 1.5 (95% CI, 1.47 to 1.54). Pathogens were positively correlated with CFS, including influenza, candida and others.

Conclusion: The findings of this study demonstrate the association between CFS and infection with common pathogens, including bacteria, virus and fungi.

Source: Hsun Chang; Chien-Feng Kuo; Teng-Shun Yu; Liang-Yin Ke; Chung-Lieh Hung; Shin-Yi Tsai. How post-infection status could lead to the increasing risks of chronic fatigue syndrome and the potential mechanisms: A 17-year population based Cohort study. Research Square, August 30, 2023. https://assets.researchsquare.com/files/rs-3289981/v1/55890598-6f0d-4f73-a9f4-5349e07baac0.pdf (Full text)

Decolonization of staphylococcus aureus and therapeutic test to assist the diagnosis in me/cfs, long covid, post-vaccine covid syndrome and other diseases with fatigue and/or chronic pain

Abstract:

Nasal Decolonization is performed with an antiseptic such as Povidone-iodine. For the Therapeutic Test an Antibiotic such as Flucloxacillin plus Probiotics or other supplements with an effect against S.aureus is indicated.

There is a Subgroup of patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID Syndrome or PACS who present a persistent bacterial infection that affects the upper respiratory tract, and especially at the level of the nostrils.

We estimate that this Subgroup of patients presenting this persistent infection as a causal or contributing factor would be around a third of all cases.

The most frequent causative agent of these persistent and/or recurrent infections is the Staphylococcus aureus bacterium. According to the studies carried out, this bacterium is present in the nasal passages of between 16 and 36% of the general population, who are asymptomatic carriers of Staphylococcus aureus, and are often unaware of it.

In health professionals who carry out care work, the percentage of carriers can exceed 50%. In a recent study carried out in health workers and medical students, 65% of nasal carriers of S. aureus were reported, and of these, 74% were multidrug-resistant (MDR) bacteria and 69% were biofilm-forming bacteria [1].

Source: Gustavo Aguirre Chang and Aurora Natividad Trujillo Figueredo. Decolonization of staphylococcus aureus and therapeutic test to assist the diagnosis in me/cfs, long covid, post-vaccine covid syndrome and other diseases with fatigue and/or chronic pain. ResearchGate [Preprint] 2/17/23. https://www.researchgate.net/publication/368646387_DECOLONIZATION_OF_STAPHYLOCOCCUS_AUREUS_AND_THERAPEUTIC_TEST_TO_ASSIST_THE_DIAGNOSIS_IN_MECFS_LONG_COVID_POST-VACCINE_COVID_SYNDROME_AND_OTHER_DISEASES_WITH_FATIGUE_ANDOR_CHRONIC_PAIN (Full text)

Systemic antibody responses against human microbiota flagellins are overrepresented in chronic fatigue syndrome patients

Abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disease with an unclear etiology and pathogenesis. Both an involvement of the immune system and gut microbiota dysbiosis have been implicated in its pathophysiology. However, potential interactions between adaptive immune responses and the microbiota in ME/CFS have been incompletely characterized. Here, we profiled antibody responses of patients with severe ME/CFS and healthy controls against microbiota and viral antigens represented as a phage-displayed 244,000 variant library.

Patients with severe ME/CFS exhibited distinct serum antibody epitope repertoires against flagellins of Lachnospiraceae bacteria. Training machine learning algorithms on this antibody-binding data demonstrated that immune responses against gut microbiota represent a unique layer of information beyond standard blood tests, providing improved molecular diagnostics for ME/CFS.

Together, our results point toward an involvement of the microbiota-immune axis in ME/CFS and lay the foundation for comparative studies with inflammatory bowel diseases and illnesses characterized by long-term fatigue symptoms, including post-COVID-19 syndrome.

Source: Vogl T, Kalka IN, Klompus S, Leviatan S, Weinberger A, Segal E. Systemic antibody responses against human microbiota flagellins are overrepresented in chronic fatigue syndrome patients. Sci Adv. 2022 Sep 23;8(38):eabq2422. doi: 10.1126/sciadv.abq2422. Epub 2022 Sep 23. PMID: 36149952. https://www.science.org/doi/10.1126/sciadv.abq2422 (Full text)