Tag: post-viral fatigue syndrome

Post-Viral Fatigue in COVID-19: A Review of Symptom Assessment Methods, Mental, Cognitive, and Physical Impairment

Abstract:

Coronavirus 2 is responsible for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), and the main sequela is persistent fatigue. Post-viral fatigue is common and affects patients with mild, asymptomatic coronavirus disease-2019 (COVID-19). However, the exact mechanisms involved in developing post-COVID-19 fatigue remain unclear. Furthermore, physical and cognitive impairments in these individuals have been widely described. Therefore, this review aims to summarize and propose tools from a multifaceted perspective to assess COVID-19 infection.

Herein, we point out the instruments that can be used to assess fatigue in long-term COVID-19: fatigue in a subjective manner or fatigability in an objective manner. For physical and mental fatigue, structured questionnaires were used to assess perceived symptoms, and physical and cognitive performance assessment tests were used to measure fatigability using reduced performance.

Source: Campos MC, Nery T, Starke AC, de Bem Alves AC, Speck AE, Junior ASA. Post-Viral Fatigue in COVID-19: A Review of Symptom Assessment Methods, Mental, Cognitive, and Physical Impairment. Neurosci Biobehav Rev. 2022 Oct 3:104902. doi: 10.1016/j.neubiorev.2022.104902. Epub ahead of print. PMID: 36202253; PMCID: PMC9528075. https://www.sciencedirect.com/science/article/pii/S0149763422003918 (Full text)

Genetic risk factors for ME/CFS identified using combinatorial analysis

Abstract:

Background:Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease that lacks known pathogenesis, distinctive diagnostic criteria, and effective treatment options. Understanding the genetic (and other) risk factors associated with the disease would begin to help to alleviate some of these issues for patients.

Methods: We applied both GWAS and the PrecisionLife combinatorial analytics platform to analyze ME/CFS cohorts from UK Biobank, including the Pain Questionnaire cohort, in a case-control design with 1,000 cycles of fully random permutation. Results from this study were supported by a series of replication and cohort comparison experiments, including use of disjoint Verbal Interview CFS, post-viral fatigue syndrome and fibromyalgia cohorts also derived from UK Biobank, and results compared for overlap and reproducibility.

Results: Combinatorial analysis revealed 199 SNPs mapping to 14 genes, that were significantly associated with 91% of the cases in the ME/CFS population. These SNPs were found to stratify by shared cases into 15 clusters (communities) made up of 84 high-order combinations of between 3-5 SNPs. p-values for these communities range from 2.3 × 10−10 to 1.6 × 10−72. Many of the genes identified are linked to the key cellular mechanisms hypothesized to underpin ME/CFS, including vulnerabilities to stress and/or infection, mitochondrial dysfunction, sleep disturbance and autoimmune development. We identified 3 of the critical SNPs replicated in the post-viral fatigue syndrome cohort and 2 SNPs replicated in the fibromyalgia cohort. We also noted similarities with genes associated with multiple sclerosis and long COVID, which share some symptoms and potentially a viral infection trigger with ME/CFS.

Conclusions: This study provides the first detailed genetic insights into the pathophysiological mechanisms underpinning ME/CFS and offers new approaches for better diagnosis and treatment of patients

Source: Sayoni Das, Krystyna Taylor, James Kozubek, Jason Sardell, Steve Gardner. Genetic Risk Factors for ME/CFS Identified using Combinatorial Analysis. medRxiv 2022.09.09.22279773; doi: https://doi.org/10.1101/2022.09.09.22279773  https://www.medrxiv.org/content/10.1101/2022.09.09.22279773v2.full-text (Full text)

The epidemiology of post viral fatigue syndrome

Abstract:

The epidemiology of the post viral fatigue syndrome was studied for the years 1985-86. With a strict definition of the syndrome, it was found that there were many misconceptions about this illness. The sex incidence was nearly equal with a similar pattern of twin peaks at 25-29 years and 40-45 years. At diagnosis, 56% were ill for three to six months and only 9% for more than two years. It is estimated that this syndrome is more common than infectious mononucleosis.

Source: Ho-Yen DO. The epidemiology of post viral fatigue syndrome. Scott Med J. 1988 Dec;33(6):368-9. doi: 10.1177/003693308803300607. PMID: 2854300. https://pubmed.ncbi.nlm.nih.gov/2854300/

Post-infectious disease syndrome

Abstract:

Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis. Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research. This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.

Source: Bannister BA. Post-infectious disease syndrome. Postgrad Med J. 1988 Jul;64(753):559-67. doi: 10.1136/pgmj.64.753.559. PMID: 3074289; PMCID: PMC2428896.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2428896/ (Full text)

Factors impacting the illness trajectory of post-infectious fatigue syndrome: a qualitative study of adults’ experiences

Abstract:

BACKGROUND: Post-infectious fatigue syndrome (PIFS), also known as post-viral fatigue syndrome, is a complex condition resulting in physical, cognitive, emotional, neurological, vocational and/or role performance disabilities in varying degrees that changes over time. The needs for health care resources are high, and costly, as is the economic burden on the affected individuals. Many factors may impact the trajectory, and frequently PIFS develops into a chronic condition. Health professionals lack understanding and knowledge, which results in delayed diagnosis, lack of recognition, appropriate treatment, support and practical help. The aim of our study was to explore, from the perspective of persons who had lived with PIFS for four years following an outbreak of Giardia l. induced enteritis, factors that may have impacted their illness trajectory and how these factors had played a role during different phases.

METHODS: In this retrospective exploratory qualitative study a group of 26 affected adults between 26 and 59 years old were selected for in-depth interviews. A maximum variation sample was recruited from a physician-diagnosed cohort of persons with PIFS enrolled at a tertiary outpatient fatigue clinic. The interviews were audio-recorded, transcribed verbatim and subjected to qualitative content analysis.

RESULTS: Unhelpful and helpful factors were associated with the healthcare system, health professionals and the affected persons were experienced as having an impact on the trajectory. External impacting factors which are related to the health care system, providers and the social security system are misdiagnosis, trivialization of symptoms, unhelpful advice, delayed diagnosis and lack of appropriate help. Internal impacting factors related to the affected individuals were lack of knowledge, overestimating functional capacity, assuming the condition will pass, ignoring body signals and denial. A model of impacting factors in each phase of the trajectory is presented.

CONCLUSION: Unmet needs may result in unnecessary disability and high societal and personal costs. Enhanced knowledge of impacting factors in each phase of the trajectory may contribute to more timely and tailored health care services and less use of health services. Increased functional capacity, improved health and ability to work or study may reduce the societal costs and the economic burden for the affected individuals

Source: Stormorken E, Jason LA, Kirkevold M. Factors impacting the illness trajectory of post-infectious fatigue syndrome: a qualitative study of adults’ experiences. BMC Public Health. 2017 Dec 13;17(1):952. doi: 10.1186/s12889-017-4968-2. (Full article)

Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study

Erratum in

  • Eur J Clin Microbiol Infect Dis. 2014 Sep;33(9):1661.

Abstract:

Chronic fatigue syndrome (CFS) is a complex disorder accompanied by unexplainable persistent fatigue, in which several etiological factors exist, such as viral infections. Using the National Health Insurance Research Database (NHIRD) of Taiwan, this study evaluated the association between herpes zoster (HZ) infection and the risk of CFS, and examined the possibility of patients developing postviral fatigue effects, including the possibility of developing other unexplainable chronic fatigue conditions.

In this prospective cohort study using the NHIRD, we identified 9,205 patients with HZ infection [ICD-9 (International Classification of Disease, Ninth Revision), code 053] and 36,820 patients without HZ infection (non-HZ) from 2005 to 2007, and followed up to the end of 2010. The incidence rate of CFS was higher in the HZ cohort than in the non-HZ cohort (4.56 vs. 3.44 per 1,000 person-years), with an adjusted hazard ratio of 1.29 [95 % confidence interval (CI) = 1.09-1.53]. It was shown that the risk of CFS without comorbidity for each patient increased from 1.25- to 1.36-fold between the CFS and non-CFS cohorts; with long-term follow-up, the HZ cohort showed a significantly higher cumulative incidence rate of developing CFS than the non-HZ patients.

We propose that patients with chronic fatigue might exist in a subset of patients that would be associated with HZ infection. The actual mechanism of development of CFS that is attributed to HZ infection remains unclear. The findings of this population cohort study provide pivotal evidence of postviral fatigue among patients with HZ infection.

 

Source: Tsai SY, Yang TY, Chen HJ, Chen CS, Lin WM, Shen WC, Kuo CN, Kao CH. Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study. Eur J Clin Microbiol Infect Dis. 2014 Sep;33(9):1653-9. doi: 10.1007/s10096-014-2095-x. Epub 2014 Apr 9. https://www.ncbi.nlm.nih.gov/pubmed/24715153

 

Gene expression correlates of postinfective fatigue syndrome after infectious mononucleosis

Abstract:

BACKGROUND: Infectious mononucleosis (IM) commonly triggers a protracted postinfective fatigue syndrome (PIFS) of unknown pathogenesis.

METHODS: Seven subjects with PIFS with 6 or more months of disabling symptoms and 8 matched control subjects who had recovered promptly from documented IM were studied. The expression of 30,000 genes was examined in the peripheral blood by microarray analysis in 65 longitudinally collected samples. Gene expression patterns associated with PIFS were sought by correlation with symptom factor scores.

RESULTS: Differential expression of 733 genes was identified when samples collected early during the illness and at the late (recovered) time point were compared. Of these genes, 234 were found to be significantly correlated with the reported severity of the fatigue symptom factor, and 180 were found to be correlated with the musculoskeletal pain symptom factor. Validation by analysis of the longitudinal expression pattern revealed 35 genes for which changes in expression were consistent with the illness course. These genes included several that are involved in signal transduction pathways, metal ion binding, and ion channel activity.

CONCLUSIONS: Gene expression correlates of the cardinal symptoms of PIFS after IM have been identified. Further studies of these gene products may help to elucidate the pathogenesis of PIFS.

Comment in: What causes prolonged fatigue after infectious mononucleosis: and does it tell us anything about chronic fatigue syndrome? [J Infect Dis. 2007]

 

Source: Cameron B, Galbraith S, Zhang Y, Davenport T, Vollmer-Conna U, Wakefield D, Hickie I, Dunsmuir W, Whistler T, Vernon S, Reeves WC, Lloyd AR; Dubbo Infection Outcomes Study. Gene expression correlates of postinfective fatigue syndrome after infectious mononucleosis. J Infect Dis. 2007 Jul 1;196(1):56-66. Epub 2007 May 24. http://jid.oxfordjournals.org/content/196/1/56.long (Full article)

 

Acupuncture in the treatment of post viral fatigue syndrome–a case report

Abstract:

This case report concerns the treatment of post viral fatigue (chronic fatigue syndrome) with electroacupuncture. This condition is particularly difficult to treat whether using conventional or complementary therapy. Whilst the treatment did not cure the patient, it appears to have facilitated her return to work and markedly improved her symptoms. There are few publications on acupuncture treatment of this condition and the approach used here has not been reported previously.

 

Source: Mears T. Acupuncture in the treatment of post viral fatigue syndrome–a case report. Acupunct Med. 2005 Sep;23(3):141-5. http://aim.bmj.com/content/23/3/141.long (Full article)

 

The prognosis of different fatigue diagnostic labels: a longitudinal survey

Abstract:

BACKGROUND: Several different diagnostic labels exist for the fatigue syndromes, including chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME) and postviral fatigue syndrome (PVFS). An allied condition is fibromyalgia. No study has examined prognostic differences across these different labels.

OBJECTIVE: To compare the prognoses of patients labelled with different fatigue syndromes in primary care.

METHODS: We performed a longitudinal survey, using electronic records from the General Practice Research Database. All 18,122 patients diagnosed by their GP with a fatigue syndrome from 1988-2001 with a minimum of one year of records after diagnosis were collated into four groups: CFS, ME, PVFS and fibromyalgia. CFS and ME were combined for the main analysis as no code for CFS was available until 1995. The length of illness was calculated as the interval between the diagnosis and the last recorded fatigue symptom, expressed as days per year, to account for differing lengths of record after diagnosis.

RESULTS: Patients with CFS/ME combined had a worse prognosis (median length of illness 80 days per year; interquartile range 0-242) than fibromyalgia (51; 0-244) or PVFS 0 (0-108), a significant difference, P < 0.001. In a subgroup analysis, ME had a worse prognosis (median length of illness in days per year 106; interquartile range 0-259) than CFS (33; 0-170), P < 0.001, in spite of a better course before diagnosis. Secondary outcome measures were consistent with these results.

CONCLUSION: There were important differences in outcome between the various fatigue labels, with ME having the worst prognosis and PVFS the best. This could be an adverse effect of the label ME itself. Alternatively, patients who are destined to have a worse prognosis may preferentially attract the ME label. Our data support the first interpretation.

 

Source: Hamilton WT, Gallagher AM, Thomas JM, White PD. The prognosis of different fatigue diagnostic labels: a longitudinal survey. Fam Pract. 2005 Aug;22(4):383-8. Epub 2005 Apr 1. http://fampra.oxfordjournals.org/content/22/4/383.long (Full article)

 

Chronic/post-viral fatigue syndrome

Chronic / post-viral fatigue syndrome is the diagnosis term Rikstrygdeverket opted for the ICD-10 called “benign myalgic encephalomyelitis / post-viral fatigue syndrome.” Benign myalgic encephalomyelitis has since 1956 designated the epidemic form of this disease picture.”Chronic Fatigue Syndrome” is the Norwegian translation of “chronic fatigue syndrome” which has different meanings according to how it is defined.

Methodological differences from evaluation and diagnosis of chronic / post-viral fatigue syndrome from a study of chronic fatigue syndrome, and states have different therapeutic implications. Rikstrygdeverket bases its diagnosis in the original research definition of “chronic fatigue syndrome” from the Centers for Disease Control in 1988, an illness which later was recognized as benign myalgic encephalomyelitis.

You can read the rest of this article here: http://tidsskriftet.no/article/1072526

 

Source: Kreyberg S. Chronic/post-viral fatigue syndrome. Tidsskr Nor Laegeforen. 2004 Sep 23;124(18):2382-3. [Article in Norwegian] http://tidsskriftet.no/article/1072526  (Full article)