Comment on: Follow up of patients presenting with fatigue to an infectious diseases clinic. [BMJ. 1992]
EDITOR,-Michael Sharpe and colleagues’ follow up study of 177 patients with chronic fatigue of uncertain origin raises several important unanswered questions, which require further investigation. Factors such as a belief that their illness followed an infection, intolerance to alcohol, and membership of a support group for patients with myalgic encephalomyelitis were all associated with an adverse prognosis. Could it be that the authors had identified patients belonging to a distinct postinfectious subgroup as many doctors maintain they do? Clearly, if this is the case future studies of this nature will have to include more objective analysis of persisting viral infection (for example, analysis of muscle biopsy specimens with the polymerase chain reaction rather than tests for VP1 antigen); immune function (for example, function of natural killer cells rather than white cell counts); and hypothalamic-pituitary-axis activity (for example, up regulation of serotonin- I receptors and basal cortisol concentrations) to see if there are characteristic abnormalities that distinguish the postinfectious subgroup.
The high incidence of intolerance to alcohol is noted as intriguing, but from personal experience, as well as from seeing many patients with a classic postinfectious fatigue syndrome, I regard this observation as an important diagnostic feature. In these patients even small amounts of alcohol cause a further deterioration in cognitive function, and I suggest that a physiological explanation may lie in the fact that alcohol increases the concentration of the neurotransmitter y-aminobutyric acid, which in turn reduces the availability of calcium ions and hence depresses brain function still further.
You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1883001/pdf/bmj00086-0047c.pdf
Source: Shepherd C. Outcome in the chronic fatigue syndrome. BMJ. 1992 Aug 8;305(6849):365. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1883001/