Journal of Chronic Fatigue Syndrome: Volume 13, Issue 4, 2006

Volume 13, Issue 4, 2006

 * Editorial by Elke Van Hoof, Kenny De Meirleir & Neil McGregor
 * Conservation of Resources and Quality of Life in Individuals with Chronic Fatigue Syndrome"'Abstract - Objective: To examine the relationship between resources and quality of life in individuals with chronic fatigue syndrome (CFS). Participants and Study Design: A cross-sectional design was used to describe associations between resource loss and gain and quality of life for 47 individuals diagnosed with CFS. Main Outcome Measures: The Conservation of Resources Evaluation was used to measure resources in terms of perceived loss and gain. Health-related quality of life was assessed with the Quality of Life Index. Results: Total resource loss and total resource gain were significant correlates of overall quality of life. Gains in self-esteem, energy, and work resources were associated with higher-perceived quality of life. Material loss and energy loss were associated with lower-perceived quality of life. Conclusions: Findings for the relationships between perceived resources of self-esteem, work, material items, and energy and perceived quality of life can be used inform future rehabilitation efforts. These relationships appear to occur independently of illness severity among individuals CFS.'"
 * Antiviral Pathway Deregulation of Chronic Fatigue Syndrome Induces Nitric Oxide Production in Immune Cells That Precludes a Resolution of the Inflammatory Response"'Abstract - Chronic fatigue syndrome (CFS) is a poorly defined medical condition diagnosed by exclusion, which, besides severe chronic fatigue as the hallmark symptom, involves inflammatory and immune activation stigma. Although viral infections are not systematically found in CFS patients, the type I interferon antiviral pathway has been repeatedly shown to be activated in peripheral blood mononuclear cells (PBMC) of the most afflicted patients. An abnormal truncated form of ribonuclease L (37-kDa RNase L) is also found in the PBMC of CFS patients and this protein has been proposed as a biological marker for CFS. Recently, the levels of this abnormal protein have been significantly correlated to the extent of inflammatory symptoms displayed by CFS patients. We report here that active double-stranded RNA-dependent kinase (PKR) is expressed and activated in parallel to the presence of the 37-kDa RNase L and to an increase in nitric oxide production by immune cells. However, PKR upregulation results also in a significant increase followed by a decrease in caspase 3 activity for the samples containing the highest levels of 37-kDa RNase L. This caspase 3 downregulation does not result from increased expression of the anti-apoptotic proteins Bcl-2 and Bcl-XL. These results therefore suggest that chronic inflammation due to excess nitric oxide production plays a role in CFS and that the normal resolution of the inflammatory process by NF-kB activation and apoptotic induction is impaired. These observations draw new directions for the therapeutic approach of CFS.'"
 * Long-Term Treatment with a Staphylococcus Toxoid Vaccine in Patients with Fibromyalgia and Chronic Fatigue Syndrome"'Abstract - One hundred and sixty patients with fibromyalgia and chronic fatigue syndrome, who were on a continuous treatment with a Staphylococcus vaccine, were followed during one year with repeated consultation visits. The patients had participated in controlled studies and been on continuous treatment with the vaccine for 22±10 months before inclusion into this follow-up study. They were treated with 1 mL of the vaccine subcutaneously every third to fourth week. Adverse events were few. The adherence to the treatment was very good. Over a period of one year, 8% withdrew, and in only 5%, the withdrawal was due to insufficient clinical effect. Only in two cases where the patients were allergic to the preservative of the vaccine, the side effects caused the withdrawal of the treatment. Ratings with scales (CPRS-15 and FibroFatigue) showed improvement from start of treatment and also further improvement during the follow-up year. In view of the natural history for these disorders the result is of interest.'"
 * Reliability of a Chronic Fatigue Syndrome Questionnaire"'Abstract - Background: A diagnostic instrument, the CFS Questionnaire, was developed for clinicians and researchers to administer to their patients as a screening instrument for CFS. The CFS Questionnaire is comprehensive, covering the inclusionary and exclusionary self-report criteria of the current U.S. case definition (Fukuda, 1994). The instrument also assesses past and current activity levels, and symptoms of post-exertional malaise to ensure these items are adequately assessed. Objectives: The goal of the present study was to evaluate the diagnostic reliability of an experimental measure for assessing chronic fatigue syndrome (CFS). Methods: This instrument was administered to 15 persons with CFS, 15 persons with major depressive disorder (MDD), and 15 controls. Using the Fukuda et al. (Fukuda, 1994) diagnostic criteria, raters independently reviewed participants' CFS Questionnaire responses and rated whether each study participant met criteria for chronic fatigue syndrome. Results: This instrument demonstrated good inter-rater reliability. Further, this instrument demonstrated adequate classification accuracy, with a 9.3 positive likelihood ratio and a .08 negative likelihood ratio. Overall, the CFS Questionnaire demonstrated good test-retest reliability, with intra-class correlation coefficients and kappa coefficients at .70 or higher for most items. Lower test-retest reliability coefficients were found for some items assessing temporal symptoms or items requiring an estimate of time. Conclusion: The present study suggests that the CFS Questionnaire is a reliable diagnostic tool. Use of the CFS Questionnaire should promote higher levels of diagnostic reliability because it allows for accurate classification of individuals with CFS.'"
 * Lyme Disease Presenting as Chronic Fatigue Syndrome"'Abstract - Objective: Chronic Fatigue Syndrome (CFS) by definition represents a diagnosis of exclusion. Late stage or “Chronic Lyme” infection with or without “co-infections” is a difficult diagnosis to establish. The symptom complex of both conditions can be very similar. This case study represents an attempt to support serious consideration for a subpopulation of patients otherwise diagnosed with “CFS,” as actually representing chronic Lyme disease. Method: A case study is presented of a 33-year-old man, who for two years, was being managed as having CFS. However, after ∼2 years of utilizing multiple modalities of management with limited success, the diagnosis of Lyme disease was reconsidered. Historical exposure risks to Lyme disease in this individual were high. He had prolonged exposure in the highly tick-infested mountains of North Carolina for 18 months, several years prior to becoming ill. More aggressive investigation confirmed the diagnosis of Lyme disease. Appropriate changes in management were associated with an improved level of functioning that was far in excess of what maximal management of CFS was able to achieve. The features of CFS and chronic Lyme disease can be very similar and include the following. Profound fatigue often associated with cognitive impairment. Other common symptoms related to both of these conditions include sleep disturbances, fibromyalgia, and dysautonomias. In pursuing clarification of this diagnosis, the author was exposed to a contrast in medical opinion regarding diagnostic tools and criteria that were perceived as creating potential barriers to the management of patients presenting with these symptoms. Conclusion: Acceptance and awareness of the possibility that Lyme disease can present as CFS has important therapeutic and prognostic implications."
 * Depression, Chronic Fatigue Syndrome, and Fibromyalgia: An Update"'Abstract - Centers for Disease Control criteria for chronic fatigue syndrome (CFS) specifically recognize that patients can have both CFS and depression. The clinician's challenge is to judge for each individual patient whether the complaint of fatigue is primarily depression, physical illness, such as CFS, or a combination of both. This review differentiates CFS and fibromyalgia, discussed as “chronic fatigue syndrome and related immune deficiency syndromes” (CFIDS), from depression in terms of physical signs, symptoms, biological parameters, brain imaging, immunology, and treatment. The review focuses on practical applications of research findings with a further focus on future ability to show clear biologic separation and specific treatment. When depressive symptoms exist with those of CFS, accurate differentiation can usually be accomplished by focusing on diagnostic criteria. Presence of multiple physical signs and symptoms of CFIDS may be of great value. In terms of laboratory testing, a single helpful test may be measuring the plasma cortisol, which is usually high in depression and low in CFS. Future research should focus on the combination of plasma cortisol with an index of serotonin function, which is high in CFIDS and low in depression. Additional research should focus on neuroimaging and immune differentiation. Combination of multiple tests should result in a significant and clinically useful separation between CFIDS and major depressive disorder (MDD). In treating patients with significant depression or MDD with CFIDS, one should think of the noradrenergic approach using bupropion or low-dose tricyclic antidepressants in combination with a selective serotonin reuptake inhibitor, especially sertraline, to aid improvement of global, pain, and immunologic parameters. Alternatively, serotonin norepinephrine reuptake inhibitors (venlafaxine and duloxetine) should be considered. Future treatment research should focus on larger placebo-controlled, double-blind trials of these and other antidepressants as well as the evaluation of psychostimulants, electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).'"