Journal of Chronic Fatigue Syndrome: Volume 1, Issue 2, 1995

Volume 1, Issue 2, 1995

 * Editorial, by Nancy Klimas & Roberto Patarca
 * Viruses and Chronic Fatigue Syndrome: Current Status"'Abstract - Because of the sudden onset of 'flu-like' symptoms in he vast majority of cases, followed by persistent illness and fatigue over several years, both RNA (retroviruses) and DNA (herpesviruses and enteroviruses) viruses have been suspected to be implicated in the pathogenesis of CFS. In recent years, evidence of the association of some viruses wilh CFS has progressed, whereas, with some others it has weakened considerably. Thus far, no single virus has been found to be the causative agent of CFS. Reactivation, however, of latent virus or viruses could contribute to the symptomatology of CFS by damaging the immune system either directly or indirectly. In this report we have provided a comprehensive review of the status of research on viral agents which have been investigated for their role in the pathogenesis of CFS.'"
 * Relationships of Cognitive Difficulties to Immune Measures, Depression and Illness Burden in Chronic Fatigue Syndrome"'Abstract - Objective. We related the subjective assessment of cognitive difficulties with lymphocyte phenotypes, cellmediated immunity (CMI), cytokine and neopterin levels in patients with chronic fatigue syndrome (CFS), in order to determine if CFS patients complaining of greater cognitive difficulties would show greater impairments in cell-mediated immunity and a greater degree of immune system dysregulation, and to determine if these cognitive difficulties would correlate with the other non-affective measures of CFS associated illness burden. We also assessed whether these relationships would hold independent of depression in two ways, by statistically covarying depression severity scores and by comparing subsets of CFS patients with and without a concurrent diagnosis of major depressive disorder. Design. A case series of CFS patients. Setting. Outpatient tertiary referral clinic at the University of Miami School of Medicine, Miami, FL. Patients. Consecutive sample of 65 patients who were referred as CFS to the University of Miami Diagnostic Immunology Clinic, who met the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of CFS and consented to participate. Main Measures. Self-assessment of cognitive difficulties, depression and illness burden, clinician-assessed depression and CFS symptoms, lymphocyte phenotype, proliferative response to mitogens, serum levels of cytokines and neopterin. Results. Among CFS patients, high Cognitive Difficulty Scale (CDS) scores were significantly related to lower lymphocyte proliferative responses to mitogens, higher neopterin levels, and higher CD4 and lower CD8 lymphocyte counts. These relationships, with the exception of T cell subset percentages, were maintained when depression severity was used as a co-variate. High CDS scores were also significantly related to lower Karnofsky scores, and greater illness burden as measured by the Sickness Impact Profile. Conclusions. Evidence is presented that CFS patients with higher cognitive difficulty scores have more immune and clinical dysfunction than those patients with less cognitive difficulty, and that these relationships are independent of depression. These observations provide support for the concept that although both cognitive difficulties and immunologic abnormalities, such as immune activation and impaired cell-mediated immunity, may represent secondary sequence to the same event(s), they are not likely to be secondary sequence to depression.'"
 * Physical, Behavioral, and Psychological Risk Factors for Chronic Fatigue Syndrome: A Central Role for Stress?"Abstract - In spite of the distinct epidemiologic features of chronic fatigue syndrome, its cause remains unknown and no risk factors for the illness have been identified. In order to better characterize CFS, we conducted a case-control study of well-defined CFS cases to identify physical, behavioral, and psychological factors related to the occurrence of CFS. The study, conducted in the metropolitan area surrounding Newark, New Jersey, USA, included 20 patients who fulfilled the CFS case definition and 20 matched controls. All subjects completed a self-administered questionnaire. The greatest difference between cases and controls was the reported level of stress from any of five sources in the 5 years prior to onset of illness (95% vs. 55%; P = 0.01 1). In addition, the risk of CFS was significantly related to the number of sources of stress, especially three or more. Other significant risk factors included a history of premenstrual syndrome, a history of eczema, loss of interest in daily activities, and panic attacks. Our results suggest that stress may be one of the factors related to the development of CFS. However, the possibility remains that the observed relationship resulted from a biased recollection of events preceding the illness. It is also possible that the perception of stress is correlated with some other variable related to the pathogenesis of CFS.'"
 * Disturbance of Hypothalamic Function and Evidence for Persistent Enteroviral Infection in Patients with Chronic Fatigue Syndrome"'Abstract - It has been suggested that one of the major effects of persistent virus infections in the production of disorders such as the chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is on the hypothalamus (Bakheir, 1992). Buspirone, which is one of the anxiolytic drugs of the azapyrone group, causes a release of prolactin by stimulation of serotonin 5-hydroxytryptamine (5-HT) receptors. The buspirone-prolactin response was studied in a subgroup of patients with CFS/ME and evidence of persistent enteroviral infection, as shown by the repealed detection of the group specific protein of enteroviruses, VPI, in the blood. Family controls who were asymptomatic were studied at the same time. In addition to the response to buspirone, diurnal variations in cortisol and prolactin levels were studied. It was found that the patients with CFS/ME had much greater rises in prolactin levels one hour after buspirone compared to controls. Cortisol levels were elevated in the patients, but the rise was not signiftcantly different between the two groups. There was a significant association between the pattern of sleep disturbance, which we speak of as the OWL syndrome, and the ratio of pre- and post-buspirone prolactin levels. This study shows that there is a hypothalamic disturbance in the patients who also had evidence of enteroviral infection as part of the disorder of CFS/ME. It represents a quantifiable biochemical alteration to be found in this group of patients.'"
 * The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study
 * Literature In Review