Journal of Chronic Fatigue Syndrome: Volume 6, Issue 3-4, 2000

Volume 6, Issue 3-4, 2000

 * Introduction by Kenny De Meirleir & Roberto Patarca-Montero
 * Report on the Second World Congress on Chronic Fatigue Syndrome and Related Disorders: Towards Effective Diagnosis and Treatment in the 21st Century
 * Role of Mycoplasmal Infections in Fatigue Illnesses: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis"Summary - 'Bacterial and viral infections are purported to be associated with several fatigue illnesses, including Chronic Fatigue Syndrome (CFS), Fibromyalgia Syndrome (FMS), Gulf War Illnesses (GWI) and Rheumatoid Arthritis (RA), as causative agents, cofactors or opportunistic infections. We and others have looked for the presence of invasive pathogenic mycoplasmal infections in patients with CFS, FMS, GWI and RA and have found significantly more mycoplasmal infections in CFS, FMS, GWI and RA patients than in healthy controls. Most patients had multiple mycoplasmal infections (more than one species). Patients with chronic fatigue as a major sign often have different clinical diagnoses but display overlapping signs/symptoms similar to many of those found in CFS/FMS. When a chronic fatigue illness, such as GWI, spreads to immediate family members, they present with similar signs/symptoms and mycoplasmal infections. CFS/FMS/GWI patients with mycoplasmal infections generally respond to particular antibiotics (doxycycline, minocycline, ciprofloxacin, azithromycin and clarithromycin), and their long-term administration plus nutritional support, immune enhancement and other supplements appear to be necessary for recovery. Examination of the efficacy of antibiotics in recovery of chronic illness patients reveals that the majority of myco-plasma-positive patients respond and many eventually recover. Other chronic infections, such as viral infections, may also be involved in various chronic fatigue illnesses with or without mycoplasmal and other bacterial infections, and these multiple infections could be important in causing patient morbidity and difficulties in treating these illnesses.'"
 * Human Herpes Virus 6 (HHV-6) Infection in Patients with Chronic Fatigue Syndrome and Its Relationship to Activation-Induced Cell Death"Summary - 'Using evidence-based medical research techniques, current knowledge about the presence of active HHV-6 infections, in a sub-population of patients with chronic fatigue syndrome (CFS), has been reviewed and implications to activation-induced cell death are presented. Therapeutic intervention methods are also disclosed with a call for clinical studies to test the hypothesis presented.'"
 * Neurological Dysfunction in Chronic Fatigue Syndrome"Summary - 'Chronic fatigue syndrome (CFS), popularly known in Europe as myalgic encephalomyelitis (ME), is a common but not a new illness. CFS/ME was classified as a neurological disease by the World Health Organisation in 1993. Neurological dysfunction is considered the principal mechanism of both physical and mental fatigue in this condition. This article reviews the neurological symptoms of the epidemic and sporadic forms of the illness. Paroxysmal changes in the severity of symptoms (fatigue and neuropsychiatric) are the hallmark features in the natural history of this disease. Ion channel abnormality leading to neuronal instability in selective anatomical pathways (basal ganglia circuitry) is proposed as the possible mechanism of fluctuating fatigue and related symptoms in CFS.'"
 * Immunology of Chronic Fatigue Syndrome"Summary - 'A review of the literature on the immunology of CFS reveals that people who have Chronic Fatigue Syndrome (CFS) have two basic problems with immune function that have been documented by most research groups: 1. immune activation, as demonstrated by elevation of activated T lymphocytes, including cytotoxic T cells, as well as elevations of circulating cytokines; and 2. poor cellular function, with low natural killer cell cytotoxicity (NKCC), poor lymphocyte response to mitogens in culture, and frequent immunoglobulin deficiencies, most often IgGl and IgG3. These findings have a waxing and waning temporal pattern which is consistent with episodic immune dysfunction (with predominance of so called T-helper type 2 and proinflammatory cytokines and low NKCC and lymphoproliferation) that can be associated as cause or effect of the physiological and psychological function derangement and/or activation of latent viruses or other pathogens. The interplay of these factors can account for the perpetuation of disease with remission/exacerbation cycles. Therapeutic intervention aimed at induction of a more favorable cytokine expression pattern and immune status is discussed.'"
 * The Biorhythm of Fatigue in Chronic Fatigue Syndrome"Summary - 'Evidence is provided for a rhythmic interpretation of fatigue in CFS.'"
 * Divalent Cations, Hormones, Psyche and Soma: Four Case Reports"Summary - 'Objectives: The steroid hormone, vitamin D and the pep-tide hormone, parathormone are reported to influence not only bone metabolism, but also other metabolic and nervous, cardiovascular and immune functions, and mood. Regular actions of these hormones depend highly on intracellular magnesium content. Although symptoms are recognized, they usually are not correlated to these hormones. Foregoing case studies have revealed that vitamin D and/or parathormone disorders are common causes of CFS-fibromyalgia like symptoms. Methods: Four patients with chronic fatigue-like symptoms and vitamin D (250HD3) and parathormone (PTH intact) disorders are illustrated to demonstrate conflicting laboratory results. Patients were treated with 5,000 to 10,000 IU cholecalciferol, plus multiminerals and trace elements. Clinical outcome was assessed and treatment difficulties are reported. Results: Diagnostic pitfalls are shown. Vitamin D and parathormone disorders are not completely detectable by calcium and phosphate screening. In 2 of this 4 demonstrated cases treatable diagnosis would have been missed without endocrinological screening. In the case of undetected long-standing disorder of these hormones, intracellular mineral derangement follows, thus inducing vitamin D resistance and parathormone ineffectiveness which makes therapy difficult. Combining vitamin D therapy with multiminerals possibly may overcome these obstacles. Conclusions: Vitamin D and parathormone disturbance should not be overlooked in chronic fatigue. Appropriate therapy is easy, inexpen-sive and harmless. Early diagnosis and treatment might be essential to avoid chronic fatigue syndrome. The complexity of diagnosis, therapy and scientific background may lead to a new understanding of “psycho-somatic” disease. The relation between intracellular minerals, trace ele-ments, cellular energy supply and responsible hormones should become clearer.'"
 * Common Clinical and Biological Windows on CFS and Rickettsial Diseases"Summary - 'From 1991, links between CFS and Rickettsial Diseases were uncovered because of their similar clinical presentation. Further research linked them even more. Five Rickettsia strains, suspected to be the cause, or an important factor in CFS, were identified by means of the Giroud Micro-Agglutination test and were widely found to be positive in patients' serum, diagnosed as suffering from CFS, Fibromyalgia, Rheumatoid Arthritis, Multiple Sclerosis, Depression, Psychosis, Heart Diseases, and Auto-Immune Diseases. This finding leads us to submit those originally differently diagnosed patients to the same tetracycline treatment. This proved to be a great success. The increasing number of patients gave us the opportunity to establish a biological checklist (regardless of the diversity of the pathology) of infections, organs' functions and auto-immune profile. We found the differences in positivity to depend on four factors: length of illness, virulence of germs, cohabitation of germs, and the state of the host immune system. These studies suggest that auto-immune diseases could have an infectious origin. Better knowledge and mastery of the co-factors would be determinant in speeding recovery. With this approach, CFS patients are being treated for the cause of their illness rather than symptomatically.'"
 * Role of Rickettsiae and Chlamydiae in the Psychopathology of Chronic Fatigue Syndrome (CFS) Patients: A Diagnostic and Therapeutic Report"Summary - 'Objective: To demonstrate the probable role of intracel-lular bacteria like Rickettsiae and Chlamydiae in the development of certain chronic psychopathological conditions and according to the efficiency of antibiotic regimes (cyclines and/or macrolides). The letter aim is based on the fact that all the patients that I have seen since 1981 had a sera reaction positive for Rickettsiae and/or Chlamydiae using the micro-agglutination on blade technique of P. Giroud and M.L. Giroud (MAG) by Prof. J.B. Jadin of Antwerpen, Belgium with special antigens cultured on guinea pig lungs and chicken embryos. Methods: This is an open study which began in 1981 in a private medical practice, not versus placebo; but with random choice. Treatment was for a minimum of six months (cyclines and/or macrolides together with vasodilatory medication; chloroquine; warm baths). Group one: 98 CFS cases; women: 78, men: 20; for 67 cases, the ancientness of symptoms is more than 2 years. Group two: 59 psycho-somatic cases; 5 schizophrenia; 3 borderline; 10 children with agressivity, excitement; 1 autistic child; 1 delirium with relapses. Results: Group one: 79.5% good and very good results; 4.1% fairly good; 16.4% failed. Group two: 82.3% good and very good results; 2.5% fairly good; 15.2% failed. Conclusion: This diagnostic and therapeutic study began in 1981. All of the Dr. Bottero's therapeutic results are confirmed since 1991 by Dr. Cecile Jadin of Randburg (South Africa) for more than 3000 CFS and other psychopathological states (300): Sydney 98 CFS Conference, Australia. We have shown that Rickettsiae and Chlamydiae are probably causative factors in many 'psychopathologies.''"
 * Chronic Psychopathologies Associated with Persistent Rickettsiae and/or Similar Germs (Chlamydiae)"Summary - 'For 60 cases of diseases that are called “Psychic” associated with persistent rickettsiae; we have: 55 good and excellent result, 5 failure, but we still have to wait a confirmation in course of time for many patients.'"