Journal of Chronic Fatigue Syndrome: Volume 14, Issue 4, 2007

Volume 14, Issue 4, 2007

 * Editorial - Lyme Disease in US ME/CFS Patients: A Psychiatric Data Analysis Related to the Apathy Construct by Kenny De Meirleir & Neil McGregor
 * Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma Species Coinfections"'Abstract - Objective: We examined the blood of 48 North American chronic fatigue syndrome (CFS) patients subsequently diagnosed with Lyme disease (Borrelia burgdorferi infection) and compared these with 50 North American CFS patients without evidence of Borrelia burgdorferi infections for presence of Mycoplasma species coinfections using forensic polymerase chain reaction. Results: We found that 68.75% of CFS/Lyme patients show evidence of mycoplasma coinfections (odds ratio [OR] = 41.8; confidence limits [CL] = 11.3–155; and p < .001) compared with controls, whereas 50% of CFS patients without a diagnosis of Lyme disease show Mycoplasma coinfections (OR = 19.0; CL = 5.3–69; and p < .001) compared with controls. Because CFS patients without a diagnosis of Lyme disease have a high prevalence of one of four Mycoplasma species and a majority show evidence of multiple infections, we examined CFS/Lyme patients' blood for various Mycoplasma species. We found that CFS patients with Lyme disease mostly had single species Mycoplasma infections (OR = 31.7; CL = 8.6–116; and p < .001) with a preponderance of Mycoplasma fermentans infections (50% of patients; OR = 59.0; CL = 7.6–460; and p < .001), whereas the most commonly found Mycoplasma species in CFS patients without Lyme disease was Mycoplasma pneumoniae (34% of patients; OR = 14.94; CL = 3.3–69; and p < .001). Conclusions: The results indicate that a subset of CFS patients show evidence of infection with Borrelia burgdorferi, and a large fraction of these patients were also infected with Mycoplasma fermentans and to a lesser degree with other Mycoplasma species.'"
 * Cognitive Function and Major Depression in Chronic Fatigue: The Apathy Construct"'Abstract - Objective: The current study examined cognitive function, major depressive disorder (MDD), and apathy construct symptoms in a large multi-site surveillance study of chronic fatigue syndrome conducted by the Centers for Disease Control and Prevention. Method: Subjects underwent neuropsychological testing and were administered the Diagnostic Interview Schedule to establish psychiatric diagnoses. Questions in the Beck Depression Inventory relating to motivation were used to develop an apathy construct. Results: Neuropsychological test results showed impairment in multiple cognitive domains in over 25% of the cohort, and raised proportions of outliers in motor and executive function. Memory complaints were not associated with tests of memory function. The apathy construct rather than MDD was associated with impaired cognition. Conclusions: Impaired cognition in chronic fatigue does not appear to be associated with MDD but rather with endorsement of construct symptoms. Similar associations were reported in medical conditions with known etiologies. These results suggest a potential biological basis for apathy construct symptoms.'"
 * Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial"'Abstract - Objective: Understanding how nonpharmacologic interventions differentially affect the subgroups of patients with chronic fatigue syndrome (CFS) might provide insights into the pathophysiology of this illness. In this exploratory study, baseline measures of normal versus abnormal cortisol were compared on a variety of immune markers and other self-report measures. Normal versus abnormal cortisol ratings were used as predictors in a nurse-delivered nonpharmacologic intervention. Methods: Participants diagnosed with CFS were assigned to 6-month nonpharmacologic interventions. Individuals were classified as having abnormal or normal cortisol levels on the basis of scores over the five testing times. Cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time. Results: Across interventions, those with abnormal cortisol at the baseline appeared not to improve over time, whereas those with normal baseline cortisol evidenced improvements on a number of immunologic and self-report measures. Conclusion: It appears that, in subgroups of individuals with CFS, baseline cortisol markers are associated with outcome trajectories for nonpharmacologic treatment trials. The implications of these findings are discussed.'"
 * The Development of an Epidemiological Definition for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"'Abstract - 'An epidemiological case-definition was developed to distinguish myalgic encephalomyelitis/chronic fatigue syndrome from other chronic fatiguing conditions by evaluating the discriminatory potential of different criteria from previous definitions. A two-part model was derived using consensus and discriminant analytic approaches. The optimal discriminators for the first part were severe debilitating fatigue affecting physical and mental functioning, a reduction in activity to less than 50% of the patient's premorbid activity level, and muscle discomfort (sensitivity 92%, specificity 66%). The variables for the second part included a reduction in activity to less than 50% of the patient's premorbid activity, myalgia, generalized muscle weakness, migratory arthralgia, and swollen lymph nodes (sensitivity 77%, specificity 88%).'"
 * How Science Can Stigmatize: The Case of Chronic Fatigue Syndrome"'Abstract - 'Objective: This article reviews issues involving the name of an illness, chronic fatigue syndrome (CFS), along with flawed epidemiologic approaches, which may have further contributed to the diagnostic skepticism and stigma that those with CFS encounter. Methods: Patient groups around the world are currently engaged in a major effort to rename this syndrome as either myalgic encephalomyelitis or myalgic encephalopathy, to undo the negative effects of the name previously given to this illness by scientists. Moreover, during the last 15 years, estimated rates of CFS have dramatically increased in both Great Britain and the United States. Results: We suggest that the increases in both the United States and Great Britain are due to a broadening of the case definition to additionally include cases with primary psychiatric conditions. Conclusion: Using a broad or narrow definition of CFS will have crucial influences on CFS epidemiologic findings, on rates of psychiatric comorbidity, and ultimately on the likelihood of finding a biological marker and identified etiology.'"