Health rising forum discussion started by Cort Johnson, 30 April 2016: Can simple blood tests help to identify Chronic Fatigue Syndrome (ME/CFS)?
How great it would be if a doctor could give a teenager with lingering fatigue after infectious mononucleosis/glandular fever a simple blood test to determine if she had chronic fatigue syndrome (ME/CFS).
She and her parents might not like that result but at least they’d have an answer to their daughters health issues and they could chart their course from there. The doctor, of course, would be quite relieved to have an answer his patients mysterious problems. He or she could study up on how to treat ME/CFS or (hopefully) send her on her way to a doctor who could (instead of a psychiatrist who can’t.)
Significant amounts of stress would be relieved on both ends and both ME/CFS as a disease and the patient would be validated.
That’s what this Renee Taylor/Nancy Klimas group (Broderick, Klimas, Fletcher) and Suzanne Vernon recent study tried to achieve. They tracked almost 300 adolescents diagnosed with infectious mononucleosis in the Chicago area for 24 months and gave the ones who got sick and a handful of the ones who recovered very simple blood, saliva and urine tests.
This study was definitely a gamble; nobody has ever found that standard blood tests tell us anything about chronic fatigue syndrome.
Harvey JM, Broderick G, Bowie A, et al. Tracking post-infectious fatigue in clinic using routine Lab tests. BMC Pediatrics. 2016;16:54 doi:10.1186/s12887-016-0596-8.
Results
There’s nothing like consistency in research. This study underscored and validated what the Dubbo studies found some ten years ago; that if you come down with infectious mononucleosis/glandular fever as an adolescent you, unfortunately, have a pretty good chance of coming with ME/CFS.
At six months 13% of them met the criteria for ME/CFS (CCC criteria tweaked by Jason), at 12 months 7% still did, and two years later 4% (@12 adolescents) were still sick. (Compare that with 11% and 9% at six and 12 months in the Dubbo studies).
It’s not clear if females are more likely to get IM than males but they were definitely hit harder by it. At six months 90% of the ME/CFS adolescents were female; at 12 months 100% were.
Blood, Saliva and Urine Test Results
The results of 59 standard laboratory tests in 13 young women with ME/CFS with those of healthy controls indicated that some differences were found and those differences highlighted the HPA axis and hormones. Unfortunately few of the abnormalities found persisted past one time point.
Reduced levels of glucose and ACTH at six months suggested that the HPA axis was sputtering. ACTH triggers the production of cortisol by the adrenal glands and is produced in response to biological stress.
The authors suggested that a cytokine (Il-6) produced during an infection could be promoting hypoglycemia in these young ME/CFS patients. Older ME/CFS and FM patients will remember that hypoglycemia was all the rage in alternative health circles a couple of decades ago.
Levels of estradiol, the primary sex hormone in women, tanked at 12 and 24 months. Those two findings fit somewhat with Broderick’s past modeling work which highlighted the HPA axis and the hormonal system in ME/CFS.
Broderick’s work suggests that female hormones may play an important role keeping female ME/CFS patients stuck in a suboptimal physiological state. His recent model suggested that women with ME/CFS fall into steady state which includes decreased cortisol, increased estradiol and increased anti-inflammatory activity.
The authors noted that an increase in neutrophils at 24 months could also reflect hormonal changes in ME/CFS women. Plus a close but non-significant tendency towards increased thyroxine levels (T4) at six and twelve months (p<.06/ p<.07) suggested thyroid gland involvement. Ultimately the study suggested that immune changes during infection may be effecting the HPA and HPT axes and female hormones.
Conclusion
This study was probably always something of a crap shoot, but it did underscore possble HPA axis and hormonal problems in ME/CFS. If validated in larger studies and with other disease cohorts it could provide the opportunity for doctors to use simple blood tests to quickly tell who has ME/CFS.
