CFS & FM reactions to Hepatitis B vaccine

Posted on 01/15/2015 by wames

Research abstract

The objectives of this study were to gather information regarding demographic and clinical characteristics of patients diagnosed with either fibromyalgia (FM) or chronic fatigue (CFS) following hepatitis B vaccination (HBVv) and furthermore to apply the recently suggested criteria of autoimmune (auto-inflammatory) syndromes induced by adjuvants (ASIA), in the aim of identifying common characteristics that may suggest an association between fibromyalgia, chronic fatigue and HBV vaccination.

Medical records of 19 patients with CFS and/or fibromyalgia following HBVv immunization were analyzed. All of which were immunized during 1990-2008 in different centers in the USA. All medical records were evaluated for demographics, medical history, the number of vaccine doses, as well as immediate and long term post-immunization adverse events and clinical manifestations.

In addition, available blood tests, imaging results, treatments and outcomes were analyzed. ASIA criteria were applied to all patients.

The mean age of patients was 28.6 ± 11 years, of which 68.4 % were females. 21.05 % had either personal or familial background of autoimmune disease. The mean latency period from the last dose of HBVv to onset of symptoms was 38.6 ± 79.4 days, ranging from days to a year.

Eight (42.1 %) patients continued with the immunization program despite experiencing adverse events. Manifestations that were commonly reported included neurological manifestations (84.2 %), musculoskeletal (78.9 %), psychiatric (63.1 %), fatigue (63.1 %), gastrointestinal complains (58 %) and mucocutaneous manifestations (36.8 %).

Autoantibodies were detected in 71 % of patients tested. All patients fulfilled the ASIA criteria. This study suggests that in some cases CFS and FM can be temporally related to immunization, as part of ASIA syndrome.

The appearance of adverse event during immunization, the presence of autoimmune susceptibility and higher titers of autoantibodies all can be suggested as risk factors. ASIA criteria were fulfilled in all patients eluding the plausible link between ASIA and CFS/FM.

Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the ‘autoimmune (auto-inflammatory) syndrome induced by adjuvants’ (ASIA) by N Agmon-Levin  et al. in Immunol Res.  2014 Nov 27. [Epub ahead of print]

Note: more on the proposed ASIA ME/CFS link:

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) 2013:
Unveiling the pathogenic, clinical and diagnostic aspects, by  Carlo Perricone et al in J Autoimmun. 2013 Dec;47:1-16.
fulltext-

 

 

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Hormones, autoimmunity and/or viruses at work in ME/CFS

Posted on 01/15/2015 by wames

Cort Johnson explores the significance of a study into age peaks in ME/CFS:

Age patterns provide pointer

A  Norwegian study of ME/CFS patient records that found two age peaks in Chronic Fatigue Syndrome, one starting from ages 10-19, the other from 30-39, could tell us something about the disorder.

ME/CFS can occur almost any time but two distinct age-related peaks showed up in a Norwegian study …What does it mean?

It wasn’t as if people of other ages didn’t come down with Chronic Fatigue Syndrome – many people in other age groups did – but the numbers of ME/CFS cases spiked in these age groups.

The least likely times to come down with ME/CFS were at the two ends of the age spectrum: from 5-9 and after the age of 55.  Just 121 cases were reported from ages 5-9, but after the age of nine the incidence of ME/CFS spiked up sharply with almost 700 cases reported from ages 10-14 and 15-19. From 20-29 it dropped about 30% with about 500 cases reported, and then zoomed up again to about 700 cases from ages 30-39. From ages 40-44, 45-49, 50-54 declined until at ages 55+ the incidence was very low indeed.

That’s in contrast to many disorders which get more prevalent as we age.
As in other surveys, young female and adult women in their most productive years were much more likely (75%) to come down with ME/CFS than men.

What does it all mean?

Females Dominate

The high rate of females with ME/CFS combined with the unusual pattern of incidence points a finger directly at female hormones.   Three periods of major hormonal fluctuations occur in women; during puberty, during pregnancy and during menopause. Spikes in ME/CFS incidence occurred during two of these; puberty and when women often get pregnant, but not during menopause.

Sex Hormones, ME/CFS and IBS

A CDC study indicating women with ME/CFS have greatly increased rates of gynecological disorders also suggested that sex hormones could play a major role in the disorder. Despite the female predominance in ME/CFS and FM sex hormones have not been well studied in either disorder, but they have been better studied in another female dominated disorder  that often co-occurs with ME/CFS and Fibromyalgia – irritable bowel syndrome.

The same pattern of disease development over time is found in IBS. The incidence of IBS peaks in women from their teens to about their mid-forties and then declines over time. By the time women reach their seventies their incidence of IBS drops to that found in men.

Estrogen

Estrogen is the major female  hormone produced. Its many effects on the body and its widely varying production had made it difficult to  study, but Broderick’s ME/CFS model suggests that estrogen triggered dysregulation of the HPA axis may play a key role the development of Chronic Fatigue Syndrome in females.

That’s Low Estrogen – If estrogen plays a role it’s probably low not high estrogen levels that are the problem. Estrogen effects neurotransmitter production and activity and electrical excitability, and has a neuroprotective effect on central nervous system functioning.

Pain Connection – Some evidence suggests low estrogen level may play a role in chronic pain.  The greater degree of emotional arousal women with IBS display in response to pain could reflect reduced estrogen levels. The association of high estrogen levels with increased opioid receptors suggests higher estrogen levels may reduce pain.

Gut Connection – Female hormones not only influence gut motility – a key feature of IBS – but also gut secretions, gut contractions, immune functioning and pain sensitivity. The fact that about a third of women with IBS issues have them only during menstruation again suggests reduced sex hormone levels could play a role.  Reduced hormone levels during menstruation have been linked to abdominal pain and bloating.

Overall, the evidence suggests that estrogen probably plays a protective role in IBS, multiple sclerosis, pain disorders and possibly chronic fatigue syndrome.  However, the lower incidence of ME/CFS during menopause – when estrogen levels tend to be low – suggests that more than estrogen is  involved.

A Positive Role for Male Hormones

In contrast to women, age appears to play little role in the development of IBS in men:  they experience no significant changes in IBS incidence throughout their lifespan.

Male hormones often get a bad rap 🙂 but the lower rates of incidence and the lack of a discernible pattern of incidence in men suggests they may have a protective function. Broderick’s modeling studies suggest that male hormones such as testosterone are protective in ME/CFS and some evidence suggests the same may be true in IBS.

Testosterone also appears to have pain reducing properties that provide protection against the development of pain disorders.  Low testosterone levels in men, for instance, have been associated with increased sensitivity to rectal pain.  Some men with ME/CFS have find testosterone supplementation helpful.
Hormones, or the lack of them, may very well be a contributing  factor to getting ME/CFS, but the spikes in incidence also point a finger at two other factors: viruses and autoimmune disorders.

The Viral Connection – Epstein Barr Virus

Spike in Adolescence  – The increasingly late exposure to the Epstein-Barr virus found in the Western world could contribute to the spike in ME/CFS prevalence in adolescence.

Exposure to EBV in infancy, when cytotoxic T-cell levels are at their highest, is usually hardly noticed, but a first exposure to EBV in adolescence often results in a severe illness such as infectious mononucleosis/glandular fever  –  which appears to trigger ME/CFS in about ten percent  of patients.

Spike in Middle Adulthood – Attributing the spike in ME/CFS prevalence in from 30-39 to EBV activation is a bit more difficult. Pregnancy in combination with the stress of child rearing could help explain it, however.

EBV reactivation in response to stress is well documented, but EBV reactivation also commonly occurs during pregnancy. One study found EBV reactivation in 35% of pregnant women by the second trimester and reactivation rates may be as high as 50% in pregnant women experiencing depression or high rates of stress.
Dramatic changes in estrogen,  progesterone and interestingly enough, cortisol – given Broderick’s model of ME/CFS – also occur during pregnancy.

Pregnancy is  also  associated with an increased risk of autoimmune disorders and the incidence of  MS increases in the first six  months after pregnancy.
Reductions in symptoms that often also occur in existing cases of ME/CFS and multiple sclerosis during pregnancy are believed to reflect spikes in estrogen.  (Anti-inflammatory cytokines that spike during pregnancy could play a role as well.)  Coming up shortly we’ll explore an estrogen targeting drug for MS that could possibly spell good news for people with ME/CFS and FM.

Set to Up to Fail? – Studies indicating that infectious mononucleosis increases the risk of coming down with multiple sclerosis later in life two-threefold raises the question whether a similar pattern might exist in chronic fatigue syndrome.

Could a severe case of mononucleosis as a teenager set you up for getting ME/CFS several decades later?

Autoimmune Disorders

A similar age-related  incidence pattern is also found in some autoimmune disorders. Lupus is most commonly diagnosed between the ages of 15-35. Multiple sclerosis (MS) is most commonly diagnosed in people between the ages of 20 and 50 years.  Sjogren’s  Syndrome typically begins in the same “middle adult” years  that ME/CFS spikes are seen in.

Conclusion

The age peaks may reflect a complex array of factors that coincide during certain periods to raise incidence levels.

The age spikes  found in this study  suggests chronic  fatigue syndrome shares  features with several other disorders.  Similar patterns of incidence in IBS, multiple  sclerosis, lupus and Sjogren’s Syndrome, and high rates of female predominance also occur in some autoimmune disorders (systemic lupus erythematosus (SLE; females:males – 9[ratio]1), autoimmune thyroid disease (8[ratio]1), scleroderma (5[ratio]1), rheumatoid arthritis (4[ratio]1) and multiple sclerosis (3[ratio]1)).

Determining what the spikes mean will  take time and much in the very complex interactions involving hormones and the immune system. The evidence suggests that a constellation of factors, perhaps involving hormones, immune activation, central nervous system excitation, and in some cases viruses play a role in producing ME/CFS.  This study highlights “danger points” when women may be particularly vulnerable.

The reduced incidence of ME/CFS and autoimmune and pain disorders in men, on the other hand, may reflect the protective effects male hormones provide.

Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008–2012   Inger Johanne Bakken, Kari Tveito, Nina Gunnes, Sara Ghaderi, Camilla Stoltenberg, Lill Trogstad, Siri Eldevik Håberg and Per Magnus Bakken et al. in BMC Medicine 2014, 12:167

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Cerebral blood flow & impaired neurocognition in POTS

Posted on 01/14/2015 by wames

Research abstract

We hypothesize that upright cognitive impairment in patients with postural tachycardia syndrome (POTS) is caused by reduced cerebral blood flow (CBF).

The CBF velocity (CBFv) measured by transcranial Doppler ultrasound decreased excessively during 70° tilt in a minority of patients with intermittent hyperpnea/ hypocapnia. Incremental tilt showed no difference in mean CBFv. But N-back memory tasking indicated progressive compromised memory, reduced functional hyperemia, and reduced neurovascular coupling. Orthostasis caused slow oscillations in CBFv linked to oscillations in arterial pressure in patients with POTS.

We also hypothesize that oscillatory CBFv degrades neurovascular coupling. We performed 2-back testing when subjects were in supine position and during incremental tilts to 15°, 30°, 45°, and 60° in 11 patients with POTS and 9 controls. Oscillatory arterial pressure, oscillatory CBFv, and neurovascular coupling were similar in supine position. The oscillatory arterial pressure increased by 31%, 45%, 67%, and 93% in patients with POTS during tilt and remained unchanged in the controls.

Oscillatory CBFv increased by 61%, 82%, 161%, and 264% in patients with POTS during tilt and remained unchanged in the controls. Functional hyperemia decreased from 4.1% to 3.0%, 1.1%, 0.2%, and to 0.04% in patients with POTS, but it was unchanged at 4% in the controls. Percent correct N-back responses decreased from 78% to 33% in patients with POTS, whereas they remained at 89% in the controls.

In patients with POTS, oscillatory CBFv was linearly correlated with functional hyperemia (r2=0.76). Increased oscillatory CBF is associated with reduced neurovascular coupling and diminished cognitive performance in patients with POTS.

Oscillatory Cerebral Blood Flow Is Associated With Impaired Neurocognition and Functional Hyperemia in Postural Tachycardia Syndrome During Graded Tilt by Julian M. Stewart, Andrew T. Del Pozzi, Akash Pandey, Zachary R. Messer, Courtney Terilli, Marvin S. Medow in Hypertension Published online before print December 15, 2014

 

 

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Fear avoidance beliefs as cause of fatigue and disability in CFS challenged

Posted on 01/14/2015 by wames

A paper published in the online journal Lancet Psychiatry claims that analysis of the PACE trial shows that fear avoidance of exercise plays a strong role in perpetuating fatigue and disability in CFS, and that the best treatment for this is CBT and GET.

This assertion has been challenged by a leading UK expert in ME. Dr Charles Shepherd believes the authors have based their conclusions on a flawed model of illness causation. They have not taken account of the medical complexities involved (muscle, brain and immune system abnormalities), nor of patient experience (exercise programmes make condition worse).

The PACE trial was completed in 2011 at a cost of £5 million and has been widely criticised for the methods used, and the inaccurate way in which it was presented and reported.

Dr Charles Shepherd (Hon Medical Adviser, ME Association):

The ME Association believes that energy management, which involves both physical and mental activity, is the most important aspect of managing ME/CFS.

Consequently, we welcome research which aims to improve our knowledge of how this can best be achieved.

Energy management programmes should be individually tailored. And they must take account of the wide range of clinical presentations and disease pathways that come under the ME/CFS umbrella.

We are therefore very critical of over-simplistic exercise regimes which are based on deconditioning, fear of activity and the assumption that people just need to ‘try harder’ in order to get better.

This approach does not acknowledge the muscle, brain and immune system abnormalities in ME/CFS, which help to provide a physical explanation for the debilitating central (brain) and peripheral (muscle) fatigue that occurs in this illness.

Feedback from patients, who are not normally treated as part of research studies, consistently indicates that around 25% find exercise programmes to be of no value. Around 50% report that their condition worsens as a result.

So the real reason why cognitive behaviour therapy and graded exercise therapy are not producing significant benefits across the whole ME/CFS population is that they are based on a flawed model of illness causation. They are are not taking account of the medical complexities involved.

In our experience, patients with ME/CFS are highly motivated to get better.

They are very willing to take part in energy management programmes that establish a safe baseline of activity, take account of the stage and severity of their illness, involve increases in physical and mental activity that are gradual, flexible and do not result in the person going beyond their limitations and causing symptom exacerbation.

We fear that the results of this study will be interpreted to reinforce the over-simplistic view that rest is bad and exercise is good for people with ME/CFS.

And without discussing the medical complexities involved, they also infer that any reluctance to progressively increase activity levels is far more related to fear or avoidance behaviour than any underlying disease process.

What we desperately need are high quality research studies that are aimed at producing a range of individual energy management programmes based on clinical presentation, stage, and severity of illness.

Read more: ME Association challenges ‘Lancet’ claim about fear of exercise leading to its avoidance in ME/CFS

Research Abstract from Lancet Psychiatry:

Background
Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms.

Methods
We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator–outcome relations by treatment group.

Findings
The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue −1·22, 95% CI −0·52 to −1·97, physical function 1·54, 0·86 to 2·31; GET vs APT, fatigue −1·86, −0·80 to −2·89, physical function 2·35, 1·35 to 3·39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue −1·37, 95% CI −0·76 to −2·21, physical function 1·90, 1·10 to 2·91), but not CBT.

Interpretation
Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome.

Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial by Prof Trudie Chalder, Kimberley A Goldsmith PhD, Prof Peter D White, Prof Michael Sharpe MD, Prof Andrew R Pickles PhD in The Lancet Psychiatary, Published online 13 January 2015

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Small-fiber polyneuropathy (SFPN) & pain / multi-system syndromes

Posted on 01/13/2015 by wames

Original article:

Background: Syndromes involving unexplained chronic widespread pain
(CWP) and multi-system symptoms are common, with 1-5% prevalence for fibromyalgia alone. They more often affect females and cause disability and high costs [1-3].

Other common syndromes include chronic fatigue, seronegative Lyme, and Gulf War Illness. Fragmentary syndromes include TMJD, POTS, CRPS, irritable bowel). These syndromes are particularly devastating in children and young adults, where they interfere with education and development and disrupt entire families [4-6]. SFPN is known to cause CWP and multi-system complaints in older adults.

Unlike the syndromes above, SFPN can be objectively diagnosed by measuring innervation in lower-leg skin biopsies, and autonomic functions testing (AFT) of heart rate, blood pressure and sweating. SFPN has several established causes including diabetes, infections, cancer, and toxins. Many causes are diagnosable, treatable, and sometimes curable. Our work suggests that unrecognized SFPN contributes to several syndromes involving CWP and multi-organ symptoms.

Materials and methods: With IRB permission, we retrospective analyzed the medical records of 41 patients with onset of unexplained CWP and multisymptoms before age 21; most had objective testing for SFPN.
We also prospectively studied 27 adult patients with fibromyalgia and
30 healthy volunteers using history, examination, skin biopsies and AFT.

Results: Retrospective chart review identified definite (in 59%) and probable SFPN (in 17%) among the young patients with onset before age 21. We characterized the clinical features, diagnostic, and treatment options for this new early-onset SFPN. Studying children, who lacked the typical causes of late-onset SFPN, implicated autoimmune causality in most. Among patients treated with immunomodulatory therapies, pain and other symptoms improved in 2/3.

Among adults with fibromyalgia, 41% of skin biopsies from subjects with fibromyalgia vs. 3% of biopsies from controls were diagnostic for SFPN, and symptom and examination scores were higher in fibromyalgia subjects than in controls (all P ≤ 0.001). All fibromyalgia patients diagnosed with SFPN then had blood tests for all known causes. None had diabetes but 62% had test-results consistent with dysimmunity, and some had genetic causes. Other laboratories have now also linked fibromyalgia to SFPN.

Conclusions: Some patients with unexplained widespread pain and multi-system syndromes such as fibromyalgia have objectively diagnosable SFPN. SFPN can affect children and young adults, not just older adults. Multiple lines of evidence suggest that early-onset SFPN has novel causes that can be treated. The prevalence of SFPN among TMJD patients is unstudied.

Small-fiber polyneuropathy (SFPN), a common underlying diagnosis in syndromes involving unexplained chronic pain and multi-system symptoms, by Anne Louise Oaklander, Heather Downs, Zeva Daniela Herzog and Max
Klein in Molecular Pain 2014, 10(Suppl 1):O12  [Published: 15 December 2014]

This article is part of the supplement: Proceedings of the Seventh Scientific Meeting of The TMJ Association

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Do you have mild ME?

Posted on 01/12/2015 by wames

Do you have mild ME?

We hear a lot about the difficulties facing the severely affected, and rightly so, as their quality of life is severely compromised. But what does it mean to be mildly affected by ME? Are the problems minor? Or can they be challenging too?

Do you have mild ME? What does that mean?

We’d like to know what symptoms you experience and how badly they make you feel. How much do symptoms fluctuate and how serious are relapses?

What problems do you face in everyday life?

What services would help? What type of information would help?

Post your comments here or on the WAMES Facebook page, or use the contact form to send us an email or contact Jan directly, so we can raise awareness and campaign for appropriate services.

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CFS is one complication of Hepatitis B vaccination

Posted on 01/12/2015 by wames

Research abstract

Hepatitis B vaccine has been administered in children and adults routinely to reduce the incidence of the disease. Even though, hepatitis B vaccine is considered as highly safe, some adverse reactions have been reported.

A literature search was carried out in PubMed, accessed via the National Library of Medicine PubMed interface, searching used the following keywords: Hepatitis B vaccine and complications from 1980 to 2014.

A total of 1147 articles were obtained out of which articles, which discuss the complications occurring orally or occurring elsewhere in the body, which have the potential to manifest orally after hepatitis B vaccination were selected.

A total of 82 articles were identified which included 58 case series or case reports, 15 review articles, 4 cross sectional studies, 3 prospective cohort studies, one retrospective cohort study and a case control study.

After reviewing the literature, we observed that complications seen after Hepatitis B vaccination are sudden infant death syndrome, multiple sclerosis, chronic fatigue syndrome, idiopathic thrombocytopenic purpura, vasculititis optic neuritis, anaphylaxis, systemic lupus erytymatosus, lichen planus and neuro-muscular disorder.

Of these complications, some are manifested orally or have the potential to manifest orally. Although, most of the complications are self-limiting, some are very serious conditions, which require hospitalization with immediate medical attention.

Hepatitis B vaccination and associated oral manifestations: a non-systematic review of literature and case reports, by B Tarakji et al in Ann Med Health Sci Res. 2014 Nov;4(6):829-36

 

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Reduction of pain during CBT for CFS

Posted on 01/09/2015 by wames

Research abstract

Background: Cognitive behavior therapy (CBT) leads to a reduction of fatigue and pain in chronic fatigue syndrome (CFS). The processes underlying the reduction in pain have not been investigated. Recently, it was shown that increased self-efficacy, decreased focusing on symptoms, increased physical functioning and a change in beliefs about activity contribute to the decrease in fatigue.

Objectives: The present study has two objectives: (1) to determine the relationship between the reduction of fatigue and pain during CBT; (2) test to what extent the model for change in fatigue is applicable to the reduction in pain.

Methods: 142 patients meeting US center for disease criteria for CFS, currently reporting pain, and starting CBT were included. A cross-lagged analysis was performed to study the causal direction of change between pain and fatigue. Pain and process variables were assessed before therapy, three times during CBT and after therapy. Actual physical activity was also assessed. The model was tested with multiple regression analyses.

Results: The direction of change between pain and fatigue could not be determined. An increase in physical functioning and decrease in focusing on symptoms explained 4 to 14% of the change in pain.

Conclusions: Pain and fatigue most probably decrease simultaneously during CBT. Pain reduction can partly be explained by a reduction of symptom focusing and increased physical functioning. Additional, yet unknown cognitive-behavioral factors also play a role in the reduction of pain.

The Process of Change in Pain During Cognitive Behavior Therapy for Chronic Fatigue Syndrome by Lotte Bloot, Marianne J Heins, Rogier Donders, Gijs Bleijenberg, Hans Knoop, in Clinical Journal of Pain 10:1097

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Neurological aspects of human parvovirus B19 infection

Posted on 01/09/2015 by wames

Research abstract

Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated.

The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis.

The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups.

Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications.

Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required.

Neurological aspects of human parvovirus B19 infection: a systematic review by F Barah, S Whiteside, S Batista, J Morris in Rev Med Virol. 2014 May;24(3):154-68.  Epub 2014 Jan 24

 

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Duloxetine – little effect on general fatigue but helps mental fatigue in CFS

Posted on 01/08/2015 by wames

Research abstract

Objective: To assess the efficacy and safety of duloxetine in patients with chronic fatigue syndrome.

Methods: A 12-week, randomized, double-blind study was designed to compare duloxetine 60-120 mg/day (n=30) with placebo (n=30) for efficacy and safety in the treatment of patients with chronic fatigue syndrome. The primary outcome measure was the Multidimensional Fatigue Inventory (MFI) general fatigue subscale (range 4–20, with higher scores indicating greater fatigue).

Secondary measures were the remaining MFI subscales, Brief Pain Inventory (BPI), Medical Outcomes Study Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), CDC Symptom Inventory, Patient Global Impression of Improvement (PGI-I), and Clinical Global Impression of Severity (CGI-S). The primary analysis of efficacy for continuous variables was a longitudinal analysis of the intent-to-treat sample, with treatment-by-time interaction as the measure of effect.

Results: The improvement in the duloxetine group on the MFI general fatigue scores was not significantly greater than the placebo group (P=0.23; estimated difference between groups at week 12 = −1.0 [95% confidence interval −2.8, 0.7]). The duloxetine group was significantly superior to placebo on the MFI mental fatigue score, BPI average pain severity and interference scores, SF-36 bodily pain domain, and CGI-Severity score. Duloxetine was generally well tolerated.

Conclusion: The primary efficacy measure of general fatigue did not significantly improve with duloxetine compared to placebo. Significant improvement in secondary measures of mental fatigue, pain, and global measure of severity suggests that duloxetine may be efficacious for some CFS symptom domains, but larger, controlled trials are needed to confirm these results.

A Randomized, Placebo-Controlled, Double-Blind, Trial of Duloxetine in the Treatment of General Fatigue in Patients with Chronic Fatigue Syndrome by Lesley M. Arnold, Thomas J. Blom, Jeffrey A. Welge, Elizabeth Mariutto, Alicia Heller in Psychosomatics 2014 12:003 Published Online: December 16, 2014

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