Relationship found between CFS and infections

Introduction: Chronic Fatigue Syndrome (CFS) is a complex disorder with a common set of core symptoms and with many secondary symptoms. Underlying chronic infection has been advocated as a contributing factor to CFS, yet its role and the extent of its impact are unconfirmed.

Method: Blood samples were obtained from eighty-eight CFS patients and twenty nine controls. Evidence of infection by certain tick-borne and respiratory pathogens was tested for through the use of nested PCR, western blot, ELISA and IFA.

Results: Of CFS participants, 19% had evidence of exposure to 3 out of 4 pathogen species compared to 3% of controls (p = 0.04). For tick-borne (TB) pathogens, 56% of CFS participants had exposure to at least one, compared to 14% of controls (p < 0.001).

Discussion: The high prevalence of exposure to multiple pathogens within the test group suggests a relationship between CFS and infective agents. As hypothesised in previous studies, the results of this study could contribute towards the argument that chronic infections, as a result of contributing to immune dysregulation, may lead to fatiguing symptoms. More specific forms of investigation using methods that directly measure pathogen levels should be undertaken.

Do certain microbiological pathogens cause or have a role in the aetiology of the disease entity known as chronic fatigue syndrome? By Thomas Kelly in Sydney Digital Theses (Open Access) 14 Apr 2014

 

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Chronic fatigue is complex and multidimensional

Abstract

 

OBJECTIVES: To investigate associated dimensions of fatigue regarding cognitive impairment, psychomotor performances, muscular effort power and circulating cytokine levels and their relations to symptom intensity in a sample of pure chronic fatigue syndrome (CFS) patients without overlapping objective sleepiness or sleep disorders.

 

METHODS: 16 CFS patients were compared to 14 matched controls. We assessed structured symptom-scales, polysomnography, multiple sleep latency tests, attention (Zazzo-Cancellation ZCT, digit-symbol-substitution DSST), psychomotor vigilance and speed (PVT, finger tapping test, FTT), dynamometer handgrip force (tonic and phasic trials) and circulating cytokines (IFN-γ, IL-1b, IL-6, IL-8, IL-10, TNF-α).

 

RESULTS: In addition to fatigue, CFS patients presented with higher affective symptom intensity and worse perceived sleep quality. Polysomnography showed more slow-wave sleep and microarousals in CFS but similar sleep time, efficiency and light-sleep durations than controls. Patients presented with impaired attention (DSST, ZCT), slower reaction times (PVT) but not with lower hit rates (FTT).

Notwithstanding lower grip strength during tonic and phasic trials, CFS also presented with higher fatigability during phasic trials.

Cytokine levels were increased for IL-1b, IL-8, IL-10 and TNF-α and fatigue intensity was correlated to grip strength and IL-8.

 

CONCLUSIONS: In contrast to sleepiness, chronic fatigue is a more complex phenomenon that cannot be reduced to one single measured dimension (i.e., sleep propensity). Showing its relations to different measurements, our study reflects this multidimensionality, in a psychosomatic disorder such as CFS. To obtain objective information, routine assessments of fatigue should rule out sleepiness, combine aspects of mental and physical fatigue and focus on fatigability.

 

Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the chronic fatigue syndrome by D Neu et al in Eur J Appl Physiol. 2014 May 31. [Epub ahead of print]

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Take responsibility for your own health says Health Minister

In a speech today, Mark Drakeford will call on the people of Wales to become ‘custodians’ of their own health

A “new bargain” needs to be struck between the people of Wales and the health service if the NHS is to continue to to thrive during and beyond the age of austerity, Health Minister Mark Drakeford will warn today.

Speaking at the NHS Confederation’s conference in Liverpool, Prof Drakeford will call on people in Wales to take more responsibility for their own health, instead of merely handing over ownership of their problems to the health service to deal with. He will say that while it is the role of the Welsh Government to create the right conditions for people to live healthier lives, members of the public must take advantage of this and fulfil their “duty” to look after themselves, becoming “custodians” of their own health.

He will tell delegates: “Governments have a responsibility to create the right conditions in which individuals can live full and healthy lives, taking responsibility for their own health.

“Each of us has a duty to look after ourselves – we must all become custodians of our own health, instead of handing ownership of our health to the nearest professional as we have traditionally done. “The NHS is there to help us in our time of need but with that comes a responsibility to use its resources wisely. The NHS is free from charge but not free from obligation.

“This then is the new bargain in this ongoing age of austerity – it is the bargain of co-production at an individual and population level. “At an individual level, the health professional and patient must work together, rather than the patient putting their health problem in the hand of the nurse, GP or consultant. The conversation we have with patients cannot always open with the question ‘What can I do for you?’ as though the encounter is one in which the health service takes onto its own shoulders the whole of the responsibility for that encounter.

“On a population level, the new bargain means that everyone accepts responsibility for their own health and a responsibility for managing demand on the NHS while the Welsh Government helps create an environment where it is easier to make healthier decisions while also safeguarding an NHS which remains firm to Bevan’s founding principles of universality, equity and free at the point of delivery.”

His comments come just weeks after the latest Welsh Health Survey showed the number of adults classed as overweight or obese stands at 58%, with 22% of people in the “obese” category alone. Meanwhile, the number of people drinking more alcohol than recommended stands at 42% and 26% of people admit binge-drinking. Just 29% of people do 30 minutes of exercise five times a week and only 33% of people eat five fruit or vegetables a day. But the survey showed some progress in tackling the rates of smoking as prevalence fell from 23% to 21% between 2012 and 2013.

Prof Drakeford’s speech will also echo his commitment to the idea of prudent healthcare, which he first outlined in January and follows the principle that the NHS should focus on what would work best for patients and make the most effective use of available resources.

He is set to highlight examples of where Wales has led the way in terms of improving public health including becoming the first in the UK to vote in favour of banning smoking in enclosed public places and introducing a mandatory food hygiene rating scheme.

He will also point to further proposals outlined in the Welsh Government’s public health white paper, which was published earlier this year. The measures include the introduction of a minimum price for alcohol of 50p per unit to tackle alcohol-related harm and for Wales to become the first in the UK to introduce a ban on e-cigarettes in public places.

Other proposals, which will be subject to consultation until June 24, include whether to make it an offence to deliver a tobacco product ordered online to someone under 18, even if the item was ordered by an adult, and introducing a national register for businesses providing cosmetic piercing, tattooing, semi-permanent skin colouring, acupuncture and electrolysis hair removal.

He will say: “Wales has a strong history of responding to citizens’ concerns and introducing practical regulations which make a positive contribution to protecting health “Taking concerted, collective action to address public health concerns remains one of the most powerful contributions any government can make to the welfare and wellbeing of its population. And I’m very proud that Wales has a long and progressive tradition when it comes to taking action to protect public health in Wales.

“For the nay-sayers, any attempt to protect public health is met with the inevitable cries of nanny-statism but our proposals, such as those outlined in our public health white paper, take a preventative approach by seeking to intervene at points which have most potential for long-term benefits, both in the health of individuals and in helping avoid higher, long-term societal and financial costs associated with avoidable ill health.”

New bargain’ to be struck between public and health service for NHS to thrive in austerity, warns Health Minister Mark Drakeford by Julia McWatt in Wales Online

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Natural killer cells in severe CFS

Abstract
Maintenance of health and physiological homeostasis is a synergistic process involving tight regulation of proteins, transcription factors and other molecular processes.
The immune system consists of innate and adaptive immune cells that are required to sustain immunity. The presence of pathogens and tumour cells activates innate immune cells, in particular Natural Killer (NK) cells.

Stochastic expression of NK receptors activates either inhibitory or activating signals and results in cytokine production and activation of pathways that result in apoptosis of target cells. Thus, NK cells are a necessary component of the immunological process and aberrations in their functional processes, including equivocal levels of NK cells and cytotoxic activity pre-empts recurrent viral infections, autoimmune diseases and altered inflammatory responses.

NK cells are implicated in a number of diseases including chronic fatigue syndrome (CFS). The purpose of this review is to highlight the different profiles of NK cells reported in CFS patients and to determine the extent of NK immune dysfunction in subtypes of CFS patients based on severity in symptoms.

Natural killer cells in patients with severe chronic fatigue syndrome, by E. W. Brenu et al in Autoimmunity Highlights, April 2013

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Do coping strategies improve health in CFS?

Abstract

OBJECTIVE/Hypothesis
The objective of this study was to examine sub-types of individuals with chronic fatigue syndrome based on variables that are associated with the energy envelope theory and to examine the role of coping strategies in explaining the differences found between the subtypes.

METHODS
Cluster analysis was used. Grouping variables included physical functioning, post-exertional malaise severity, and the extent to which an individual was outside of the energy envelope. These clusters were evaluated using discriminant function analysis to determine whether they could be differentiated based on coping styles.

RESULTS
Cluster analysis identified three groups. Clusters 1 and 2 were consistent with the energy envelope theory. However, Cluster 3 was characterized by patients with the most impairment, but they were to a lesser extent exceeding their energy envelope. Coping strategies explained a small percentage (10%) of the variance in differentiating the clusters.

DISCUSSION
Energy maintenance may be associated with improved functioning and less severe symptoms for some. However, patients in Cluster 3 were closer to remaining within their energy envelope and also used higher levels of adaptive coping but were more impaired than Cluster 2.

This suggests that adaptive coping strategies were not associated with improved health, as members of Cluster 3 were severely limited in functioning.

Examining the energy envelope and associated symptom patterns in chronic fatigue syndrome: does coping matter? by AA Brown, MA Evans, LA Jason in Chronic Illness,  12 April 2013

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Couples’ experiences of interacting with outside others in CFS

Abstract

OBJECTIVES

Social isolation and stigma are frequently reported by patients with chronic fatigue syndrome/myalgic encephalomyelitis and relationships in the home environment with those close to the patients (their ‘significant others’) may thus be particularly important. Rather little attention has yet been paid to the beliefs and experiences of ‘significant others’ themselves in this context. This study sought to explore in-depth the beliefs and experiences of both patients and ‘significant others’ in relation to chronic fatigue syndrome/myalgic encephalomyelitis.

METHODS

In-depth interviews using a semi-structured interview schedule designed around the core constructs of the Common-Sense Model of self-regulation were conducted with two patients with chronic fatigue syndrome/myalgic encephalomyelitis and their spouses. Interpretative Phenomenological Analysis was used to analyse interview data.

RESULTS

Experiences of social interactions in relation to chronic fatigue syndrome/myalgic encephalomyelitis with others outside of the relationship dyad emerged as a key issue for all participants when reflecting on their experiences of living with the condition. These concerns are presented under two themes: interactions with healthcare professionals and interactions with the social world.

CONCLUSIONS

It is evident that significant others play an important role in the lived experience of chronic fatigue syndrome/myalgic encephalomyelitis. For both patients and significant others, the wider social world and interactions with outside others may be important influences on dyadic coping in chronic fatigue syndrome/myalgic encephalomyelitis. Both future research and treatment interventions could usefully include a ‘significant other’ perspective.

Couples’ experiences of interacting with outside others in chronic fatigue syndrome: a qualitative study, by Joanna Brooks, Nigel King, Alison Wearden in Chronic Illness, e-pub ahead of print 12 April, 2013

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Brain fog due to reduced blood flow in CFS

Abstract
Chronic Fatigue Syndrome (CFS) is defined as greater than 6 months of persistent fatigue that is experienced physically and cognitively. The cognitive symptoms are generally thought to be a mild cognitive impairment, but individuals with CFS subjectively describe them as “brain fog.”

The impairment is not fully understood and often is described as slow thinking, difficulty focusing, confusion, lack of concentration, forgetfulness, or a haziness in thought processes. Causes of “brain fog” and mild cognitive impairment have been investigated.

Possible physiological correlates may be due to the effects of chronic orthostatic intolerance (OI) in the form of the Postural Tachycardia Syndrome (POTS) and decreases in cerebral blood flow (CBF). In addition, fMRI studies suggest that individuals with CFS may require increased cortical and subcortical brain activation to complete difficult mental tasks.

Furthermore, neurocognitive testing in CFS has demonstrated deficits in speed and efficiency of information processing, attention, concentration, and working memory. The cognitive impairments are then perceived as an exaggerated mental fatigue.

As a whole, this is experienced by those with CFS as “brain fog” and may be viewed as the interaction of physiological, cognitive, and perceptual factors. Thus, the cognitive symptoms of CFS may be due to altered CBF activation and regulation that are exacerbated by a stressor, such as orthostasis or a difficult mental task, resulting in the decreased ability to readily process information, which is then perceived as fatiguing and experienced as “brain fog.”

Future research looks to further explore these interactions, how they produce cognitive impairments, and explain the perception of “brain fog” from a mechanistic standpoint.

Caught in the thickness of brain fog: exploring the cognitive symptoms of Chronic Fatigue Syndrome by AJ Oconin in Frontiers in Integrative Physiology, 5 April 2013

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Lyme disease and Chronic arthropod-borne neuropathy (CAN)

Abstract

SUMMARY  This series of serologically confirmed Lyme disease is the largest reported in the UK and represents 508 patients who presented to one hospital in the South of England between 1992 and 2012. The mean rate of borreliosis throughout this period was 9·8/100 000 population, much higher than the reported national rate of 1·7/100 000. The actual rate increased each year until 2009 when it levelled off.

Patients clinically presented with rash (71%), neurological symptoms (16%, of whom half had VII cranial nerve palsies), arthropathy (8%), pyrexia (5%), cardiac abnormalities (1%) or other manifestations (<1%). Twenty percent of patients had additional non-specific symptoms of fatigue, myalgia, and cognitive changes.

Serological diagnosis was with a two-tiered system of ELISA and immunoblot. There was a marked seasonal presentation in the summer months and in the first and sixth decades of life. A third of patients gave a clear history of a tick bite. The median interval between tick bite and clinical symptoms was 15 days [interquartile range (IQR) 9-28 days], with a further interval of 14 days to clinical diagnosis/treatment (IQR 2-31 days). Most cases were acquired locally and only 5% abroad.

Patients responded to standard antibiotic therapy and recurrence or persistence was extremely rare. A second group of patients, not included in the clinical case series, were those who believed they had Lyme disease based on a probable tick bite but were seronegative by currently available validated tests and presented with subjective symptoms.

This condition is often labelled chronic Lyme disease. These patients have a different disease from Lyme disease and therefore an alternative name, chronic arthropod-borne neuropathy (CAN), and case definition for this condition is proposed. We suggest that this chronic condition needs to be distinguished from Lyme disease, as calling the chronic illness ‘Lyme disease’ causes confusion to patients and physicians. We recommend research initiatives to investigate the aetiology, diagnosis and therapy of CAN.

Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy, by MS Dryden et al in Epidemiol Infect. 2014 May 9:1-12 [Epub ahead of print]

 

 

 

 

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Distinguishing fatigue in different conditions

Abstract

CONTEXT: Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries.

OBJECTIVE: Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features.

METHODS: Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics.

RESULTS: The interview had good internal consistency (Cronbach α “fatigue” = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by “fatigue” or “neurocognitive difficulties” items allocated most patients to one group, whereas “mood disturbance” items correctly classified patients with depression only.

CONCLUSIONS: The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.

Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview, by BK Bennett in Psychosom Med. 2014 May 6. [Epub ahead of print]

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International criteria identifies distinct subgroup in CDC definition of CFS

Abstract

Background: Several diagnostic definitions are available for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) that varies significantly in their symptom criteria. This pilot study was conducted to determine whether simple biological and clinical measures differed between CFS/ME patients meeting the 1994 Centres for Disease Control and Prevention (CDC) criteria, the International Consensus Criteria (ICC), as well as healthy controls.

Methods: A total of 45 CFS/ME patients and 30 healthy controls from the South East Queensland region of Australia provided a blood sample, reported on their current symptoms, as well as aspects of their physical and social health using the Short-Form Health Survey (SF-36), and the World Health Organisation Disability Adjustment Schedule 2.0 (WHO DAS 2.0). Differences were examined using independent sample t-testing.

Results: Patients fulfilling the ICC definition reported significantly lower scores (p < 0.05) for physical functioning, physical role, bodily pain, and social functioning than those that only fulfilled the 1994 CDC definition. ICC patients reported significantly greater (p < 0.05) disability across all domains of the WHO DAS 2.0.

Conclusions: These preliminary findings suggest that the ICC identifies a distinct subgroup found within patients complying with the 1994 CDC definition, with more severe impairment to their physical and social functioning.

A comparison of health status in patients meeting alternative definitions for chronic fatigue syndrome/myalgic encephalomyelitis, by Samantha C Johnston et al in

Health and Quality of Life Outcomes 2014, 12:64

 

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