Chronic Fatigue Syndrome and Fibromyalgia

[LymeEnigma]

Chronic Fatigue Syndrome Patients Subsequently Diagnosed
with Lyme Disease Borrelia burgdorferi: Evidence for
Mycoplasma species Co-Infections

Garth L. Nicolson,1 PhD
Nancy L. Nicolson, 1 PhD
Joerg Haier,2 MD, PhD

1The Institute for Molecular Medicine, Huntington Beach, California, USA,
2Department of Surgery, University Hospital, Munster, Germany

Correspondence: Prof. Garth L. Nicolson, The Institute for Molecular Medicine, P.O. Box 9355, S.
Laguna Beach, California 92652. Tel: [phone]; Email: [e-mail]; Website:
www.immed.org

Abstract:

Objective: We examined the blood of 48 North American Chronic Fatigue Syndrome
(CFS) patients subsequently diagnosed with Lyme Disease Borrelia burgdorferi and compared these to
50 North American CFS patients without evidence of Borrelia burgdorferi infections for presence of
Mycoplasma spp. co-infections using forensic polymerase chain reaction. Results: We found that
68.75% of CFS/Lyme patients show evidence of mycoplasma co-infections (Odds Ratio=41.8,
Confidence Limits=11.26-155.16, p<0.001) compared to controls, whereas 50% of CFS patients
without a diagnosis of Lyme Disease Borrelia burgdorferi show mycoplasma co-infections (OR=19.0,
CL=5.25-68.78, p<0.001 compared to controls). Since 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 Borrelia burgdorferi mostly had single species
mycoplasma infections (OR=31.67, CL=8.63-116.16, p<0.001) with a preponderance of M. fermentans
infections (50% of patients, OR=59.0, CL=7.55-460, p<0.001), whereas the most commonly found
Mycoplasma spp. in CFS patients without Lyme Disease was M. penumoniae (34% of patients.
OR=14.94. CL=3.25-68.73, p<0.001). 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.

Full article: sacfs.asn.au/download/Netal-LymeJCFS2008.pdf

[LymeEnigma]

J Clin Virol. 2006 Dec;37 Suppl 1:S39-46.

Is human herpesvirus-6 a trigger for chronic fatigue syndrome?

Komaroff AL.

Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 10 Shattuck Street, Suite 602, Boston, MA 02115, USA. [e-mail]

Chronic fatigue syndrome (CFS) is an illness currently defined entirely by a combination of non-specific symptoms. Despite this subjective definition, CFS is associated with objective underlying biological abnormalities, particularly involving the nervous system and immune system. Most studies have found that active infection with human herpesvirus-6 (HHV-6)--a neurotropic, gliotropic and immunotropic virus--is present more often in patients with CFS than in healthy control and disease comparison subjects, yet it is not found in all patients at the time of testing. Moreover, HHV-6 has been associated with many of the neurological and immunological findings in patients with CFS. Finally, CFS, multiple sclerosis and seizure disorders share some clinical and laboratory features and, like CFS, the latter two disorders also are being associated increasingly with active HHV-6 infection. Therefore, it is plausible that active infection with HHV-6 may trigger and perpetuate CFS in a subset of patients.

PMID: 17276367 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/17276367?dopt=AbstractPlus

[LymeEnigma]

J Infect Dis. 1995 Nov;172(5):1364-7.Links

Erratum in:
J Infect Dis 1995 Dec;172(6):1643.

Prevalence of IgM antibodies to human herpesvirus 6 early antigen (p41/38) in patients with chronic fatigue syndrome.

Patnaik M, Komaroff AL, Conley E, Ojo-Amaize EA, Peter JB.

Specialty Laboratories, Inc., Santa Monica, California 90404-3900, USA.

To evaluate the association between human herpesvirus 6 (HHV-6) and chronic fatigue syndrome (CFS), 2 geographically separate groups of CFS patients (125 and 29 patients, respectively) and healthy controls (150 and 15 controls, respectively) were compared, using an EIA, for antibodies to HHV-6 early antigen p41/38 (EA). Sixty percent (93/154) of CFS patients were were positive for HHV-6 EA IgM, 40% (61/154) were positive for IgG, and 23% (35/154) were positive for both. A total of 119 (77%) of the CFS patients were positive for HHV-6 EA IgG or IgM (or both); only 12% (20/165) of the controls had IgG or IgM to HHV-6 EA. These data demonstrate that more CFS patients than controls had elevated levels of HHV-6 EA-specific IgM, perhaps indicating active replication of HHV-6 in CFS.

PMID: 7594679 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/7594679?dopt=AbstractPlus

[LymeEnigma]

Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study

Ian Hickie, psychiatrist1, Tracey Davenport, biostatistician1, Denis Wakefield, immunologist2, Ute Vollmer-Conna, psychologist3, Barbara Cameron, research fellow2, Suzanne D Vernon, molecular virologist4, William C Reeves, epidemiologist4, Andrew Lloyd, infectious diseases physician2, Dubbo Infection Outcomes Study Group

1 Brain and Mind Research Institute, Sydney University, Sydney, NSW 2050, Australia, 2 School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, 3 School of Psychiatry, University of New South Wales, 4 Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 31033, USA

Correspondence to: A Lloyd [e-mail]

Abstract

Objective To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections.

Design Prospective cohort study following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetii (Q fever), or Ross River virus (epidemic polyarthritis).

Setting The region surrounding the township of Dubbo in rural Australia, encompassing a 200 km geographical radius and 104 400 residents.

Participants 253 patients enrolled and followed at regular intervals over 12 months by self report, structured interview, and clinical assessment.

Outcome measures Detailed medical, psychiatric, and laboratory evaluations at six months to apply diagnostic criteria for chronic fatigue syndrome. Premorbid and intercurrent illness characteristics recorded to define risk factors for chronic fatigue syndrome. Self reported illness phenotypes compared between infective groups.

Results Prolonged illness characterised by disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance was evident in 29 (12%) of 253 participants at six months, of whom 28 (11%) met the diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors.

Conclusions A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.

Full article: www.bmj.com/cgi/content/full/333/7568/575

[LymeEnigma]

J Med Virol. 1995 Feb;45(2):156-61.

Detection of enterovirus-specific RNA in serum: the relationship to chronic fatigue.

Clements GB, McGarry F, Nairn C, Galbraith DN.

Regional Virus Laboratory, Ruchill Hospital, Glasgow, United Kingdom.

The serum of 88 chronic fatigue patients was screened for enteroviral specific sequences by polymerase chain reaction (PCR) assay. The PCR method used was "nested" PCR targetting the 5' nontranslated region of the enteroviral genome which yielded a final fragment length of 264 base pairs. Samples were obtained from patients during 1990-1991. In addition, buffy coat specimens and stool specimens were examined in some patients. Samples from two cohorts of comparison individuals were also obtained. The comparison groups were firstly, acutely ill individuals with symptoms consistent with a presumed enteroviral infection (matched by age, sex, and date of receipt of specimen) and secondly, healthy individuals (matched by age and date of receipt of specimen). Enteroviral specific sequences were detected in 36 of 88 serum samples from chronic fatigue patients, 22 of 82 acutely ill individuals, and 3 of 126 healthy individuals. The enteroviral PCR positivity did not correlate with any one particular feature of chronic fatigue nor did it reflect any history of illness at onset of fatigue, duration of fatigue, or age of patient. These results provide new evidence for the presence of enteroviral specific sequences in serum, buffy coat, and stool samples in many patients with chronic fatigue. This may reflect a persistent enterovirus infection in a proportion of chronic fatigue patients.

PMID: 7775934 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/7775934?dopt=AbstractPlus

[LymeEnigma]

Sporadic postinfectious neuromyasthenia

Irving E. Salit

Abstract
Outbreaks of epidemic neuromyasthenia have occurred throughout the world for many years, but sporadic cases have only recently been recognized. Fifty consecutive previously well patients with prolonged and excessive fatigue after an apparent acute infection were investigated. Most were well educated, active, unmarried women aged 30 to 40 years. The precipitating infection had many clinical presentations. The chronic phase of the illness was characterized by a fairly common set of symptoms. Physical examination and laboratory testing generally gave normal results. Of the 50 patients 16 were found to be infected with Epstein-Barr virus, 7 with other viruses, 4 with parasites and 2 with Mycoplasma pneumoniae. The caustive agent was not known in 22 cases. The mean duration of the illness was 27.6 months, and the mean proportion of time lost from work or school was 39%. Drug therapy was not beneficial; supportive therapy was useful. Further investigation is required to determine optimal management of sporadic neuromyasthenia.

Full article: www.pubmedcentral.nih.gov/picrender.fcgi?artid=1346266&blobtype=pdf

[LymeEnigma]

Persistence of enteroviral RNA in chronic fatigue syndrome is associated
with the abnormal production of equal amounts of positive and negative
strands of enteroviral RNA

Louise Cunningham, 1 N. E. Bowles, l~ R. J. M. Lane, 2 V. Dubowitz 3 and L. C. Archard l*

1Department of Biochemistry, Charing Cross and Westminster Medical School St Dunstan's Road, London W6 8RF,
2Regional Neurosciences Centre, Charing Cross Hospital (Fulham), Fulham Palace Road, London W6 8RF and
3Department of Paediatrics, Royal Postgraduate Medical School Hammersmith Hospital Du Cane Road,
London W12 OHS, U.K.

Abstract:

A subgenomic restriction fragment from cDNA prepared
from Coxsackie B2 virus (CVB2) RNA was
snbcloned into a riboprobe vector allowing the production
of enteroviral group-specific RNA probes complementary
to either the positive (genomic) or negative
(template) strand of enteroviral RNA. These riboprobes
were used to follow productive infection of
cultured cells by CVB2; as expected, positive strand
RNA was synthesized in approximately 100-fold
excess over negative strand. RNA was extracted from
muscle biopsy samples from patients with chronic
fatigue syndrome and probed for the presence of
enteroviral RNA. In cases where enteroviral RNA was
detected the amounts of positive and negative strands
of enteroviral RNA were approximately equal, in
contrast to the situation in tytic infection of cultured
cells. This suggests that entrovirus pesistence in muscle
is due to a defect in control of viral RNA synthesis.

Full article: vir.sgmjournals.org/cgi/reprint/71/6/1399

[LymeEnigma]

Arthritis Rheum. 1991 Oct;34(10):1319-24.

Fibromyalgia and parvovirus infection.

Leventhal LJ, Naides SJ, Freundlich B.

Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.

An infectious cause of fibromyalgia (FM) has been hypothesized based upon the observed similarity of this entity and chronic fatigue syndrome. Three patients developed symptoms of FM after documented episodes of acute parvovirus B19 infections. B19 antibody determinations were obtained approximately 1 month after the symptoms began; both IgM and IgG titers were positive at that time. All 3 patients met criteria for FM. Polysomnography performed on 2 of the patients revealed profound alpha-wave intrusion throughout nonrapid eye movement sleep. A more careful search for viral infections in FM patients whose symptoms appear following a "flu-like" illness appears warranted.

PMID: 1657005 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/1657005?dopt=AbstractPlus

[enochroot]

Great work - makes me want to give the anti virals a shake - I will use THAT to make
this nuisance call to my GP (CIGNA/PT) worthwhile!

[LymeEnigma]

Good luck!!!