I wanted to take a short break from our regularly scheduled blog on nightmares to talk about a recently published article, by Dr. John Chia in The Journal of Clinical Pathology. It concerned a well-known but very difficult disease to describe and diagnose called Chronic Fatigue Syndrome (CFS).
First, some important background: While many people think of CFS as a "new age" diagnosis, it has actually been around for many years. Back in 1750 people described it as "febricula" or little fever. After many name changes and lots of very controversial diagnostic criteria through out the years, its safe to say that this disease has had a long history. It is estimated that more than 1 million people in the USA suffer from CFS, however probably less than 20% have been diagnosed.
According to the Center for Disease Control (1994), CFS is defined as:
Clinically evaluated, unexplained, persistent or relapsing fatigue lasting for 6 months, whose symptom start can be pinpointed, is not the result of ongoing exertion, is not alleviated by rest, and leads to a significant reduction in the patient's previous level of functioning at educational, social, occupational, or personal activities.
In addition there should be four or more of the following persistent or recurring symptoms: problems with memory or concentration, sore throat, tender lymph nodes (aka "swollen glands"), muscle ache, joint pain, headaches, unrefreshing sleep, and a general feeling of being unwell for more than 24 hours after physical exertion.
As you might be able to tell from the definition, the symptoms are vague and difficult to pin down with any diagnostic tests. This has led many people and medical professionals to doubt the existence of CFS as a disease. This problem has been compounded by the inability of scientists to find a cause. Various possibilities have been explored. These include Ebstein-Barr virus (the virus that causes mononucleosis), Lyme disease, problems with the immune system (i.e. autoimmunity, where the cells in the body "attack" other cells), hormonal deficits, and even depression. Unfortunately, none of these hypotheses have fully panned out as a cause of CFS.
Given that background, we can appreciate this new and exciting research.
Dr. Chia, driven by his 14 year old son being diagnosed with CFS in 1997, has now discovered a possible viral link to CFS. An interesting note is that his son is co-author of this paper. While most previous research has tried to find viruses in the blood and in the muscle, Dr. Chia performed stomach biopsies in 165 patients with CFS, who had persistent or intermittent gastrointestinal symptoms. They were looking for evidence of enterovirus, a common pathogen associated with acute respiratory and gastrointestinal problems. They compared these biopsies to biopsies from healthy volunteers and discovered that while 82% of patients with CFS showed evidence of persistent enterovirus infection, only 20% of normal patients had evidence of enterovirus. This may help prove an association between enterovirus infection and CFS.
The reason why this is such exciting news is because it may help doctors and scientists to have both an easier task of diagnosing CFS and developing effective treatment measures while allowing monitoring of the patient's response to therapy.
Published On: October 04, 2007