Consultations & Comments - Chronic Fatigue Syndrome: Is Infection to Blame?

Is chronic fatigue syndrome related to infection? If so how does this affect the approach to therapy? — MD Because patients with chronic fatigue syndrome (CFS) frequently report an infection-like event at the onset of their condition, the possible role of viral or other infections has been extensively investigated.1 Epstein-Barr virus, Cytomegalovirus, human herpesviruses 6 and 7, varicella-zoster virus, influenza virus, Brucella abortus, Borrelia burgdorferi, Mycoplasma species, Chlamydia, and  Toxoplasma gondii have been studied as possible causes.  Although higher rates have been detected for antibodies against certain pathogens (eg, Mycoplasma2), no evidence is currently available to support the idea that a persistent infection by any of these agents causes CFS. In addition, no correlation has been found between altered immunologic patterns and elevated antibody titers against any known human viruses.3,4 Therefore, there are no current recommendations to treat patients with CFS based on targeting one of these pathogens. Even so, the possibility of an infection-like event that serves to trigger CFS by altering the homeostasis of the host remains to be explored further. — Henry C. Lin, MD Associate Professor of Medicine Keck School of Medicine University of Southern California Los Angeles REFERENCES: 1. Evengard B, Klimas N. Chronic fatigue syndrome: probable pathogenesis and possible treatments. Drugs. 2002;62:2433-2446. 2. Endresen GK. Mycoplasma blood infection in chronic fatigue and fibromyalgia syndromes. Rheumatol Int. 2003;23:211-215. 3. Landay AL, Jessop C, Lennette ET, Levy JA. Chronic fatigue syndrome: clinical condition associated with immune activation. Lancet. 1991;338:707-712. 4. Fye KH, Whiting-O’Keefe QE, Lennette ET, Jessop C. Absence of abnormal Epstein-Barr virus serologic findings in patients with fibrosis. Arthritis Rheum. 1988;31:1455-1456.