Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) is a medically unexplained disorder. Patients afflicted with CFS often report severe fatigue, flu-like symptoms, and neuropsychological impairments, which can include mental “fogginess”, decreased concentration, poor memory, low motivation, diminished mood, and increased duration of sleep.
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The Centers for Disease Control and Prevention estimate that between 1 and 4 million Americans have CFS, but less than 20% have actually been correctly diagnosed. The diagnosis of CFS is usually not made until fatigue has been present for at least six months, is unrelieved by bed rest, and is accompanied by cognitive symptoms, such as memory impairment or poor concentration. There are often somatic symptoms, such as flu-like symptoms, muscle or joint pain. While six months is the minimum required duration to consider the diagnosis, some patients have a chronic, unremitting course lasting years. Although CFS was initially thought to be a psychosomatic illness, research has shifted to determining the biological basis to the disorder.
It is not a surprise that infectious agents also may trigger psychiatric symptoms. Most people have experienced fatigue and mental fogginess during an acute viral infection. But there is now evidence that a number of infectious agents can induce chronic infections leading to long-standing or progressive psychiatric symptoms. For example, the association between infectious agents and schizophrenia is a long-standing one. Studies based on populations affected by the Nazi blockade of cities in Netherlands during World War II showed that mothers who were ill or under starvation conditions during the second trimester of pregnancy were at much higher risk of having a child with schizophrenia. In 2008, a large Swedish national cohort study of 1.2 million children born between 1973 and 1985 and followed for over 20 years showed an increased incidence of schizophrenia in people who had childhood infections of the mumps virus or cytomegalovirus (CMV). Recent studies have shown that the DNA of Herpes-1 virus (the cold sore virus) is located in the pathological plaques in Alzheimer’s disease.
Over the years, numerous studies have demonstrated a link between chronic viral infections and a number of conditions that alter brain function. For example, research has shown a number of chronic viral infections can be found in patients with Chronic Fatigue Syndrome (CFS). Viruses such as Epstein-Barr virus (EBV), CMV, and several herpes viruses (e.g., Herpes 1, 6, 7 – HSV-1, HHV-6, HHV-7) cause or contribute to the symptoms of a large percentage of patient with CFS. These infections are generally not acute, but represent intracellular reactivation of an old infection; hence, an elevation of IgM antibodies is typically not seen with active infections of EBV, CMV, or HHV-6. Careful studies have shown 70% of patients with CFS had active HHV-6 infection through the use of primary cell cultures and confirmation using assays of monoclonal antibodies specific for HHV-6 proteins and by PCR. Moreover, a higher proportion of CFS patients have multiple simultaneous infections, such as HHV-6 and HHV-7. Research also has revealed chronic occult bacterial infections in patients with CFS. This, in part, reflects a compromised immune system.
CFS can often be confused with depression. Patients have low energy, loss of interest in activities, increased sleeping, and often low mood – all of which are symptoms that would meet the diagnostic requirements for depression. As a result, patients can be diagnosed with depression and treated with antidepressants. These are often ineffective for CFS, as one might expect. A significant proportion of patients with “treatment-resistant depression” may in fact have CFS or some other chronic viral infection.
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