Friday, September 21, 2012

Chronic Fatigue Syndrome- Not Caused by an Infectious Disease

Here is a brief commentary in the NY Times on chronic fatigue syndrome. Recently, chronic fatigue syndrome has been linked to infection with xenotropic murine leukemia virus-related virus (XMRV). Many were skeptical. Over the years, the syndrome has been associated with other viruses such as EBV,CMV and HHV6, none of which has held up to scientific scrutiny.  

Journal mBio reported the results of a prospective, multicenter analysis of chronic fatigue and XMRV and found no evidence of XMRV infection. 

The etiology of chronic fatigue syndrome remains elusive. I am sympathetic for those who suffer from chronic fatigue. As a profession, we must not mislead patients by suggesting that the malady is an infectious disease or that a simple cure or treatment is at hand.

It is time to move on.

1 comment:

  1. I'm sure you are aware that eliminating two viruses out of many does not mean ME/CFS is or is not an infectious disease.

    It means these two specific viruses do not cause this disease (ICD-10 G93.3).

    The reason Alter et al looked specifically at patients with an infectious trigger (and excluded patients with psychiatric disorders) is because many of the symptoms of ME/CFS are common to infectious disease - swollen lymph nodes, fatigue, new onset of headaches, nausea, muscle pain.

    In 2006 the CDC did a study with multiple pathogens and concluded that the severity of the infection was key not which pathogen or psychological factors. This fits with the immunological research.

    According to Dr Lipkin, in a Twiv podcast with Columbia University virologist Dr. Vincent Racaniello, he has no intention of dwelling on XMRV or pMLV. Instead the focus at the Columbia University Center for Infection and Immunity has moved on to a metagenomics study and biomarkers for ME/CFS. The CDC also has a metagenomics study in the works as do other researchers some of them the same researchers that could not confirm XMRV or pMLV in ME/CFS. As the authors of Shin et al 2011 stated, "It is also vital to state that there is still a wealth of earlier data (2, 10) to encourage further research into the involvement of other infectious agents in CFS, and these efforts must continue.

    No one is misleading patients, but not everyone understands the biomedical research or is familiar with it.