T he C hronicles of C hronic F atigue C hronic fatigue syndrome as an infectious disease : a review of etiological agents Amy Hassenberg Chronic fatigue syndrome has long walked the fine line between being categorized as a mental or a physical disease. More common in women and middle-aged patients, the disease displays symptoms which include chronic fatigue, loss of concentration, musculoskeletal pain, joint pain, severe headache, and extreme exhaustion that last at least six months or longer (Mayo Clinic 2000). Because these are just symptoms (subjective self-reports of the patient) and no physical signs or definitive laboratory methods of diagnoses exist, there is often a stigma attached to whether or not the condition is of psychiatric or physical origin. Recently, however, there has been evidence linking chronic fatigue syndrome to a slew of infectious agents, prompting public health officials to reevaluate the syndrome as an infectious disease. “I s I t A ll I n M y H ead ?” The name “syndrome,” rather than “disease” proper, suggests that chronic fatigue is a figment of the mind; some psychiatrists go so far as to write off the clinical manifestations as simply hypochondriac in nature. In fact, the most common misdiagnoses in patients with (CDC 2006). Because of the nonspecific symptoms and the confusion in pinpointing the origin of the fatigue, it is hard to estimate the number of affected individuals—the CDC estimates it at one million Americans with 80% of cases undiagnosed. Chronic fatigue syndrome has always been closely associated with psychiatric disorder. A study done at the University of Leeds found that patients who had developed chronic fatigue were nine times more likely to have suffered stressful events and difficulties in the three months before the onset of disease than were healthy subjects (Hatcher 1991, 387). Chronic fatigue syndrome patients were also more than three times as likely to suffer from depression. However, Leonard Jason, a professor of psychology at DePaul University in Chicago, when interviewed about the disease reported, “If you ask a person who is depressed, ‘What would you do tomorrow if you were better?’ they say, ‘I don’t know.’ Chronic fatigue sufferers will give you a list of ten things,” (Schorr 2005). H ints of an I nfectious A gent There have been many hypotheses as to the etiology behind chronic fatigue syndrome from purely psychological notions to actual infectious agents. In recent years, however, there has been a greater push towards finding a biological cause of the syndrome for a variety of reasons. First of all, epidemics of chronic fatigue syndrome are sometimes centered about a geographic location, suggesting a common source of a microorganism, or the communicability of a microorganism. Outbreaks in Lake Tahoe, Utah; Key West, Florida; and Punta Gorda, Florida have occurred where dozens of people would acquire chronic fatigue syndrome simultaneously. Entire hospital staffs in both LA county and London, UK have also fallen victim to this syndrome (Patarca-Montero 2004). It is not just a Western affliction, as outbreaks have been documented in remote places like South Africa and tribal New Zealand. Secondly, researchers have found evidence that suggests that in a time of high stress, a viral infection can damage the central nervous system, causing changes in the immune system which reflect the traditional symptoms of chronic fatigue. In various studies, there has been evidence of an elevated number of natural killer cells and activated CD2 cells and T8 cells. While these may be signs of chronic stress and depression, once again suggesting the psychiatric origin of the syndrome, they are also signs of recurrent viral infections (Holmes 1991, 387). In fact, most patients who suffer episodic bouts of chronic fatigue B S J “Because these are just symptoms (subjective self- reports of the patient) and there are no physical signs or definitive laboratory methods of diagnoses, there is often a stigma attached to whether or not the condition is of psychiatric or physical origin” chronic fatigue syndrome are major depression and somatoform disorders which can manifest themselves in physically similar symptoms (Fukuda, et al 1994, 953). There is currently no standard treatment available for the debilitating disease. The syndrome is typically long lived and the rate of recovery is as low as 5% of cases. As a result, it usually consumes a patient’s life 10 • B erkeley S cientific J ournal • I nfectious D isease • F all 2010 • V olume 14 • I ssue 1
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