Dear Collegues: I think we need to clarify that chronique fatigue syndrome (CFS) is a severe diagnosis to be established by a psychiatrist. At the Intl. Conference for Clinical Immunology in Amsterdam (19.-22.6.97, published in The Immunologist) there was a session making clear that in CFS there is no significant relationship to immunological parameters esp. lymphocyte subsets. On the other hand there are patients with fatigue probably induced by chronic viral infection where the number or activity of NK cells may be reduced and non-MHC-restricted T cells might be elevated to compensate. These often do not fullfill the criteria of true CFS. To avoid further misunderstanding another term should be coined for these patients (eg. post viral fatigue), as these discussions last for a long time. It is often hard to find the causative virus when the popular immunosuppressive ones like EBV, CMV, varicella etc. have been excluded beside. Of course other differential diagnosis have to be excluded first as pointed out by Lachy McLean becuase they are more frequent and the lab tests are less expensive. There have been reports of successful interferon or virostatic treatment but it is still a grey area in medicine that requires thorough research. Many viruses replicate in human leukocytes and cause a phase of immunosuppression where the susceptibility to bacterial infections is increased. In the post viral patients it would be nice to know the preinfection data to answer the question who was first chronic infection or NK (?) immunodeficiency (disregarding the HLA issue). Another diagnostic problem we encounter is the differentiation among eg. arthritis (or autoimmune disease like SLE) and viral infection to justify eg. cortisone treatment. In both cases there are similar signs of immune activation. I look forward to see further comments. Thomas Nebe Dr.med. C. Thomas Nebe Universitaetsklinikum Mannheim Zentrallabor Theodor-Kutzer-Ufer 1-3 D-68167 Mannheim Tel. +49 621 383-3485 FAX +49 621 383-3819 e-mail: thomas.nebe@ikc.ma.uni-heidelberg.de http://www.ma.uni-heidelberg.de/inst/ikc/ > -----Original Message----- > From: Lachy McLean [SMTP:l.mclean@auckland.ac.nz] > Sent: Sunday, July 04, 1999 4:18 AM > To: Cytometry Mailing List > Subject: CHRONIC FATIGUE SYNDROME > > > While acknowledging that it is a very debilitating problem for > many of these patients, there is really NO agreed organic > pathology in CFS beyond that secondary to chronic physical > deconditioning. No shortage of hypotheses (chronic infection et > al) but none that have stood the test of time. > > It's hard to see the clinical utility in immunophenotyping unless > it's part of a well defined research protocol (sorry if that's > the case Mike, you didn't say). The only justifiable > investigations in routine clinical management are those directed > at excluding a treatable alternative diagnosis eg hypothyroidism, > Vitamin B12 deficiency, SLE. > > I have a number of patients with Chronic Fatigue Syndrome / > Fibromyalgia (90% of patients with either label fulfill criteria > for the other) and only wish we had something more effective to > offer - unfortunately treatment is often as unrewarding as lab > investigation. > > Lachy McLean > Rheumatologist / Clinical Immunologist > <<ATT01256.ATT>>
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