Chronic Fatigue Syndrome: Shoenfeld Y

Maoz D, Shoenfeld Y. · No affiliation provided · Harefuah. · Pubmed #16642629 No free full text.

Abstract: BACKGROUND: Chronic fatigue syndrome (CFS) is characterized by severe fatigue and other non-specific symptoms. It causes disturbance of normal function. Uncertainty about etiology and the appropriate treatment, combined with high prevalence of psychiatric comorbidity, cause a problem in the perception of the disease by the patient, physician and society. OBJECTIVES: This review recapitulates the updated information regarding CFS. It addresses the following aspects: definitions, diagnosis, demographic figures, etiology and treatment options. Since much about CFS is yet to be known, a large amount of work has recently been performed on this subject. Current perceptions, as recognized today, are also presented. METHODS: A literature search was performed using Medline. RESULTS: Accurate diagnosis of CFS patients is low despite the disabling fatigue. CFS patients present certain demographic characteristics and the illness etiology is as yet unclear. Nonetheless, many possible directions exist with inconclusive evidence about certain suspected causes. There are no treatment guidelines available. Different treatment approaches were investigated without consensus on the results. CONCLUSIONS: CFS is an illness that should be taken seriously by the medical establishment. Conscious awareness of the malady might reduce rates of undiagnosed patients. The different etiologic factors showing some degree of involvement in CFS, might suggest that this syndrome is a multi-factorial condition. Despite the fact that there is no distinct undisputed treatment, there are 2 treatments (cognitive behavioral therapy and graded exercise therapy) that might be effective.

Bassi N, Amital D, Amital H, Doria A, Shoenfeld Y. · Department of Rheumatology, University of Padova, Padova, Italy. · Isr Med Assoc J. · Pubmed #18300582 links to  free full text

Abstract: Chronic fatigue syndrome is a heterogeneous disorder with unknown pathogenesis and etiology, characterized by disabling fatigue, difficulty in concentration and memory, and concomitant skeletal and muscular pain. Several mechanisms have been suggested to play a role in CFS, such as excessive oxidative stress following exertion, immune imbalance characterized by decreased natural killer cell and macrophage activity, immunoglobulin G subclass deficiencies (IgG1, IgG3) and decreased serum concentrations of complement component. Autoantibodies were also suggested as a possible factor in the pathogenesis of CFS. Recent studies indicate that anti-serotonin, anti-microtubule-associated protein 2 and anti-muscarinic cholinergic receptor 1 may play a role in the pathogenesis of CFS. It has been demonstrated that impairment in vasoactive neuropeptide metabolism may explain the symptoms of CFS.

Appel S, Chapman J, Shoenfeld Y. · Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel. · Autoimmunity. · Pubmed #17364497 No free full text.

Abstract: Chronic fatigue syndrome (CFS) is characterized by severe disabling fatigue lasting for more than 6 months associated with physical and mental disturbances such as headache, arthralgia, myalgia, memory impairment, sore throat and tender lymph nodes. The exact pathogenesis is still unknown. Several models were proposed to explain its etiology including chronic infection, endocrine dysfunction, autonomic imbalance, depression, decreased immunity states and an aberrant reaction to infection. No convincing evidence was found to support any of the suggested pathogenic mechanisms. The current concept is that CFS pathogenesis is a multi factorial condition in which an infective agent cause an aberrant immune response characterized by a shift to Th-2 dominant response. When the response fails to be switched-off, a chronic immune activation occurs and clinically expressed as the symptomatology of CFS. Vaccinations are used in order to stimulate the immune system to induce a persistent immunity against the favorable antigens. Several syndromes that contain chronic fatigue as one of their symptoms, such as "Gulf war syndrome" and macrophagic myofasciitis were related to vaccinations. Can vaccinations induce the aberrant immune response of CFS? Little is known about this issue. There are some reports on CFS occurring after vaccination, but few prospective and retrospective studies failed to find such an association. A working group of the Canadian Laboratory Center for Disease Control (LCDC) that was founded in order to examine the suspected association between CFS and vaccinations concluded that there is no evidence that relates CFS to vaccination. Further studies are requested to examine this issue since it is very conceivable that if infection can lead to CFS, vaccination may also lead to it in the same immune-mediated pathogenesis.

Ablin JN, Shoenfeld Y, Buskila D. · Department of Rheumatology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · J Autoimmun. · Pubmed #17071055 No free full text.

Abstract: As the pathogenesis of fibromyalgia continues to raise debate, multiple putative triggers have been implicated. The current review summarizes the available data linking fibromyalgia to either infection or vaccination. Multiple infectious agents have been associated with the development of either full-blown fibromyalgia (e.g. hepatits C), or with symptom complexes extensively overlapping with that syndrome (e.g. chronic Lyme disease). The cases of Lyme disease, mycoplasma, hepatits C and HIV are detailed. Despite the described associations, no evidence is available demonstrating the utility of antibiotic or anti-viral treatment in the management of fibromyalgia. Possible mechanistic links between fibromyalgia and HIV are reviewed. Associations have been described between various vaccinations and symptom complexes including fibromyalgia and chronic fatigue syndrome. The case of Gulf War syndrome, a functional multisystem entity sharing many clinical characteristics with fibromyalgia is discussed, with emphasis on the possibility of association with administration of multiple vaccinations during deployment in the Persian Gulf and the interaction with stress and trauma. Based on this example a model is proposed, wherein vaccinations function as co-triggers for the development of functional disorders including fibromyalgia, in conjunction with additional contributing factors.

Nancy AL, Shoenfeld Y. · Center for Autoimmune Diseases, Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel. · Autoimmun Rev. · Pubmed #18725327 No free full text.

Abstract: BACKGROUND: Chronic fatigue syndrome (CFS) that defines by prolonged fatigue and other manifestations, was recently integrated into a spectrum of central sensitivity syndromes including several diseases as fibromylagia. CFS etiology is multi-factorial commonly triggered by infectious agents. Vaccines, induce an immune response similarly to infections, and may trigger just like infections autoimmune diseases, CFS and fibromyalgia. Furthermore vaccines contain an adjuvant which enhances their immune stimulation. CASE PRESENTATION: A 56-year-old woman was diagnosed with CFS accompanied by fibromyalgia, demyelination and autoantibodies. Her illness begun following the 2nd dose of hepatitis-B vaccine, and was aggravated by the 3rd vaccination. She underwent silicone breast implantation 6 years before vaccination with no adverse events. However, between the 2nd and 3rd vaccination she suffered a breast injury with local inflammation. Upon explanation of her breast implants silicone leak was observed. DISCUSSION: Vaccines have been reported to precede CFS mainly following exposure to multiple vaccinations (e.g. the Gulf war syndrome), or as an adverse response to the vaccine adjuvant (e.g. the macrophagic myofasciitis syndrome). Silicone is considered an adjuvant to the immune system, and may induce "the adjuvant disease". Silicone implant, especially silicone leak relationship with autoimmunity and CFS has been the focus of considerable debates. CONCLUSION: Our patient illness started following hepatitis-B vaccine, suggesting that it was caused or accelerated by vaccination. In parallel to vaccination our patient suffered from breast injury, which might represent the time of silicone leak. The exposure to the adjuvant, silicone, might have augmented her immune response to the vaccine. To the best of our knowledge this is the first case of combined adverse effect to vaccine and silicone. Vaccine safety in individuals with silicone implants requires further studies.