CFS A Medical Menace

Infectious disease states can be associated with fatigue of varying degrees. Chronic bacterial infections associated with continuous debilitating fatigue are uncommon since the advent of modern antibiotic therapy. Unfortunately, there is a much smaller drug-armentarium to be used against viruses and organisms such as the causative agent in Lyme's disease. Post-viral fatigue syndromes, however, are seen commonly after a variety of viruses, the best-known of which is Epstein-Barr Virus (EBV), or the cause of the common variety of infectious mononucleosis. The term infectious mononucleosis syndrome was coined in medical literature in 1920. Since that time a wide-ranging variety of viruses is known to cause an infectious mononucleosis syndrome. Some examples of such viruses are adeno-viruses, coxsackie viruses, cytomegalic virus (CMV) and a variety of enteroviruses. Some authorities view CFIDS, or CFS, as a chronic viral reactivation syndrome (See Table 1 for a pathophysiology of CFS). There is a great deal of controversy currently as to how many viruses may be involved, and teams of suspect-viruses have been postulated with some cases suspected to have 5 or more viruses possibly interacting to cause clinical CFIDS. Even animal viruses such as the Spuma Virus are under clinical investigation. In some cases, a retrovirus similar to HLTV-2 appears to play an important role, especially where the central nervous system has been damaged and neurologic symptoms are prominent.

A first diagnostic approach to ascertain if an individual has CFIDS, or CFS, must include a work-up or diagnostic evaluation to exclude other important or serious causes of chronic fatigue such as: anemia, arthritic diseases, cancer, collagen-vascular diseases such as lupus erythematosis, acute or chronic Lyme's Disease, inflammatory bowel diseases, malnutrition and malabsorptive states, parasitic infections and finally, of course, AIDS.

Once this type of complete clinical evaluation has excluded the above types of fatigue causes, although any of these can and often does coexist with CFIDS, then the current clinical state of the individual must be ascertained by physical and laboratory evaluation. It isn’t unusual to find that as a result of viral activity or infection there may be inflammatory disease of the muscles, tendons, joints, liver, pancreas, thyroid, central nervous system and also of the gastrointestinal tract, including the stomach, small bowel and colon.

Also, in as many as 50% or more of CFIDS sufferers, there is an exacerbation , or flare-up of allergies (Strauss and others see bibliography**). Mild or borderline allergies may become moderate to severe in nature, and asthma can become active or, if already present, can become more severe.

Clearly, as previously outlined, the individual with CFIDS, or CFS, can be seriously or severely ill, and total disability is not uncommon for some period of time. Some cases suffer a more on-and-off clinical course.

The challenge to the treating physician is a therapeutic one. In over ten years of treating such cases, Dr. Mazlen’s approach is complimentary in nature; it includes diet and nutritional interventions, medical, nutritional and/or drug therapy for the complications that occur, life-style adjustments, therapeutic exercise and stress management.

It should be emphasized that stress can reactivate Epstein-Barr Virus (EBV) (see paper of Ronald Glaser and others in Dr. Mazlens’s bibliography**). In their study, even examination stress among medical students could trigger measurable EBV (latent) reactivation. Dr. Mazlen’s experience is that all varieties of stress; emotional, physical and socioeconomic, are associated with relapses which can be mild to severe in degree.

It is the overall impression that successful treatment of the individual with CFIDS, or CFS, must be the treatment of the whole person in context with his or her total environment. This is the philosophy that guides Dr. Mazlen’s treatment programs, which includes nutritional support, drug therapy, psychological support groups, exercise programs and IV treatments such as gamma-globulin and others.

There are several researchers currently investigating the possibility of other novel or new viruses in the causation of CFS. Some viruses under investigation are the Spuma Virus and a mystery AIDS-like virus.

More recently in the 1990’s, attention has been drawn to another family of viruses as a cause of post-viral fatigue syndrome, and possibly a cause of CFIDS as well; namely, the coxsackie virus. British Scientists and medical researchers in England discovered coxsackie viruses to be the cause of a mid-1980’s epidemic of post-viral fatigue syndrome. Previously known and studied, this family of enteroviruses had been shown to cause meningitis, myocarditis, pericarditis, pleurisy, pleuritis, hepatitis and pancreatitis among other disease states. Some of the various A and B serotypes of this enterovirus family have more characteristic disease-state profiles, but what is important to the understanding of CFIDS is their ability to produce viral persistance in an infected host, and thus to cause chronic, relapsing disease states in humans. (Table 3 bottom of page)

Coxsackie B virus has been implicated in widespread or localized myalgia, also known as Bornholm Disease, which was first described in the late 1800’s, characterized by fever and chest and/or abdominal pain. This form of epidemic pleurodynia has been prevalent in the greater metropolitan New York region for over 2 years. The emerging picture stemming from this regional epidemic included numerous cases of both coxsackievirus mononucleosis (or post-viral fatigue syndrome) and exacerbated or relapsing CFIDS. The importance of being aware of this possible contribution of apparent CFS cases is that coxsackievirus B (post-viral syndrome) may persist anywhere from 2 months to 2 years independent of what other concomitant infectious diseases may be present. Most often, persistent coxsackievirus B infection affects muscles, reduces exercise tolerance and causes muscle pain commonly referred to as myalgia, and can be a cause of fibromyalgia rheumatica.

Table 1 - Pathophysiology of Chronic Fatigue Syndrome