Clinical reality has proved over the years that chronic fatigue syndrome (CFS) is a complex disorder, which does not have one absolute cause behind it. Rather, there are multiple underlying causes that feed off of each other and together manifest as chronic fatigue. Further, the group of factors that may cause one person's illness may be different from someone else with similar symptoms.
Infections can either trigger or contribute to CFS. These may include viruses such as Epstein Barr or herpes, or bacterial infections, including Lyme disease. Chronic fatigue syndrome is not a “mysterious” disease anymore. It can be treated, if all underlying factors are properly diagnosed and addressed.
Infections Present With Chronic Fatigue Syndrome
Numerous studies have demonstrated a high incidence of chronic infections in chronic fatigue syndrome. These include viral infections of Epstein Barr (EBV), cytomegalovirus (CMV), human herpes virus-6, (HHV-6), and bacterial infections such as mycoplasma, chlamydia pneumonia (CP) and Borrelia burgdorferi (Lyme disease).
A study published in Acta Pathologica, Microbiologica et Immunologica Scandinavica found that 52% of CFS patients had active mycoplamsa infection, 30.5% had active HHV-6 infection, and 7.5% had Chlamydia pneumonia infections vs. only 6%, 9% and 1% of controls, respectively.
Another study published in the Journal Immunology and Medical Microbiology also confirmed there is a high incidence of active mycoplasma infection among European CFS patients. It was revealed that 68% of these patients had an active mycoplasma infection as diagnosed with specialized polymerase chain reaction (PCR) testing.
Why Are These Infections Present in Chronic Fatigue Syndrome Patients?
Due to the immune dysfunction seen in CFS patients, there may also be a lack of IgG antibodies present. It has also been shown that the presence of antithyroid antibodies in CFS patients has a significant correlation with active HHV-6 infection. There is also evidence that CFS may be due to the above discussed infections with “stealth adaptation”. This notion refers to certain viruses, which can avoid immune elimination by deleting genes required for effective antigenic recognition by the cellular immune system. Such viruses don’t have to confront the body’s cellular immune defense mechanisms and can, therefore, evade the immune system and create persistent ongoing infections.
Why Are These Infections Often Undetected?
There is controversy regarding the presence of active infections in CFS patients because physicians, including infectious disease specialists, do not understand that the standard way to diagnose acute infections, an elevation of IgG and IgM antibodies, is not a sensitive means of detecting chronic infections in such cases.
Chronic reactivating infection, such as those mentioned above, do not stimulate IgM antibodies as they are not new infections, but rather intracellular reactivating infections. Most doctors will tell patients who have elevated IgG antibodies that they had an old infection or previous exposure and that there is no evidence of, or they do not have an active infection, because that is what they learned in medical school. But this standard way of detecting active infections has clearly been shown to be inaccurate and miss the overwhelming majority of patients with active infections.
Polymerase chain reaction (PCR) testing is much more sensitive in a research setting than in the clinical setting because if the blood sits for more than a few hours, the infectious organism’s DNA degrades and often goes undetected. The lack of sensitivity is also determined by the fact that these infections are not concentrated in the blood, but rather in the tissues, especially nerves, brain and the white blood cells.
Physicians must have a high incidence of suspicion and look for elevated IgG or early antigen (EA) antibodies along with other signs of chronic infections including low natural killer cell activity, high RNAse-L activity, high ACE (> 35), coagulation activation, high tumor necrosis factor (TNF), low melanocyte stimulation hormone (MSH), high interleukin-6 (IL-6), low WBC, increased 1-25 vitamin D/1-25 vitamin D ratio and elevated or decreased total IgA, IgM or IgG levels.