Evidence of Atypical Chronic Fatigue Syndrome (CFS)

Chronic fatigue syndrome symptoms have been baffling for decades — but biological evidence of an atypical form of CFS may help diagnose and treat the condition.

Some doctors, and even families, have characterized chronic fatigue syndrome (CFS), sometimes called myalgic encephalomyelitis (ME), as a psychological problem instead of a physical illness. After all, despite decades of research, no cause of the debilitating disorder has been pinpointed. However, the Centers for Disease Control and Prevention (CDC) says CFS patients have real symptoms — such as profound fatigue, body-wide aches and pains, sleep disturbances, and brain “fog” —  and research Is revealing clues about how CFS is triggered.

For example, scientists are using high tech molecular methods to search blood from CFS patients for previous infections. So far, the CDC reports, no single infectious agent has been identified as the cause of CFS. But several different infections — including Epstein-Barr virus, Ross River virus, and Coxiella burnetti — are linked to chronic fatigue syndrome symptoms in 10 to 12 percent of cases.

Now a study headed by scientists at Columbia University’s Mailman School of Public Health has found tell-tale biological evidence of changes in the immune system in two groups of people with CFS.

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“We now have biological evidence that the triggers for ME/CFS may involve distinct pathways to disease, or, in some cases, predispose individuals to the later development of serious comorbidities,” said Mady Hornig, MD, Columbia University associate professor of epidemiology and lead author of the study.

Chronic fatigue syndrome symptoms

All the patients investigated had similar chronic fatigue syndrome symptoms, but how their condition first developed was different. One group’s symptoms began, as the condition typically does, soon after a flu-like illness. The second group of patients with atypical CFS became ill with debilitating fatigue months after contracting viral encephalitis or traveling in a foreign country or after receiving a blood transfusion.

Unlike the group of classic CFS patients, many in the atypical group had developed another serious illness along with CFS, including Gulf War illness, seizures, and multiple sclerosis-like disorders. Those with atypical CFS were also far more likely than typical CFS patients, and the general population, to have been diagnosed with a wide range of cancers.

For their CFS study, the Columbia University researchers measured levels of 51 immune biomarkers in cerebrospinal fluid samples taken from 32 volunteers with typical CFS and 27 volunteers with the atypical form of the condition.

What is chronic fatigue syndrome?

The analyses provided more evidence CFS is a real condition. All the CFS patients had signs of an unbalanced or dysregulated immune system with immune system markers were dramatically out of kilter within the central nervous system, compared to people who don’t suffer from CFS.

Those with atypical CFS had lower levels of certain important immune molecules, including significantly lower levels of interleukin 7, a protein associated with viral infections, and interleukin 17A, chemokine and ligand 9 — immune molecules linked to regulating inflammation and implicated in several neurological disorders.

What’s more, these abnormal levels of immune molecules were far more likely to remain steady or to become even more unbalanced over the years in the atypical CFS patients, compared to the people with the classic form of CFS. According to the researchers, this suggests there is an ongoing, “smoldering,” or chronic inflammation associated with atypical CFS.

“Early identification of patients who meet the usual clinical criteria when first diagnosed but then go on to develop atypical features would help clinicians like myself identify and treat these complex cases,” said study co-author Daniel L. Peterson, MD, a physician at Sierra Internal Medicine in Incline Village, Nevada, who treats CFS patients.

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