CFS - can be caused by chronic infection

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When one is ill with a virus, it is not the virus which makes one feel ill, it is the body's response to that virus. The immune system fights infections by releasing immune mediators like interferons, cytokines (cell killers) etc. These substances, our own toxins, are thought to be the substances which make CFS sufferers feel ill. It is thought that part of the problem with post viral fatigue is an on-going reaction to virus, even after the virus has gone. i.e. the immune system has become switched on and can't turn off. In this respect the immune system is responding in an allergic way - ie on-going unnecessary activity which is simply making the sufferer ill.

This means that treatment should be aimed at the immune system to persuade it to respond appropriately - ie not in a pro-inflammatory way. See Inflammation.


Other suspects

Use the following as a check list to make sure these possibilities have at least been considered:

Some chronic infections need specialist treatment in their own right, such as hepatitis B and C and HIV infection.

  • Gut dysbiosis. See Fermentation in the gut and CFS.
  • Helicobacter pylori: a blood test for helicobacter pylori antibodies is now available at most district general hospitals so your GP should be able to do this. H pylori infection can also be tested for by helicobacter pylori breath test. Indeed, if you have had eradication therapy for H pylori, then this is the follow-up test to see if eradication has worked (antibody levels remain positive for many months after).
  • Urinary tract infections can be tested for using the multistix urine testing kit (this can be ordered through this website). This looks for a range of abnormalities. If there is infection, expect to see positives for protein, nitrites and/or leucocytes. Positive results need treatment with antibiotics. I usually start with a "best guess" antibiotic such as trimethoprim. But a full sample of urine (mid stream urine microscopy and culture) should also be sent off to ascertain which bacteria are there and to which antibiotic it is sensitive. See Irritable Bladder Syndrome.
  • Pelvic inflammatory disease and prostatitis. The best screening service for these is offered by the London Clinic - it involves doing a batch of tests which look for signs of infection. Alternatively local clinics ("special clinic") for sexually transmitted disease can do the relevant tests.

The available blood tests are as follows, with the possible reasons for getting them done:

  • Amoebic antibodies. If illness started with gastroenteritis when living in an area of poor sanitation. Treatable with drugs.
  • Borrelia antibodies (Lyme's disease). Contact with ticks from sheep or deer. I honestly do not know the best way to diagnose and treat this problem! The tests are not reliable neither to my mind is the treatment!
  • Brucella antibodies: Usually acquired in parts of Europe, Middle East, Central and South America.
  • Chlamydia antibodies . Chlamydia is a group of bugs also called mycoplasma, the smallest known free living organisms. They cause a variety of diseases including pneumonia, but the commonest problem associated with fatigue is sexually transmitted disease - pelvic inflammatory disease in women and prostatitis in men. Men may have no symptoms of infection. Sexually transmitted diseases are the commonest chronic infections in UK. Chlamydia may also be responsible for: Gulf War syndrome mycoplasma incognito - difficult to test for and treat.
  • Psittacosis (from parrots) and ornithosis (from birds) - rare
  • Echinococcus (tapeworm) antibody. Tapeworms are usually acquired from dogs.
  • Enteroviral antibody screen (coxsackie virus, adenovirus, polio virus and echo virus). These common viral infections may cause no illness at all, gastroenteritis or 'flu-like symptoms. There is no specific treatment for these infections.
  • Epstein-Barr virus screen. This is the cause of glandular fever, a common trigger of CFS. Indeed, it has been estimated that over 20% of people getting glandular fever never fully recover their previous energy levels. No specific treatment for this viral infection.
  • Helicobacter antibody. The bacteria helicobacter pylori lives in the stomach. The stomach tries to get rid of it by producing extra acid. This extra acid production can cause problems such as duodenal ulcer, gastric ulcer, gastritis and oesophagitis, which present with symptoms of indigestion, acidity and heartburn.
  • Hepatitis A antibodies (Total)- HAV. This causes a mild, non serious jaundice. No specific treatment for this virus.
  • Hepatitis B core antibody HBcAB
  • Hepatitis B e antibody HbeAb. Hepatitis B is a nasty chronic infection which can certainly cause fatigue. No specific treatment for this virus.
  • Hepatitis B surface antibody (post vaccination check) to see if vaccination has been effective.
  • Hepatitis C antibody HCV. Hepatitis C is a nasty chronic infection which can certainly cause fatigue. No specific treatment for this virus.
  • Hepatitis D (Delta) - usually found with the other hepatitis viruses.
  • Hepatitis E antibody (IgG)
  • Herpes I and II combined IgG antibody test. HSV I causes cold sores and is very common with over half the population testing positive. HSV II is sexually transmitted and is one cause of genital warts (they can also be caused by papovaviruses). In women warts are risk factor for cervical cancer. Both HSV I and II are sensitive to anti-virals such as acyclovir.
  • HIV antibodies HIV1 and 2. This website does not offer HIV testing. This has to be done at specialist clinics.
  • Leishmania antibody. Leishmania is a tropical disease transmitted by sandfly bites.
  • Leptospira antibody. This causes hepatitis, acquired from rat's urine, treatable with penicillin.
  • Malaria antibodies. Malaria should be suspected in any person with 'flu like illness recently returning from a malarial area, regardless of whether or not they have taken malaria prophylaxis. I don't know if malaria does cause CFS, but I don't see why it could not be a trigger.
  • Measles antibodies. A viral infection and trigger of CFS. Vaccination also produces antibodies.
  • Mumps antibodies. A viral infection and trigger of CFS. Vaccination also produces antibodies.
  • Mycoplasma antibodies. See chlamydia, above.
  • Mycoplasma incognito. For information about this infection, see Nancy and Garth Nicholson's website www.immed.org.
  • Parvovirus antibodies. Causes "slapped cheek" in children. Can cause arthritis in women. No treatment for this viral infection.
  • Rubella IgG. A viral infection and trigger of CFS. Vaccination also produces antibodies.
  • Salmonella antibodies. There are many strains of salmonella, one of which is typhoid. They are one cause of food poisoning.
  • Schistosoma antibodies. Schistosomiasis is a tropical disease acquired through paddling in infected water. Treatable.
  • Toxoplasma antibodies Total. A protozoal infection acquired from cats. May cause low grade fever and swollen lymph nodes. Difficult to treat.
  • TPHA & VDRL. This is a test for syphilis, which is now very rare since this spirochete is very sensitive to penicillin. All pregnant women are routinely tested for this disease.

Positive results and treatment

A positive antibody test means that there has been exposure at some time in the past to that particular infection, it does not necessarily mean there is active infection now. For helicobacter pylori, breath testing will indicate active current infection. I would normally treat a positive test for chlamydia since this is resistant to commonly used antibiotics. For other infections ultra sensitive tests looking for DNA from the offending organism can be done (PCR tests) but I very rarely do them. E-mail me if you have a particular query. The point about any infection is that the diagnosis is both a clinical and a laboratory one - furthermore, lab tests are fallible!

Furthermore, positive results do not mean a cure is round the corner. The problem with CFS is that the immune system is not working properly. This may be why the infection was picked up in the first place. Any antifungals and antibiotics to treat these conditions only give a percentage kill, furthermore there is likely to be an allergic element with inappropriate immune reactions getting in the way. Again see Inflammation and Antioxidants - poor anti-oxidant status is a disease amplifying problem! This essentially is my approach to treating any of the above problems - ie put theimmune system in as fit a state as possible so it can sort things out!

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