Following is news of current publications and research efforts underway related to chronic fatigue syndrome (CFS)—also called chronic fatigue and immune dysfunction syndrome.

Genetic basis for OI
Orthostatic intolerance (OI), a syndrome that may play a role in CFS, has been linked to a genetic defect. OI is characterized by lightheadedness, fatigue and syncope and is associated with postural tachycardia and plasma norepinephrine concentrations that are disproportionately high.

Researchers at Vanderbilt University studied identical twins, both with symptoms of OI and disordered uptake of norepinephrine, and several members of their immediate family. DNA analysis revealed a functional mutation in the gene encoding the norepinephrine transporter that renders the transporter nonfunctional and causes altered heart-rate regulation and altered norepinephrine metabolism. This in turn may lead to the symptoms of OI.

The researchers point out that the genetic mutation does not explain all cases of OI, since it was not found to be present in 254 unrelated people, including controls, patients with hypertension and other patients with OI.

Shannon, JR et al. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med. 2000; 342: 541-9.

Kids’ blood pressure problems documented
Postural orthostatic tachycardia syndrome (POTS) has been recognized as a cause of fainting and blood pressure problems in adults with CFS. While studying adolescents with more severe problems in autonomic tone, researchers at the Medical College of Ohio documented a subgroup of adolescents who may also have POTS.

They found that during a baseline tilt table test, patients demonstrated a heart rate increase of more than 30 beats per minute within the first 10 minutes upright. This resulted in symptoms such as tachycardia, palpitations, extreme fatigue, lightheadedness and cognitive impairment.

They concluded that POTS represents a mild, potentially treatable form of autonomic dysfunction that can be readily identified and treated.

Karas B et al. The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue exercise
intolerance, and cognitive impairment in adolescents. PACE. 2000; 23: 344-51.
 
Mycoplasma and urinary infections
CFS patients frequently report urinary problems, and mycoplasmas have been investigated as a cause of CFS-like symptoms.

Researchers from the Cleveland Clinic Foundation in Ohio recently found that infection with ureaplasma urealyticum or Mycoplasma hominis may be responsible for a sizeable percentage of chronic urinary tract problems in women.

The researchers tested 48 women referred for complex urinary problems and possible interstitial cystitis. More than half tested positive for mycoplasma infections, which disappeared after treatment with antibiotics.

On a symptom severity scale from 0 (mild) to 3 (severe), the patients’ symptoms decreased from 2.2 to 0.7, and urinary frequency decreased from 9.2 times daily to 6.8 times daily.

“After excluding anatomic, neurologic or other infectious etiologies, we recommend culturing and treating mycoplasma in women with chronic voiding symptoms before pursuing…more invasive diagnostic procedures,” the researchers say.

Potts JM et al. Association of chronic urinary symptoms in women and ureaplasma urealyticum. Urology. 2000; 55: 486-89.

Fatigue in children
A DePaul University research team has published results of a screening of 12,000 households in Chicago with children ages 5-17. The results indicate that more than 4% of those children had serious fatigue and 2% had “CFS-like” illness. The percentage of children who had CFS is probably lower.

The study, which is published in the most recent issue of The Journal of Chronic Fatigue Syndrome (2000, volume 6), showed that adolescents had a slightly higher rate of CFS-like illness (2.91%) than pre-pubescent children (1.96%).

Those diagnosed with CFS-like illness were almost evenly divided between male (47.5%) and female (52.5%). Children of Latino origin had the highest representation in the CFS-like group. 

Jordan et al. Prevalence of fatigue and chronic fatigue syndrome-like illness in children and adolescents. J Chron Fatigue Syndrome. 2000; 6: 3-21.

Fatigue drug for MS
A recent study involving 72 multiple sclerosis (MS) patients showed that the drug Modanfinil relieved their severe fatigue.
Researchers from Ohio State University College of Medicine and Kaiser Permanente in San Diego say Modanfinil causes less stimulant effect than other drugs currently used to treat fatigue because it targets the specific regions of the brain that control sleep and wakefulness.

The research was presented at the American Academy of Neurology’s annual meeting in May. There is no published evidence yet that Modanfinil can relieve fatigue in CFS patients.

Apply for award
The Dutch ME (myalgic encelphaomyelitis, another name for CFS) Fund is offering an award, consisting of a sculpture and 10,000 Dutch guilders, for the best scientific article on ME/CFS. The winner will accept the award in person and give a lecture at the award ceremony in spring 2001. Travel expenses will be covered.

Applicants must send a copy of their article with a cover letter to the Dutch ME Fund before December 1, 2000. For details, contact the Dutch ME Fund, Postbus 10279, 1001 EG Amsterdam, The Netherlands or e-mail to mefonds@worldmail.nl.