A case-control study to assess possible triggers & cofactors in Chronic Fatigue Syndrome (CFS)

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PURPOSE: To assess possible triggers and cofactors for chronic

fatigue syndrome (CFS) and to compare levels of selected

cytokines between cases and an appropriately matched control


PATIENTS AND METHODS: We conducted a case-control study

of 47 cases of CFS obtained through a regional CFS research

program maintained at a tertiary care medical center. One

age-, gender-, and neighborhood-matched control was identified

for each case through systematic community telephone sampling.

Standardized questionnaires were administered to cases and

controls. Sera were assayed for transforming growth

factor-beta (TGF-beta), interleukin-1 beta, interleukin-6,

tumor necrosis factor-alpha, and antibody to Borrelia

burgdorferi and Babesia microti.

RESULTS: Cases were more

likely to have exercised regularly before illness onset than

controls (67% versus 40%; matched odds ratio (MOR) = 3.4; 95%

CI = 1.2 to 11.8; P = 0.02). Female cases were more likely to

be nulliparous prior to onset of CFS than controls (51% versus

31%; MOR = 8.0; 95% CI = 1.03 to 170; P = 0.05). History of

other major factors, including silicone-gel breast implants

(one female case and one female control), pre-morbid history

of depression (15% of cases, 11% of controls) and history of

allergies (66% of cases, 51% of controls) were similar for

cases and controls. However, cases were more likely to have a

diagnosis of depression subsequent to their diagnosis of CFS

compared to a similar time frame for controls (MOR =

undefined; 95% CI lower bound = 2.5; P < 0.001). Positive

antibody titers to B burgdorferi (one case and one control)

and B microti (zero cases and two controls) were also similar.

CONCLUSIONS: Further investigation into the role of prior

routine exercise as a cofactor for CFS is warranted. This

study supports the concurrence of CFS and depression, although

pre-morbid history of depression was similar for both groups.

MacDonald KL, Osterholm MT, LeDell KH, White KE, Schenck CH, Chao

CC, Persing DH, Johnson RC, Barker JM, Peterson PK

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