Enteroviruses & postviral fatigue syndrome

Postviral fatigue syndrome (PFS) occurs both in epidemics and

sporadically. Many of the original epidemics were related to

poliomyelitis outbreaks which either preceded or followed

them. The core clinical symptoms are always the same: severe

fatigue made worse by exercise, myalgia, night sweats,

atypical depression and excessive sleep. The other common

symptoms include dysequilibrium disorders and irritable bowel

syndrome. We have detected enteroviral genome sequences in

muscle biopsies from cases of PFS, using specific enteroviral

oligonucleotide primers in the polymerase chain reaction

(PCR). In addition, whole virus particles can be demonstrated

in PCR-positive muscle, using solid-phase immuno-electron

microscopy. An increase in the number and size of muscle

mitochondria was found in 70% of PFS cases, suggesting an

abnormality in metabolic function. Evidence of hypothalamic

dysfunction was present, particularly involving

5-hydroxytryptamine metabolism. A putative model of PFS, based

on persistent enteroviral infection in laboratory mice,

revealed resolving inflammatory lesions in muscle with,

however, a marked increase in the production of certain

cytokines in the brain. This model may help to explain the

pathogenesis of PFS.

Behan PO, Behan WM, Gow JW, Cavanagh H, Gillespie S

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