Pathogenic tracks in fatigue syndromes

This review analyses the recent literature devoted to two related

fatigue syndromes: chronic fatigue syndrome (CFS) and acute

onset postviral fatigue syndrome (PVFS). The articles are

grouped into five pathogenic tracks: infectious agents, immune

system, skeletic muscle, hypothalamo-pituitary-adrenal (HPA)

axis and psychiatric factors. Although a particular infectious

agent is unlikely to be responsible for all CFS cases,

evidence is shown that host-parasite relationships are

modified in a large proportion of patients with chronic

fatigue. Antibody titres against infectious agents are often

elevated and replication of several viruses could be

increased. Chronic activation of the immune system is also

observed and could be due to the reactivation of persistent or

latent infectious agents such as herpes viruses (i.e. HHV-6)

or enteroviruses. It could also be favorised by an impaired

negative feedback of the HPA axis on the immune system. A

model is proposed where the abnormalities of the HPA axis are

primary events and are mainly responsible for a chronic

activation of the immune system which in turn induces an

increased replication of several viruses under the control of

cellular transcription factors. These replicating viruses

together with cytokines such as TNF-alpha would secondarily

induce functional disorders of muscle and several aspects of

asthenia itself.

Moutschen M, Triffaux JM, Demonty J, Legros JJ, Lefebvre PJ

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