Immunophenotyping in post-giardiasis functional gastrointestinal disease and chronic fatigue syndrome.
BACKGROUND
A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). Markers of immune dysfunction have given conflicting results in CFS and FGID patient populations. The aim of this study was to evaluate a wide selection of markers of immune dysfunction in these two co-occurring post-infectious syndromes.


METHODS
48 patients, reporting chronic fatigue in a questionnaire study, were clinically evaluated five years after the outbreak and grouped according to Fukuda criteria for CFS (n=19) and idiopathic chronic fatigue (n=5) and Rome II criteria for FGIDs (n=54). 22 Giardia exposed non-fatigued individuals and 10 healthy unexposed individuals were recruited as controls. Peripheral blood lymphocyte subsets were analyzed by flow cytometry.


RESULTS
In peripheral blood we found significantly higher CD8 T-cell levels in PI-FGID, and significantly lower NK-cell levels in PI-CFS patients. Severity of abdominal and fatigue symptoms correlated negatively with NK-cell levels. A tendency towards lower T-cell CD26 expression in FGID was seen.


CONCLUSIONS
Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations suggesting a possible immunological abnormality in these conditions. We found no significant changes in other markers examined in this well-defined group of PI-CFS and PI-FGID elicited by a gastrointestinal infection. Controlling for co-morbid conditions is important in evaluation of CFS-biomarkers.
Institute of Medicine, University of Bergen, Bergen N-5021, Norway. kurt.hanevik@med.uib.no
Kurt
K
Hanevik
Einar K
EK
Kristoffersen
Steinar
S
Sørnes
Kristine
K
Mørch
Halvor
H
Næss
Ann C
AC
Rivenes
Jørn E
JE
Bødtker
Trygve
T
Hausken
Nina
N
Langeland
D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism; D015673:Fatigue Syndrome, Chronic / Q000209:etiology / Q000276:immunology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000276:immunology*; D005873:Giardiasis / Q000150:complications*; D006801:Humans; D016130:Immunophenotyping / Q000379:methods*; D008297:Male; D008875:Middle Aged