title: The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability.
abstract: Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge. The effect of psychological counseling is limited, with significant but very slight improvements in psychometric measures of fatigue and disability but no improvement on scientific measures of physical impairment compared to controls. Similarly, exercise regimes either produce significant, but practically unimportant, benefit or provoke symptom exacerbation. Many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. More sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies, including Parvoviruses, HHV6, variants of Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal or other biotoxin exposure. Herein, we explain the epigenetic factors that may render such individuals susceptible to the chronic pathology induced by such agents, how such agents induce pathology, and, indeed, how such pathology can persist and even amplify even when infections have cleared or when biotoxin exposure has ceased. The presence of active, reactivated, or even latent Herpes virus could be a potential source of intractable fatigue accompanied by profound physical and or cognitive disability in some patients, and the same may be true of persistent Parvovirus B12 and mycoplasma infection. A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi. The complex tropism, life cycles, genetic variability, and low titer of many of these pathogens makes their detection in blood a challenge. Examination of lymphoid tissue or CSF in such circumstances may be warranted.
authors.affiliation: Tir Na Nog, Bryn Road seaside 87, Llanelli, SA15 2LW, Wales, UK.
authors.forename: Gerwyn
authors.initials: G
authors.lastname: Morris
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia.|Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Walder
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia. dr.michaelmaes@hotmail.com.|Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. dr.michaelmaes@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Maes
mesh_terms: D001419:Bacteria / Q000378:metabolism*; D003071:Cognition; D006233:Persons with Disabilities; D005221:Fatigue / Q000382:microbiology* / Q000503:physiopathology / Q000821:virology*; D006801:Humans; D009183:Mycotoxins / Q000009:adverse effects*; D014780:Viruses / Q000378:metabolism*
chemical_list: D009183:Mycotoxins
keywords: Chronic fatigue syndrome; Cognition; Depression; Immune; Inflammation; Neurology; Oxidative stress; Psychiatry; Toll-like receptor