Nancy G. Klimas

Cytokine expression profiles of immuneimbalance in post-mononucleosis chronic fatigue

BackgroundAs Chronic Fatigue Syndrome (CFS) has been known to follow Epstein-Bar virus (EBV) and other systemic infections; our objective was to describe differences in immune activation in post-infective CFS (PI-CFS) patients and recovered controls. We studied 301 adolescents prospectively over 24 months following the diagnosis of monospot-positive infectious mononucleosis (IM). We found an incidence of CFS at 6, 12 and 24 months of 13%, 7% and 4% respectively.MethodsUsing chemiluminescent imaging we measured the concentrations of IL-1a, 1b, 2, 4, 5, 6, 8, 10, 12 (p70), 13, 15, 17 and 23, IFN-γ, TNF-α and TNF-β in duplicate plasma samples available in bio-bank from 9 PI-CFS subjects and 12 recovered controls at 24 months post-infection.ResultsStandard comparative analysis indicated significant differences in IL-8 and 23 across subject groups. In constructing a linear classification model IL-6, 8 and 23 were selected by two different statistical approaches as discriminating features, with IL-1a, IL-2 and IFN-γ also selected in one model or the other. This supported an assignment accuracy of better than 80% at a confidence level of 0.95 into PI-CFS versus recovered controls.ConclusionThese results suggest that co-expression patterns in as few as 5 cytokines associated with Th17 function may hold promise as a tool for the diagnosis of post-infectious CFS.

Disability and chronic fatigue syndrome : clinical, legal, and patient perspectives

Contents Introduction * Editorials * Chronic Fatigue Syndrome and Disability * Disability Evaluation for Chronic Fatigue Syndrome * Disability Evaluation * Long-Term Disability for Chronic Fatigue Syndrome * Neuropsychological Assessment of Chronic Fatigue Syndrome * Impairment of Patients with Chronic Fatigue Syndrome * The Legal Perspective * Social Security Disability Program * Disability Policy and CFIDS: A Washington Perspective * A Primer for Chronic Fatigue Syndrome Claimants in Applying for Long-Term Disability Policy Benefits * Perspectives on CFS and Impairment: Proposed Guidelines for Disability Determination * The Patients Perspective * Long-Term Disability: Long-Term Deception? * Negotiating the Maze of Disability Insurance: One Patients Perspective * Index* Reference Notes Included