AHMF: 98 Conference: McGregor

Host versus Acquired Responses in Defined CFS Patients

McGregor NR, Dunstan RH, Butt HL [1], Roberts TK, Klineberg IJ.

Collaborative Pain Research Unit:
Department of Biological Sciences
The University of Newcastle
Callaghan
NSW 2308
Australia.
Neurobiology Research Unit
Centre for Oral Health Research
University of Sydney
Westmead Hospital
Westmead
NSW 2084
Australia.
1 Division of Microbiology and Infectious Diseases, Hunter Area Pathology Service, John Hunter Hospital, Newcastle, NSW 2305, Australia.

The current CFS definitions define a heterogeneous group of conditions. The CFS definition can be divided into two sub-components, those symptoms related to the host response (fatigue, pain, cognitive alterations) and those symptoms indicative of an acquired or infectious response (fever, sore throat, Iymphodynia). Common host responses such as fatigue and pain are of multiple types and initiated by many different mechanisms. The use of these common highly variable host responses, such as fatigue or pain, as diagnostic markers of any disease is philosophically flawed as they give little indication of the potential aetiology(s). Therefore analysis of those features associated with the acquired or infectious responses may allow determination of the potential aetiology of a number of conditions currently defined as CFS, whilst analysis of host response may allow determination of genetic or acquired host susceptibility to the various acquired conditions.

Analysis of the lipid and urinary organic and amino acid excretion along with symptom presentation allow the detection of both acquired and host responses, which could be used to differentiate between the various potential disease entities.

Combinations of auto-immune, persistent viral (e.g. enteroviruses), chronic bacterial infections/toxicity, environmental toxin exposure and secondary viral reactivation along with host genetic and acquired susceptibility can be used to determine the patients disease status in many cases.

These data clearly indicate the heterogeneous nature of the disease entities currently defined by the CFS definition. The use of CFS as a clinical diagnosis is not supported by the available data and should be replaced with the diagnosis of a chronic fatigue disorder.