CHARLOTTE, N.C. -- Medical researchers are finding increasing evidence that chronic fatigue syndrome (CFS), which causes persistent weakness and fatigue, is caused by an overactive immune system that exhausts the patient by refusing to slow down.
Normally the immune system returns to a vigilant but dormant state after an infection is stopped, but for unknown reasons, the immune systems of CFS patients seem to keep on going long after the infection is gone, leaving them exhausted, with fevers, sore throats, muscle pain, memory and concentration problems and other symptoms. That was among the conclusions of many studies reported at the two-day Research Conference of the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association held here over the weekend.
The conference focused on what for many years has been called "yuppie flu" because its victims often are well-educated, middle-class women in their 30s and 40s with so many symptoms that their problem has been confused with everything from flu to serious depression.
However, a test that may help differentiate the CFS patient from people with psychologically induced fatigue is being developed by a California researcher.
Jay A. Levy, of the University of California in San Francisco, said his laboratory was developing a blood test that could detect the activated immune state of CFS patients. But, he cautioned, most hospitals do not have the equipment needed to perform the test at this time.
Elaine DeFreitas, of Philadelphia's Wistar Institute, said that in some ways CFS was the immunologic mirror image of AIDS. In advanced AIDS patients, the immune system is exhausted and unable to fight infections that ultimately kill the patient.
The CFS patient's activated immune system, however, seems to offer protection from many viral infections but at the terrible cost of the weariness, said Paul R. Cheney, the Charlotte physician who identified the first victims of this disease.
Cheney said that often the first sign that his patients were getting better was when they started getting colds again.
Levy drew cheers from the 400 participants of the conference when he urged that the name of CFS be changed to "chronic immune activation syndrome." Not only is this a more accurate description of the syndrome, he said, it would eliminate the word "fatigue," which many CFS activists feel misleads people into believing that CFS is a psychological problem under the control of its victims.
Many sufferers of the disease object to "chronic fatigue syndrome," a term coined by the federal Centers for Disease Control and used in most medical literature in this country.
No matter how researchers look at this disease -- whether they're studying the immune system, looking for possible CFS drugs or collecting epidemiologic data -- they end up finding more evidence that CFS involves the immune system.
Clinicians discovered that symptoms often temporarily disappeared in women who became pregnant. It's well known that pregnancy depresses the immune system to prevent the body from seeing the placenta as foreign tissue that should be rejected.
All of the drugs that show promise in relieving CFS seem to work by manipulating the immune system. Among the drugs are:
* Prozac, an anti-depression drug, which seems to relieve symptoms by improving communication between components of the immune system rather than by reducing depression.
* Ampligen, which was used with disappointing results to treat AIDS, but which boosts the activity of natural killer cells, a disease-fighting component of the immune system that doesn't function properly in CFS patients. A five-city trial of this drug is under way and the results should be available by next summer.
* Kutapressin, an old drug for cold sores and other herpes infections, which seems to relieve CFS in some patients by manipulating the immune system, though doctors could not say how.
Though all these drugs seem to work in some patients, researchers have lacked the funds to run the costly trials needed determine if they are generally effective.