Is Rituximab really controlling HHV-8 in CFS patients?
http://asheducationbook.hematologylibrary.org/content/2013/1/103.full
Prevalence in the cerebrospinal fluid of the following infectious agents in a cohort of 12 CFS subjects: human herpes virus-6 and 8; chlamydia species; mycoplasma species; EBV; CMV; and Coxsackievirus.
Levine, S. Journal of Chronic Fatigue Syndrome, 2001, 9, 1/2, 41-51.
Abstract:
Over the last decade a wide variety of infectious
agents have been associated with the CFS as potential
etiologies for this disorder. Many of these agents are
neurotrophic and have been linked previously to other
diseases involving the central nervous system (CNS).
Human herpes virus-6 (HHV-6), especially the B
variant, has been found in autopsy specimens of
patients who suffered from MS. Because patients with
CFS manifest a wide range of symptoms involving the
CNS as shown by abnormalities on brain MRIs, SPECT
scans of the brain and results of tilt table testing
we sought to determine the prevalence of HHV-6, HHV-8,
Epstein-Barr Virus (EBV), cytomegalovirus (CMV),
mycoplasma species, chlamydia species, and Coxsackie
virus in the spinal fluid of a group of 12 patients
with CFS (CDC criteria '94).
We found evidence of HHV-6, HHV-8, chlamydia species, CMV and Coxsackie virus in 6/12 samples. Plasma tests
were negative. It was surprising to obtain such a
relatively high yield of infectious agents in cell
free specimens of spinal fluid that had not been
centrifuged. Future research in spinal fluid analysis,
in addition to testing tissue samples by polymerase
chain reaction (PCR) and other direct viral isolation
techniques will be important in characterizing
subpopulations of CFS patients, especially those with
involvement of the CNS.
The low rate of isolation of HHV-6 may be related to
the lack of gross neurological findings in the
patients at the time of testing.
Crimson Crescents Facilitate CFS Diagnosis
By Robert B. Marchesani
By Robert B. Marchesani
Infectious Disease News, November 1992
MINEOLA, NY—A new physical finding in chronic fatigue
syndrome patients may finally give clinicians what they have
only dreamed about a clinical way to diagnose the disease.
Burke A. Cunha, MD, discovered what he called crimson crescents
in the mouths of 80% of his CFS patients.
If Most CFS patients have crimson crescents, then most probably have HHV-8/K.S. in some form.
CFS Patients' "Crimson Crescents" May Be Diagnostic Of
The Syndrome
A Long Island physician who studies CFS, Dr. Burke A. Cunha,
has discovered what he calls "crimson crescents" in the throats of CFS patients.
The crescents are so distinctive that Dr. Cunha believes that their presence
indicates that CFS is present, even if the physician (or the patient) observes
no other indication of the syndrome. Even more intriguing, Dr. Cunha has found
that the crescents are associated with high levels of Human Herpes Virus 6
(HHV-6), a virus that is found to be actively growing in AIDS and CFS patients.
Dr. Cunha described his finding in a medical journal, and in
November 1992, it was the cover story of the Infectious Disease News, a
newsletter for primary care physicians. The crescents are described as being
"crimson purple," and looking like half of a crescent moon.
Dr. Cunha says the crescents occur in 80 percent of CFS
patients.
After he reported his finding in the Annals of Internal
Medicine, Dr. Cunha says he received calls from physicians all over the country.
They told Dr. Cunha that, once they knew to look for the crescents, they were
also finding them in their CFS patients.
Dr. Cunha thinks that many physicians may not have seen the
crescents because they occur on both sides of the back of the throat, behind the
back molars. Most physicians, Dr. Cunha remarked to Infectious Disease News,
don't really look at the sides of the throat.
Dr. Cunha is convinced that the crimson crescents are highly
correlated with CFS. "If your patient has crimson crescents, you can now say it
is probably chronic fatigue syndrome," Dr. Cunha told Infectious Disease News.
Dr. Cunha also said, however, that he has found the crimson
crescents in three to five percent of all patients who complain of sore throat
-- which may mean that the number of peoople who have CFS has been grossly
underestimated. The crescents have not been seen in patients with other
illnesses that produce sore throats, such as mononucleosois, strep throat,
cytomegalovirus infection of the throat, or common viral sore throat.
Dr. Cunha thinks that the crescents may occur in CFS
patients because they are caused by the active HHV-6 found in the patients.
"I believe that the virus that causes chronic fatigue comes
from young adults or children who give it to adults," Dr. Cunha told Infectious
Disease News. "...I don't know why there is a difference, but the children do
not have chronic fatigue. HHV-6 is a virus of children, and it may manifest as
chronic fatigue in adults."
Dr. Cunha is trying to culture HHV-6 out of the crescents,
but he has found that laboratories that perform throat cultures usually do not
have the facilities to detect HHV-6, which is a fairly new human virus. To try
to find HHV-6, he plans to perform biopsies on the crescents, Dr. Cunha told
Infectious Disease News.
Dr. Cunha also pointed out that increased HHV-6 and
decreased natural killer cell activity are the two most consistent laboratory
findings in CFS. He thinks that the presence of the crimson crescents by
themselves, however, are evidence enough that CFS is present.
"If you are a physician out in the middle of nowhere and you
can't get HHV-6 titers and you can't get the natural killer cell percentage,
then the crimson crescents may be the only way besides history that can suggest
the diagnosis" of CFS, Dr. Cunha told Infectious Disease News.
