Chronic Fatigue Syndrome and Psychoneuroimmunology
Nancy Klimas Miami Veterans Administration Medical Center; University of Miami Medical School
Robert Morgan, Fernando Salvato, Flavia Van Riel, Carrie Millon, and Mary Ann Fletcher University of Miami Medical School
Chronic fatigue syndrome was defined clinically by a Centers for Disease Control committee only recently ( Holmes et al., 1988). Somewhat earlier Straus et al. ( 1985) employed the term Chronic Epstein-Barr Virus Syndrome to essentially the same disorder. This syndrome is of uncertain etiology -- but may have relevance to the field of psychoneuroimmunology. As its immunologic abnormalities are better understood, and the psychosocial and psychoneurologic ramifications described, the possibility of psychoneuroimmunologic pathways in the both the etiology and persistence of this illness should be entertained. Further, behavioral interventions may have a place in treatment.
The etiology of chronic fatigue syndrome is not yet established. However, there is support for a role of chronic virus reactivation, particularly herpesviruses, in the clinical symptomatology and chronicity of this syndrome. Reactivation of Epstein-Barr virus and human herpesvirus-6, both ubiquitous viruses with very high prevalence of viral infection in the population, was reported to occur with regularity in chronic fatigue syndrome, and antibodies to these viruses were used as markers for the syndrome ( Jones & Straus, 1987; Niederman, Chun-Ren, Kaplan, & Brown, 1988; Straus et al., 1985; Ablashi, et al., 1987).
Following primary infection with a virus of the herpes family, the intact immune system usually fails to eliminate the virus, but can restrict it to a