Enterovirus in the Chronic Fatigue Syndrome

To the Editor: The chronic fatigue syndrome is a recurring illness of unknown cause characteriaze by incapacitating fatigue and a range of symptoms and laboratory findings suggestive of hypothalamic dysfunction (1-3). Rare pateints who have died from other acute causes have had cellular infiltrates in the hypothalamus (4) The syndrome usually follows a flu-like illness, and circumstantial evidence has implicated enteroviruses (1). We therfore examined the central nervous system of a woman with the sydnrome who died from suicide for the presence of entrovirus.

In June 1992, a 30 year old woman who had met all criteria attempted suicide and died of complications. Immediately after death, tissue was removed from the brain, heart, skelatal muscle, lungs and spleen and was stroed at -80 degrees C. The brain samples were from the frontal, temporal, parietal and occiptial cortices and from the mid-brain, hypothalamus, and brain stem. Control samples were obrained from four patients who died of cerebrovascular diseases and from four age- and sex- matched patients who had committed suicide during severe depression over the next 2 months.

Ribornucleic acid (RNA) from the tissues was prepared fro analysis by PCR. The RNA samples were prepared and amplified using oligonucleotide primers.

No enteroviral seces were detected in any of the control tissues. Positive PCR sequences were deteced in the muscle, heart, and brain samples from the hypothalamus and brain stem region of our patient with this syndrome. Sequence analyses on the PCR products were compatible with exogenous virus and not with contamination. The results showed and entervirus with an 83% similarity to Coxsakievirus B3. Although the findings may represent chance occurance, they futher support the possibility that hypothalamic dysfunction exist in the pathogenesis of the syndrome. Also, they suggest that the chronic fatigue syndrome may be mediated by enterovirus infection and that persisten symptoms may reflect selective persistence in affected organs.

Frances Mcgarry
John Gow
Peter O Behan