5.1: Evaluation of the evidence for infections as factors in the pathophysiology of CFS

Non-specific infections

• Raised titres of IgG antibodies directed against common viruses (e.g., herpesviruses, enteroviruses) are common, but are of no pathophysiological or diagnostic significance (Horwitz et al. 1985; Jones et al. 1985; Straus et al. 1985; Buchwald et al. 1987a, 1987b, 1992, 1996; Calder et al. 1987; Holmes et al. 1987; Bell et al. 1988; Hellinger et al. 1988; Miller et al. 1991; Kitani et al. 1996) (Level I)

• Common, non-specific infections (e.g., upper respiratory tract infections) are not likely to trigger CFS (Wessely et al. 1995a) (Level II)  

Epstein-Barr virus

• Infectious mononucleosis can trigger CFS (White et al. 1995a, 1995b) (Level II)

• Reactivation of EBV replication is not increased in prevalence (Gold et al. 1990; Sumaya 1991; Jones 1985) (Level II)  

Enteroviruses

• Earlier reports of enteroviral RNA particles in the muscles have not been confirmed by more comprehensive studies (Archard et al. 1988; Gow et al. 1991, 1994; Bowles et al. 1993; Clements et al. 1995; Galbraith et al. 1995; McArdle et al. 1996; Lindh et al. 1996) (Level I)  

Retroviruses

• Strong evidence against a role for retroviruses in CFS (Defreitas et al. 1991; Flugel et al. 1992; Gow et al. 1992; Folks et al. 1993; Khan et al. 1993; Heneine et al. 1994) (Level I)  

Human herpesvirus 6

• Conflicting evidence for reactivation of HHV-6 replication (Buchwald et al. 1992; Hay and Jenkins 1994; Yalcin et al. 1994; DiLuca et al. 1995; Patnaik et al. 1995; Kitani et al. 1996) (Level III-4)  

Ross River virus

• Retrospective studies suggest CFS may follow RRV infection (Lloyd et al. 1990a; Selden and Cameron 1996; Westley-Wise et al. 1996) (Level III-2)  

Non-viral infections (Q fever, Lyme disease)

• Retrospective studies suggest CFS may follow adequately treated Q fever or Lyme disease (Bujak et al. 1993, 1996; Shadick et al. 1994; Sigal 1994; Ayres et al. 1996; Marmion et al. 1996) (Level IV)

• The existence of Lyme disease in Australia has not been confirmed (Hudson et al. 1994) (Level III-3)

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