Gut Inflammation in Chronic Fatigue Syndrome

Shaheen E Lakhan; Annette Kirchgessner

Disclosures

Nutr Metab. 2010;7(1) 

In This Article

Endotoxemia

Although confidence in the link between infection and CFS pathogenesis has waned,[8] recent studies have suggested that infection with gut pathogens could be related to CFS onset.

Raised serum concentrations of IgA and IgM to lipopolysaccharide (LPS) of gram-negative enterobacteria, such as Pseudomonas aeruginosa, Morganella morganii, Proteus mirabilis, Pseduomonas putida, Citrobacter koseri, and Klebsiella pneumoniae have been reported in CFS patients.[12] The prevalence and median values for serum IgA against the LPS of enterobacteria were significantly greater in patients with CFS than in normal volunteers and patients with partial CFS. Moreover, serum IgA levels were significantly correlated to the severity of illness, as measured by the FibroFatigue scale.[12] The FibroFatigue scale is an observer's rating scale with 12 items measuring pain, muscular tension, fatigue, concentration difficulties, failing memory, irritability, sadness, sleep disturbances, and autonomic disturbances and irritable bowel, headache, and subjective experience of infection.[36] It is a reliable and valid measuring instrument that is used to monitor symptom severity and change during treatment of CFS patients.[36]

Normally, the intestinal epithelium acts as a continuous barrier to avoid LPS translocation; however, some endogenous or exogenous events may alter this protective function.[37] This may induce an increased bacterial translocation and thus increased serum endotoxin concentrations which, in turn may trigger an immune response.[38] Thus, the increased serum IgA and IgM levels against LPS in CFS indicate the presence of increased gut permeability and an immune response mounted against LPS of the enterobacteria.[12]

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