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The Development of Laboratory Tests For Investigating Chronic Fatigue and Pain Disorders [1998]
Dunstan RH, McGregor NR, Butt HL, Roberts TK, Zerbes M, Klineberg IJ
The Development of Laboratory tests
A diagnosis of chronic fatigue syndrome (CFS) requires the exclusion of other known fatigue related diseases. It also requires compliance with a clinical definition that is primarily characterised by unexplained, persistent or relapsing, chronic and debilitating fatigue lasting more than six consecutive months.
The patient set derived by this process is heterogeneous, and has proved very difficult to study clinically and scientifically. There is an urgent demand for a range of specialised tests to be developed to assist the clinicians in classifying the various types of chronic fatigue and chronic pain disorders. Data from studies involving analyses of plasma lipids and urinary excretion of metabolites together, with their associations with symptom presentation has been used to classify patients with similar metabolic profiles into subgroups.These subgroups comprise relatively homogeneous sets of patients for investigation. Individual patients can also be matched to the metabolic profiles from the CPRU’s research to assign their altered homeostasis patterns to a particular CFS type.
In addition, the test data can provide insight into potential management strategies, as certain host responses can be determined, and nutrient deficiencies identified. Three main types of specialist tests are currently available. These are:1. Urine test
Analyses of the metabolites in the urine can indicate whether the patient has a significantly altered pattern of excretion representing an altered homeostasis, and whether or not that patient can be assigned to a previously defined type of chronic fatigue disorder. The data provided can indicate whether fibrillar or non-fibrillar catabolism is active in the patient, and whether any anomalies identified in the excretion pattern provide objective evidence for gut, neurological, energy and urea cycle dysfunction. An indication of specific amino acid deficiencies can also be obtained.
2. Blood lipid testAnalyses of plasma lipid profiles can indicate anomalies in lipid homeostasis and enable the assignment of a patient to a previously defined type of chronic fatigue disorder. The test can detect deficiencies in essential fatty acid composition, detect dysregulation of essential fatty acid desaturation and elongation, and provide evidence for the presence of host responses to infectious agents.
3. Faecal MicrobiologyAnalyses of faecal aerobic and anaerobic micro-organisms in conjunction with faecal lipid analysis can provide extensive data on the functional integrity of the gastrointestinal tract. The data can indicate overgrowths of specific organisms such as Bacteroides and low numbers of critical organisms such as E. coli, Lactobacillus and Bifidobacterium species. This data can lead to developing strategies for reconstituting the bowel flora. The faecal lipid data can further indicate evidence for dysfunctional bowel flora. Evidence also be obtained for malabsorption, and the functional activities of the anaerobic organisms in their interconversions of bile and sterol products.
REFERENCES:Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: A working case definition. Ann. Intern. Med. 1988; 108:387-389.
Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: A comprehensive approach to its definition and study. Ann. Intern. Med. 1994; 121:953-959.
McGregor NR, Dunstan RH, Zerbes M, Butt HL, Roberts TK, Klineberg IJ. Preliminary determination of a molecular basis to chronic fatigue syndrome. Biochem. Molec. Med. 1996; 57: 73-80.
McGregor NR, Dunstan RH, Zerbes M, Butt HL, Roberts TK, Klineberg IJ. Preliminary determination of the association between symptom expression and urinary metabolites in subjects with chronic fatigue syndrome. Biochem.
Molec. Med. 1996; 58:85-92.McGregor NR, Dunstan RH, Butt HL, Zerbes M, Roberts TK, Klineberg IJ (1997). A preliminary assessment of the association of SCL-90-R psychological inventory responses with changes in urinary metabolites in patients with chronic fatigue syndrome. J Chronic Fatigue Syndrome 3:17-37
© CPRU and F Bartosy 1999
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