Patients with Persistent Polyclonal B-Cell Lymphocytosis Share the Symptomatic Criteria of Systemic Exertion Intolerance Disease

Introduction: Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare and still poorly understood entity, with 90% of cases occurring in female smokers. Patients often appear tired and in pain, but the clinical symptoms remain imprecise. The main risk is the development of lymphoma in some cases. To better understand the characteristics of the fatigue associated with PPBL and study its relationship with systemic exertion intolerance disease (SEID), we analyzed the symptoms in a cohort of patients with PPBL included in the French national registry. Material and methods: An anonymous questionnaire following the recommendations of the Institute of Medicine/National Academy of Medicine for screening of the new SEID criteria was created in French and mailed to 50 patients. Results: Thirty-nine (78%) contacted patients responded. The studied population was mainly constituted of women (90%) with an average age of 50 (18–59) years. Smoking was a constant factor in all patients. A total of 28/39 (72%) respondents met the SEID symptoms criteria. Severe chronic fatigue for more than 6 months was noted in 36/39 cases (92%). Unrefreshing sleep, post-exertional malaise, cognitive impairment, and orthostatic intolerance were described in 30/39 (77%), 32/39 (82%), 28/39 (72%), and 27/39 (69%) cases, respectively. Pain (arthralgia, myalgia, headache) was present in 26/39 (67%) cases. The most prominent SEID symptoms were fatigue, followed by post-exercise discomfort and cognitive difficulties. The most disabling symptom was non-restorative sleep, followed by pain. An inflammatory and/or autoimmune context was noted in 13 patients (33%), and these comorbidities could have favored the deterioration of the general condition. Three patients also presented with fibromyalgia. However, 3 patients did not mention any complaints. Conclusion: This survey indicated that patients with PPBL most often initially presented with disabling chronic fatigue, chronic pain, and other symptoms suggestive of SEID but requiring more studies to confirm it. Education of medical staff about the symptoms of PPBL should be encouraged to better assess this peculiar condition.

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Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2024358118 ◽

2021 ◽

Vol 118 (34) ◽

pp. e2024358118

Author(s):

Bindu D. Paul ◽

Marian D. Lemle ◽

Anthony L. Komaroff ◽

Solomon H. Snyder

Keyword(s):

Chronic Fatigue Syndrome ◽

Bacterial Infections ◽

Orthostatic Intolerance ◽

Neurological Diseases ◽

Chronic Fatigue ◽

Myalgic Encephalomyelitis ◽

Redox Imbalance ◽

Fatigue Syndrome ◽

Unrefreshing Sleep ◽

Hypometabolic State

Although most patients recover from acute COVID-19, some experience postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC). One subgroup of PASC is a syndrome called “long COVID-19,” reminiscent of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a debilitating condition, often triggered by viral and bacterial infections, leading to years-long debilitating symptoms including profound fatigue, postexertional malaise, unrefreshing sleep, cognitive deficits, and orthostatic intolerance. Some are skeptical that either ME/CFS or long COVID-19 involves underlying biological abnormalities. However, in this review, we summarize the evidence that people with acute COVID-19 and with ME/CFS have biological abnormalities including redox imbalance, systemic inflammation and neuroinflammation, an impaired ability to generate adenosine triphosphate, and a general hypometabolic state. These phenomena have not yet been well studied in people with long COVID-19, and each of them has been reported in other diseases as well, particularly neurological diseases. We also examine the bidirectional relationship between redox imbalance, inflammation, energy metabolic deficits, and a hypometabolic state. We speculate as to what may be causing these abnormalities. Thus, understanding the molecular underpinnings of both PASC and ME/CFS may lead to the development of novel therapeutics.

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COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211009385 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110093

Author(s):

Sonia Poenaru ◽

Sara J. Abdallah ◽

Vicente Corrales-Medina ◽

Juthaporn Cowan

Keyword(s):

Chronic Fatigue Syndrome ◽

Sleep Disturbances ◽

Q Fever ◽

Orthostatic Intolerance ◽

Chronic Fatigue ◽

Myalgic Encephalomyelitis ◽

Exercise Intolerance ◽

Laboratory Findings ◽

Fatigue Syndrome ◽

Post Infectious

Coronavirus disease 2019 (COVID-19) is a viral infection which can cause a variety of respiratory, gastrointestinal, and vascular symptoms. The acute illness phase generally lasts no more than 2–3 weeks. However, there is increasing evidence that a proportion of COVID-19 patients experience a prolonged convalescence and continue to have symptoms lasting several months after the initial infection. A variety of chronic symptoms have been reported including fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. These symptoms are similar to those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic multi-system illness characterized by profound fatigue, sleep disturbances, neurocognitive changes, orthostatic intolerance, and post-exertional malaise. ME/CFS symptoms are exacerbated by exercise or stress and occur in the absence of any significant clinical or laboratory findings. The pathology of ME/CFS is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. Although not exclusively considered a post-infectious entity, ME/CFS has been associated with several infectious agents including Epstein–Barr Virus, Q fever, influenza, and other coronaviruses. There are important similarities between post-acute COVID-19 symptoms and ME/CFS. However, there is currently insufficient evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies.

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Adolescent Chronic Fatigue and Orthostatic Intolerance

Clinical Pediatrics ◽

10.1177/0009922816644730 ◽

2016 ◽

Vol 56 (1) ◽

pp. 85-89 ◽

Cited By ~ 2

Author(s):

Breann N. Kluck ◽

Ashley N. Junghans-Rutelonis ◽

Amie E. Jones ◽

Philip R. Fischer ◽

Karen E. Weiss

Keyword(s):

Orthostatic Intolerance ◽

Chronic Fatigue

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Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.222 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Chandralekha Ashangari ◽

Samreen F Asghar ◽

Sadaf Syed ◽

Amna A Butt ◽

Amer Suleman

Keyword(s):

Heart Rate ◽

Nerve Conduction Study ◽

Nerve Conduction ◽

Clinical Symptoms ◽

Orthostatic Intolerance ◽

Tibial Nerve ◽

Sensory Nerves ◽

Exercise Intolerance ◽

Postural Orthostatic Tachycardia Syndrome ◽

Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

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Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome

Brain Behavior and Immunity ◽

10.1016/j.bbi.2018.11.008 ◽

2019 ◽

Vol 76 ◽

pp. 82-96 ◽

Cited By ~ 2

Author(s):

Chinh Bkrong Nguyen ◽

Surendra Kumar ◽

Manuela Zucknick ◽

Vessela N. Kristensen ◽

Johannes Gjerstad ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Gene Networks ◽

Clinical Symptoms ◽

Chronic Fatigue ◽

Plasma Norepinephrine ◽

Immune Gene ◽

Fatigue Syndrome

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Complement Component C1q as a Potential Diagnostic Tool for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Subtyping

Journal of Clinical Medicine ◽

10.3390/jcm10184171 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4171

Author(s):

Jesús Castro-Marrero ◽

Mario Zacares ◽

Eloy Almenar-Pérez ◽

José Alegre-Martín ◽

Elisa Oltra

Keyword(s):

Chronic Fatigue Syndrome ◽

Clinical Symptoms ◽

Hierarchical Cluster ◽

Chronic Fatigue ◽

Blood Parameters ◽

Myalgic Encephalomyelitis ◽

Complement Factor ◽

Fatigue Syndrome ◽

Pain Symptoms ◽

Rule Out

Background: Routine blood analytics are systematically used in the clinic to diagnose disease or confirm individuals’ healthy status. For myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a disease relying exclusively on clinical symptoms for its diagnosis, blood analytics only serve to rule out underlying conditions leading to exerting fatigue. However, studies evaluating complete and large blood datasets by combinatorial approaches to evidence ME/CFS condition or detect/identify case subgroups are still scarce. Methods: This study used unbiased hierarchical cluster analysis of a large cohort of 250 carefully phenotyped female ME/CFS cases toward exploring this possibility. Results: The results show three symptom-based clusters, classified as severe, moderate, and mild, presenting significant differences (p < 0.05) in five blood parameters. Unexpectedly the study also revealed high levels of circulating complement factor C1q in 107/250 (43%) of the participants, placing C1q as a key molecule to identify an ME/CFS subtype/subgroup with more apparent pain symptoms. Conclusions: The results obtained have important implications for the research of ME/CFS etiology and, most likely, for the implementation of future diagnosis methods and treatments of ME/CFS in the clinic.

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Abstract 20: Kawasaki Disease In France: Incomplete Forms Are Frequent And Associated With A High Frequency Of Cardiac Complications

Circulation ◽

10.1161/circ.131.suppl_2.20 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Maryam Piram ◽

Martha Darce Bello ◽

Stéphanie Tellier ◽

Etienne Merlin ◽

Elise Launay ◽

...

Keyword(s):

Clinical Symptoms ◽

Coronary Aneurysm ◽

National Registry ◽

Biological Data ◽

High Rate ◽

Data Repository ◽

Cardiac Complications ◽

Mixed Ancestry ◽

Coronary Abnormalities ◽

Epidemiological Characteristics

KD is the main vasculitis affecting children < 5 years and the leading cause of acquired heart disease in children. Its epidemiology is few reported in France. Even if IVIG is still the standard treatment; the management of patients at risk for cardiac complications may change toward reinforced (and new) therapeutic approaches. Kawanet is a clinical and biological data repository aimed to define the epidemiological characteristics of KD in France. Methods: Institutional physicians received information on a national registry for KD. All patients suspected with KD and seen since 2011 were eligible to enter the study. An eCRF was implemented in a web database.The included patients without the AHA international criteria were reviewed by an experts' committee. Results: 468 cases were entered by 84 physicians from 65 centers. The AHA classification gave: 280 complete KD, and 73 incomplete KD. An expert consensus classified 48 other patients as probable leading to 401 patients considered as KD (M229/F72). 67 were excluded (incomplete data or doubful). The median age at diagnosis was 3.1y (2m-14y). Their ethnical backgrounds were: European Caucasian 67%, Eastern Caucasian/North African 15%, afro-Caribbean 13%, Asian 4% and mixed ancestry 1%. The clinical symptoms were (%): conjunctivitis 84, cheilitis 82, diffuse exanthema 74, modification of the extremities 73, oral erythema 66, cervical adenopathy 52, raspberry tongue 49, seat erythema 26, perineal desquamation 18 and BCG erythema 5. The cardiac complications were: coronary dilatation 30%, pericarditis 15%, coronary aneurysm 4%, and myocarditis 3% (1 death). 392/401 (98%) patients received IVIG, 64 (21%) and 5 required 2 and 3 courses. The mean treatment delay was 6 days. The factors associated with the coronary abnormalities were: male gender (p=0.01), young KD onset age (p=0.03), and resistance to IVIG (p=0.03). conclusion: KD diagnosis remains challenging and overdiagnosis represents at least 10% of cases in this registry. Incomplete forms of KD account for 37 % and are associated with coronary dilatation/aneurysm (34%; p<0.01) and a high rate of IVIG resistance. Unlike previous studies, our population is very mixed with 28 % of children from the Middle East and Africa, in whom KD is still few reported.

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Efficacy of Repeat Immunoadsorption

Journal of Clinical Medicine ◽

10.3390/jcm9082443 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2443 ◽

Cited By ~ 1

Author(s):

Markus Tölle ◽

Helma Freitag ◽

Michaela Antelmann ◽

Jelka Hartwig ◽

Mirjam Schuchardt ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Clinical Symptoms ◽

Pilot Trial ◽

Treatment Protocol ◽

Chronic Fatigue ◽

Myalgic Encephalomyelitis ◽

Proof Of Concept ◽

Rapid Improvement ◽

Fatigue Syndrome

(1) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex neuroimmunological disease. There is evidence for an autoimmune mechanism for ME/CFS with an infection-triggered onset and dysfunction of ß2-adrenoreceptor antibodies (ß2AR-AB). In a first proof-of-concept study, we could show that IA was effective to reduce ß2AR-AB and led to improvement of various symptoms. (2) Five of the ME/CFS patients who had clinical improvement following treatment with a five-day IA were retreated in the current study about two years later with a modified IA protocol. The severity of symptoms was assessed by disease specific scores during a follow-up period of 12 months. The antibodies were determined by ELISA. (3) The modified IA treatment protocol resulted in a remarkable similar clinical response. The treatment was well tolerated and 80–90% decline of total IgG and ß2AR-AB was achieved. Four patients showed a rapid improvement in several clinical symptoms during IA therapy, lasting for six to 12 months. One patient had no improvement. (4) We could provide further evidence that IA has clinical efficacy in patients with ME/CFS. Data from our pilot trial warrant further controlled studies in ME/CFS.

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A rare case of primary pulmonary diffuse large B cell lymphoma with CD5 positive expression

Open Medicine ◽

10.1515/med-2016-0010 ◽

2016 ◽

Vol 11 (1) ◽

pp. 49-51 ◽

Cited By ~ 2

Author(s):

Tao Wang ◽

Mingming Zhang ◽

Jianrong Sun ◽

Dong Hao ◽

Zhijiang Qi ◽

...

Keyword(s):

B Cell ◽

Clinical Symptoms ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Imaging Features ◽

Ct Guided ◽

Large B Cell Lymphoma ◽

Halo Sign ◽

Positive Expression ◽

Large B Cell

AbstractPrimary pulmonary diffuse large B-cell lymphoma (PPDLBCL) is extremely rare. Its clinical symptoms and signs are nonspe cific, and imaging features also have not yet been well-defined. Further description is important for the diagnosis and treatment of PPDLBCL. Herein, we reported a case of a patient who suffered from bilateral chest pain and dyspnea. Computed tomography (CT) of chest demonstrated bilateral lung mass, consolidations and reverse halo sign, while consolidations and reverse halo sign are uncommon according to previous reports. Tissue samples were taken by CT guided needle biopsy. The histological samples showed PPDLBCL. This case was special in view of positive expression of CD5. After the case was treated by cyclophosphamide pirarubicin vindesine dexamethasone (CHOP) chemotherapy for six courses, her clinical symptoms were partially alleviated, while CT showed progression disease. This case report highlights different imaging features and characteristics of molecular biology, and reviews study progress of PPDLBCL.

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All that shine is not gold: modelling the true relation between orthostatic intolerance, fibromyalgia and chronic fatigue syndromes

Clinical Autonomic Research ◽

10.1007/s10286-008-0498-4 ◽

2008 ◽

Vol 18 (6) ◽

pp. 298-298

Author(s):

Juvenia Bezerra Fontenele ◽

Luzia Kalyne A. M. Leal ◽

Francisco Hélder Cavalcante Félix

Keyword(s):

Orthostatic Intolerance ◽

Chronic Fatigue ◽

True Relation

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