Chronic fatigue syndrome associated with herpesvirus infections
Chronic fatigue syndrome (CFS) is an important medical and social problem in view of the great influence on the quality of life and disability in the modern human population. It is necessary to distinguish the actual CFS from the syndrome with similar clinical manifestations caused by chronic reactivated lymphotropic herpesvirus infection induced by Epstein-Barr virus, human herpesvirus-6, -7 and, more rarely, cytomegalovirus. The virus-associated disease has a biphasic course with predominance of immune-inflammatory disorders in the first months/years and the development of neurodegeneration by type of mesial temporal sclerosis later on. Since the currently recognized criteria for the diagnosis of CFS suggested by the Centers for Disease Control and Prevention do not allow us to distinguish these two heterogeneous diseases, the identification of reactivated herpesvirus according to the results of the polymerase chain reaction of blood leukocytes (but not blood serum) or the detection of specific antibodies to certain virus mo-lecules associated with reactivation is the cornerstone of the diagnosis. Another important component of the diagnosis is evaluating the immune status and identifying, based on these findings, the immunodeficiency disease, which is the reason for maintaining the chronic reactivated state of the opportunistic virus in the human body due to the decreasing immune surveillance. According to the results of controlled clinical studies in CFS associated with herpesvirus infection, the combination therapy, which includes the acyclic analogue of guanosine for suppressing viral activity and the agent of targeted immunotherapy to compensate for the causative immunodeficiency, is optimal. This review deals with the comprehensive coverage of the evidence base accumulated up to now with respect to the etiology, pathogenesis, diagnosis and treatment of CFS associated with herpesvirus infections.
chronic fatigue syndrome; herpesviruses; immunodeficiency disease; review
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