Hope for Chronic Fatigue Syndrome

medicine.stanford.edu/newsletter/2011:

Jose G. Montoya, MD, has treated more than 200 people
with chronic fatigue syndrome (CFS). The defining symptoms—
disabling fatigue, brain fog, muscle and joint pain,
impaired sleep, sore throat, and enlarged lymph nodes—
indicate that a disease is clearly present. Whatever causes
CFS, however, remains a mystery and a troubling concern
for patients who suffer from symptoms, which are often
inconsistent with what laboratory tests and examinations
can actually find. Sadly, this profound dichotomy has led to
disbelief among some physicians and members of the medical
community as to whether patients are actually sick.
For the past 6 years, Montoya, an associate professor in the
division of infectious diseases, has postulated that CFS can
be linked to an infection from pathogens such as herpes
viruses, Chlamydia pneumoniae, tick borne pathogens, or
enteroviruses. “We have an increasing number of success
stories where patients get better with long-term treatment
of the specific pathogen,” said Montoya.
The problem, however, is that these different pathogens
often produce the same group of symptoms. “We have the
equivalent to pneumonia as a disease in chronic fatigue
syndrome but haven’t found the infiltrate yet to objectively
say this patient has CFS. We’re still working with the clinical
definition and to establish the relationship with the
specific pathogens.”
Ongoing Research
A $1.4 million grant from the pharmaceutical company
that manufactures the anti-viral drug Valcyte has enabled
Montoya do a double-blind, placebo-controlled, randomized
trial whose results are highly suggestive that patients
improve because of the drug and not the placebo.
Additional funds from a generous private donation fuels
the search for pathogens in the blood of CFS patients.

In
collaboration with Ian
Lipkin, MD, at Columbia
University, and utilizing
innovative technologies
such as mass tag, PCR,
Green chip, or 454 deep
sequencing (which have
never been tried with CFS
patients), researchers may
find known or unknown
organisms. Montoya also
collaborates with other
Stanford faculty and the Stanford Human Immune Monitoring
Core Facility to analyze the blood through immunological
techniques. Several hundred patients are enrolled in
these studies.
The Big Picture
CFS is believed to affect between one and four million
Americans and accounts for approximately $9 to $18 billion
in lost productivity due to illness. Montoya’s long-term goal
is to eliminate chronic fatigue syndrome. Slowly, he has introduced
the condition, which was previously ostracized by
academic centers into the division of infectious diseases. He
hopes that physicians who treat CFS patients will eventually
see it as making a contribution to human health.
“I think the future of infectious diseases is going to be in
the challenges posed by viruses, other intercellular pathogens,
and chronic illnesses. For these we have poor diagnostics
and limited therapies. Connecting an unexplained
chronic illness and other diseases with these pathogens
will shape the future of our subspecialty. It will expand the
therapeutic armamentarium beyond treating extracellular
bacteria and fungi to more challenging and unexplained
syndromes associated with infection.”