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Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study, 2023, Chang et al

Discussion in 'ME/CFS research' started by Dolphin, Sep 5, 2023.

  1. Dolphin

    Dolphin Senior Member (Voting Rights)

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    5,317
    Preprint details in this post

    Final publication is linked in a post below - see here

    **********
    Free:
    https://assets.researchsquare.com/f...-6f0d-4f73-a9f4-5349e07baac0.pdf?c=1693414746

    How post-infection status could lead to the increasing risks of chronic fatigue syndrome and the potential mechanisms: A 17-year populationbased Cohort study

    Hsun Chang Mackay Memorial Hospital
    Chien-Feng Kuo Mackay Memorial Hospital
    Teng-Shun Yu China Medical University Hospital
    Liang-Yin Ke Kaohsiung Medical University
    Chung-Lieh Hung Mackay Memorial Hospital
    Shin-Yi Tsai (  stsai22@jhu.edu ) Johns Hopkins University https://orcid.org/0000-0001-7978-778X

    Abstract

    Background: Serological studies have suggested that viruses and atypical pathogens are associated with CFS, but no study has focused on typical and common pathogens. This study aims to assess the association of infections with a variety of common pathogens with the risk of CFS and provide evidence for the hypothesis that infection triggers CFS.

    Methods: The nested case-control study identified 2,000,000 adult patients from a nationwide population-based health insurance claims database from January 1, 2000, to December 31, 2017. Each case with a diagnosis of infection by pathogens was matched with one control using a propensity score. Patients with more than one potential pathogen, younger than 20 years old, or with a history of CFS or infection with certain pathogens before the index date were excluded. Univariate and multivariate Cox proportional hazard models were applied to estimate the HR, aHR, and corresponding 95% CI. The multivariate analysis had adjustments for age, sex, comorbidities, and medication confounders.

    Results: A total of 395,811 cases with 1: 1 matched controls were included (58.2% female; mean age [standard deviation], 44.15 [17.02]). Among these, the aHR of the pathogen cohort was 1.5 (95% CI, 1.47 to 1.54). Pathogens were positively correlated with CFS, including influenza, candida and others.

    Conclusion: The findings of this study demonstrate the association between CFS and infection with common pathogens, including bacteria, virus and fungi.

     
    Last edited by a moderator: Nov 11, 2023
    Dolphin, Sep 5, 2023
    #1
    EzzieD, RedFox, DokaGirl and 2 others like this.
  2. LarsSG

    LarsSG Senior Member (Voting Rights)

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    "CFS was defined as ICD-9-CM 780.7 and ICD-10-CM G93.3, R53.8" so much broader than ME, this includes "malaise and fatigue" in general. Common issue with studies from Taiwan.
     
    LarsSG, Sep 5, 2023
    #2
    Michelle, NelliePledge, Dolphin and 6 others like this.
  3. Hutan

    Hutan Moderator Staff Member

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    And that might be the most accurate statement in the introduction. There's an awful lot of saying things confidently when we really don't know.

    Never mind the exact pathogenesis, I don't think we have yet narrowed down which ball park we are operating in.

    Yeah, but is it though? I've pretty sure I've seen a lot of papers where these cytokines aren't different.

    Same for this. I've had moderately higher levels of t-regs, and I think I've seen that reported elsewhere

    maybe it's true, but I don't think we have evidence

    I think the jury might even still be out on that one.

    Metal exposure? Environmental factors? I don't know that we can say with any confidence that these are triggering events. And I don't think we know how pathogen exposure triggers ME/CFS.

    We don't know that this is what is going on in ME/CFS.

    We don't know if that is relevant in ME/CFS.

    There's no good evidence for hypocortisolism driving ME/CFS symptoms, despite so many people wanting out to be true. And there's the pro inflammatory cytokines again.

    Uhh

    At least there's a 'may' there.

    It's not good enough. People with ME/CFS can't be blamed for saying 'there's so much biological evidence' when researchers just trot out a whole lot of speculation as fact. (Happy to be proven wrong on any of those).
     
    Hutan, Sep 5, 2023
    #3
    Michelle, Dolphin, RedFox and 3 others like this.
  4. Hutan

    Hutan Moderator Staff Member

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    That's an interesting question.

    That seems pretty significant. Look at the hazard ratio for people taking doxycycline (0.1). It goes against the idea that the antibiotics, and especially (cipro)floxacin might be predisposing factors for ME/CFS onset.

    I expect that are plenty ifs and buts to apply to the finding, but it looks worth looking into. The lower risk in patients with dementia might just be because whatever symptoms the dementia patient has, they are attributed to dementia.
     
    Hutan, Sep 5, 2023
    #4
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  5. Hutan

    Hutan Moderator Staff Member

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    Hutan, Sep 5, 2023
    #5
    Dolphin, RedFox and Sean like this.
  6. Hutan

    Hutan Moderator Staff Member

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    No association found with EBV... Due to a limited number of cases, but even so.
    And nothing for dengue fever or Lyme or rickettsias.

    I don't know. The Taiwanese health database should be a gold mine of information, but it's hard to know what can be trusted.
     
    Hutan, Sep 5, 2023
    #6
    Dolphin and Sean like this.
  7. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Merged thread. Final publication

    Abstract
    Background

    Previous serological studies have indicated an association between viruses and atypical pathogens and Chronic Fatigue Syndrome (CFS). This study aims to investigate the correlation between infections from common pathogens, including typical bacteria, and the subsequent risk of developing CFS. The analysis is based on data from Taiwan’s National Health Insurance Research Database.

    Methods
    From 2000 to 2017, we included a total of 395,811 cases aged 20 years or older newly diagnosed with infection. The cases were matched 1:1 with controls using a propensity score and were followed up until diagnoses of CFS were made.

    Results
    The Cox proportional hazards regression analysis was used to estimate the relationship between infection and the subsequent risk of CFS. The incidence density rates among non-infection and infection population were 3.67 and 5.40 per 1000 person‐years, respectively (adjusted hazard ratio [HR] = 1.5, with a 95% confidence interval [CI] 1.47–1.54). Patients infected with Varicella-zoster virus, Mycobacterium tuberculosis, Escherichia coli, Candida, Salmonella, Staphylococcus aureus and influenza virus had a significantly higher risk of CFS than those without these pathogens (p < 0.05). Patients taking doxycycline, azithromycin, moxifloxacin, levofloxacin, or ciprofloxacin had a significantly lower risk of CFS than patients in the corresponding control group (p < 0.05).

    Conclusion
    Our population-based retrospective cohort study found that infection with common pathogens, including bacteria, viruses, is associated with an increased risk of developing CFS.

    https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-023-04636-z
     
    Last edited by a moderator: Nov 11, 2023
    Sly Saint, Nov 11, 2023
    #7
    Sean, Hutan, cassava7 and 2 others like this.
  8. Andy

    Andy Committee Member

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    "The study defined CFS as ICD-9-CM 780.7 and ICD-10-CM G93.3, R53.8."

    ICD-9-CM 780.7 being "Malaise and fatigue", ICD-10-CM G93.3 is "Postviral and related fatigue syndromes" and ICD-10-CM R53.8 is "Other malaise and fatigue".
     
    Andy, Nov 11, 2023
    #8
    Sean, Hutan, Wonko and 3 others like this.
  9. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    Among individual pathogens, infection with Borrelia burgdorferi (the bacteria that causes Lyme Disease) seems to have resulted in the highest incidence rate (11.77).
     
    ME/CFS Skeptic, Nov 11, 2023
    #9
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  10. Wonko

    Wonko Senior Member (Voting Rights)

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    Were they also amazed to find that people given a diagnostic code for broken bones in the leg were found to have broken legs?
     
    Wonko, Nov 11, 2023
    #10
    Michelle likes this.

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