Azithromycin in Chronic Fatigue Syndrome (CFS), an analysis of clinical data
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Azithromycin in Chronic Fatigue Syndrome (CFS), an analysis of clinical data Ruud CW Vermeulen*1 and Hans R Scholte2 Address: 1CFS and Pain Research Center Amsterdam, Waalstraat 25-31, 1078 BR Amsterdam, The Netherlands and 2Department of Biochemistry, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands Email: Ruud CW Vermeulen* - [email protected]; Hans R Scholte - [email protected] * Corresponding author
Published: 15 August 2006 Journal of Translational Medicine 2006, 4:34
doi:10.1186/1479-5876-4-34
Received: 27 June 2006 Accepted: 15 August 2006
This article is available from: http://www.translational-medicine.com/content/4/1/34 © 2006 Vermeulen and Scholte; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: CFS is a clinical state with defined symptoms, but undefined cause. The patients may show a chronic state of immune activation and treatment with an antibiotic in this subgroup has been suggested. Methods: In a retrospective study, the response of CFS patients to azithromycin, an antibiotic and immunomodulating drug, has been scored from the patients records and compared with clinical and laboratory data. Azithromycin was not the first choice therapy, but offered when the effect of counseling and L-carnitine was considered insufficient by the patient and the clinician. Results: Of the 99 patients investigated, 58 reported a decrease in the symptoms by the use of azithromycin. These responding patients had lower levels of plasma acetylcarnitine. Conclusion: The efficacy of azithromycin in the responsive patients could be explained by the modulating effect on a chronic primed state of the immune cells of the brain, or the activated peripheral immune system. Their lower acetylcarnitine levels may reflect a decreased antioxidant defense and/or an increased consumption of acetylcarnitine caused by oxidative stress.
Background In 1994 Fukuda et al. [1] defined CFS as a chronic persistent fatigue that is present for over 6 months, is not caused by activity nor alleviated by rest and accompanied with at least 4 other symptoms: cognitive impairment, pain in joints, muscles or head, unrefreshing sleep, soar throat, tender lymph nodes and postexertional malaise with slow recovery. Nevertheless, CFS remained subject to debate and even the mere existence of the syndrome was still questioned by some. The presentation of the results of quantitative morphology of the brain in CFS patients by Okada et al [2], later confirmed by De Lange et al [3] may change this opinion. The loss of grey matter in the brain,
especially in Brodmann's area 9, was related to physical impairment, but not to the duration of the symptoms. Although other explanations were considered as well, this may indicate
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