TGI Friday! Our weekly roundup of research abstracts and news that sometimes slip out of sight | 28 September 2012

Note: Q fever is among the many viruses associated with subsets of ME and CFS patients. More general information can be found HERE:

From Eur J Clin Microbiol Infect Dis. 2012 Sep 26. [Epub ahead of print]

Targeted screening as a tool for the early detection of chronic Q fever patients after a large outbreak.

Wegdam-Blans MC, Stokmans RA, Tjhie JH, Korbeeck JM, Koopmans MP, Evers SM, van der Voort PH, Teijink JA.
Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), de Run 6250, 5504 DL, Veldhoven, The Netherlands, m.wegdam@pamm.nl.

Abstract

In the aftermath of the Dutch Q fever outbreak, an increasing number of patients are being diagnosed with chronic Q fever. Most of these patients are unaware of being infected with Coxiella burnetii, the
causative agent of Q fever.

To find patients in an earlier, asymptomatic stage, a targeted screening strategy (TSS) for patients with risk factors for chronic Q fever was started in the southeast region of Noord-Brabant. In total,
763 patients were tested using an IgG phase II indirect fluorescent antibody test (IFAT), of which 52 (7 %) patients tested positive.

Ten of these 52 patients displayed a chronic Q fever serological profile. All of these 10 patients had a heart valve(s) or (endo-)vascular prosthesis. All except one were asymptomatic.

Suggestive signs for chronic infections on positron emission tomography-computed tomography (PET-CT) were demonstrated in 5 (50 %) of these patients. Forty-two out of the 52 patients with a positive
screening test showed a past Q fever serological profile. After a year of follow-up (every 3 months), none of these patients showed elevation of antibody titres and no new chronic Q fever patients were found in this group.

A targeted screening programme is a useful instrument for detecting patients at risk of developing chronic Q fever.

From the Journal of the Royal College of Physicians of Edinburgh Issue Vol 40/4 2010, link shows pdf of full paper.

The Newcastle NHS Chronic Fatigue Syndrome Service: not all fatigue is the same

(1) J L Newton, (2) H Mabillard, (3) A Scott, (4) A Hoad, (5) G Spickett
(1) Professor of Ageing and Medicine, NIHR Biomedical Research Centre in Ageing and Institute for Ageing & Health, Newcastle University, and Consultant Physician, Northern Regional CFS/ME Clinical Service, Newcastle upon Tyne Hospitals NHS Trust;
(2,3) Medical students, NIHR Biomedical Research Centre in Ageing and Institute for Ageing & Health, Newcastle University;
(4) Foundation doctor;
(5) Consultant Immunologist and Northern Regional CFS Clinical Service Champion, Northern Regional CFS/ME Clinical Service, Newcastle upon Tyne Hospitals NHS Trust, UK

Abstract

In England the Department of Health has funded specialist clinical services aimed at diagnosing and managing the symptoms of chronic fatigue syndrome (CFS). These services are not available to those who do not fulfil the diagnostic criteria for CFS.

This service evaluation examined the proportion of those referred to a specialist CFS service fulfilling the Fukuda diagnostic criteria for CFS and the alternative fatigue-associated diagnoses.

The CFS database was interrogated to include every patient referred to the Newcastle service from November 2008 to December 2009. All medical notes were reviewed and the diagnosis, sex and age recorded. Data were compared to a previous service evaluation (2005–07).

In 2008–09, 260 subjects were referred: 19 referrals per month (260/14), compared with 17 referrals per month in 2005–07 (375/24). The proportion of patients diagnosed with CFS increased significantly compared with 2007 (36% [20/56] vs 60% [157/260]; p<0.0001).Of the 40% of patients subsequently found not to have CFS the most common diagnosis was fatigue associated with a chronic disease (47% of all alternative diagnoses); 20% had primary sleep disorders, 15% psychological/psychiatric illnesses and 4% a cardiovascular disorder. Thirteen per cent remained unexplained (5.2% of the total referrals).This study found a significant increase in the proportion of patients referred to National Health Service (NHS) CFS services diagnosed with CFS.A large proportion of patients presenting with fatigue are not eligible for referral to the Department of Health specialist fatigue services, which represents an unmet need in terms of symptom management in current NHS services.

From the Journal of the Royal Society of Medicine (short reports), 3 January 2012.

Alternative diagnoses to chronic fatigue syndrome in referrals to a specialist service: service evaluation survey

Anoop Devasahayam(1), Tara Lawn(2), Maurice Murphy (3), and Peter D White(4)

(1) NHS Greater Glasgow and Clyde, Yorkhill Hospital, Glasgow, UK
(2) East London Foundation Trust, St Bartholomew's Hospital, London, UK
(3) Barts and The London NHS Trust, St Bartholomew's Hospital, London, UK
(4) Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK

Abstract

OBJECTIVE To assess the accuracy of diagnoses made by referrers to a chronic fatigue syndrome (CFS) service.

DESIGN Retrospective service evaluation surveys of both rejected referral letters and medical case-notes after full clinical assessment.

SETTING A specialist CFS clinic in London, UK.

PARTICIPANTS

In the first survey, we assessed rejected referral letters between March 2007 and September 2008. In the second survey, we ascertained the primary diagnosis made in case-notes of 250 consecutive new patients assessed between April 2007 and November 2008.

MAIN OUTCOME MEASURES Reasons for rejection of referrals and primary diagnosis in those assessed.

RESULTS

In the first survey, 154 out of 418 referrals (37%) were rejected. Of these, 77 out of the available 127 referrals (61%) had a likely alternative diagnosis. In the second survey of clinically assessed patients, 107 (43%) had alternative medical/psychiatric diagnoses, while 137 out of 250 (54%) patients received a diagnosis of CFS. The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS.

CONCLUSIONS

Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses. Specialist medical assessment for patients with unexplained, disabling, chronic fatigue needs to incorporate both medical and psychiatric assessments.

Our thanks to Tate Mitchell who circulated links to the second and third studies on Co-Cure today. They were cited in an article called ‘Misdiagnosis on a massive scale?' by Dr Neil Abbot, research director at ME Research UK, which first appeared in MERUK's ‘Breakthrough' magazine.