CFS 5 years after giardiasis: differential diagnoses, characteristics and natural course

[WillowJ]

Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course

Kristine Mørch, Kurt Hanevik, Ann C Rivenes, Jørn E Bødtker, Halvor Næss, Bjarte Stubhaug, Knut-Arne Wensaas, Guri Rortveit, Geir E Eide, Trygve Hausken and Nina Langeland

BMC Gastroenterology 2013, 13:28 doi:10.1186/1471-230X-13-28
Published: 12 February 2013

Abstract (provisional)

Background

A high prevalence of chronic fatigue has previously been reported following giardiasis after a large waterborne outbreak in Bergen, Norway in 2004. The aim of this study was to describe and evaluate differential diagnoses and natural course of fatigue five years after giardiasis among patients who reported chronic fatigue three years after the infection.

Methods

Patients who three years after Giardia infection met Chalder's criteria for chronic fatigue (n=347) in a questionnaire study among all patients who had laboratory confirmed giardiasis during the Bergen outbreak (n=1252) were invited to participate in this study five years after the infection (n=253). Structured interviews and clinical examination were performed by specialists in psychiatry, neurology and internal medicine/infectious diseases.

Fukuda et al's 1994 criteria were used to diagnose chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). Self-reported fatigue recorded with Chalder Fatigue Questionnaire three and five years after infection were compared.

Results

53 patients were included. CFS was diagnosed in 41.5% (22/53) and ICF in 13.2% (7/53). Chronic fatigue caused by other aetiology was diagnosed in 24.5% (13/53); five of these patients had sleep apnoea/hypopnoea syndrome, six had depression and five anxiety disorder, and among these two had more than one diagnosis. Fatigue had resolved in 20.8% (11/53). Self-reported fatigue score in the cohort was significantly reduced at five years compared to three years (p<0.001).

Conclusion

The study shows that Giardia duodenalis may induce CFS persisting as long as five years after the infection. Obstructive sleep apnoea/hypopnoea syndrome, depression and anxiety were important differential diagnoses, or possibly comorbidities, to post-infectious fatigue in this study. Improvement of chronic fatigue in the period from three to five years after giardiasis was found.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

[Little Bluestem]

If

Improvement of chronic fatigue in the period from three to five years after giardiasis was found.

then I suspect it was just that - chronic fatigue, not Chronic Fatigue Syndrome. I have not heard of many people spontaneously getting better. But then, those people might not be online looking for ways to speed up their improvement.

 

[LaurelW]

This really interests me, because I had giardiasis in '89, got mono in '90 and full-blown CFS in '94.

 

[biophile]

Those who had experienced chronic fatigue following giardiasis earlier, but who no longer had fatigue affecting normal life, were categorised as “Recovered from fatigue”.

Fatigue score at 3 years : "Recovered from fatigue" - Mean, range (SD): 18, 15–22 (1.86).

Those fatigue scores are a little high to be normal? See this older post by Dolphin on normative data for CFQ:

http://forums.phoenixrising.me/inde...d-pace-trial-protocol.3928/page-53#post-88401

Perhaps the keyword here is "no longer had fatigue affecting normal life"?

 

[snowathlete]

Interesting. Thanks for posting. My article on zoonoses mentions this outbreak and the earlier study. I would have referenced this study too had it been published a few days earlier.

The Giardia also caused IBS in a lot of patients which of course is often co-morbid with CFS.

 

[WillowJ]

If

then I suspect it was just that - chronic fatigue, not Chronic Fatigue Syndrome. I have not heard of many people spontaneously getting better.

these are all kinds of patients - you can see from the abstract that uncategorized post-viral fatigue, ICF, and CFS are mentioned, as well as 'recovered' patients. It is well known that from uncategorized fatigue after virus, more will have greater improvement earlier on (it is unclear to me whether some recover fully? or some recover to fairly normal life with some symptoms but carry a danger of relapse).

I thought the recovery from general-fatigue-after-infection category was interesting to compare with recovery claims from various therapies, as they sometimes use/include patients who have not been ill for very long.

 

[snowathlete]

These people, when the outbreak originally occurred, knowing the cause of their illness, all had treatment for it with metronidazole too, so their chances of getting better would have been greater than others (some of us perhaps) who may have the same cause but not know it.