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Infection, Vaccination, and Autoantibodies in Chronic Fatigue Syndrome, Cause or Coincidence?


  • Oscar-Danilo Ortega-Hernandez,

    1. Department of Internal Medicine “B” and Research for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
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  • Yehuda Shoenfeld

    1. Department of Internal Medicine “B” and Research for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    3. Incumbent of the Laura Schwarz-Kip Chair for Autoimmunity, Tel-Aviv University, Tel-Aviv, Israel
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Address for correspondence: Yehuda Shoenfeld, M.D., F.R.C.P., Department of Medicine “B”, Sheba Medical Center, Tel Hashomer 52621, Israel. Voice: +972 3 5302652; fax: +972 3 5352855.


Chronic fatigue syndrome (CFS) is a heterogeneous syndrome of unknown etiology and physiopathology. CFS patients complain about disabling fatigue, depression, difficulty with memory, and concomitant skeletal and muscular pain. Interestingly enough, there is certain overlap between CFS symptoms, autoimmune rheumatic disease, and infectious diseases. Certain neuroendocrine-immune abnormalities have also been described, and autoantibodies commonly described in some autoimmune diseases have been found in CFS patients as well. An increasing number of autoantibodies, mainly directed against other nuclear cell components, have been illustrated. Likewise, an association between some infectious agents, antibody production, and later CFS onset has been reported. Similarly, vaccination is depicted as playing an important role in CFS onset. Recently, a case report pointed toward a causal association between silicone breast linkage, hepatitis B virus vaccination, and CFS onset in a previous healthy woman. Such findings suggest that there is a likely deregulation of the immune system influenced by specific agents (infections, vaccination, and products, such as silicone). Evidence suggests that CFS is a complex disease in which several risk factors might interact to cause its full expression. Thus, although different alterations have been found in CFS patients, undoubtedly the main feature is central nervous system involvement with immunological alterations. Therefore, a new term neuro-psycho-immunology must be quoted. New studies based on this concept are needed in order to investigate syndromes, such as CFS, in which immunological alterations are thought to be associated with concomitant psychological and health disturbances.

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