Q J Med 1999; 92: 293
© 1999 Association of Physicians
Correspondence |
Fatigue syndromes
Sir,
The paper by Pentilla et al. on cytokine dysregulation in post-Q-fever fatigue syndrome1 not only provides evidence that when this syndrome follows Q fever it is causally related to rickettsial infection, but also illustrates the way in which methodologically nominalist definitions allow the disease terminology to be used in diagnostic statements concisely and without unwarranted implications.2
`Chronic fatigue syndrome', defined in clinical-descriptive terms, should convey no causal implication; when there is convincing evidence of a causal factor, the case belongs to a causally-defined subset of this syndrome, and in the diagnostic statement this factor should take precedence. `Post-Q-fever fatigue syndrome', with the acceptable acronym QFS, conforms to this desideratum. The use of this term leaves no doubt that the findings are relevant to only one sub-set of CFS, with no implication that they are applicable to all cases of this syndrome. Of course, they lead to a series of further questions about this subset, such as the mechanisms by which the symptoms are produced and the possibility of specific therapeutic approaches. About these, testable hypotheses can be advanced.
This contrasts with the confusion caused by the thoughtless acceptance of the unjustified term `myalgic encephalomyelitis' (ME) as synonymous with CFS. This term can properly refer only to some sort of inflammatory process affecting the brain and spinal cord and associated with muscle pain. Since no such change has been demonstrated in any instance, its use can imply only the belief that the central nervous system is affected by changes of this sort too subtle to be detected by any current procedure. This is an untestable hypothesis.
References
1.
Pentilla LA, Harris RJ, Storm F, et al. Cytokine dysregulation in the post-Q-fever fatigue syndrome. Q J Med 1998; 91:549–60.
2. Scadding JG. Essentialism and nominalism in medicine: logic of diagnosis in disease terminology. Lancet 1996; 348:594–6.[Medline]
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