Background: The role of pathogen specific cellular immune responses against the eliciting pathogen in development\nof post-infectious chronic fatigue syndrome (PI-CFS) is not known and such studies are difficult to perform. The aim of\nthis study was to evaluate specific anti-Giardia cellular immunity in cases that developed CFS after Giardia infection\ncompared to cases that recovered well. Patients reporting chronic fatigue in a questionnaire study three years after a\nGiardia outbreak were clinically evaluated five years after the outbreak and grouped according to Fukuda criteria for\nCFS and idiopathic chronic fatigue. Giardia specific immune responses were evaluated in 39 of these patients by\nproliferation assay, T cell activation and cytokine release analysis. 20 Giardia exposed non-fatigued individuals and 10\nhealthy unexposed individuals were recruited as controls.\nResults: Patients were clinically classified into CFS (n = 15), idiopathic chronic fatigue (n = 5), fatigue from other causes\n(n = 9) and recovered from fatigue (n = 10). There were statistically significant antigen specific differences between\nthese Giardia exposed groups and unexposed controls. However, we did not find differences between the Giardia\nexposed fatigue classification groups with regard to CD4 T cell activation, proliferation or cytokine levels in 6 days\ncultured PBMCs. Interestingly, sCD40L was increased in patients with PI-CFS and other persons with fatigue after\nGiardia infection compared to the non-fatigued group, and correlated well with fatigue levels at the time of sampling.\nConclusion: Our data show antigen specific cellular immune responses in the groups previously exposed to Giardia\nand increased sCD40L in fatigued patients.
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