SBS/CFS in Iran

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Correspondence

Is there any relation between moldy building exposure and chronic

fatigue syndrome?

Journal: Med Hypotheses. 2006 Mar 7; [Epub ahead of print]

Authors: Shahriar Gharibzadeh and Sayed Shahabuddin Hoseini

Affiliations: Neuromuscular Systems Laboratory, Faculty of Biomedical

Engineering, Amirkabir University of Technology, Somayyeh, Hafez,

Tehran

15875-4413, Iran, and Faculty of Medicine, Tehran University of

Medical

Sciences, Enghelab Street, Tehran, Iran

Tel.: +9821 6454 2369; fax: +9821 6649 5655. E-Mail:

shahab337@...

Available online 9 March 2006.

It is reported that workers who are employed in moldy buildings, show

different symptoms like respiratory difficulties, fatigue, fever and

headache. Hirvonen et al. have reported elevated cytokines

(interleukin-1,

interleukin-6 and tumor necrosis factor a) and nitric oxide (NO)

levels in

nasal lavage of workers in exposure to moldy buildings. Due to

laboratory

tests, Aspergillus fumigatus, Trichoderma, Actinomycetes, etc. were

detected in indoor air [1].

On the other hand, chronic fatigue syndrome (CFS) is the current name

for a

disorder characterized by debilitating fatigue and several associated

complaints including headache, sleep disorder, low grade fever and

concentration difficulties [2]. It is mentioned that post-

infectious,

immunological, and psychological factors are involved in the syndrome

[3].

Researches in patients with CFS have shown a significant elevation in

serum

levels of interleukin-1 and tumor necrosis factors a and ß [4]. which

can

result in the appearance of CFS symptoms. Small amounts of

circulating

cytokines can enter the cerebrospinal fluid and the parenchyma of the

brain

[5]. Cytokines administered systemically or directly into the

central

nervous system have shown to alter the activity of hypothalamus,

hippocampus, and prefrontal cortex [6].

In addition, elevated nitric oxide levels have been documented in CFS

patients. It is hypothesized that NO plays a significant role in

pain

sensitization, which is seen in these patients [7]. Moreover,

excessive NO

production is an important factor in pulmonary manifestations

including

vasodilation, edema and cytotoxicity [1].

It seems from the abovementioned points that, in accordance with the

post-infectious theory of CFS, the exposure to moldy conditions may

be a

trigger for the onset of CFS. Moreover, the working of persons with

CFS in

moldy conditions may aggravate their symptoms including pulmonary

pain and

psychoneurological manifestations. Surely, our hypothesis needs to

be

validated by experimental evaluation.

References

[1] M.R. Hirvonen, M. Ruotsalainen, M. Roponen, A. Hyvarinen, T.

Husman and

V.M. Kosma et al., Nitric oxide and proinflammatory cytokines in

nasal

lavage fluid associated with symptoms and exposure to moldy building

microbes, Am J Respir Crit Care Med 160 (1999) (6), pp. 1943-1946.

[2] N. Afari and D. Buchwald, Chronic fatigue syndrome: a review, Am

J

Psychiatry 160 (2003) (2), pp. 221-236.

[3] K. Fukuda, S.E. Straus, I. Hickie, M.C. Sharpe, J.G. Dobbins and

A.

Komaroff, The chronic fatigue syndrome: a comprehensive approach to

its

definition and study. International Chronic Fatigue Syndrome Study

Group,

Ann Intern Med 121 (1994) (12), pp. 953-959.

[4] A. Linde, B. Andersson, S.B. Svenson, H. Ahrne, M. Carlsson and

P.

Forsberg et al., Serum levels of lymphokines and soluble cellular

receptors

in primary Epstein-Barr virus infection and in patients with chronic

fatigue syndrome, J Infect Dis 165 (1992) (6), pp. 994-1000.

[5] W.A. Banks, A.J. Kastin and E.G. Gutierrez, Interleukin-1 alpha

in

blood has direct access to cortical brain cells, Neurosci Lett 163

(1993)

(1), pp. 41-44.

[6] S. Zalcman, J.M. Green-, L. Murray, D.M. Nance, D. Dyck

and H.

Anisman et al., Cytokine-specific central monoamine alterations

induced by

interleukin-1, -2 and -6, Brain Res 643 (1994) (1-2), pp. 40-49.

[7] J. Nijs, B. Van de Velde and K. De Meirleir, Pain in patients

with

chronic fatigue syndrome: does nitric oxide trigger central

sensitisation?,

Med Hypotheses 64 (2005) (3), pp. 558-562.