Image provided by: University of Oregon Libraries; Eugene, OR
About Just out. (Portland, OR) 1983-2013 | View Entire Issue (April 1, 1987)
» t Immune Dysfunction — Part 1 A layperson’s report on a disturbing medical syndrome. BY NANCY R. WALSETH, J. D. othing is more fascinating to ponder than the incredibly complex human immune system. This multi-organ network performs innumerable daily mira cles in all of us, apparently a very hardy and usually unproblemmatic system. Yet, aside from the occasional bubble baby story, or perhaps a seasonal ho-hum report on hay fever and the efficacy of allergy shots, the immune system did not get much press prior to the outbreak of AIDS in the United States. AIDS has catapulted the immune system from relative public obscurity into media stardom. Science writers and public television producers have raced to trans late what little is understood about it into plain English. Over and over, we have heard about antigens, antibodies, B lymphocytes, helper T cells, and memory T cells, and their respective specific, time- critical functions. How those cells know what to do, and when to do it, is yet unknown, but we do know that the cells and substances which comprise our immune system do certain amazing things, somehow, to keep us alive despite a life long onslaught of malevolent foreign in vaders (e.g., bacteria and viruses) and en vironmental toxins. The big research breakthrough on AIDS, of course, was the isolation of the specific viral agent, HIV, which causes and spreads the disease. Now, the search for a vaccine and cure progresses slowly ! hampered by the larger mystery, the Byzantine puzzle — the workings of the immune system itself, which cannot be dissected and preserved in a jar or readily observed in action. But AIDS, though undeniably the worst, is only one of several relatively new and I alarming immune-dysfunction syndromes, j Ironically, early AIDS research yielded an important ancillary discovery which finally provided a name for one of these other severely debilitating, but apparently not fatal, immunologic illnesses: Chronic Epstein-Barr virus (CEBV) syndrome. This insidious, perplexing illness had been observed by doctors for several de cades, wth patients presenting a complex of chronic symptoms including debilitat ing fatigue, achiness, fever, sore throat and sometimes swollen glands. Their primary complaint was not the severity, but rather, the chronicity of their symp toms; they simply did not get well. They were diagnosed as having everything from the flu to multiple sclerosis, and suspected of being hypochondriac, psychosomatic or simply depressed. A review of the literature reveals that the appellation “ chronic Epstein-Barr virus syndrome” is actually more a theory than a diagnosis, and that the “ discovery” of the Epstein-Barr connection has not stilled, but rather has fueled, a raging con troversy among researchers as to the role of this virus in the development of this chronic illness. Further, as is true of AIDS research, our lack of understanding of the immune system itself hampers all CEBV research. Most of the data, except for blood test results, seems to be anecdotal rather than clinical. CEBV syndrome is not contagious; in N -t~ ~ ttx -------r 1 " fact, one’s initial contact with the virus seems to be almost irrelevant. Researchers agree that by the age of thirty, 90 percent of us have already experienced (and our immune systems have successfully dealt with) a primary Epstein-Barr infection, which can manifest either in childhood as a simple cold, or in adolescence or adult hood as infectious mononucleosis. Mono can last from a few weeks to a few months, and is marked by symptoms of extreme fatigue, swollen glands, sore throat, fever, headache, and some degree of malaise (mental debilitation). During the time the virus is actively replicating in your cells, you carry it in your throat, your saliva and your sinus cavity, and can pass it to another person by an exchange of saliva (kissing), or by a well-directed sneeze. After the virus has stopped replicating due to the defensive work of your immune system, it remains forever in some of your B lymphocytes but is considered “ inactive,” or dormant. (During this time, you probably cannot pass the virus to others, but there is some disagreement on this.) Since 90 percent of us already have it, concern over the spread of the virus is almost moot, overshadowed by the question of why most immune sys tems can fight the Epstein-Barr virus into submission, while some apparently cannot. Researchers tackling this question seem to disagree on everything, including whether the Epstein-Barr virus bears any causal relation at all to the syndrome now named after it, as opposed to a different kind of co-relation. Those accepting the theory that the symptoms are caused by the Epstein-Barr virus make the CEBV diagnosis on the basis of levels of certain antibodies pro duced by the body in response to the virus. “ Late antibody titers” above a certain level are considered diagnostic of CEBV in patients who have been sick for over two years. CEBV skeptics, however, point out that although these high late antibody titers are often found in persons suffering from chronic fatigue, they also have been found in healthy persons. Related credibility battles are waged in the literature between doctors who apply the CEBV diagnosis only to patients who never recovered from their initial Epstein- Barr infection, and doctors who also apply the diagnosis to patients who recovered from mono years ago and then experienced a seeming recurrence of the disease. Doctors in the latter group ascribe to the theory that a re-activation of the long- inactive Epstein-Barr virus has occurred in the lymphocytes. Yet, at least one researcher has flatly said in a 1986 paper that the Epstein-Barr virus is incapable of such a reactivation and that those patients who seem to be suffering from a recurrence rather than a primary infection should be evaluated for other possible causes of their symptoms. In other words, CEBV may be a copout diagnosis in some cases. At any rate, we know that the ubiqui tous Epstein-Barr virus is not the sole cause of CEBV syndrome; if it were, 90 percent of us would be sick. Some genetic and environmental coincidences among these chronically ill people have been noted in the literature, but apparently not explored very deeply. They seem ■ - - - - - - potentially tremendously important, espe cially in view of the controversy over the basic diagnosis. In terms of prevention, they may be more important than the virus itself. NEXT MONTH, Part 2 of this article will present the stories of some local vic tims of CEBV and Environmental Illness, and will suggest that several diverse clues — genetic predisposition (allergies), environmentally toxic manmade products, and the new field of psychoneuro immunology — should be more seriously considered and discussed by those attempting to understand and convey to the public what these puzzling diseases may be trying to tell us about the way we live, and perhaps even about the way we think! See Vue Experience the unusual Reservations (503)547 3227 9S5W H ighw ay«* 6 2 m ites South o f Yachats. O regon 97498 16 S P E C I A L P IZ Z A S Including Waldorf, Greek, Tomato Overkill, Tex-Mex, Pesto with Sundried Toma toes, and the usual favorites! By the Slice or Whole - Here or To Go! PSU CA M PU S 1909 S W Sixth Avenut 224 0311 DOW NTOW N 222 S W Washington 224 5477 VISTA SPR IN G CAFE 2440 S W Vista Avenue 222 2811 the American Barber Shop “A Family Place ’ C L A R I C E JOHNSTON D. M. D. D E N T I STRY for adults and children • Treatment explained and discussed • Weekdays, Evenings and Saturdays • Flexible payment plans • Nitrous oxide available • New patients welcome 233-3622 230 N.E. 20th (Three blocks north of Burnside) 6740 S.W . Capitol Hwy. Portland, Oregon 97219 245-1429 --------------------- ---- ÎM iJuK rthtlSfà* A p n f !987