Authors: Donovan J. Anderson, M.D. Willow Valley Medical Center, Mohave Valley, AZ and W. John Martin M.D., Ph.D.,Center for Complex Infectious Disease, Rosemead CA

OBJECTIVE: To relate the chronic fatigue syndrome to a wider spectrum of virally induced dysfunctional brain illnesses, including cases with complex and severe neurological and neuropsychiatric manifestations.

METHODS: Clinical information was reviewed on over 100 patients involved in an apparent infectious illness occurring in the Mohave Valley region of the United States in the spring of 1996.

RESULTS: Patients initially presented with an acute gastrointestinal illness. Subtle neurological findings were apparent in a third of the patients at the time of their initial illness, and developed subsequently in an unexpectedly large number of patients from the Mohave Valley and surrounding areas. All of the patients studied were shown to be virally infected using a specialized virus culture method. By comparison, approximately 90% of individuals donating blood for transfusion, have consistently tested negative in repeated double-blind studies. The virus induced a marked vacuolating cytopathic effect in both human and animal cell lines and had additional characteristics that have been defined for "stealth-adapted" viruses. Stealth-adaptation refers to a process whereby viruses that lack critical antigenic targets required to evoke effective anti-viral inflammatory responses can, nevertheless, retain the capacity to replicate and to cause characteristic cellular damage. While the majority of the infected patients seen at the Willow Valley Medical Center could reasonably be categorized as having the chronic fatigue syndrome and/or fibromyalgia, these clinical labels did not encompass the complex and diverse clinical manifestations seen in a subset of the patients with severe diseases. Several of the patients with rapidly deteriorating brain function died. Other patients have presented with overt signs of illnesses affecting major organ systems in addition to the brain. Examples of severe illnesses will be presented that involve the heart, endocrine glands, liver, skin, hematopoietic and coagulation systems. It was not uncommon to see family members with differing major clinical manifestations. Detailed histological and electron microscopic features on a brain biopsy obtained on an 8 year old son of a woman with a major depressive disorder, will be shown. The boy initially presented as a behavioral and learning disorder, ascribed to his disrupted family situation. Seven months later, when severe brain damage was readily apparent on CT and MRI scans, the clinical neurological findings were modest with no abnormalities detected in motor, sensory or autonomic nervous system functions. The child's condition deteriorated further with some improvement from courses of ganciclovir and steroid therapy. He subsequently died from cerebral herniation. Other fatal cases associated with stealth virus infection will be described. The virus isolated from patients seen within the Mohave Valley has been deposited with the American Type Culture Collection.

CONCLUSION: The chronic fatigue syndrome is viewed as being part of a spectrum of diseases induced by atypical cytopathic (stealth-adapted) viruses. The term multi-system stealth virus infection with encephalopathy (MSVIE) more accurately defines the nature of the illness present in many of the infected patients seen within the Mohave Valley. Stealth virus infections can lead to serious and occasionally fatal diseases.