A young woman with rigors and abdominal pain
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d689 (Published 09 March 2011) Cite this as: BMJ 2011;342:d689
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We welcome the rapid response by Dr Garson. Recent research does
indeed throw doubt on the role of XMRV in chronic fatigue syndrome. Many
of the papers quoted by Dr Garson were printed after this article had been
through peer review. Although this is not an excuse, it does illustrate
the speed at which this field has progressed.
Nonetheless, an association between EBV infection and chronic fatigue
syndrome remains suspected. As it now appears unlikely that XMRV is a
human pathogen, and thus unable to activate latent EBV, we would welcome
any suggestions on new theories or suspected pathogens.
Competing interests: No competing interests
A pregnancy test was performed and was negative. The authors agree
this finding should have been included in the manuscript.
Competing interests: No competing interests
Thank you for reporting this interesting case of infectious
mononucleosis in a young woman.
It is of concern, however, that the report does not mention excluding
pregnancy as a cause of her symptoms.The possibility of an ectopic, or
infectious complications of pregnancy, should always be considered (as
evidenced by latest CMACE report on maternal deaths, released a fortnight
ago).
Pregnancy should also be excluded before any diagnostic imaging in
women of childbearing age, as highlighted in another article in the same
edition of the BMJ.
Competing interests: No competing interests
Re: Endgames, Case Report: A young woman with rigors and abdominal
pain. Leach et al., BMJ 2011 342:d689; doi:10.1136/bmj.d689
The Long Answer to Question 4 of this Case Report published in the
BMJ on 9th March (BMJ 2011 342:d689) includes the following potentially
misleading statement: "Recent research suggests that infection with the
retrovirus XMRV causes chronic fatigue syndrome." The news article cited
[1] to support this statement was published in October 2009 soon after the
initial report of a link between XMRV and chronic fatigue syndrome (CFS)
appeared [2]. Since that time numerous studies from several countries
including the UK [3 - 9] have failed to confirm any association between
XMRV and CFS.
Furthermore, it is now considered highly probable that XMRV is not a
human pathogen and that the detection of XMRV in patients with CFS and
prostate cancer was due to laboratory contamination rather than due to
genuine infection [10 - 12].
References:
1. Kean S. Chronic fatigue and prostate cancer: a retroviral
connection? Science 2009; 326:215.
2. Lombardi VC, Ruscetti FW, Das Gupta J, Pfost MA, Hagen KS,
Peterson DL, Ruscetti SK, Bagni RK, Petrow-Sadowski C, Gold B, Dean M,
Silverman RH, Mikovits JA. Detection of an infectious retrovirus, XMRV, in
blood cells of patients with chronic fatigue syndrome. Science 2009;
326:585-589.
3. Groom HC, Boucherit VC, Makinson K, Randal E, Baptista S, Hagan S,
Gow JW, Mattes FM, Breuer J, Kerr JR, Stoye JP, Bishop KN. Absence of
xenotropic murine leukaemia virus-related virus in UK patients with
chronic fatigue syndrome. Retrovirology 2010; 7:10.
4. Erlwein O, Kaye S, McClure MO, Weber J, Wills G, Collier D,
Wessely S, Cleare A. Failure to detect the novel retrovirus XMRV in
chronic fatigue syndrome. PLoS ONE 2010; 5:e8519
5. van Kuppeveld FJ, de Jong AS, Lanke KH, Verhaegh GW, Melchers WJ,
Swanink CM, Bleijenberg G, Netea MG, Galama JM, van der Meer JW.
Prevalence of xenotropic murine leukaemia virus-related virus in patients
with chronic fatigue syndrome in the Netherlands: retrospective analysis
of samples from an established cohort. BMJ 2010; 340:c1018. doi:
10.1136/bmj.c1018.
6. Switzer WM, Jia H, Hohn O, Zheng H, Tang S, Shankar A, Bannert N,
Simmons G, Hendry RM, Falkenberg VR, Reeves WC, Heneine W. Absence of
evidence of xenotropic murine leukemia virus-related virus infection in
persons with chronic fatigue syndrome and healthy controls in the United
States. Retrovirology 2010; 7:57.
7. Hong P, Li J, Li Y. Failure to detect Xenotropic murine leukaemia
virus-related virus in Chinese patients with chronic fatigue syndrome.
Virol J 2010; 7:224.
8. Hohn O, Strohschein K, Brandt AU, Seeher S, Klein S, Kurth R, Paul
F, Meisel C, Scheibenbogen C, Bannert N. No evidence for XMRV in German
CFS and MS patients with fatigue despite the ability of the virus to
infect human blood cells in vitro. PLoS One 2010; 5:e15632.
9. Henrich TJ, Li JZ, Felsenstein D, Kotton CN, Plenge RM, Pereyra F,
Marty FM, Lin NH, Grazioso P, Crochiere DM, Eggers D, Kuritzkes DR,
Tsibris AM. Xenotropic murine leukemia virus-related virus prevalence in
patients with chronic fatigue syndrome or chronic immunomodulatory
conditions. J Infect Dis 2010, 202:1478-1481.
10. Hue S, Gray ER, Gall A, Katzourakis A, Tan CP, Houldcroft CJ,
McLaren S,Pillay D, Futreal A, Garson JA, Pybus OG, Kellam P, Towers GJ.
Disease-associated XMRV sequences are consistent with laboratory
contamination. Retrovirology 2010; 7:111.
11. Garson JA, Kellam P, Towers GJ. Analysis of XMRV integration
sites from human prostate cancer tissues suggests PCR contamination rather
than genuine human infection. Retrovirology 2011; 8:13.
12. Smith RA. Contamination of clinical specimens with MLV-encoding
nucleic acids: implications for XMRV and other candidate human
retroviruses. Retrovirology 2010; 7:112.
Competing interests: No competing interests
Re: A young woman with rigors and abdominal pain
I am concerned that this young woman who in the absence of a suggestive history should be considered immunocompetent and without either convincing haematological laboratory indices or inflammatory markers received not one but two broad spectrum beta lactam antibiotics before an alternative aetiology was considered and pursued. It is more daring in my view not to prescribe antibiotics when not clearly indicated and in an era when antimicrobial stewardship has never been more important it rather unfortunately seems to be the accepted absolute norm in our hospitals nationwide to see patients on broad spectrum antimicrobials without indication. The perennial fear of sepsis is of course the likely culprit for such poor practice but, I would assert, does not excuse such idescretions in patient management.
Competing interests: No competing interests