The Development of Laboratory-Based Tests in Chronic Pain and Fatigue:

1. Muscle Catabolism and Coagulase Negative Staphylococci Which Produce
Membrane Damaging Toxins

J Chronic Fatigue Syndrome, Vol. 7(2) 2000, pp. 53-7

R. H. Dunstan, DPhil; N. R. McGregor, MDSc; T.K. Roberts, PhD; H. Butt,
PhD; S.H. Niblett, BSc; T. Rothkirch, BSc

Collaborative Pain Research Unit, Department of Biological
Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.

ABSTRACT.
Background: The diagnosis of chronic fatigue syndrome (CFS) requires the
exclusion of other known fatigue-related diseases because the core
symptoms of CFS represent a general host response to many well-defined
diseases. The patient set derived by this process is heterogeneous in
their polysymptomatic presentation and has proved very difficult to study
clinically and scientifically.

Objectives: To investigate the alterations in urine excretion and
microbiology in patients with CFS.

Results:  CFS patients had multiple anomalies in their amino acid and
organic acid homeostasis. Sub-groups of CFS patients could be delineated
on the basis of their urine excretion and their symptom presentation. The
most common feature was an active muscle catabolism resulting in a
depletion of amino acids and associated organic and keto-acids. The
extent of muscle catabolism was directly correlated to pain severity. The
carriage of toxin-producing coagulase negative staphylococci (MDT-C0NS)
was strongly correlated with the catabolic response and pain severity.

Conclusions: An hypothesis has been constructed where an occult pathogen,
such as MDT-CoNS, may be an aetiological agent contributing to the
sustenance of a chronic fatigue/pain disorder, a comorbid pathogen. Urine
analysis offers an opportunity for assessment of muscle catabolism and
sub-classification of chronic fatigue patients leading to a number of
management options. The detection of MDTCoNS identifies potentially
treatable agents that contribute to the fatigue and pain condition.

KEYWORDS. Staphylococcus, toxin, pain, fatigue, urine