Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review

Amy Wallis; Michelle Ball; Sandra McKechnie; Henry Butt; Donald P Lewis; Dorothy Bruck

doi:10.1186/s12967-017-1229-1

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review

J Transl Med. 2017 Jun 7;15(1):129. doi: 10.1186/s12967-017-1229-1.

Authors

Amy Wallis¹, Michelle Ball², Sandra McKechnie³, Henry Butt⁴, Donald P Lewis⁵, Dorothy Bruck²

Affiliations

¹ Psychology Department, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia. amy.wallis@vu.edu.au.
² Psychology Department, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
³ College of Engineering & Science, Victoria University, Melbourne, VIC, Australia.
⁴ Bioscreen Yarraville (Aust) Pty Ltd, Melbourne, VIC, Australia.
⁵ CFS Discovery Clinic, Melbourne, VIC, Australia.

Abstract

Background: The pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of D-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of D-lactic acidosis (D-la).

Methods: D-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high D-lactate levels. Fifty-nine D-la episodes were included in the qualitative synthesis comparing D-la symptoms with ME/CFS diagnostic criteria. A narrative review of D-la mechanisms and relevance for ME/CFS was provided.

Results: The majority of neurological disturbances reported in D-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported D-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS.

Limitations: Interpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for D-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined.

Conclusions: Shared symptomatology and underlying microbiota-gut-brain interactions raise the possibility of a continuum of acute (D-la) versus chronic (ME/CFS) presentations related to D-lactate absorption. Measurement of D-lactate in ME/CFS is needed to effectively evaluate whether subclinical D-lactate levels affect neurological symptoms in this clinical population.

Keywords: Acidosis, lactic; Dysbiosis; Encephalomyelitis, myalgic; Fatigue syndrome, chronic; Microbiota-gut–brain; Neurological symptoms.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Acidosis, Lactic / pathology*
Adult
Child
Fatigue Syndrome, Chronic / pathology*
Female
Humans
Male