Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report

BioPsychoSocial Medicine

Takakazu Oka²  Yoshio Kanemitsu⁴  Nobuyuki Sudo²  Haruo Hayashi³  Kae Oka¹ 

[1] Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan

[2] Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

[3] Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu 807-8555, Japan

[4] Section of Psychosomatic Medicine, Department of General Medicine, Fukuoka Dental College, Fukuoka, Japan

关键词: Cytokine;    Stress interview;    Psychogenic fever;    Stress-induced hyperthermia;    Chronic fatigue syndrome;   

Others  :  1082356
DOI  :  10.1186/1751-0759-7-7

 received in 2012-10-17, accepted in 2013-03-01,  发布年份 2013

【 摘 要 】

Background

Low-grade fever is a common symptom in patients with chronic fatigue syndrome (CFS), but the mechanisms responsible for its development are poorly understood. We submit this case report that suggests that psychological stress contributes to low-grade fever in CFS.

Case presentation

A 26-year-old female nurse with CFS was admitted to our hospital. She had been recording her axillary temperature regularly and found that it was especially high when she felt stress at work. To assess how psychological stress affects temperature and to investigate the possible mechanisms for this hyperthermia, we conducted a 60-minute stress interview and observed the changes in the following parameters: axillary temperature, fingertip temperature, systolic blood pressure, diastolic blood pressure, heart rate, plasma catecholamine levels, and serum levels of interleukin (IL)-1β and IL-6 (pyretic cytokines), tumor necrosis factor-α and IL-10 (antipyretic cytokines). The stress interview consisted of recalling and talking about stressful events. Her axillary temperature at baseline was 37.2°C, increasing to 38.2°C by the end of the interview. In contrast, her fingertip temperature decreased during the interview. Her heart rate, systolic and diastolic blood pressures, and plasma levels of noradrenaline and adrenaline increased during the interview; there were no significant changes in either pyretic or antipyretic cytokines during or after the interview.

Conclusions

A stress interview induced a 1.0°C increase in axillary temperature in a CFS patient. Negative emotion-associated sympathetic activation, rather than pyretic cytokine production, contributed to the increase in temperature induced by the stress interview. This suggests that psychological stress may contribute to the development or the exacerbation of low-grade fever in some CFS patients.

【 授权许可】

   
2013 Oka et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Komaroff AL, Fagioli LR, Geiger AM, Doolittle TH, Lee J, Kornish RJ, Gleit MA, Guerriero RT: An examination of the working case definition of chronic fatigue syndrome. Am J Med 1996, 100:56-64.
• [2]Oka T: Stress-induced hyperthermia observed in chronic fatigue syndrome patients and its treatement. Nihon Hirou Gakkaishi (in Japanese) 2012, 7:42-48.
• [3]Oka T, Oka K, Kobayashi T, Sugimoto Y, Ichikawa A, Ushikubi F, Narumiya S, Saper CB: Characteristics of thermoregulatory and febrile responses in mice deficient in prostaglandin EP1 and EP3 receptors. J Physiol 2003, 551:945-954.
• [4]Lkhagvasuren B, Nakamura Y, Oka T, Sudo N, Nakamura K: Social defeat stress induces hyperthermia through activation of thermoregulatory sympathetic premotor neurons in the medullary raphe region. Eur J Neurosci 2011, 34:1442-1452.
• [5]Hayashida S, Oka T, Mera T, Tsuji S: Repeated social defeat stress induces chronic hyperthermia in rats. Physiol Behav 2010, 101:124-131.
• [6]Endo Y, Shiraki K: Behavior and body temperature in rats following chronic foot shock or psychological stress exposure. Physiol Behav 2000, 71:263-268.
• [7]Bhatnagar S, Vining C, Iyer V, Kinni V: Changes in hypothalamic-pituitary-adrenal function, body temperature, body weight and food intake with repeated social stress exposure in rats. J Neuroendocrinol 2006, 18:13-24.
• [8]Oka T, Oka K, Hori T: Mechanisms and mediators of psychological stress-induced rise in core temperature. Psychosom Med 2001, 63:476-486.
• [9]Oka T, Oka K: Mechanisms of psychogenic fever. Adv Neuroimmine Biol 2012, 2:1-15.
• [10]Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, Jones JF, Dubois RE, Cunningham-Rundles C, Pahwa S: Chronic fatigue syndrome: a working case definition. Ann Intern Med 1988, 108:387-389.
• [11]Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A: The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994, 121:953-959.
• [12]Leon LR: Invited review: cytokine regulation of fever: studies using gene knockout mice. J Appl Physiol 2002, 92:2648-2655.
• [13]Pardon MC, Kendall DA, Perez-Diaz F, Duxon MS, Marsden CA: Repeated sensory contact with aggressive mice rapidly leads to an anticipatory increase in core body temperature and physical activity that precedes the onset of aversive responding. Eur J Neurosci 2004, 20:1033-1050.
• [14]Marazziti D, Di Muro A, Castrogiovanni P: Psychological stress and body temperature changes in humans. Physiol Behav 1992, 52:393-395.
• [15]Briese E: Emotional hyperthermia and performance in humans. Physiol Behav 1995, 58:615-618.
• [16]Nozu T, Okano S, Kikuchi K, Yahata T, Kuroshima A: Effect of immobilization stress on in vitro and in vivo thermogenesis of brown adipose tissue. Jpn J Physiol 1992, 42:299-308.
• [17]van Marken Lichtenbelt WD, Vanhommerig JW, Smulders NM, Drossaerts JM, Kemerink GJ, Bouvy ND, Schrauwen P, Teule GJ: Cold-activated brown adipose tissue in healthy men. N Engl J Med 2009, 360:1500-1508.
• [18]Saito M, Okamatsu-Ogura Y, Matsushita M, Watanabe K, Yoneshiro T, Nio-Kobayashi J, Iwanaga T, Miyagawa M, Kameya T, Nakada K: High incidence of metabolically active brown adipose tissue in healthy adult humans: effects of cold exposure and adiposity. Diabetes 2009, 58:1526-1531.