Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited.
Chester, A C, Levine, P H · Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 1994 · DOI
Quick Summary
This study looked at three groups of people in different buildings who reported feeling sick, and found that some developed symptoms beyond what's typically expected from poor indoor air quality. While many had the usual complaints like respiratory irritation and headaches from their building environments, others developed more serious symptoms like extreme fatigue and neurological problems that match ME/CFS. The researchers concluded that ME/CFS may often occur alongside or be connected to sick building syndrome.
Why It Matters
This study is significant because it highlights a potential environmental factor or trigger associated with ME/CFS symptom development, which could help explain why some ME/CFS cases appear to emerge suddenly in clustered outbreaks. For patients, understanding potential environmental contributors may help identify triggers or prevention strategies. For researchers, the observation of concurrent SBS and ME/CFS symptoms suggests investigating shared pathophysiological mechanisms or how environmental exposures might precipitate or exacerbate ME/CFS.
Observed Findings
90% (9/10) of frequently-used conference room teachers in Truckee developed severe fatigue
23% (5/22) of responding teachers in Elk Grove's J wing developed severe fatigue
10% (9/93) of responding office workers in Washington, D.C. developed severe fatigue
Affected individuals exhibited both typical SBS symptoms (mucous membrane irritation) and ME/CFS-characteristic neurological symptoms not typical of SBS
Neurological complaints were noted as characteristic features distinguishing the severe illness from typical SBS
Inferred Conclusions
ME/CFS is frequently associated with or may co-occur alongside sick building syndrome
Environmental exposures (such as those causing SBS) may be connected to the development of more severe illness including ME/CFS
ME/CFS should be considered in investigations of building-related illness outbreaks, as affected individuals may present with both environmental and neurological symptoms
Remaining Questions
What specific environmental agents or exposures in these buildings might trigger ME/CFS development, and do they differ from typical SBS triggers?
Is the association between SBS and ME/CFS causal, or do shared environmental exposures trigger separate conditions independently?
What This Study Does Not Prove
This study does not prove that sick building syndrome causes ME/CFS, nor does it establish that poor indoor air quality is the primary trigger for ME/CFS in general. The observational nature means the researchers could not control for other variables, so other shared exposures, infections, or factors could explain both conditions. Correlation between concurrent symptoms does not demonstrate a causal mechanism.
Why does the prevalence of severe fatigue vary so dramatically across the three sites (10-90%), and what factors determine who develops severe illness versus mild SBS?
Could other confounding factors (infections, stress, genetic susceptibility) explain the co-occurrence rather than direct environmental causation?