1998 Clinical and Scientific Meeting

Peter Snow MB. ChB FRNZCGP

3 Norfolk St
New Zealand

CFS: A New Zealand Perspective

New Zealand`s entry into the world wide phenomena of Chronic Fatigue Syndrome was through an epidemic in a small rural district around the town of Tapanui, West Otago during 1984. It was extensively studied and the results published in the NZMJ, Poore.M, Snow.P "An unexplained Illness in West Otago" 1984. 97.351-354 .

In retrospect the most significant contribution of this article was the symptom profile, which now clearly mimics that of Chronic Giardiasis, a disease then not recognised in New Zealand, but considered at the time by the workers. Low laboratory yields and failed response to flagyl therapy distracted us from pursuing that line.

The combined research of the Department of Conservation, CDC, Ministry of Agriculture and Fisheries whose principal workers Tim Brown and G Ionas have indicated the widespread occurrence of Giardia cysts in all New Zealand waterways and in a wide range of domestic and feral animals.

Martin Wolfe`s review on Giardiasis Clinical Microbiological Reviews Jan 1992 p 93-100 indicated the importance of the concept of Chronic Giardiasis and the difficulty in achieving a high laboratory yield. It was also indicated that treatment of clinical cases of Giardiasis despite negative results was acceptable therapeutics.

The availability of effective cysticidal agents such as Nitroimidazoles, Tinidazole and Naxogin both 96% effectivity compared to Metronidazole 40% gave us a more effective therapeutic regime.

Paul Levine`s 10 yr follow up of the West Otago or Tapanui outbreak showed a near 100% recovery of this group, all who at various times through that period were treated with the Nitroimidazoles. Archives of Internal Medicine 1997;157 : 750-754 Paul Levine Peter Snow Epidemic Neuromyasthenia and Chronic Fatigue Syndrome in West Otago New Zealand. A ten year follow up M.Holmes, P.Snow as yet unpublished Three Year Study of Fatigue in General Practice confirms the high incidence of bowel disorders in those presenting with Chronic Fatigue and the very low incidence of Chronic Fatigue syndrome as per CDC protocol less than 5%.

It is argued that in the New Zealand experience, a significant cause of Chronic Fatigue is from Chronic Giardiasis, a recently recognised pathogen in New Zealand waterways. The newer Nitroimidazoles have demonstrated to be effective therapeutic agents.


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