Membrane Damaging Toxins from Coagulase-Negative Staphylococcus Are 
Associated with Self-Reported Temporomandibular Disorder (TMD) in Patients 
with Chronic Fatigue Syndrome

J Chronic Fatigue Syndrome, Vol: 12 Issue: 3, Cover Date: 2004, 
Publication Date: 2005, Copyright Date: 2004, Page: 25 - 43

Authors: Lee N. Metcalf, BSc; Neil R. McGregor, MDSc, PhD; Timothy K. 
Roberts, PhD

Affiliations:
Lee N. Metcalf BSc, Bioanalytical Research Group, Department of Biological 
Sciences, University of New Castle, Callaghan, NSW 2308, Australia
Neil R. McGregor MDSc PhD, Jaw and Oro-facial Pain Research Unit, Centre 
for Oral Health Research, Bio21 Molecular Science and Biotechnology 
Institute, University of Sydney, University of Melbourne, Parkville, VIC, 
3012, Australia, binrm@bigpond.com
Timothy K. Roberts PhD, Bioanalytical Research Group, Department of 
Biological Sciences, University of Newcastle, Callaghan, NSW 2308, Australia

Address correspondence to: Dr. Neil R. McGregor, Bio21 Molecular Science 
and Biotechnology Institute, The University of Melbourne, 2 Park Street, 
Parkville, Victoria 3012, Australia (E-mail: binrm@bigpond.com ).

The authors would like to thank, Henry L. Butt, PhD, R. Hugh Dunstan, PhD, 
and Professor Iven J. Klineberg, PhD for their contributions to the 
manuscript and the development of the study design and comments. Also the 
Gideon Lang Foundation, the Judith Mason CFS Research Grant and the Lower 
Hunter CFS/ME Fundraising Association for their financial support and 
members of the Hunter Valley branches of the ME/CFS society of NSW for 
their support and encouragement.

Available online at http://www.haworthpress.com/web/JCFS



Aim: To assess whether there is any association between membrane damaging 
toxin production by Staphylococcus spp. and self-reported TMD symptom 
expression in a group of patients selected to have CFS.

Methods: Thirty-three defined Chronic Fatigue Syndrome (CFS) patients and 
33 age and sex-matched controls were assessed to evaluate the relationship 
between carriage of membrane damaging toxin producing staphylococcus, CFS 
and temporomandibular dysfunction (TMD) symptoms.

Results: The CFS patients had an increased prevalence of face pain (Odds 
Ratio = 21.0, 95% CL 4.2-106, P < .001) and temporomandibular joint (TMJ) 
clicking/locking (OR = 5.7, 95% CL 1.423.5, P < .007), and the 
coagulase-negative staphylococcus maximum% Beta-toxin haemolysis per 
patient. Both multivariate and univariate analyses revealed an association 
between the membrane damaging delta-toxin producing CoNS (MDT-CoNS) species 
per subject and face pain prevalence and intensity within both the CFS 
patients and the control subjects. No association was found between CoNS 
toxin production and TMJ clicking/locking. Importantly, alpha and 
beta-toxin production by CoNS was associated with patient reporting of 
arthritis.

Conclusions: These data confirm the original observations of the 
association between MDTCoNS and facial muscle pain (Butt et al, 1998; 
McGregor et al, 2003). These data also suggest that MDT-CoNS associated 
facial muscle pain expression represents a distinct clinical entity, which 
has an increased prevalence in CFS patients.


Keywords: Staphylococcal toxins, staphylococcal haemolysins, bacterial 
toxins, pain aetiology, myofascial pain syndrome, chronic fatigue syndrome, 
TMD pain

© 2004 by The Haworth Press, Inc. All rights reserved.