Materiały źródłowe

• #1 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/symptoms-causes/syc-20360490

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complicated disorder. […] The cause of ME/CFS is unknown, although there are many theories. Experts believe it might be triggered by a combination of factors. […] The cause of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is still unknown. A combination of factors may be involved, including: […] Genetics. ME/CFS appears to run in some families, so some people may be born with a higher likelihood of developing the disorder. […] Infections. Some people develop ME/CFS symptoms after getting better from a viral or bacterial infection. […] Physical or emotional trauma. Some people report that they experienced an injury, surgery or significant emotional stress shortly before their symptoms began. […] Problems with energy usage. Some people with ME/CFS have problems converting the body’s fuel, primarily fats and sugars, into energy.

• #1 Myalgic encephalomyelitis/chronic fatigue syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome

  The cause of the disease is unknown. […] ME/CFS often starts after an infection, such as mononucleosis. […] A genetic factor is believed to contribute, but there is no single gene known to be responsible for increased risk. […] Other factors may include problems with the nervous and immune systems, as well as energy metabolism. […] ME/CFS is a biological disease, not a psychological condition, and is not due to deconditioning. […] Viral infections have long been suspected to cause ME/CFS, based on the observation that ME/CFS sometimes occurs in outbreaks and is possibly connected to autoimmune diseases. […] How viral infections cause ME/CFS is unclear; it could be via viral persistence or via a „hit and run” mechanism, in which infections dysregulate the immune system or cause autoimmunity.

• #1 Chronic Fatigue Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557676/

  Various infectious etiologies, including the Epstein-Barr virus (EBV), the human herpesvirus (HHV)-6, and the human parvovirus B19, are hypothesized to trigger the disease. […] It has been observed that alterations in the levels of CD 21+ CD19+ and activated CD5+ cells in patients with chronic fatigue syndrome. […] The pathophysiological mechanisms leading to chronic fatigue syndrome are not entirely understood. […] Studies have shown an interaction between changes in the genes secondary to changes in the environment, leading to epigenetic modification. […] Studies have also detected autoantibodies against certain neurotransmitters and neurons, leading to alterations in neurotransmitter response, sleep patterns, and neurocognition. […] The presence of proinflammatory changes causes speculation about the involvement of neuroinflammation in the pathogenesis and clinical presentation of the disease process. […] Chronic fatigue syndrome has no cure, and the symptoms can persist for years. Its clinical course fluctuates between remissions and relapses.

• #1 Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1644-y

  The pathomechanisms of ME/CFS are still unknown, and there are no standardized biological markers or tests for diagnostics; therefore, even the existence of this medical diagnosis has been questioned for long time. […] The illness has been frequently accompanied with various viral infections and studies have been conducted on association of ME/CFS with Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus (HHV) 6, HHV-7, HHV-8, human parvovirus B19 (B19V), enteroviruses, lentivirus and bacteria as mycoplasma. […] In the majority of ME/CFS cases, there is no conclusive evidence for chronic viral infection, but it is plausible that viruses could act via a hit and run mechanism; this theory proposes that viruses trigger the disease, cause immune abnormalities and leave a dysfunctional immune system and/or autoimmunity.

• #1 What Causes ME/CFS Causes | ME/CFS | CDC

  https://www.cdc.gov/me-cfs/causes/index.html

  Scientists don’t yet know what causes myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). […] The disease may have more than one cause or environmental factor that triggers it. […] Many areas are being researched to understand what causes ME/CFS including infections and genetics. […] Because the cause of ME/CFS is not known, many potential causes are being studied. These include infections, how the body uses energy, how people respond to infection, inflammation, toxins or injury, and genetics. […] People with ME/CFS often begin with an illness similar to the flu. This has made researchers suspect an infection may trigger ME/CFS. […] About 1 in 10 people who get infected by Epstein-Barr virus, Ross River virus, or Coxiella burnetti later develop an illness like ME/CFS. […] Chronic symptoms following other acute infections are experienced by some patients. These chronic symptoms resemble ME/CFS. Because of this, ME/CFS may be a chronic illness following an unknown infection.

• #1 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10434940/

  ME/CFS is a disabling and often severe disease, so-far incurable, that has long been associated with discrete outbreaks and sporadic incidents of viral-like illness. […] There is actually no proof that multiple different pathogens can cause ME/CFS. Yet, this hypothesis persists largely due to the overinterpretation of data from at least 2 studies. […] History offers persuasive evidence to suspect the enterovirus (EV) family of causing ME/CFS. […] Both circumstantial and direct evidence exists to support such a conclusion. […] Aside from associations of EVs with past ME/CFS outbreaks and sporadic cases, well documented by Dr. Byron Hyde, there is also more contemporary evidence that favors enteroviruses. […] A vast number of enteroviral infections occur worldwide every year, with reports that as many as 50% are asymptomatic.

• #1 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia/1/001244

  Energy production — The way that cells within the body get energy is different in people with ME/CFS than in people without the condition. It’s unclear how this is linked to developing the illness. […] Long COVID or Post-acute sequelae of SARS CoV-2 infection (PASC) — Some people who have been infected with the COVID-19 virus continue to have symptoms weeks or months later. This is called long COVID. Because symptoms such as extreme fatigue, difficulty concentrating, dizziness, and sleep problems are similar to ME/CFS, researchers are looking into a possible connection between the two conditions. […] Genetics or environmental factors may also play a role in the development of ME/CFS.

• #1 Stanford Myalgic Encephalomyelitis – Chronic Fatigue Syndrome | ME/CFS Initiative | Stanford Medicine

  https://med.stanford.edu/chronicfatiguesyndrome.html

  At Stanford, we believe that a subset of cases of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) may be related to infection. […] The nature of the association is still unknown, but we use two possible hypotheses in our research. One hypothesis is that the symptoms of ME/CFS could be triggered by the persistent activity of a pathogen (for example, a bacteria or virus) in the patient. However, the second hypothesis is that the symptoms of ME/CFS may be caused not by the pathogen itself, but rather by the body’s immune response to the pathogen. […] From an epidemiological perspective, it has been known for many years that the onset of CFS is often acute and preceded by a viral or infection-like illness. […] It has also been observed that many infectious pathogens implicated in ME/CFS can affect the central nervous system.

• #1 Onset of ME/CFS – MEpedia

  https://me-pedia.org/wiki/Onset_of_ME/CFS

  The onset of ME/CFS can be sudden (acute) or gradual. Sudden onset is more common. In cases of sudden onset, it is usually easy to identify the trigger of the illness, such as physical trauma, overwhelming stress, or a viral/bacterial infection. Children, particularly adolescents, will more likely have an acute illness like the flu or mononucleosis as their onset. […] 72% of ME/CFS patients report that a bacterial or a viral infection was their onset of ME/CFS; 4.5% trauma; 4.5% surgery or childbirth; 2.2% allergic reaction; 1.7% stress or trauma. […] Genes are being considered for a risk in developing ME/CFS as sometimes several members of the same family will develop ME/CFS. […] A small number of ME patient charities, for example The Hummingbirds’ Foundation for ME hold the view that ME is always caused by a virus, but chronic fatigue syndrome (CFS) may have non-viral triggers, and do not recognize bacterial infections or non-infectious events as a potential cause or trigger.

• #1 What Causes ME/CFS Causes | ME/CFS | CDC

  https://www.cdc.gov/me-cfs/causes/index.html

  It is possible ME/CFS is caused by changes in a person’s immune system or how it responds to infection or stress. […] Both ME/CFS and autoimmune disease are more common in women and both are characterized by increased inflammation. […] Patients with ME/CFS commonly report infections, or physical or emotional stress before they become ill. […] Some patients with ME/CFS have lower levels of the hormone cortisol than healthy people. […] Low cortisol levels may lead to increased inflammation and chronic activation of the immune system. […] Scientists have found differences between people with ME/CFS and healthy people in the way their cells use food to create energy. […] Sometimes, members of the same family have ME/CFS. Studies done in twins and families suggest that genes and environment might both play a role in ME/CFS.

• #1 Chronic Fatigue Syndrome (CFS) Causes – Who Gets It and Why

  https://www.webmd.com/chronic-fatigue-syndrome/what-is-chronic-fatigue-syndrome

  Doctors don’t know what causes ME/CFS, but they have identified different underlying abnormalities in people with the condition. […] Several parts of the immune system are different in people with ME/CFS. Some research indicates that these abnormalities may cause the symptoms of the illness. […] If you have ME/CFS, the cells in your body have trouble making enough energy. […] Abnormalities show up in pictures of the brain (like MRI or CT scans), in levels of brain hormones, and in the brain’s electrical system (brain waves). These abnormalities can come and go and aren’t necessarily permanent. […] When you stand, your blood pressure could drop and your heart might start to beat faster. […] Some studies have found abnormalities in the structure of certain genes. Others point to abnormalities in the way certain genes are turned on and off inside your cells. Studies of identical and non-identical twins indicate that some people inherit a genetic likelihood of getting the illness.

• #1 Myalgic Encephalomyelitis (Chronic Fatigue Syndrome): Symptoms, causes, treatments, and your questions answered.

  https://examine.com/conditions/myalgic-encephalomyelitis/?srsltid=AfmBOoqHcY8NHeIcegtNr9XhdFYSLIjh2NyoNhWJA27yV9DpGS9lWiA4

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness characterized by profound, severe fatigue lasting at least six months that gets worse with exertion and which sleep doesn’t alleviate. […] The cause of CFS is still very much debated. Currently, the prevailing attitude is that CFS is fundamentally a neurological condition individuals with CFS show subtle but distinct changes to cognition (e.g., slower information processing, reduced working memory, and poor learning). That said, CFS still lacks characteristic signs (neurological, immunological, or otherwise). […] It is not uncommon for several members of the same family to be diagnosed with CFS. Therefore, genetic factors probably contribute to the risk of CFS, but studies have not consistently identified one single gene or gene variant that increases the risk for CFS. In other words, CFS, like many conditions, is a multifactorial disorder in which many genetic and environmental risk factors are involved.

• #1 Chronic Fatigue Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-fatigue-syndrome-a-to-z

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complicated illness characterized by at least six months of extreme fatigue that is not relieved by rest, and a group of additional symptoms that also are constant for at least six months. […] The exact cause of chronic fatigue syndrome remains a mystery. […] Several parts of the immune system remain activated for long periods in people with chronic fatigue syndrome. […] There is growing evidence that some patients with chronic fatigue syndrome have an autoimmune condition: their immune system is attacking particular tissues in the body. […] Patients with chronic fatigue syndrome have defects in the ability of cells in their bodies to make energy. […] Many different tests of the brain, and of the autonomic nervous system, reveal abnormalities that are not seen in healthy people of the same age, or in people with other conditions that can cause fatigue, such as depression.

• #1 Myalgic encephalomyelitis/chronic fatigue syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome

  Between 60% and 80% of cases start after an infection, usually a viral infection. […] Different types of viral infection have been implicated in ME/CFS, including airway infections, bronchitis, gastroenteritis, or an acute „flu-like illness”. […] Reactivation of latent viruses, in particular EBV and human herpesvirus 6, has also been hypothesised to drive symptoms. […] ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy metabolism. […] Observed changes in the immune system include decreased natural killer cell function and, in some cases, autoimmunity. […] A range of structural, biochemical, and functional abnormalities are found in brain imaging studies of people with ME/CFS. […] Neuroinflammation has been proposed as an underlying mechanism of ME/CFS that could explain a large set of symptoms.

• #1 Chronic Fatigue Syndrome: Causes and Risk Factors

  https://www.verywellhealth.com/what-causes-chronic-fatigue-syndrome-716100

  One theory is that allergies, stress, and infection may combine to deplete a chemical called adenosine triphosphate (ATP), which stores energy in cells. […] Some ME/CFS patients show evidence of decreased ATP production. […] Irregularities may be seen in the immune systems of people with chronic fatigue syndrome, but researchers have not found a consistent pattern of abnormalities. […] The immune system produces many chemicals that are collectively called cytokines. […] Some ME/CFS patients have high levels of these chemicals, which scientists theorize could cause symptoms of chronic fatigue, including exhaustion and muscle aches. […] Researchers are especially interested in some of the central nervous system (CNS) chemicals and hormones controlled by the HPA axis. […] Neurotransmitters are chemicals that communicate messages between nerve cells in your brain and throughout your body.

• #1 Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/me-cfs/about/possible-causes.html

  Scientists think that the immune system might be contributing to ME/CFS in other ways, including chronic production of cytokines. […] Patients with ME/CFS commonly report physical or emotional stress before they become ill. […] Scientists found differences between people with ME/CFS and healthy people in the way cells in their bodies get their energy. […] Studies done in twins and families suggest that both genes and environment might play a role in ME/CFS.

• #1 An Overview of Myalgic encephalomyelitis and its causes

  https://www.openaccessjournals.com/articles/an-overview-of-myalgic-encephalomyelitis-and-its-causes-15490.html

  Immune system problems. The vulnerable systems of people who have habitual fatigue pattern appear to be bloodied slightly, but its unclear if this impairment is enough to actually beget the complaint. […] Hormonal imbalances. People who have habitual fatigue pattern also occasionally experience abnormal blood situations of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown. […] Physical or emotional trauma. Some people report that they endured an injury, surgery or significant emotional stress shortly before their symptoms began.

• #1 Myalgic Encephalomyelitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs-pro

  Myalgic encephalomyelitis (ME), or chronic fatigue syndrome (CFS), is a complex, chronic medical condition affecting multiple body systems and of unknown cause. […] The underlying cause of ME/CFS is still not well understood. […] Approximately 50-80% of people with ME/CFS start suddenly with a flu-like illness. […] ME/CFS is often found after infection by a virus, bacterium, or parasite, suggesting an immunological dysfunction, accompanied by a strong genetic predisposition, as shown in twin analysis. […] Viral involvement is a well-supported theory due to the high index of an infectious onset in at least half of the patients. […] Life stressors can cause a negative impact on the neuroendocrine circuits of stress, leading to other complications besides immunological impairment. […] In addition to immune and viral aetiology, the attenuation of the hypothalamus-pituitary-adrenal (HPA) axis is documented in adult and adolescent ME/CFS patients, with marked evidence of systemic hypocortisolism, which can influence immunological and neuronal homeostasis. […] Studies have reported enhanced sympathetic nervous activity, as well as increased levels of catecholamines in ME/CFS, providing some evidence for a neuroactive pattern in the pathophysiology of ME/CFS.

• #1 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=hw32907

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease that causes you to feel so ill that you can’t do your normal activities. […] Doctors don’t know what causes ME/CFS. It seems to follow after a flu-like illness. High stress may also lead to ME/CFS for some people. And changes in a person’s immune system may also play a role. It’s likely that a number of factors or triggers come together to cause ME/CFS. […] Doctors don’t know what causes ME/CFS. It seems to follow after a flu-like illness like Epstein-Barr Virus (EBV). But EBV doesn’t cause all cases of ME/CFS. Other infections like parvovirus B19 and Ross River virus may also be linked to ME/CFS. […] High stress may also lead to ME/CFS for some people. This could be a period of high physical or emotional stress or a major life event. […] Changes in a person’s immune system may also play a role. […] It’s likely that a number of factors come together to cause ME/CFS.

• #1 What is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)? – RTHM

  https://rthm.com/articles/what-is-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  Reduced blood flow to the brain upon upright positioning has been demonstrated in ME/CFS. […] Cardiovascular manifestations may be secondary to nervous or immune system dysregulation, but invasive CPET testing demonstrates that a significant portion of ME/CFS patients have poor blood return to the heart with upright positioning and exercise. […] Some studies demonstrate HPA Axis dysregulation with blunted ACTH and cortisol responses, lower levels of T3 thyroid hormone, and low growth hormone (GH) levels. […] Several studies demonstrate cellular reliance on amino acids (from protein) as a primary energy source and decreased ability to utilize more efficient energy sources like glucose, fatty acids, and ketones. […] Re-activation of latent herpes viruses like EBV, the persistence of viruses in specific tissues, chronic low-level or undiagnosed infection with vector-borne infections, translocation of intestinal flora into the bloodstream leading to increased levels of IL-1, TNF alpha, neopterin, and elastase that can contribute to common symptoms seen in ME/CFS. […] Some studies demonstrate an unusually high prevalence of tethered cord syndrome, spinal instabilities, Chiari malformation, and connective tissue disorders in ME/CFS patients.

• #1 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

  https://www.mdpi.com/2075-4418/9/3/91

  There has been an increasing effort to investigate the aetiology and maintenance of symptoms, including for patients with no infectious prodrome. […] Interestingly, one of the hypotheses that attempts to explain the aetiological component of the condition suggests the involvement of inflammatory cascades impairing either the functionality of the blood–brain barrier or the gut barrier. […] Viral involvement is a well-supported pathophysiological theory due to the high index of an infectious onset in at least half of the patients, and confirmed findings of biochemical dysregulation of the 2-5A synthetase/ribonuclease L antiviral defense pathway in monocytes. […] The alteration of this pathway and the reduced cytotoxic activity of the NK cells in ME/CFS patients are recognized as the main findings of the immunological impairment on ME/CFS patients.

• #1 Chronic Fatigue Syndrome (CFS) Causes – Who Gets It and Why

  https://www.webmd.com/chronic-fatigue-syndrome/what-is-chronic-fatigue-syndrome

  ME/CFS often, but not always, begins with a sudden infectious-like illness (fever, sore throat, aching muscles, upset stomach). Research found that several different types of infectious agents can trigger the beginning of the illness, including Epstein-Barr virus (a common cause of mononucleosis), Lyme disease bacteria, and Q fever bacteria. […] Several studies indicate that serotonin, a major brain chemical, plays an important role in ME/CFS symptoms. People with the illness have low levels of cortisol, a hormone the body releases in response to stress.

• #1 An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03143-3

  In our unifying hypothesis of the pathophysiology of ME/CFS and the pathophysiology of the skeletal muscle disturbances there is no need to assume a specific neurological pathology to explain the neurological symptoms. […] Decreased CBF, disturbed local blood flow regulation and neurovascular coupling, central adrenergic hyperactivity, hypocapnia and increase in intracranial pressure seem to play a strong role in the pathophysiology of the neurological symptoms in ME/CFS. They can well explain cognitive impairment, brain fog, headache, psychomotor slowing, ataxia and loss of coordination of movements, hypersensitivity, sleep disturbances and dysautonomia.

• #1 Chronic fatigue syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/chronic-fatigue-syndrome

  Abnormal levels of certain chemicals in the brain system known as the hypothalamus-pituitary-adrenal (HPA) axis have been proposed as a cause of CFS. […] Researchers are investigating links between autonomic system dysfunction and CFS. […] Some people who have CFS also have symptoms of a condition known as neurally mediated hypotension (NMH). […] A related condition experienced by some people with CFS is called postural orthostatic tachycardia syndrome (POTS).

• #1 Long COVID, ME/CFS and the Importance of Studying Infection-Associated Illnesses > News > Yale Medicine

  https://www.yalemedicine.org/news/long-covid-mecfs-and-the-importance-of-studying-infection-associated-illnesses

  Research on Long COVID may also shine light on the underlying causes of myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS. […] Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a neuroinflammatory, neuroimmune illness most commonly triggered by infection, such as Epstein-Barr virus, though patients have reported other triggers as well, such as physical accidents and environmental exposures. […] Research has shown that ME/CFS involves dysfunction of the immune and nervous systems, as well as cardiovascular, connective tissue, gastrointestinal, metabolic, and mitochondrial dysfunction, she says. […] Studies over the last few years have found that about half of people with Long COVID meet diagnostic criteria for ME/CFS, and the prevalence of ME/CFS has been growing as a result of the pandemic and Long COVID.

• #1 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011523

  ME/CFS is a disabling and often severe disease, so-far incurable, that has long been associated with discrete outbreaks and sporadic incidents of viral-like illness. […] There is actually no proof that multiple different pathogens can cause ME/CFS. Yet, this hypothesis persists largely due to the overinterpretation of data from at least 2 studies. […] A 2006 Australian study is oft cited as proof that virtually any number of infections cause ME/CFS. […] In another study, this one from Norway, investigators cited influenza as an instigator of ME/CFS. […] History offers persuasive evidence to suspect the enterovirus (EV) family of causing ME/CFS. […] Both circumstantial and direct evidence exists to support such a conclusion. […] Moreover, ME/CFS case descriptions by health professionals of the era are consistent with the features of known enteroviral infections.

• #1 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10434940/

  The strongest hypothesis for the cause of ME/CFS outbreaks is spread of an uncommon variant of a common virus family. […] Ignoring the abundant evidence for EV involvement in ME/CFS has slowed research into the possible dire but hidden consequences of EV infections, including persistence in virus reservoirs.

• #1 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011523

  Aside from associations of EVs with past ME/CFS outbreaks and sporadic cases, well documented by Dr. Byron Hyde, there is also more contemporary evidence that favors enteroviruses. […] A vast number of enteroviral infections occur worldwide every year, with reports that as many as 50% are asymptomatic. […] The strongest hypothesis for the cause of ME/CFS outbreaks is spread of an uncommon variant of a common virus family. […] A new localized outbreak would offer an ideal opportunity to pinpoint a pathogen that could have caused pre-2020 ME/CFS cases. […] A striking number of ME/CFS patients mention an acute infection with EBV or some other human herpesvirus (HHV) as the start of their illness. […] If someone has a long course of mononucleosis, an additional virus that may or may not cause symptoms might be necessary for induction of ME/CFS.

• #1 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

  https://www.mdpi.com/2075-4418/9/3/91

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown aetiology that is recognized by the World Health Organization (WHO) and the United States Center for Disease Control and Prevention (US CDC) as a disorder of the brain. […] The pathophysiological mechanisms are unclear but the neuro-immuno-endocrinological pattern of CFS patients gleaned from various studies indicates that these three pillars may be the key point to understand the complexity of the disease. […] Even though over the last few decades clinicians have reached a consensus to diagnose ME/CFS, the underlying aetiology is not well understood. […] Approximately 50–80% of patients with ME/CFS start suddenly with a flu-like illness, from which patients do not recover. ME/CFS is commonly found after infection by a virus, bacteria, or parasite, suggesting an immunological dysfunction as the possible beginning of the multi-systemic impairment, which is accompanied by a strong genetic predisposition, as shown in a twin analysis.

• #1 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review

  https://www.mdpi.com/2075-4418/9/3/91

  The purpose of this review is to propose a coherent connection between the three pillars of the pathophysiology of the ME/CFS described in the literature: the immunological system, the neuroendocrine system, and the central nervous system, leading to a clear explanation of the symptomatology of the disease in the absence of a reference standard.

• #1 An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03143-3

  There is accumulating evidence of endothelial dysfunction, muscle and cerebral hypoperfusion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). […] ME/CFS is classified as a neurological disease. This is based on neurological symptoms including mental fatigue, impaired cognition, psychomotor slowing, disturbed sleep, hypersensitivities to noise, light and smells, headache, pain and paresthesias and severe dysautonomia. […] In a first hypothesis paper initially stimulated by the finding in ME/CFS patients of autoantibodies against 2-adrenergic receptors (2AdR) we hypothesized that 2AdR dysfunction could be of critical importance in the pathophysiology of ME/CFS. […] The aim of the present hypothesis paper is to propose causes of the frequent neurological symptoms in ME/CFS, and how the previously identified pathomechanisms could also translate into the neurological symptoms, that we have not addressed so far.

• #1 Chronic Fatigue Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557676/

  Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a complex multisystem disease commonly characterized by severe fatigue, cognitive dysfunction, sleep problems, autonomic dysfunction, and post-exertional malaise, which can severely impair patients’ ability to conduct the activities of daily living. […] The etiology of chronic fatigue syndrome (CFS) is controversial, complicated, and incompletely understood. Controversy exists about single versus multiple causations. Many theories exist regarding the involvement of infections, the immune system, and genetics in this complex interplay. […] Increasing evidence supports the role of genetic susceptibility in patients with CFS. Many studies have reported the role of family history in the development of CFS or similar fatigue-like symptoms.

• #1 Chronic Fatigue Syndrome – Special Subjects – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/special-subjects/chronic-fatigue-syndrome/chronic-fatigue-syndrome

  Chronic fatigue syndrome (CFS, also called myalgic encephalomyelitis/chronic fatigue syndrome [ME/CFS]) is a syndrome of life-altering fatigue lasting 6 months that is unexplained and is accompanied by a number of associated symptoms. […] Etiology of CFS is unknown. No infectious, hormonal, immunologic, or psychological cause has been established. […] Relatives of patients with CFS have an increased risk of developing the syndrome, suggesting a genetic component or common environmental exposure. Recent studies have identified some genetic markers that might predispose to CFS. Some researchers believe the etiology will eventually be shown to be multifactorial, including a genetic predisposition and exposure to microbes, toxins, and other physical and/or emotional trauma. […] Etiology is unclear but probably involves multiple factors, including genetic susceptibility, microbial exposure, and environmental and psychological factors.

• #1 Controversies related to ME/CFS – Wikipedia

  https://en.wikipedia.org/wiki/Controversies_related_to_ME/CFS

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a long history of controversy. The diagnosis is controversial, and its etiology is still not fully understood. […] Despite being a relatively common and disabling disease, a large proportion of professionals are either unaware or dismissive of it. […] Despite ample evidence that ME/CFS is an organic disease, many clinicians do not recognise it as genuine or underestimate its seriousness. […] Individuals with the condition describe the struggle for healthcare and legitimacy due to what is described as bureaucratic denial of the condition because of its lack of a known etiology. […] Governments and health organisations have been criticised for their lack of funding into ME/CFS research. ME/CFS is one of the most underfunded diseases compared to disease burden.

• #1 Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients

  https://www.mdpi.com/1648-9144/60/1/83

  In sum, the evidence does not align with the central claim of psychosomatic disease models of ME/CFS, which assumes that dysfunctional cognitions and the resulting deconditioning explain the etiology and maintenance of ME/CFS symptoms. […] Even though, in recent years, more and more healthcare practitioners view ME/CFS correctly as a somatic illness, there are still widespread views in the medical community of ME/CFS being a psychosomatic illness.

• #1 Chronic fatigue syndrome (CFS) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease. […] The causes of ME/CFS are complex and not yet fully understood. […] Despite researchers identifying many biological abnormalities in people living with the disease, we do not yet know the cause. […] Research clearly demonstrates that ME/CFS is a biological illness, and it is not caused by being unfit or mental health problems. […] Scientists are starting to understand some of the biological changes in the bodies of people with ME/CFS, although they have not yet found how to prevent, or cure it. […] ME/CFS is what’s known as an energy-limiting chronic illness (ECLI), which means the body doesn’t make energy properly at a cellular level. […] Exercise is not a cure or treatment for ME/CFS. […] Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.

• #1 About the Disease – Solve ME/CFS Initiative

  https://solvecfs.org/me-cfs-long-covid/about-the-disease/

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, complex, neuroimmune disease that profoundly limits the health and productivity of patients and, like Long Covid, is often triggered by an infection. […] At this time, the cause of ME/CFS is not fully understood. […] The cause of ME/CFS may vary from person to person. Some people became sick with ME/CFS following a sudden and severe flu-like illness. Others became sick with ME/CFS gradually over a period of months or years without noticing a specific cause. Research has shown that there is genetic, central nervous system, immune and metabolic factors involved in ME/CFS and scientists are studying these connections to develop diagnostic tests and treatments. […] There is currently no FDA-approved treatment or drug for ME/CFS. As neither a cause nor cure for ME/CFS has been identified, treatment is directed at relieving symptoms.

• #1 Myalgic encephalomyelitis – MEpedia

  https://me-pedia.org/wiki/Myalgic_encephalomyelitis

  Myalgic encephalomyelitis (ME) is a chronic, inflammatory, physical and neurological and immune-mediated disease that presents with symptoms involving multiple bodily systems. It is frequently triggered by a viral infection or a flu-like illness. […] According to the CDC the hallmark symptom of myalgic encephalomyelitis is post-exertional malaise (PEM), which is the worsening of ME/CFS symptoms after minimal physical, mental, or emotional effort. […] There are no approved pharmacological treatments for ME anywhere in the world except in Argentina, which has approved the immunomodulator Ampligen (rintatolimod) for severe ME/CFS as of August 23, 2016. […] Although risk factors for myalgic encephalomyelitis have been identified, no single definitive virus has been found in all cases, which has led to the claim that ME is a common end path of a variety of infectious insults.

• #1 Myalgic Encephalomyelitis (

  https://www.health.ny.gov/diseases/conditions/me-cfs/

  Although cognitive behavior therapy (CBT) and graded exercise therapy (GET) were once recommended to treat patients with ME, these interventions assume that patients are afraid to exercise and thus become out of shape (deconditioned). But these conclusions are based on studies that included patients with other fatiguing conditions. The recommendations to use CBT and GET to treat ME have caused more harm than good for people with ME and have been eliminated from the Centers for Disease Control and Prevention (CDC) website. […] Currently, there are no FDA-approved treatments specifically for ME.

• #1 Long COVID, ME/CFS and the Importance of Studying Infection-Associated Illnesses > News > Yale Medicine

  https://www.yalemedicine.org/news/long-covid-mecfs-and-the-importance-of-studying-infection-associated-illnesses

  Numerous studies have revealed a significant overlap in symptoms reported by patients with Long COVID and ME/CFS. […] Both Long COVID and ME/CFS can be difficult to diagnose. […] More research is critical to better understand the underlying mechanisms of both Long COVID and ME/CFS and to inform future clinical trials. […] Pollack recommends that both researchers and clinicians screen for co-occurring diseases in those diagnosed with ME/CFS or Long COVID. […] Ongoing research, including work at Yale by the lab of Akiko Iwasaki, PhD, seeks to clarify the basis for Long COVID and to better understand its relationship with ME/CFS. […] We also need deep phenotyping and mechanistic research that helps us identify subsets most likely to benefit from certain treatments.

• #1 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  There is no cure for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Treatment focuses on symptom relief. The most disruptive or disabling symptoms should be addressed first. […] Many alternative therapies have been promoted for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but very few have evidence that they work.

• #1 Clinical features and diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-myalgic-encephalomyelitis-chronic-fatigue-syndrome

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), previously known as chronic fatigue syndrome (CFS), is a chronic, often debilitating illness, characterized by severe fatigue and other symptoms. […] In persons with ME/CFS, multiple underlying abnormalities involving the central and autonomic nervous systems, the immune system, energy metabolism, the cardiovascular system, and the gut microbiome have been described. […] However, there is only a limited understanding of what triggers the abnormalities and how the abnormalities cause symptoms. […] The epidemiology, pathophysiology, clinical manifestations, and diagnosis of ME/CFS are reviewed here.

• #1 What is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)? – RTHM

  https://rthm.com/articles/what-is-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  ME/CFS is a serious, complex, and chronic systemic disease that can have a profoundly negative impact on the lives of sufferers as well as their families. […] While the exact cause of ME/CFS is unknown, over 80% of cases stem from a previous infection, such as the Epstein-Barr Virus, SARS, SARS-CoV-2, or enterovirus. Fungal infections and bacterial infections may also trigger ME/CFS. […] While there is an established connection between infections, stressors, and the development of ME/CFS, there is still so much that researchers and physicians do not understand when it comes to ME/CFS. […] The same chemical in the body can affect multiple different cell types in different ways, and different cell types can produce the same chemical signals. […] Studies have most reliably shown reduced natural killer (NK) cell function. Some studies show abnormal cytokine levels. Others show an altered ability of the immune system to respond to specific infections like EBV.

• #2 What Causes ME/CFS Causes | ME/CFS | CDC

  https://www.cdc.gov/me-cfs/causes/index.html

  Scientists don’t yet know what causes myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). […] The disease may have more than one cause or environmental factor that triggers it. […] Many areas are being researched to understand what causes ME/CFS including infections and genetics. […] Because the cause of ME/CFS is not known, many potential causes are being studied. These include infections, how the body uses energy, how people respond to infection, inflammation, toxins or injury, and genetics. […] People with ME/CFS often begin with an illness similar to the flu. This has made researchers suspect an infection may trigger ME/CFS. […] About 1 in 10 people who get infected by Epstein-Barr virus, Ross River virus, or Coxiella burnetti later develop an illness like ME/CFS. […] Chronic symptoms following other acute infections are experienced by some patients. These chronic symptoms resemble ME/CFS. Because of this, ME/CFS may be a chronic illness following an unknown infection.

• #2 Myalgic encephalomyelitis/chronic fatigue syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome

  Between 60% and 80% of cases start after an infection, usually a viral infection. […] Different types of viral infection have been implicated in ME/CFS, including airway infections, bronchitis, gastroenteritis, or an acute „flu-like illness”. […] Reactivation of latent viruses, in particular EBV and human herpesvirus 6, has also been hypothesised to drive symptoms. […] ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy metabolism. […] Observed changes in the immune system include decreased natural killer cell function and, in some cases, autoimmunity. […] A range of structural, biochemical, and functional abnormalities are found in brain imaging studies of people with ME/CFS. […] Neuroinflammation has been proposed as an underlying mechanism of ME/CFS that could explain a large set of symptoms.

• #2 Chronic Fatigue Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557676/

  Various infectious etiologies, including the Epstein-Barr virus (EBV), the human herpesvirus (HHV)-6, and the human parvovirus B19, are hypothesized to trigger the disease. […] It has been observed that alterations in the levels of CD 21+ CD19+ and activated CD5+ cells in patients with chronic fatigue syndrome. […] The pathophysiological mechanisms leading to chronic fatigue syndrome are not entirely understood. […] Studies have shown an interaction between changes in the genes secondary to changes in the environment, leading to epigenetic modification. […] Studies have also detected autoantibodies against certain neurotransmitters and neurons, leading to alterations in neurotransmitter response, sleep patterns, and neurocognition. […] The presence of proinflammatory changes causes speculation about the involvement of neuroinflammation in the pathogenesis and clinical presentation of the disease process. […] Chronic fatigue syndrome has no cure, and the symptoms can persist for years. Its clinical course fluctuates between remissions and relapses.

• #2 Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1644-y

  The pathomechanisms of ME/CFS are still unknown, and there are no standardized biological markers or tests for diagnostics; therefore, even the existence of this medical diagnosis has been questioned for long time. […] The illness has been frequently accompanied with various viral infections and studies have been conducted on association of ME/CFS with Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus (HHV) 6, HHV-7, HHV-8, human parvovirus B19 (B19V), enteroviruses, lentivirus and bacteria as mycoplasma. […] In the majority of ME/CFS cases, there is no conclusive evidence for chronic viral infection, but it is plausible that viruses could act via a hit and run mechanism; this theory proposes that viruses trigger the disease, cause immune abnormalities and leave a dysfunctional immune system and/or autoimmunity.

• #2 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=hw32907

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease that causes you to feel so ill that you can’t do your normal activities. […] Doctors don’t know what causes ME/CFS. It seems to follow after a flu-like illness. High stress may also lead to ME/CFS for some people. And changes in a person’s immune system may also play a role. It’s likely that a number of factors or triggers come together to cause ME/CFS. […] Doctors don’t know what causes ME/CFS. It seems to follow after a flu-like illness like Epstein-Barr Virus (EBV). But EBV doesn’t cause all cases of ME/CFS. Other infections like parvovirus B19 and Ross River virus may also be linked to ME/CFS. […] High stress may also lead to ME/CFS for some people. This could be a period of high physical or emotional stress or a major life event. […] Changes in a person’s immune system may also play a role. […] It’s likely that a number of factors come together to cause ME/CFS.

• #2 Chronic Fatigue Syndrome: Causes and Risk Factors

  https://www.verywellhealth.com/what-causes-chronic-fatigue-syndrome-716100

  An infectious trigger is also suspected because many ME/CFS cases start suddenly after a flu-like condition. […] The CDC notes that about 10 percent of people who have had an infection with Epstein-Barr virus (the usual cause of mononucleosis), Ross River virus (spread by mosquitoes in Australia and New Guinea), or Coxiella burnetti (the cause of Q fever) go on to develop symptoms that meet the criteria for ME/CFS. […] Other infections that have been suspected and studied include HHV-6, Lyme disease, and enterovirus. […] However, none of these infections has been shown to cause ME/CFS. […] Chronic fatigue syndrome appears to have some features in common with autoimmune diseases such as lupus or multiple sclerosis, in which the immune system mistakenly attacks healthy parts of the body.

• #2 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10434940/

  The strongest hypothesis for the cause of ME/CFS outbreaks is spread of an uncommon variant of a common virus family. […] Ignoring the abundant evidence for EV involvement in ME/CFS has slowed research into the possible dire but hidden consequences of EV infections, including persistence in virus reservoirs.

• #2 Long COVID, ME/CFS and the Importance of Studying Infection-Associated Illnesses > News > Yale Medicine

  https://www.yalemedicine.org/news/long-covid-mecfs-and-the-importance-of-studying-infection-associated-illnesses

  Research on Long COVID may also shine light on the underlying causes of myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS. […] Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a neuroinflammatory, neuroimmune illness most commonly triggered by infection, such as Epstein-Barr virus, though patients have reported other triggers as well, such as physical accidents and environmental exposures. […] Research has shown that ME/CFS involves dysfunction of the immune and nervous systems, as well as cardiovascular, connective tissue, gastrointestinal, metabolic, and mitochondrial dysfunction, she says. […] Studies over the last few years have found that about half of people with Long COVID meet diagnostic criteria for ME/CFS, and the prevalence of ME/CFS has been growing as a result of the pandemic and Long COVID.

• #2 Chronic Fatigue Syndrome: Causes and Risk Factors

  https://www.verywellhealth.com/what-causes-chronic-fatigue-syndrome-716100

  Some people with ME/CFS have abnormal levels of certain important neurotransmitters (serotonin and dopamine). […] The level of the stress hormone cortisol tends to be low in ME/CFS patients. […] Some theorize this could make it hard to deal with stress, either physical (such as infection or exertion) or mental. […] In some, chronic fatigue and pain are associated with exposure to various chemicals and environmental toxins. […] Two to four times as many women are diagnosed with ME/CFS as are men. […] Any cause, if discovered, would need to account for this difference. […] While myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) isn’t necessarily hereditary, there can be a genetic component that predisposes some people to develop it. […] Some studies have found that ME/CFS can be caused by a problem arising in the immune system triggered by one of three infections: Epstein-Barr virus, Ross River virus, Coxiella burnetti bacteria. […] According to the CDC, one in 10 people who get the above infections will develop symptoms of ME/CFS. […] Yes, some studies have pinpointed that emotional stress or childhood trauma specifically is a risk factor for developing ME/CFS.

• #2 Myalgic encephalomyelitis/chronic fatigue syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome

  The cause of the disease is unknown. […] ME/CFS often starts after an infection, such as mononucleosis. […] A genetic factor is believed to contribute, but there is no single gene known to be responsible for increased risk. […] Other factors may include problems with the nervous and immune systems, as well as energy metabolism. […] ME/CFS is a biological disease, not a psychological condition, and is not due to deconditioning. […] Viral infections have long been suspected to cause ME/CFS, based on the observation that ME/CFS sometimes occurs in outbreaks and is possibly connected to autoimmune diseases. […] How viral infections cause ME/CFS is unclear; it could be via viral persistence or via a „hit and run” mechanism, in which infections dysregulate the immune system or cause autoimmunity.

• #2 Onset of ME/CFS – MEpedia

  https://me-pedia.org/wiki/Onset_of_ME/CFS

  The exact cause has not yet been identified in research. […] The International Consensus Criteria for ME recognizes that ME can develop suddenly, gradually, or after an infectious disease (for example, viral or bacterial outbreaks within a community). […] There may not be any potential trigger identified when ME begins. […] Myalgic encephalomyelitis is a systemic acutely acquired illness initiated by a virus infection which is characterised by post encephalitic damage to the brain stem; a nerve centre through which many spinal nerve tracts connect with higher centres in the brain in order to control all vital bodily functions this is always damaged in M.E. […] This persisting multilevel central nervous system (CNS) dysfunction, and in particular, inconsistent CNS dysfunction is undoubtedly both the chief cause of disability in M.E. and the most critical in the definition of the entire disease process.

• #2 Chronic Fatigue Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557676/

  Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a complex multisystem disease commonly characterized by severe fatigue, cognitive dysfunction, sleep problems, autonomic dysfunction, and post-exertional malaise, which can severely impair patients’ ability to conduct the activities of daily living. […] The etiology of chronic fatigue syndrome (CFS) is controversial, complicated, and incompletely understood. Controversy exists about single versus multiple causations. Many theories exist regarding the involvement of infections, the immune system, and genetics in this complex interplay. […] Increasing evidence supports the role of genetic susceptibility in patients with CFS. Many studies have reported the role of family history in the development of CFS or similar fatigue-like symptoms.

• #2 Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/me-cfs/about/possible-causes.html

  Scientists think that the immune system might be contributing to ME/CFS in other ways, including chronic production of cytokines. […] Patients with ME/CFS commonly report physical or emotional stress before they become ill. […] Scientists found differences between people with ME/CFS and healthy people in the way cells in their bodies get their energy. […] Studies done in twins and families suggest that both genes and environment might play a role in ME/CFS.

• #2 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

  https://my.clevelandclinic.org/health/diseases/17720-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or chronic fatigue syndrome (CFS) is a condition that causes you to feel so tired and exhausted that it interferes with your ability to complete your daily routine or even get out of bed. Your fatigue doesnt improve with rest and gets worse after physical activity or mental exertion. Symptoms usually last for six months or longer. […] Healthcare providers dont know the exact cause of chronic fatigue syndrome. Research suggests there could be several factors that might lead to CFS: Low blood pressure. Stress. An infection. Immune system changes (how your body responds to stress or an infection). Changes to how your body makes and uses energy. […] There may be a genetic link to CFS. Studies found it can run in your biological family history. More research is necessary to determine what gene is responsible for this condition. […] With treatment, most chronic fatigue syndrome symptoms improve. But some people dont return to the same health or functional state as they were before their symptoms appeared. The condition affects everyone differently. Talk to your healthcare provider about what your prognosis looks like.

• #2 What Causes ME/CFS Causes | ME/CFS | CDC

  https://www.cdc.gov/me-cfs/causes/index.html

  It is possible ME/CFS is caused by changes in a person’s immune system or how it responds to infection or stress. […] Both ME/CFS and autoimmune disease are more common in women and both are characterized by increased inflammation. […] Patients with ME/CFS commonly report infections, or physical or emotional stress before they become ill. […] Some patients with ME/CFS have lower levels of the hormone cortisol than healthy people. […] Low cortisol levels may lead to increased inflammation and chronic activation of the immune system. […] Scientists have found differences between people with ME/CFS and healthy people in the way their cells use food to create energy. […] Sometimes, members of the same family have ME/CFS. Studies done in twins and families suggest that genes and environment might both play a role in ME/CFS.

• #2 What is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)? – RTHM

  https://rthm.com/articles/what-is-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  ME/CFS is a serious, complex, and chronic systemic disease that can have a profoundly negative impact on the lives of sufferers as well as their families. […] While the exact cause of ME/CFS is unknown, over 80% of cases stem from a previous infection, such as the Epstein-Barr Virus, SARS, SARS-CoV-2, or enterovirus. Fungal infections and bacterial infections may also trigger ME/CFS. […] While there is an established connection between infections, stressors, and the development of ME/CFS, there is still so much that researchers and physicians do not understand when it comes to ME/CFS. […] The same chemical in the body can affect multiple different cell types in different ways, and different cell types can produce the same chemical signals. […] Studies have most reliably shown reduced natural killer (NK) cell function. Some studies show abnormal cytokine levels. Others show an altered ability of the immune system to respond to specific infections like EBV.

• #2 Chronic Fatigue Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-fatigue-syndrome-a-to-z

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complicated illness characterized by at least six months of extreme fatigue that is not relieved by rest, and a group of additional symptoms that also are constant for at least six months. […] The exact cause of chronic fatigue syndrome remains a mystery. […] Several parts of the immune system remain activated for long periods in people with chronic fatigue syndrome. […] There is growing evidence that some patients with chronic fatigue syndrome have an autoimmune condition: their immune system is attacking particular tissues in the body. […] Patients with chronic fatigue syndrome have defects in the ability of cells in their bodies to make energy. […] Many different tests of the brain, and of the autonomic nervous system, reveal abnormalities that are not seen in healthy people of the same age, or in people with other conditions that can cause fatigue, such as depression.

• #2 Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/me-cfs/about/possible-causes.html

  Scientists have not yet identified what causes myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It is possible that ME/CFS has more than one cause, meaning that patients with ME/CFS could have illness resulting from different causes. In addition, it is possible that two or more triggers might work together to cause the illness. […] People with ME/CFS often have their illness begin in a way that reminds them of getting the flu. This has made researchers suspect an infection may trigger ME/CFS. In addition, about one in ten people who become infected with Epstein-Barr virus, Ross River virus, or Coxiella burnetti will develop a set of symptoms that meet the criteria for ME/CFS. […] It is possible that ME/CFS is caused by a change in the persons immune system and the way it responds to infection or stress.

• #2 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia/1/001244

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term illness that affects many body systems. […] The exact cause of ME/CFS is unknown. It may have more than one cause. For example, two or more possible causes may work together to trigger the illness. […] Researchers are looking into these possible causes: Infection — About 1 out of 10 people who develop certain infections, such as Epstein-Barr virus and Q fever, go on to develop ME/CFS. Other infections have also been studied, but not one cause has been found. […] Immune system changes — ME/CFS may be triggered by changes in the way a person’s immune system responds to stress or illness. […] Mental or physical stress — Many people with ME/CFS have been under serious mental or physical stress before becoming ill.

• #2 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) | Altru Health System

  https://www.altru.org/health-library/conditions/myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complicated disorder. […] The cause of ME/CFS is unknown, although there are many theories. Experts believe it might be triggered by a combination of factors. […] The cause of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is still unknown. A combination of factors may be involved, including: Genetics. ME/CFS appears to run in some families, so some people may be born with a higher likelihood of developing the disorder. Infections. Some people develop ME/CFS symptoms after getting better from a viral or bacterial infection. Physical or emotional trauma. Some people report that they experienced an injury, surgery or significant emotional stress shortly before their symptoms began. Problems with energy usage. Some people with ME/CFS have problems converting the body’s fuel, primarily fats and sugars, into energy.

• #2 Chronic Fatigue Syndrome: Causes and Risk Factors

  https://www.verywellhealth.com/what-causes-chronic-fatigue-syndrome-716100

  One theory is that allergies, stress, and infection may combine to deplete a chemical called adenosine triphosphate (ATP), which stores energy in cells. […] Some ME/CFS patients show evidence of decreased ATP production. […] Irregularities may be seen in the immune systems of people with chronic fatigue syndrome, but researchers have not found a consistent pattern of abnormalities. […] The immune system produces many chemicals that are collectively called cytokines. […] Some ME/CFS patients have high levels of these chemicals, which scientists theorize could cause symptoms of chronic fatigue, including exhaustion and muscle aches. […] Researchers are especially interested in some of the central nervous system (CNS) chemicals and hormones controlled by the HPA axis. […] Neurotransmitters are chemicals that communicate messages between nerve cells in your brain and throughout your body.

• #2 Myalgic Encephalomyelitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs-pro

  Myalgic encephalomyelitis (ME), or chronic fatigue syndrome (CFS), is a complex, chronic medical condition affecting multiple body systems and of unknown cause. […] The underlying cause of ME/CFS is still not well understood. […] Approximately 50-80% of people with ME/CFS start suddenly with a flu-like illness. […] ME/CFS is often found after infection by a virus, bacterium, or parasite, suggesting an immunological dysfunction, accompanied by a strong genetic predisposition, as shown in twin analysis. […] Viral involvement is a well-supported theory due to the high index of an infectious onset in at least half of the patients. […] Life stressors can cause a negative impact on the neuroendocrine circuits of stress, leading to other complications besides immunological impairment. […] In addition to immune and viral aetiology, the attenuation of the hypothalamus-pituitary-adrenal (HPA) axis is documented in adult and adolescent ME/CFS patients, with marked evidence of systemic hypocortisolism, which can influence immunological and neuronal homeostasis. […] Studies have reported enhanced sympathetic nervous activity, as well as increased levels of catecholamines in ME/CFS, providing some evidence for a neuroactive pattern in the pathophysiology of ME/CFS.

• #2 What is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)? – RTHM

  https://rthm.com/articles/what-is-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  Reduced blood flow to the brain upon upright positioning has been demonstrated in ME/CFS. […] Cardiovascular manifestations may be secondary to nervous or immune system dysregulation, but invasive CPET testing demonstrates that a significant portion of ME/CFS patients have poor blood return to the heart with upright positioning and exercise. […] Some studies demonstrate HPA Axis dysregulation with blunted ACTH and cortisol responses, lower levels of T3 thyroid hormone, and low growth hormone (GH) levels. […] Several studies demonstrate cellular reliance on amino acids (from protein) as a primary energy source and decreased ability to utilize more efficient energy sources like glucose, fatty acids, and ketones. […] Re-activation of latent herpes viruses like EBV, the persistence of viruses in specific tissues, chronic low-level or undiagnosed infection with vector-borne infections, translocation of intestinal flora into the bloodstream leading to increased levels of IL-1, TNF alpha, neopterin, and elastase that can contribute to common symptoms seen in ME/CFS. […] Some studies demonstrate an unusually high prevalence of tethered cord syndrome, spinal instabilities, Chiari malformation, and connective tissue disorders in ME/CFS patients.

• #2 An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03143-3

  In our unifying hypothesis of the pathophysiology of ME/CFS and the pathophysiology of the skeletal muscle disturbances there is no need to assume a specific neurological pathology to explain the neurological symptoms. […] Decreased CBF, disturbed local blood flow regulation and neurovascular coupling, central adrenergic hyperactivity, hypocapnia and increase in intracranial pressure seem to play a strong role in the pathophysiology of the neurological symptoms in ME/CFS. They can well explain cognitive impairment, brain fog, headache, psychomotor slowing, ataxia and loss of coordination of movements, hypersensitivity, sleep disturbances and dysautonomia.

• #2 Chronic Fatigue Syndrome | Arthritis Foundation

  https://www.arthritis.org/diseases/chronic-fatigue-syndrome

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex illness marked by profound exhaustion that lasts at least six months. […] Its not clear why some people develop ME/CFS. Its a complicated disease that likely has many causes. Sometimes it follows an infection or severe emotional stress. It can also result from: […] Abnormal changes in the autonomic nervous system, which regulates vital functions like heart rate, digestion and body temperature. POTS, an autonomic disorder, affects about 1% of the population and is especially common in people with ME/CFS or long COVID. […] Immune system problems, like autoimmune forms of arthritis, where the body attacks its own tissues. Many people with ME/CFS also have fibromyalgia or an autoimmune disease. […] Defects in the bodys energy chemistry. […] Dysbiosis an unhealthy imbalance in the microbial ecosystem in the gut. […] Inability to get enough oxygen and blood to muscle tissue.

• #2 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011523

  The US government devised the name Post-Acute Sequalae of COVID-19 (PASC) to describe a post-acute illness syndrome suffered by victims who endured this deadly virus. […] Ignoring the abundant evidence for EV involvement in ME/CFS has slowed research into the possible dire but hidden consequences of EV infections, including persistence in virus reservoirs.

• #2 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011523

  ME/CFS is a disabling and often severe disease, so-far incurable, that has long been associated with discrete outbreaks and sporadic incidents of viral-like illness. […] There is actually no proof that multiple different pathogens can cause ME/CFS. Yet, this hypothesis persists largely due to the overinterpretation of data from at least 2 studies. […] A 2006 Australian study is oft cited as proof that virtually any number of infections cause ME/CFS. […] In another study, this one from Norway, investigators cited influenza as an instigator of ME/CFS. […] History offers persuasive evidence to suspect the enterovirus (EV) family of causing ME/CFS. […] Both circumstantial and direct evidence exists to support such a conclusion. […] Moreover, ME/CFS case descriptions by health professionals of the era are consistent with the features of known enteroviral infections.

• #2 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011523

  Aside from associations of EVs with past ME/CFS outbreaks and sporadic cases, well documented by Dr. Byron Hyde, there is also more contemporary evidence that favors enteroviruses. […] A vast number of enteroviral infections occur worldwide every year, with reports that as many as 50% are asymptomatic. […] The strongest hypothesis for the cause of ME/CFS outbreaks is spread of an uncommon variant of a common virus family. […] A new localized outbreak would offer an ideal opportunity to pinpoint a pathogen that could have caused pre-2020 ME/CFS cases. […] A striking number of ME/CFS patients mention an acute infection with EBV or some other human herpesvirus (HHV) as the start of their illness. […] If someone has a long course of mononucleosis, an additional virus that may or may not cause symptoms might be necessary for induction of ME/CFS.

• #2 The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome | PLOS Pathogens

  https://journals.plos.org/plospathogens/article%3Fid=10.1371/journal.ppat.1011523

  A vast number of enteroviral infections occur worldwide every year, with reports that as many as 50% are asymptomatic. […] The strongest hypothesis for the cause of ME/CFS outbreaks is spread of an uncommon variant of a common virus family. […] A striking number of ME/CFS patients mention an acute infection with EBV or some other human herpesvirus (HHV) as the start of their illness. […] If someone has a long course of mononucleosis, an additional virus that may or may not cause symptoms might be necessary for induction of ME/CFS. […] The US government devised the name Post-Acute Sequalae of COVID-19 (PASC) to describe a post-acute illness syndrome suffered by victims who endured this deadly virus. […] Ignoring the abundant evidence for EV involvement in ME/CFS has slowed research into the possible dire but hidden consequences of EV infections, including persistence in virus reservoirs.

• #2 Controversies related to ME/CFS – Wikipedia

  https://en.wikipedia.org/wiki/Controversies_related_to_ME/CFS

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a long history of controversy. The diagnosis is controversial, and its etiology is still not fully understood. […] Despite being a relatively common and disabling disease, a large proportion of professionals are either unaware or dismissive of it. […] Despite ample evidence that ME/CFS is an organic disease, many clinicians do not recognise it as genuine or underestimate its seriousness. […] Individuals with the condition describe the struggle for healthcare and legitimacy due to what is described as bureaucratic denial of the condition because of its lack of a known etiology. […] Governments and health organisations have been criticised for their lack of funding into ME/CFS research. ME/CFS is one of the most underfunded diseases compared to disease burden.

• #2 Chronic fatigue syndrome (CFS) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease. […] The causes of ME/CFS are complex and not yet fully understood. […] Despite researchers identifying many biological abnormalities in people living with the disease, we do not yet know the cause. […] Research clearly demonstrates that ME/CFS is a biological illness, and it is not caused by being unfit or mental health problems. […] Scientists are starting to understand some of the biological changes in the bodies of people with ME/CFS, although they have not yet found how to prevent, or cure it. […] ME/CFS is what’s known as an energy-limiting chronic illness (ECLI), which means the body doesn’t make energy properly at a cellular level. […] Exercise is not a cure or treatment for ME/CFS. […] Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.

• #2 Chronic Fatigue Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-fatigue-syndrome-a-to-z

  Although there is a lot of evidence that chronic fatigue syndrome is caused by a physical problem involving the immune system, energy metabolism and the nervous system, there is no laboratory test or procedure to confirm the diagnosis. […] To be diagnosed as ME/CFS, symptoms must last for at least six months. […] There is no FDA proven treatment for ME/CFS.

• #2 Controversies related to ME/CFS – Wikipedia

  https://en.wikipedia.org/wiki/Controversies_related_to_ME/CFS

  Studies eventually concluded that neither people nor the blood supply had been infected with the XMRV virus, and the origin of the virus was likely a lab contaminant in the supplies used by the polymerase chain reaction (PCR) process of the studies that found virus in blood. […] The trial generated considerable criticism. […] The full research data for the PACE trial was requested by both patients acting as citizen scientists, and by other researchers but was initially denied until a 2016 tribunal ordered the data be released. […] The 2021 guidelines no longer include GET or CBT as treatments. […] Studies show medical neglect, trivialisation, and psychologization have contributed to increased risk of suicide in patients suffering from ME/CFS. […] Because of a lack of awareness and education about ME/CFS in the medical community delays in diagnosis and misdiagnosis are common.

• #2 Long COVID, ME/CFS and the Importance of Studying Infection-Associated Illnesses > News > Yale Medicine

  https://www.yalemedicine.org/news/long-covid-mecfs-and-the-importance-of-studying-infection-associated-illnesses

  Numerous studies have revealed a significant overlap in symptoms reported by patients with Long COVID and ME/CFS. […] Both Long COVID and ME/CFS can be difficult to diagnose. […] More research is critical to better understand the underlying mechanisms of both Long COVID and ME/CFS and to inform future clinical trials. […] Pollack recommends that both researchers and clinicians screen for co-occurring diseases in those diagnosed with ME/CFS or Long COVID. […] Ongoing research, including work at Yale by the lab of Akiko Iwasaki, PhD, seeks to clarify the basis for Long COVID and to better understand its relationship with ME/CFS. […] We also need deep phenotyping and mechanistic research that helps us identify subsets most likely to benefit from certain treatments.

• #2 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  There is no cure for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Treatment focuses on symptom relief. The most disruptive or disabling symptoms should be addressed first. […] Many alternative therapies have been promoted for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but very few have evidence that they work.

• #2 Myalgic Encephalomyelitis (

  https://www.health.ny.gov/diseases/conditions/me-cfs/

  Myalgic Encephalomyelitis (ME), commonly referred to as chronic fatigue syndrome or ME/CFS, is a widely misunderstood disease. […] Experts do not yet know the exact cause of ME, but many people start feeling the symptoms of ME after contracting a viral or other type of infection, or following surgery, physical trauma, or a change in hormonal status. It is possible that the symptoms of ME result from an abnormal response by the immune system, most often to an infection. […] What is known is that ME is not a psychiatric disorder and it is not caused by a lack of exercise, contrary to common belief. […] In 2015, the National Academy of Medicine published new diagnostic criteria for ME, which require the presence of the following: substantial impairment in activity that lasts six months or more and is accompanied by fatigue, post-exertional malaise (PEM), unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.

• #2 Chronic Fatigue Syndrome (ME/CFS): Overview and More

  https://www.verywellhealth.com/understanding-chronic-fatigue-syndrome-4158459

  Chronic fatigue syndrome is a condition that generally involves deep fatigue, unrefreshing sleep, exercise intolerance, and neurological issues referred to as brain fog. […] The exact cause of chronic fatigue syndrome is unknown but is believed to be a combination of genetic predisposition and environmental factors. […] While the causes of chronic fatigue syndrome are still unclear, the condition has been linked to a number of factors, including genetics; viral or other infections; hormone, immune, or central nervous system dysregulation; stress; and exposure to toxins. […] Some researchers believe the condition may result from several of these factors coming together under the right conditions. […] Some research suggests that disruption or dysregulation of the sympathetic nervous system and the hormones involved in the HPA axis may be involved in chronic fatigue syndrome.

• #3 ME/CFS Basics | ME/CFS | CDC

  https://www.cdc.gov/me-cfs/about/index.html

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious and often long-lasting illness that keeps people from doing their usual activities. […] There is no known cause or cure. Care usually means treating the symptoms that most affect a person’s life. […] ME/CFS is a biological illness that affects many body parts. It causes severe fatigue not improved by rest, problems thinking and sleeping, dizziness, pain, and many other symptoms. […] ME/CFS may get worse after they do any activity — physical or mental. This symptom is called post-exertional malaise (PEM). […] It is difficult to diagnose because there is no specific test for ME/CFS. […] Symptoms of ME/CFS may appear similar to many other illnesses. There is no test to confirm ME/CFS. This makes it difficult to diagnose. […] There is no cure or approved treatment for ME/CFS. But some symptoms can be treated or managed.

• #3 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

  https://my.clevelandclinic.org/health/diseases/17720-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or chronic fatigue syndrome (CFS) is a condition that causes you to feel so tired and exhausted that it interferes with your ability to complete your daily routine or even get out of bed. Your fatigue doesnt improve with rest and gets worse after physical activity or mental exertion. Symptoms usually last for six months or longer. […] Healthcare providers dont know the exact cause of chronic fatigue syndrome. Research suggests there could be several factors that might lead to CFS: Low blood pressure. Stress. An infection. Immune system changes (how your body responds to stress or an infection). Changes to how your body makes and uses energy. […] There may be a genetic link to CFS. Studies found it can run in your biological family history. More research is necessary to determine what gene is responsible for this condition. […] With treatment, most chronic fatigue syndrome symptoms improve. But some people dont return to the same health or functional state as they were before their symptoms appeared. The condition affects everyone differently. Talk to your healthcare provider about what your prognosis looks like.

• #3 Chronic Fatigue Syndrome (Myalgic Encephalomyelitis): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/235980-overview

  The exact cause of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) remains a mystery, but it increasingly is being recognized as a chronic illness linked to infections. […] Illness resembling ME/CFS has been reported following infections with various diseases such as Epstein-Barr, Ross River, Coxiella burnetii (Q fever), herpesviruses, enterovirus, rubella, Candida albicans, bornaviruses, mycoplasma, retroviruses, and SARS-CoV-2 (COVID-19). […] While no single infectious agent has been identified as the definitive cause of ME/CFS, up to 80% of patients develop ME/CFS following an acute viral-like illness, with the specific cause often unknown. […] Certain patients mention that they have encountered an accident, trauma, immobilization, surgical procedure, or notable physical or emotional stress before the emergence of ME/CFS symptoms.

• #3 What is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)? – RTHM

  https://rthm.com/articles/what-is-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs/

  Reduced blood flow to the brain upon upright positioning has been demonstrated in ME/CFS. […] Cardiovascular manifestations may be secondary to nervous or immune system dysregulation, but invasive CPET testing demonstrates that a significant portion of ME/CFS patients have poor blood return to the heart with upright positioning and exercise. […] Some studies demonstrate HPA Axis dysregulation with blunted ACTH and cortisol responses, lower levels of T3 thyroid hormone, and low growth hormone (GH) levels. […] Several studies demonstrate cellular reliance on amino acids (from protein) as a primary energy source and decreased ability to utilize more efficient energy sources like glucose, fatty acids, and ketones. […] Re-activation of latent herpes viruses like EBV, the persistence of viruses in specific tissues, chronic low-level or undiagnosed infection with vector-borne infections, translocation of intestinal flora into the bloodstream leading to increased levels of IL-1, TNF alpha, neopterin, and elastase that can contribute to common symptoms seen in ME/CFS. […] Some studies demonstrate an unusually high prevalence of tethered cord syndrome, spinal instabilities, Chiari malformation, and connective tissue disorders in ME/CFS patients.

• #3 An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03143-3

  In our unifying hypothesis of the pathophysiology of ME/CFS and the pathophysiology of the skeletal muscle disturbances there is no need to assume a specific neurological pathology to explain the neurological symptoms. […] Decreased CBF, disturbed local blood flow regulation and neurovascular coupling, central adrenergic hyperactivity, hypocapnia and increase in intracranial pressure seem to play a strong role in the pathophysiology of the neurological symptoms in ME/CFS. They can well explain cognitive impairment, brain fog, headache, psychomotor slowing, ataxia and loss of coordination of movements, hypersensitivity, sleep disturbances and dysautonomia.

• #3 Controversies related to ME/CFS – Wikipedia

  https://en.wikipedia.org/wiki/Controversies_related_to_ME/CFS

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a long history of controversy. The diagnosis is controversial, and its etiology is still not fully understood. […] Despite being a relatively common and disabling disease, a large proportion of professionals are either unaware or dismissive of it. […] Despite ample evidence that ME/CFS is an organic disease, many clinicians do not recognise it as genuine or underestimate its seriousness. […] Individuals with the condition describe the struggle for healthcare and legitimacy due to what is described as bureaucratic denial of the condition because of its lack of a known etiology. […] Governments and health organisations have been criticised for their lack of funding into ME/CFS research. ME/CFS is one of the most underfunded diseases compared to disease burden.

• #3 Chronic fatigue syndrome (CFS) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease. […] The causes of ME/CFS are complex and not yet fully understood. […] Despite researchers identifying many biological abnormalities in people living with the disease, we do not yet know the cause. […] Research clearly demonstrates that ME/CFS is a biological illness, and it is not caused by being unfit or mental health problems. […] Scientists are starting to understand some of the biological changes in the bodies of people with ME/CFS, although they have not yet found how to prevent, or cure it. […] ME/CFS is what’s known as an energy-limiting chronic illness (ECLI), which means the body doesn’t make energy properly at a cellular level. […] Exercise is not a cure or treatment for ME/CFS. […] Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.

• #4 Chronic fatigue syndrome (CFS) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs

  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease. […] The causes of ME/CFS are complex and not yet fully understood. […] Despite researchers identifying many biological abnormalities in people living with the disease, we do not yet know the cause. […] Research clearly demonstrates that ME/CFS is a biological illness, and it is not caused by being unfit or mental health problems. […] Scientists are starting to understand some of the biological changes in the bodies of people with ME/CFS, although they have not yet found how to prevent, or cure it. […] ME/CFS is what’s known as an energy-limiting chronic illness (ECLI), which means the body doesn’t make energy properly at a cellular level. […] Exercise is not a cure or treatment for ME/CFS. […] Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.

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