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Chronic Fatigue Syndrome – Work in Progress

This is a work in progress and is being updated regularly. Check back regularly, as I will be steadily improving the site and adding more information.

Chronic Fatigue Syndrome / ME / Post-Viral Fatigue Syndrome / CFIDS / CEBV

The illness is also known as chronic fatigue immune dysfunction syndrome (CFIDS), and outside of the USA is usually known as myalgic encephalomyelitis (ME). In the past the syndrome has been known as Chronic Epstein-Barr virus (CEBV). Chronic Fatigue Syndrome is also mistaken for Fibromyalgia which is a chronic musculoskeletal syndrome.

In CFS/ME it seems that we should see this as an illness probably caused by enteroviruses, acting on a body that is for many reasons already stressed biologically, with high pre-morbid levels of oxidative stress, resulting in high peroxynitrite levels. Other biological stressors may be the cause or add to this, such as IAG or these may be mechanical, dietary, environmental, physical, infective or psychological.

What seems important is that the blood-brain barrier becomes permeable allowing viral entry. Treatments should be aimed at identifying and removing these stressors

There also exists a chronically activated immune system, which may result from the initial insult or co-existent microbial, or toxin overload or a combination of the two. It seems that there is over-expression of aberrant RNA, derived initially from an enterovirus, protected by a viral type coat which in the presence of LMWRNase L leads to extreme ATP depletion… Pollution and vaccines have been suggested as a cause for the loss of control of HERV associated mRNA production.

Following this hypercoagulability develops, causing problems in both blood and lymph microcirculation’s. This hypercoagulability may arise from a combination of hereditary, immune mediated and oxidative stress pathways. We have chronic sympathetic system activation, from many causes.

Multiple subtle endocrine changes are also present in the CFSME/FM complex, both quantitatively in terms of hormone levels, and also qualitatively, with loss of circadian rhythmicity. Given the bi-directional flow of information between the nervous, endocrine and immune systems, we are presented with a perfect example of Chaos Biology. This results in a failure of homeostasis and homeodynamics. Simply stated, a body that cannot respond to any form of biological stress, be it environmental, infective, physical or psychological.

Medical history is littered with illnesses that were thought to be psychogenic e.g. Tuberculosis, epilepsy and Hypothyroidism.

Chronic Fatigue Syndrome/ME and Fibromyalgia plus Associated Syndromes
Evidence for their organic basis: A summary of the suggested underlying pathophysiologies and treatment approaches
Dr. Andrew John Wright

The epidemiology data below is mainly from the pen of Dr. Betty Dowsett, Hon. Consultant Virologist.

“The illness usually affects young to middle aged adults. The studies which have been done tend to show that this is mainly a disease of temperate climates, where bowel and respiratory infections are seasonably interrupted. This is in comparison with tropical areas, where solid adult immunity exists, by the reasons of continuous exposure to infection and where lesser standards of hygiene persist.

“Of the studies that have been done, the average statistical increase in the incidence of ME between l965 and l990 was between 50 and 70%. It is thought that this is possibly due to an enteroviral infection. The majority of patients, between 60% and 80%, report that a ‘flu’-like illness rushes in the onset of ME, which is more common in Summer and Autumn than in Winter and Spring (63% compared with 37% in a study of 225 patients).

“Studies show that the commonest age of onset in both sexes actually lies between the third and fourth decade. There is unity of ratio between males and females until puberty and then a 3 to 1 ratio develops between females and males.

“In an analysis of 420 patients who presented between ten days and two years of the onset of the illness, 31% were seen to be improving; 20% were still fluctuating between relapse and remission; 25% had achieved a steady level of disability, and 24% had experienced no remission or were deteriorating. This shows CFS/ME is not a short-term illness and improvement does not proceed in a linear fashion.

“If it is an enterovirus that initially commonly circulates in local populations, the effects are probably asymptomatic in the majority. However, those people affected through genetic and environmental factors then go on to develop disabling fatigue. This is probably around 6% of those exposed. However, although around 25% to 30% improve, the others develop a more serious multi-system disease involving cardiac, endocrine and immune system abnormalities. Unfortunately, there appears to be a lifetime risk of relapse in all patients.”

Number Spring Summer Autumn Winter
Acute Onset 184 23.4% 18% 29% 29%
Chronic Decline 86 29% 18.6% 28% 24.4%

Therefore there seems to be a lull in summer.

A recent population based study in Chicago, using telephone screening and medical screening for those identified with Chronic Fatigue Syndromes, revealed an incidence of 422/100,000. The highest incidence being in women aged 40-49, amongst ethnic minorities and those with poor education and socio-economic status.

A further study sponsored by AfME and the SAMEC Trust also showed a high incidence in ethnic minorities, but also little understanding amongst the population, as it has always been viewed as an illness of white middle classes. This leads to a reduced quality of life, inability to work, and depression.
In Short: 60-80% report a flu-like illness begins CFS. The commonest time of onset is age 20-30. CFS is not a short-term illness and fluctuates between periods of being more or less debilitating. There appears to be a lull in symptoms in summer.





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