Myalgic Encephalomyelitis / Chronic Fatigue Syndrome Information

The virus described on this website can precipitate chronic fatigue syndrome / myalgic-encephalomyelitis (ME/CFS). This page provides overview information on the known and suspected causes of chronic fatigue syndrome, as well basic details about treatments.

Clinical Signs and Symptoms of Chronic Fatigue Syndrome

Chronic fatigue syndrome manifests a whole array of clinical symptoms, both physical and mental, which may include:

Persistent fatigue not due to ongoing exertion, and not really relieved by rest. The fatigue is of a new onset, and greatly reduces activity levels, compared to before the onset. Unrefreshing sleep, often with a disturbed circadian rhythm. Cognitive dysfunction (also known as brain fog) which consists of: short-term memory and working memory deficits, problems recalling words or names, loss of focus and awareness, disorientation. Mood disorders which may include: emotional sensitivity, emotional lability (unstable or exaggerated emotion) and irritability. Anxiety, panic attacks, and depression are common comorbidities in ME/CFS. Post-exertional malaise: physical or mental exertion triggers a state of profoundly worsened symptoms. This appears right after the exertion, or hours or days later. This state then lasts for days or weeks.
Abdominal: gut pain, irritable bowel, diarrhea. Headaches of a new type. Chest pain. Tinnitus, dizziness, balance problems, fainting. Irregular heartbeat. Chronic sore throat or a recurring sore throat. Chronic cough. Sensitivities to sounds, light, chaotic or busy environments, heat or cold. Allergies or intolerances to foods, alcohol, odors, chemicals, pollen or medications may appear. Dry mouth, dry eyes, blurred vision. Muscles: aches, pain, weakness, or tingling sensations in muscles. Lymph nodes: enlarged or painful in the neck and armpits. Joint pain: moving from one joint to another, but without swelling or redness. Orthostatic intolerance: an upright posture (standing up) creates symptoms such as fatigue, dizziness, nausea, greatly increased heart rate, sweating, lightheadedness, blood pressure drop, and sometimes passing out.

For the complete set of symptoms used for ME/CFS diagnosis, see the CDC ME/CFS Criteria or the more in-depth Canadian Consensus ME/CFS Definition.

Microbial Causes and Associations of Chronic Fatigue Syndrome

Chronic fatigue syndrome is associated with, or caused by, a long-term infection with one or more of these viruses or bacteria:

Enterovirus. Enterovirus infection (with coxsackievirus B or echovirus) is associated with chronic fatigue syndrome. 1 2 3 4 5 This type of ME/CFS is difficult to treat, though some people benefit from interferon therapy, 1 or oxymatrine. 1

Parvovirus B19. Parvovirus B19 infection is a known cause of chronic fatigue syndrome. 1 2 3 This cause of ME/CFS can often be treated with intravenous immunoglobulin. 1

Chlamydia pneumoniae. Chlamydia pneumoniae is a bacterium known to cause chronic fatigue syndrome. 1 This form of ME/CFS is treatable with a cocktail antibiotics.

Coxiella burnetii. Coxiella burnetii is a rare bacterium that causes Q-fever, and has also been known to cause chronic fatigue syndrome. 1 2 This form of ME/CFS is treatable with antibiotics.

Brucella. Brucella is a bacterium known to cause chronic fatigue syndrome-like symptoms. Brucella infection is treatable with antibiotics.

Giardia lamblia, a protozoan parasite that infects the small intestine causing giardiasis, has been shown to later lead to ME/CFS in a small percentage (around 5%) of individuals infected with it. 1 2 3

Human herpes six virus (HHV-6). Active infection with HHV-6 has been found in chronic fatigue syndrome, and this may be an exacerbating factor in CFS. 1 2 Dr A. Martin Lerner discovered that ME/CFS patients who have an active HHV-6 infection benefit from the antivirals valganciclovir (Valcyte) and valacyclovir (Valtrex). 1 The antiviral famciclovir (Famvir) may be used in place of Valtrex. Professor Jose Montoya also found Valcyte effective when there is an active HHV-6 infection. 1 Nexavir (formerly Kutapressin) displays potent in vitro activity against HHV-6. 1 2 The antimalarial drug artesunate has efficacy against HHV-6. 1

Epstein-Barr virus (EBV). EBV infection may cause ME/CFS-like symptoms for a short period of several months, and sometimes for longer periods. This infection often clears itself up in time, and then ME/CFS symptoms resolve. Active infection with EBV has also been found in chronic fatigue syndrome, 1 2 and this may be an exacerbating factor in ME/CFS. Dr A. Martin Lerner discovered that ME/CFS patients who have an active EBV infection benefit from the antivirals valganciclovir (Valcyte) and valacyclovir (Valtrex). 1 The antiviral famciclovir (Famvir) may be used in place of Valtrex. Professor Jose Montoya also found Valcyte effective when there is an active EBV infection. 1 Nexavir (formerly Kutapressin) may have some in vitro activity against Epstein-Barr virus. 1

Mycoplasma bacteria infection, from species such as Mycoplasma fermentans, Mycoplasma hominis and Mycoplasma penetrans, may cause or contribute to ME/CFS symptoms. 1 2

Other pathogenic microbes linked to ME/CFS include: Herpes simplex I and II, cytomegalovirus, HHV-7, varicella zoster virus, hepatitis C virus, HTLV I and II, neurovirulent influenza A, Ross River virus, SARS coronavirus, and Toxoplasma gondii.

Other Precipitating Factors Linked to Chronic Fatigue Syndrome

Exposure to organophosphate pesticides has been implicated as a causal, contributory or predisposing factor to ME/CFS. 1 Exposure to significant quantities of mold toxins (usually from water-damaged buildings) is a causal, contributory or predisposing factor for precipitating ME/CFS (certain species of mold contain potent neurotoxins). 1 2 If corticosteroids (immunosuppressants) are given during the acute phase of a significant respiratory infection, this has been found to sometimes lead to ME/CFS. 1 Exposure to ciguatoxin can result in chronic fatigue syndrome. 1 2 Exposure to ionizing radiation is a cause of ME/CFS-like symptoms (post-radiation syndrome). 1 Cancer patients who undergo radiation therapy or chemotherapy quite often develop ME/CFS soon after. 1 Chronic fatigue syndrome can sometimes ensue after an episode of meningitis. 1 ME/CFS can appear within days of receiving a blood transfusion (probably from transfer of viral infection). 1 Chronic fatigue syndrome can very occasionally appear after having major surgery (possibly due to a blood transfusion during surgery).  Sometimes a major physical trauma — particularly a motor vehicle accident — can precipitate ME/CFS; trauma to the head has been shown to lead to fatigue. 1 Food poisoning very occasionally leads to ME/CFS. Chronic fatigue syndrome has sometimes been precipitated by vaccination, 1 such as hepatitis B virus vaccination. 1 Silicone used for breast and other implants, as well as silicone injections, can in rare cases cause an ME/CFS-like illness, as well as autoimmune conditions. Exposure to tung oil has been proposed as a cause for ME/CFS. 1 2 Jaw bone infections (osteomyelitis) may cause ME/CFS-like symptoms. Temporomandibular joint dysfunction (jaw misalignment) may cause ME/CFS-like symptoms. 1 2

Already having the conditions of: irritable bowel syndrome, 1 2 3 interstitial cystitis, 1 2 chronic prostatitis 1 and/or endometriosis 1 may act as predisposing factors to acquiring ME/CFS, as these are all common comorbidities of ME/CFS, and such comorbidities are sometimes suspected of playing causal roles. Many of these comorbid conditions are caused by or linked to microbial infection, thus already taxing the immune system. When a person later contracts an additional microbial agent such as the virus described on this website, one might speculate that the immune system gets overloaded in some way, causing chronic fatigue syndrome to arise.

Other comorbid conditions often seen to accompany (or arise after acquiring) chronic fatigue syndrome include: multiple chemical sensitivity (increased allergies), temporomandibular joint disorder (problems with the jaw joint or jaw muscles), myofascial pain syndrome, attention deficit hyperactivity disorder, eating disorders, chronic headaches / migraines, Hashimoto’s thyroiditis, prolapsed mitral valve, Raynaud’s disease, and Sjögren’s syndrome (sicca syndrome).

Testing for Chronic Fatigue Syndrome

There is no specific test for chronic fatigue syndrome itself, and ME/CFS will not show up on regular blood tests. ME/CFS is diagnosed purely on symptoms. The CDC’s criteria for diagnosing chronic fatigue syndrome by its symptoms can be seen here.

Roughly similar symptoms to those of ME/CFS can arise in other conditions such as: chronic hepatitis C virus infection, celiac disease, hypothyroidism and anemia. Where appropriate, these conditions should first be tested for and ruled out before you consider a diagnosis of chronic fatigue syndrome.

Doctors and Clinics that Treat Chronic Fatigue Syndrome

Well-known chronic fatigue syndrome doctors include:
Dr John Chia (Torrance, California)
Dr Jose Montoya (Stanford University, California)
Dr Kenny De Meirleir (Himmunitas, near Brussels, Belgium)
Dr Nancy Klimas (Miami, Florida)
Dr Daniel Peterson (Sierra Internal Medicine, Nevada)
Dr Daniel Dantini (Ormond Beach, Florida)
Dr Lerner (Oakland, Michigan)
Dr Charles W. Lapp (Charlotte, North Carolina)
Dr Derek Enlander (New York)
Dr Garth Nicolson (Huntington Beach, California)
Dr Byron Hyde (Ottawa, Canada)
Dr Lucinda Bateman
Breakspear Medical Group (Hertfordshire, UK)
Dr Sarah Myhill (Powys, Wales, UK)
Lists of local doctors that treat chronic fatigue syndrome:
List 1: Doctors that Treat Chronic Fatigue Syndrome
List 2: Doctors that Treat Chronic Fatigue Syndrome
Australian ME/CFS Good Doctor List

Links to Chronic Fatigue Syndrome Treatments

Ongoing Survey on the Best Supplements for ME/CFS
Immune and Pathogen Resources – Phoenix Rising
Dr. Cheney’s Basic Treatment Plan for Chronic Fatigue Syndrome
CFS: The Nutritional Approach
Comprehensive Compendium of Drugs, Herbs and Vitamins for Treating ME/CFS
ME Action UK – Chronic Fatigue Syndrome – Useful Treatments
Dr Jay Goldstein’s ME/CFS Drug Treatments
DiagnoseMe – ME/CFS Treatments Rated with ✔ To ✔✔✔ Ticks
Excellent List of ME/CFS Herbs and Supplements
List of ME/CFS Doctors’ Protocols
Chronic Fatigue Syndrome — A Roadmap For Testing And Treatment
Syndrome De Fatigue Chronique / Encéphalomyélite Myalgique — Feuille de Route de Tests
Hormones etc for Treating Chronic Fatigue Syndrome
NaturDoctor – Chronic Fatigue Syndrome
Townsend Letter for Doctors & Patients – ME/CFS Treatments
Medical Insider — ME/CFS Resource
Overcoming ME/CFS, Fibromyalgia and Gulf War Illness/Syndrome
Chronic Fatigue Syndrome –
Anecdotal Evidence Of Different ME/CFS Treatments — Maija Haavisto
Treatment for Chronic Fatigue Syndrome
Enterovirus Foundation: Recommend Immune Boosters
Clinical Trials in US for Chronic Fatigue Syndrome

ME/CFS Forums / Bulletin Boards

Phoenix Rising Forum
Health Rising Forum
Prohealth ME/CFS Forum

ME/CFS Patient Blogs

Health Rising — Cort Johnson’s Excellent ME/CFS and Fibromyalgia Blog
Fibromyalgia and CFS Blog (by Adrienne Dellwo at
Living With Chronic Fatigue Syndrome

ME/CFS Research Overview

ME Research UK
Pathophysiology Of Chronic Fatigue Syndrome (Wikipedia)

ME/CFS Latest News

Phoenix Rising: Chronic Fatigue Syndrome News
Google ME/CFS News
ProHealth ME/CFS News
NewsMedical.Net ME/CFS News

Virology and Microbiology Blogs

Virology Blog of Vincent Racaniello
Microbiology Bytes Blog of Dr Alan Cann

Infectious Disease / Virology News

CDC: Emerging Infectious Diseases Journal
The International Society for Infectious Diseases (ISID) – Latest News
Infectious Disease News
Science Daily Infectious Disease News
Science Daily Virus News
BrightSurf Virus News
The Guardian: Infectious Disease News
Coxsackievirus Infections: Recent Articles and Abstracts
Echovirus Infections: Recent Articles and Abstracts
Emerging Viruses News on this Website
FluTrackers — Emerging Respiratory Diseases
List of Human Diseases Linked to Infectious Pathogens

Introduction to the Enteroviruses (Coxsackievirus, Echovirus)

Non-Polio Enteroviruses — CDC
Enterovirus Foundation
Frequently Asked Questions by ME/CFS Patients
Enterovirus Pathophysiology
Enterovirus Infections of the Central Nervous System — the home of Picornaviruses
Picornaviridae Taxonomy — NCBI
Enterovirus Taxonomy — NCBI