ME/CFS Info

Myalgic Encephalomyelitis / Chronic Fatigue Syndrome Information

The virus described on this website can precipitate chronic fatigue syndrome / myalgic-encephalomyelitis (ME/CFS). This page provides an overview on the known and suspected causes of chronic fatigue syndrome, as well as 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 relieved by rest. Fatigue is of a new onset, and greatly reduces activities. Unrefreshing sleep, going to sleep or remaining asleep is hard; altered circadian rhythm (eg awake at night, sleeping during the day). Post-exertional malaise (PEM): physical or mental exertion triggers a state of profoundly worse symptom severity. PEM appears right after the exertion, or hours or days later. This PEM state then lasts for days or even weeks. Cognitive dysfunction (also known as brain fog) which consists of: short-term memory deficits, difficulties in processing information, problems recalling words or names, loss of focus and awareness, confusion and disorientation. Neuropsychological: emotional sensitivity, more susceptible to emotional stress, blunted emotions, emotional lability (emotions are unstable or exaggerated), personality change. Anxiety, panic attacks and depression can appear in chronic fatigue syndrome.
Abdominal: gut pain, irritable bowel, diarrhea. Headaches of a new type. Chronic cough. Chest pain. Irregular heartbeat. Chronic sore throat or recurring sore throat. Tinnitus, dizziness, balance problems. Sensitivities to ordinary sounds, to light, to chaotic or busy environments, to heat or cold. Intolerances to foods, alcohol, odors, chemicals, pollen or drug medications may appear. Blurred vision, dry eyes, dry mouth. Muscles: aches, pains, weakness or tingling. Lymph nodes: enlarged or tender in the neck and armpits. Joint pain: moving from one joint to another, without swelling or redness. Sweating or feverishness episodes. Cold hand and feet. 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 formally used for chronic fatigue syndrome diagnosis, see the CDC Fukuda 1994 CFS Criteria, the Canadian Consensus ME/CFS Criteria or the nice and simple IOM Criteria.

Microbial Causes and Associations of Chronic Fatigue Syndrome

Chronic fatigue syndrome is associated with chronic infection with one or more of the following viruses and bacteria:

Enterovirus (coxsackievirus B or echovirus) has been associated with chronic fatigue syndrome in numerous studies. This type of ME/CFS is difficult to treat, though 25% of patients get major benefits from the immunomodulator oxymatrine. 1

Human herpes six virus (HHV-6). Active infection with HHV-6 has been found in chronic fatigue syndrome Dr Martin Lerner discovered that ME/CFS patients who have an active HHV-6 infection improve using the antiviral valganciclovir (Valcyte). 1 Professor Jose Montoya also found Valcyte effective when there is an active HHV-6 infection. 1

Epstein-Barr virus (EBV). Active infection with EBV has been found in chronic fatigue syndrome. Dr Martin Lerner discovered that ME/CFS patients who have an active EBV infection improve using 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

Cytomegalovirus (CMV). Active infection with CMV has been found in chronic fatigue syndrome. Dr Martin Lerner discovered that ME/CFS patients who have an active CMV infection improve using the antiviral valganciclovir (Valcyte). 1

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

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

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

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

Bartonella bacteria can cause fatigue, brain fog and memory loss, and so can worsen your ME/CFS symptoms. It is not a cause of ME/CFS, but is a co-infection that may contribute to ME/CFS symptoms.

Babesia is a malaria-like protozoan parasite that causes fatigue, mood changes, flu-like symptoms, headache, muscle aches and joint pain. Babesia infects red blood cells causing a disease known as babesiosis. It is not a cause of ME/CFS, but is a co-infection that may contribute to ME/CFS symptoms.

Brucella is a bacterium known to cause chronic fatigue syndrome-like symptoms. Brucella infection is treatable with antibiotics. It is not a cause of ME/CFS, but is a co-infection that may contribute to ME/CFS symptoms.

Mycoplasma bacteria infection, from species such as Mycoplasma fermentans, Mycoplasma hominis and Mycoplasma penetrans, may cause fatigue. It is not a cause of ME/CFS, but is a co-infection that may contribute to ME/CFS symptoms.

Other pathogenic microbes linked to ME/CFS include: HHV-7, herpes simplex I and II, varicella zoster virus, Ross River virus, West Nile virus, influenza A and Toxoplasma gondii.

Prevalence of These Pathogens

Most of the above microbes are extremely common in people: Epstein Barr virus is found in around 90% of adults, 1 HHV-6 is found in nearly 100% of adults (and in 80% of children by 2 years old), HHV-7 is found in 98% of adults, 1 Chlamydia pneumoniae in 74% of adults, 1 coxsackievirus B IgG antibodies in 55% of adults, 1 coxsackievirus B3 in 7% of infants, coxsackievirus B4 in 2% of infants, echovirus 9 in 2% of infants, 1 cytomegalovirus in 58% of adults, 1 parvovirus B19 in 61% of adults, 1 herpes simplex I in 54% of adults, and herpes simplex II in 16% of adults. 1 Most of these pathogens, once caught, cannot be eliminated, just controlled by the immune system (a healthy immune system ensures these pathogens are kept in an inactive dormant state). However, there is evidence that in ME/CFS, these pathogens are not being properly suppressed by the immune response, and have thus become active.

Other Precipitating Factors Linked to Chronic Fatigue Syndrome

Exposure to mold toxins (usually from water-damaged buildings) may be a predisposing factor for precipitating ME/CFS. 1 2 Exposure to organophosphate pesticides may be a predisposing factor to ME/CFS. 1 Chronic fatigue syndrome is sometimes precipitated by vaccination, 1 especially hepatitis B virus vaccination. 1 If corticosteroids are given during the acute phase of a significant respiratory infection, this has been found to sometimes lead to ME/CFS. 1 Chronic fatigue syndrome can sometimes ensue after an episode of meningitis. 1 ME/CFS can appear within days of receiving a blood transfusion (possibly from transfer of viral infection). 1 Chronic fatigue syndrome can occasionally appear after having major surgery (possibly due to a blood transfusion during surgery). 1 2 Sometimes a major physical trauma — particularly a motor vehicle accident — can precipitate 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 can develop ME/CFS soon after. 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. 1 Exposure to tung oil has been proposed as a cause for ME/CFS. 1 2 Jaw bone infections (osteomyelitis) may cause or contribute to ME/CFS symptoms. 1 Temporomandibular joint dysfunction (jaw misalignment) may cause ME/CFS-like symptoms. 1 2

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. Some of the various criteria use for diagnosing chronic fatigue syndrome by its symptoms are given here: CDC Fukuda 1994 CFS Criteria, the Canadian Consensus ME/CFS Criteria and the nice and simple IOM Criteria.

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.

A comprehensive explanation of the tests and treatment used in ME/CFS found here:
Chronic Fatigue Syndrome — A Roadmap for Testing and Treatment

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