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Nightingale Research Foundation definition
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===Clinical Features=== The clinical features of Myalgic Encephalomyelitis are consistent with the following characteristics that can easily be documented by the physician. ====1. M.E. is an acute onset biphasic epidemic or endemic (sporadic) infectious disease process==== Both [[Epidemic]] and Non-Epidemic cases are often preceded by a series of repeated minor infections in a previously well patient that would suggest either a vulnerable [[immune system]], or an immune system subject to overwhelming stressors such as: <ol start="1" type="a"> <li> repetitive contact with a large number of infectious persons, <li> unusually long hours of exhausting physical and / or intellectual work, <li> physical traumas, <li> immediate past immunizations, particularly if given when the patient has concurrent allergic or autoimmune or [[infectious disease]] or if the patient is leaving for a third world country within three weeks of receiving the immunization, <li> epidemic disease cases whose onset and periodicity appear to occur cyclically in a susceptible population, <li> the effect of travel, as in exposure to a new subset of virulent infections, or <li> the effects of starvation diets. </ol> (It should be noted that subsets c, d, e, f and g are all stressors associated with decreased immune adaptability plus an associated infection with an appropriate neurovascular infectious [[virus]] or other infectious agent. This may be due either to an immediate preexisting infectious disease or to a closely following infection, either of which may or may not be recognized.) ====2. Primary Infection Phase==== The first phase is an epidemic or endemic (sporadic) infectious disease generally with an incubation period of 4 to 7 days; in most, but not all cases, an infection or infectious process is evident. <sup>''(See Clinical and Scientific Basis of M.E./CFS, Chapter 13, pps. 124-126)''</sup> ====3. Secondary Chronic Phase==== The second and chronic phase follows closely on the first phase, usually within two to seven days; it is characterized by a measurable diffuse change in the function of the Central Nervous System. This second phase is the persisting disease that most characterizes M.E. ====4. The Presence or Absence of Various Pain Syndromes is highly variable==== The pain syndromes associated with the acute and chronic phases of M.E. may be described as Early and Late findings. '''Early Findings''': <ol start="1" type="a"> <li> severe headaches of a type never previously experienced; <li> these are often associated with neck rigidity and occipital pain; <li> retro-orbital eye pain; <li> migratory muscle and arthralgia pain; <li> cutaneous hypersensitivity. </ol> '''Late Findings''': Any of the early findings plus: <ol start="6" type="a"> <li> [[fibromyalgia]]-like pain syndromes. This is only a partial list of the multiple pain syndromes. Many of the pain features tend to decrease over time but can be activated or increased by a wide range of external & chemical stressors. <sup>''(See Clinical and Scientific Basis of M.E./CFS, Chapter 5, pps. 58-62)''</sup> </ol>
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