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Onset of ME/CFS
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The '''onset of ME/CFS''' can be sudden (acute) or gradual.<ref name="Chu" /><ref name="CDC-clinical">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html | title = Presentation and Clinical Course of ME/CFS {{!}} Information for Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS {{!}} CDC | date = 2018-12-12 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2019-02-07}}</ref> Sudden onset is more common.<ref name="Chu" /><ref name="CDC-clinical" /> Dr. [[Melvin Ramsay]] and Dr. [[Byron Hyde]] both describe sudden/acute onsets for [[myalgic encephalomyelitis]] (ME)<ref name="Evans2018">{{Cite journal | last = Evans | first = Meredyth | authorlink = Meredyth Evans | authorlink2 = Leonard Jason | date = 2018 | title=Onset patterns of chronic fatigue syndrome and myalgic encephalomyelitis|url=https://www.openaccessjournals.com/articles/Onset%20patterns%20of%20chronic%20fatigue%20syndrome%20and%20myalgic%20encephalomyelitis.pdf|journal=Research on Chronic Diseases|volume=|issue=|pages=2|quote=|via= | last2 = Jason | first2 = Leonard}}</ref> as oppose to [[ME/CFS]] being acute or gradual.<ref name="CDC-clinical" /> 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 infection|viral]]/[[bacterial infection]].<ref name="Chu" /> Children, particularly adolescents, will more likely have an acute illness like the [[Influenza|flu]] or [[mononucleosis]] as their onset.<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/me-cfs-children/children-symptoms-diagnosis.html | title = Symptoms and Diagnosis of ME/CFS in Children {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2019-01-18 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2019-01-29}}</ref> Acute symptoms develop over hours to days. 85% of patients report a trigger. 72% of [[ME/CFS]] patients report that [[Bacterial disease onset|a bacterial]] or [[Viral onset hypothesis|a viral infection]] was their onset of ME/CFS; 4.5% [[trauma]]; 4.5% surgery or childbirth; 2.2% [[allergies|allergic reaction]]; 1.7% [[stress]] or trauma.<ref>{{Cite web|url=https://www.cdc.gov/grand-rounds/pp/2016/20160216-presentation-chronic-fatigue-H.pdf | title = CDC Public Health Grand Rounds - Chronic Fatigue Syndrome - Advancing Research and Clinical Education | last = | first = | authorlink = | date = |website=cdc.gov | page = 6|archive-url=|archive-date=|access-date=}}</ref> [[Genetics of chronic fatigue syndrome|Genes]] are being considered for a risk in developing ME/CFS as sometimes several members of the same family will develop ME/CFS.<ref name="causes">{{Cite web|url=https://www.cdc.gov/me-cfs/about/possible-causes.html | title = Possible Causes {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = | first = | date = 2017-07-14 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|access-date=2018-10-15}}</ref><ref name="Dibble2020" /><ref name="Schlauch, 2016" /> == Pre-onset triggers == The [[International Consensus Criteria]] (ICC) Primer includes a patient assessment form, which includes factors that may have triggered ME, these can be infectious (for example, a virus), or non-infectious (for example, exposure to chemical [[toxin]]s or severe physical injury). === Infectious exposure or events === * minor [[Infection|infections]], [[Vaccine|vaccination]], [[Upper respiratory infection|upper respiratory infections]], [[sinusitis]], [[pneumonia]], [[Gastrointestinal tract|gastrointestinal illness]] (after sinusitis or pneumonia), [[Dental infection|dental infections]], [[vaginal infection]], [[cystitis]], [[prostatitis]], [[Blood donation|blood transfusion]] * exposure to: sick people, unfamiliar [[Infection|infectious]] agents when traveling, particularly following [[Vaccine|vaccinations]], [[contaminated water]], poor quality [[recycled air]] === Non-infectious exposure or events === * exposure to: chemical toxins, [[heavy metals]], or [[Mold|moulds]] * severe physical trauma e.g. whiplash/spinal injury/[[Guide for patients having surgery|surgery]] * anaesthetics * undue [[stress]] * [[Steroid|steroids]] Other triggers have been recognized besides these, and some people report several potential triggers or no known cause.<ref name="Chu" /> == Is ME always caused by a virus? == A small number of [[Myalgic encephalomyelitis|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 infection|bacterial infections]] or non-infectious events as a potential cause or trigger.<ref name="hfme">{{Cite web|url=http://www.hfme.org/methemedicalfacts.htm | title = M.E.: The medical facts | last = Bassett | first = Jodi | authorlink=Jodi Bassett | date = 2010 | website = [[The Hummingbirds' Foundation for ME]]|archive-url=|archive-date=|access-date=2019-02-09|quote=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. (Hence the name Myalgic Encephalomyelitis.) The CNS is diffusely injured at several levels, these include the cortex, the limbic system, the basal ganglia, the hypothalamus and areas of the spinal cord and its appendages. 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.}}</ref> The onset events recognized as potential causes or triggers in the ICC are based on events prior to illness that have been reported by patients meeting the diagnostic criteria for ICC ME or based on the consensus of experts. The exact cause has not yet been identified in research. [[Lily Chu|Chu]] et al. (2019) reported on pre-onset events for patients meeting the CFS [[Fukuda criteria]] only.<ref name="Chu" /> {{See also|Viral onset hypothesis}} == Development of ME == The [[International Consensus Criteria]] for ME recognizes that ME can develop * suddenly * gradually, or * after an [[Infectious disease|infectious disease]] (for example, viral or bacterial [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|outbreaks]] within a community) * have a non-infectious event shortly before onset * there may not be any potential trigger identified when ME begins ==Criteria== *In the [[Holmes criteria]], description of the main symptom complex as initially developing over a few hours to a few days is an optional criterion for diagnosis, under the section ''Minor Symptom Criteria''.<ref name="Holmes, 1988">{{Cite journal | last1 = Holmes | first1 = Gary P. | authorlink1 = Gary Holmes | authorlink2 = | first2 = Jonathan E. | last2 = Kaplan | authorlink3 = Nelson Gantz | first3 = Nelson M. | last3 = Gantz | first4 = Anthony L. | last4 = Komaroff | authorlink4 = Anthony Komaroff | first5 = Lawrence B. | last5 = Schonberger | authorlink5 = | first6 = Stephen E. | last6 = Straus | authorlink6 = Stephen Straus | first7 = James | last7 = Jones | authorlink7 = | first8 = Richard E. | last8 = Dubois | authorlink8 = | first9 = Charlotte | last9 = Cunningham-Rundles | first10 = Savita | last10 = Pahwa | first11 = Giovanna | last11 = Tosato | first12 = Leonard | last12 = Zegans | first13 = David T. | last13 = Purtilo | title = Chronic Fatigue Syndrome: A Working Case Definition | date = 1988 |volume=108 |issue=3 |pages=387-389 | doi = 10.7326/0003-4819-108-3-387 | pmid =2829679| journal = Annals of Internal Medicine | url = http://www.ncf-net.org/patents/pdf/Holmes_Definition.pdf }}</ref> ==Notable studies == * 2020, Genetic risk factors of ME/CFS: a critical review<ref name="Dibble2020">{{Cite journal | title = Genetic risk factors of ME/CFS: a critical review | date = 2020-08-03|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530519/|journal=Human Molecular Genetics|volume=29|issue=R1|pages=R117–R124 | last = Dibble | first = Joshua J | author-link = | last2 = McGrath | first2 = Simon J | authorlink2 = Simon McGrath | last3 = Ponting | first3 = Chris P | authorlink3 = Chris Ponting|doi=10.1093/hmg/ddaa169|pmc=7530519|pmid=32744306|access-date=|issn=0964-6906|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530519 (Full text)] * 2019, Onset patterns and course of [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]]<ref name="Chu">{{Cite journal | last = Chu | first = Lily | authorlink = Lily Chu | last2 = Valencia | first2 = Ian J. | authorlink2 = Ian Valencia | last3 = Garvert | first3 = Donn W. | authorlink3 = | last4 = Montoya | first4 = Jose G. | authorlink4 = Jose Montoya | date = Jan 14, 2019 | title = Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract|journal=Frontiers in Pediatrics|volume=7|issue=|pages=12|doi=10.3389/fped.2019.00012|quote=|via=}}</ref> [https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract (Full text)] *2016, Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Schlauch, 2016">{{Cite journal | last1 = Schlauch | first1 = Karen A. | authorlink1 = Karen Schlauch | last2 = Khaiboullina | first2 = Svetlana F. | authorlink2 = Svetlana Khaiboullina | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny de Meirleir | last4 = Rawat | first4 = Shanti | authorlink4 = Shanti Rawat | last5 = Petereit | first5 = J | authorlink5 = | last6 = Rizvanov | first6 = Albert A | authorlink6 = Albert Rizvanov | last7 = Blatt | first7 = Nataliya | authorlink7 = Nataliya Blatt | last8 = Mijatovic | first8 = Tatjana | authorlink8 = Tatjana Mijatovic| last9 = Kulick | first9 = D | authorlink9 = | last10 = Palotás | first10 = András | authorlink10 = András Palotás | last11 = Lombardi | first11 = Vincent C. | authorlink11 = Vincent Lombardi | title = Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome| journal = Translational Psychiatry | volume = 6 | issue = 2 | page = e730| date = 2016| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ | pmid = | pmc = PMC4872418 | doi = 10.1038/tp.2015.208}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ (Full Text)] * 2014, Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012<ref name="twin-peaks">{{Cite journal | last = Bakken | first = Inger Johanne | last2 = Tveito | first2 = Kari | last3 = Gunnes | first3 = Nina | last4 = Ghaderi | first4 = Sara | last5 = Stoltenberg | first5 = Camilla | last6 = Trogstad | first6 = Lill | last7 = Håberg | first7 = Siri Eldevik | last8 = Magnus | first8 = Per | date = 2014-10-01 | title = Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189623|journal=BMC medicine|volume=12|pages=167|doi=10.1186/s12916-014-0167-5|issn=1741-7015|pmc=4189623|pmid=25274261|via= | author-link = Inger Johanne Bakken}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189623 (Full text)] ==See also == * [[Bacterial disease onset]] * [[Viral onset hypothesis]] * Possible [[:Category:Infectious agents|Infectious agents]] for ME/CFS onset * [[Epidemiology of myalgic encephalomyelitis and chronic fatigue syndrome|Epidemiology]] * [[Risk factors]] * [[Pediatric myalgic encephalomyelitis and chronic fatigue syndrome|Pediatric]] * [[Prevalence of myalgic encephalomyelitis and chronic fatigue syndrome|Prevelance]] * [[Prognosis for myalgic encephalomyelitis and chronic fatigue syndrome|Prognosis]] * [[Corticosteroids given during acute viral infection may trigger myalgic encephalomyelitis]] * [[Pesticide exposure link to ME/CFS]] == Learn more == * [https://www.youtube.com/watch?v=rtVtH-cwhBY Dr. Ron Davis Gives an Update on ME/CFS Gene Research] - YouTube * [https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html Presentation and Clinical Course of ME/CFS]<ref name="CDC-clinical" /> - CDC * 2018, [https://www.openaccessjournals.com/articles/Onset%20patterns%20of%20chronic%20fatigue%20syndrome%20and%20myalgic%20encephalomyelitis.pdf Onset patterns of chronic fatigue syndrome and myalgic encephalomyelitis]<ref name="Evans2018" /> == References == {{Reflist}} [[Category:Core topics]]
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