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Postviral fatigue syndrome
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[[File:Postviral fatigue syndrome symptoms.png|thumb|right|alt=Postviral Fatigue Syndrome. The core clinical symptoms are always the same: severe fatigue made worse by exercise, myalgia, night sweats, atypical depression and excessive sleep. The other common symptoms include dysequilibrium disorders and irritable bowel syndrome. —Behan et al. (2007)|Quote from: Behan, et al. (2007). [https://onlinelibrary.wiley.com/doi/abs/10.1002/9780470514382.ch9 Enteroviruses and Postviral Fatigue Syndrome.]]] '''Postviral Fatigue Syndrome''' (PVFS) refers to a chronic fatiguing illness which begins after a virus. PVFS has many similarities to [[myalgic encephalomyelitis]] (ME) and [[chronic fatigue syndrome]] (CFS).<ref name="Lask1990">{{Cite web|url=https://adc.bmj.com/content/archdischild/65/11/1198.full.pdf | title = Postviral fatigue syndrome | last = Lask | first = B | last2 = Dillon | first2 = M J| date = Nov 1990|archive-url=|archive-date=|url-status=|access-date= | authorlink = | authorlink2 = |volume=65|issue=11 | page = 1198|journal=Archives of Disease in Childhood}}</ref><ref name="Archer1987">{{Cite journal | last = Archer | first = M.I. | date = 1987 | title = The post-viral syndrome: a review | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/|journal=The Journal of the Royal College of General Practitioners|volume=37|issue=298|pages=212–214|issn=0035-8797|pmid=3320358|via=}}</ref> Since not all cases of [[Myalgic encephalomyelitis|ME]] or [[Chronic fatigue syndrome|CFS]] are preceded by a [[Viral onset hypothesis|viral infection]], the term PVFS has become outdated and is nowadays seldom used in scientific literature. As ME expert [[Peter Behan]] explained these developments: “It became abundantly, crystal clear that several patients had developed the syndrome, the identical syndrome but they had developed the syndrome not following a viral or other infection but due to their reaction to a particular form of physical or psychological stress.”<ref name="ShepherdBook">{{Cite book | last = Shepherd | first = C. | authorlink =Charles Shepherd | date = 1999 | title=Living with Me: the Chronic, Post-viral Fatigue Syndrome|location=London|publisher=Vermilion|isbn=0091816793|pages=|edition=|volume=|language=|title-link=Living with M.E. | url = |access-date= | author-link = |veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=}}</ref><ref>{{Cite web|url=https://www.youtube.com/watch?time_continue=2119&v=li7zQgN-PxQ | title = ME: The Toxic Tiredness (Part 2) | last = | first = | date = Feb 1, 2012 | website = YouTube|publisher=forcedout99|at=35:19|archive-url=|archive-date=|url-status=|access-date=}}</ref> ==Symptoms== By 1990, a group of core and minor symptoms of Postviral Fatigue Syndrome were described: * severe [[post-exertional malaise |fatigue made worse by exercise]] - now called post-exertional malaise (PEM) *persisting or relapsing 'fatigue' or easy fatiguability *[[myalgia]] (muscle pain) *[[depression]], which may be atypical *[[hypersomnia|excessive sleep]] or other [[sleep dysfunction|sleep disturbance]] *[[concentration problems|concentration difficulties]] *may or may not follow what appears to be an acute infectious illness, such as a [[virus]], [[bacteria]] or [[parasite]] infection<ref name="Lask1990" /><ref name="Behan2007" /><ref name="Behan1988">{{Cite web|url=https://pubmed.ncbi.nlm.nih.gov/3063394/ | title = Postviral Fatigue Syndrome | last = Behan | first = P.O. | authorlink = Peter Behan | last2 = Behan | first2 = W.M. | authorlink2 = | date = 1988 | website = Critical reviews in neurobiology|language=en|pmid=3063394|archive-url=|archive-date=|url-status=|access-date=2020-04-28}}</ref> Lask and Dillon (1990) also reported: *[[low-grade fever|mild fever]] *[[sore throat]] *[[sore lymph node]]s *[[headache]]s *migratory [[arthralgia|joint pain]] *[[photophobia|light sensitivity]] *forgetfulness *irritability<ref name="Lask1990" /> Behan and Behan (1988) also reported: *exhaustion *[[emotional lability]] Behan et al. (2007) also reported: *[[night sweat]]s (a core symptom) *dysequilibrium disorders, e.g. [[dizziness]], [[balance problems|balance]] or gait problems *[[Irritable bowel syndrome]]<ref name="Behan2007">{{Cite book | last = Behan | first = P.O. | last2 = Behan | first2 = W.M.H. | last3 = Gow | first3 = J.W. | last4 = Cavanagh | first4 = H. | last5 = Gillespie | first5 = S. | date = 2007 | url=https://onlinelibrary.wiley.com/doi/abs/10.1002/9780470514382.ch9|chapter=Enteroviruses and Postviral Fatigue Syndrome | title = Ciba Foundation Symposium 173 ‐ Chronic Fatigue Syndrome | editor-last = Bock | editor-first = G.R.|editor-last2=Whelan|editor-first2 = J.|doi=10.1002/9780470514382.ch9|pages=|isbn=|edition=|volume=|language=|title-link=|access-date=|publisher= | author-link = Peter Behan|veditors=|others=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> In children, symptoms may include: *lethargy *headache *abdominal pain *subjective [[paresis|muscular]] weakness<ref name="Lask1990" /> These symptoms were altered and adapted over time, with over 20 different sets of [[:Category:Definitions|diagnostic criteria]] being published, and psychological symptoms including depression and emotional lability regarded as potential consequences of the illness, rather than diagnostic symptoms.<ref name="fukuda1994" /><ref name="canadianconsensus-CCC" /> ==Diagnostic criteria== The most commonly used diagnostic criteria is the 1994 [[Fukuda criteria]], uses the name [[chronic fatigue syndrome]], and allows for non-viral triggers.<ref name="fukuda1994" /> This requires at least '''6 months''' of "persistent or relapsing" fatigue which persists despite rest, has a significant impact on daily life, and includes at least ''four'' of the following symptoms: *[[post-exertional malaise|post-exertional malaise]] (PEM) lasting more than 24 hours *substantial impairment in short-term memory or concentration *sore throat *tender lymph nodes *muscle pain *multi-joint pain without swelling or redness *[[headache]]s of a new type, pattern, or severity *[[sleep dysfunction|unrefreshing sleep]]<ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | authorlink = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2 = Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5 = James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15 | title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url =https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref> More recent definitions have emphasized post-exertional malaise rather than fatigue, and used alternative for the illness, including the [[Systemic Exertion Intolerance Disease]] (2015) and the [[International Consensus Criteria|International Consensus Criteria for ME]] (2011).<ref name="ICC2011primer" /><ref name="seid">{{Cite web|url=http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFScliniciansguide.pdf | title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Redefining an Illness | last = Clayton | first = Ellen Wright | date = 2015 | website = National Academies|archive-url=|archive-date=|url-status=|access-date= | authorlink = Ellen Wright Clayton | last2 = Alegria | first2 = Margarita | authorlink2 = Margarita Alegría | authorlink3 = Lucinda Bateman | authorlink4 = Lily Chu | authorlink5 = Charles Cleeland | authorlink6 = Ronald Davis | authorlink7 = Betty Diamond | authorlink8 = Theodore Ganiats | authorlink9=Betsy Keller | last3 = Bateman | first3 = Lucinda | last4 = Chu | first4 = Lily | last5 = Cleeland | first5 = Charles | last6 = Davis | first6 = Ronald | last7 = Diamond | first7 = Betty | last8 = Ganiats | first8 = Theodore | last9 = Keller | first9 = Betsy | last10 = Klimas | first10 = Nancy | authorlink10=Nancy Klimas | last11 = Lerner | first11 = A Martin | authorlink11=Martin Lerner | last12 = Mulrow | first12 = Cynthia | authorlink12=Cynthia Mulrow | last13 = Natelson | first13 = Benjamin | authorlink13 = Benjamin Natelson | last14 = Rowe | first14 = Peter | authorlink14=Peter Rowe | last15 = Shelanski | first15 = Michael | authorlink15=Michael Shelanski}}</ref><ref name="Jason2015">{{Cite journal | last= Jason | first = Leonard A. | author-link = Leonard Jason | last2 = Sunnquist | first2 = Madison | authorlink2 = Madison Sunnquist | last3 = Brown | first3 = Abigail | authorlink3 = Abigail Brown | last4 = Newton | first4 = Julia L. | authorlink4 = Julia Newton | last5 = Strand | first5 = Elin Bolle | authorlink5 = Elin Strand | last6 = Vernon | first6 = Suzanne D. | authorlink6 = Suzanne Vernon | date = 2015-07-03 | title = Chronic fatigue syndrome versus systemic exertion intolerance disease|url=https://doi.org/10.1080/21641846.2015.1051291|journal = Fatigue: Biomedicine, Health & Behavior |volume=3|issue=3|pages=127–141|doi=10.1080/21641846.2015.1051291|issn=2164-1846|pmc = 4556426|pmid=26345409|access-date=|quote=|via=}}</ref> ==Viruses== Many different viruses have been reported immediately before the onset of postviral fatigue syndrome, including: *[[Cocksackievirus]]es<ref name="Archer1987" /><ref name="canadianconsensus-CCC" /> *[[Cytomegalovirus]]<ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" /> *[[Dengue virus]]es<ref name="Dengue2017">{{Cite journal | last = Umakanth | first = M | authorlink = | date = Aug 2017 | title = Post dengue fatigue syndrome|url=http://scholarsmepub.com/wp-content/uploads/2017/09/SJMPS-38858-861.pdf|journal=Saudi Journal of Medical and Pharmaceutical Sciences|volume=3|issue=8 | pages = 858-861|doi=10.21276/sjmps|pmc=|pmid=|access-date=|quote=|via=}}</ref> *[[Ebola]] can cause a post-Ebola syndrome which has similarities<ref name="Scott2017">{{Cite journal | last = Scott | first=Janet T | author-link = | last2 = Semple | first2 = Malcolm G | authorlink2 = | date = May 2017 | title = Ebola virus disease sequelae: a challenge that is not going away|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818139/|journal=The Lancet. Infectious diseases|volume=17|issue=5 | pages = 470–471|doi=10.1016/S1473-3099(17)30027-0|issn=1473-3099|pmc=5818139|pmid=28094207|access-date=|quote=|via=}}</ref> *[[Epstein-Barr virus]]<ref name="Archer1987" /><ref name="canadianconsensus-CCC" /><ref name="Hickie2006" /><ref name="ICC2011primer" /> *[[Enterovirus]]es<ref name="Archer1987" /><ref name="canadianconsensus-CCC" /> *[[Human herpesvirus 6]], [[Human herpesvirus 7|7]]<ref name="ICC2011primer" /> and other herpes viruses<ref name="canadianconsensus-CCC" /> *[[Influenza]] viruses<ref name="canadianconsensus-CCC" /> *[[Parovirus B19]]<ref name="ICC2011primer" /> *[[Ross River virus]]<ref name="Hickie2006" /> *[[SARS-CoV]], the coronavirus that causes [[Severe acute respiratory syndrome|SARS]]<ref name="SARS-415378">{{Cite journal | last = Lam | first = Marco Ho-Bun | last2 = Wing | first2 = Yun-Kwok | last3 = Yu | first3 = Mandy Wai-Man | last4 = Leung | first4 = Chi-Ming | last5 = Ma | first5 = Ronald C.W. | last6 = Kong | first6 = Alice P.S. | last7 = So | first7 = W.Y. | last8 = Fong | first8 = Samson Yat-Yuk | last9 = Lam | first9 = Siu-Ping| date = 2009-12-14 | title = Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up | url =https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378|journal=Archives of Internal Medicine|language=en|volume=169|issue=22|pages=2142–2147|doi=10.1001/archinternmed.2009.384|issn=0003-9926}}</ref> *[[Varicella zoster virus]], which causes Chickenpox<ref name="Archer1987" /> == Classification == === ICD-10 title === Postviral fatigue syndrome is the official concept title of code G93.3 in the ICD-10,<ref>{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/G93.3 | title = ICD-10 Version:2016 | website = [[World Health Organization]]|access-date=2018-08-24 | date = | last = World Health Organization | first = | authorlink = World Health Organization|archive-url=|archive-date=|url-status=}}</ref> the medical classification list of the [[World Health Organization]] (WHO). "Benign myalgic encephalomyelitis" is inscribed as an inclusion, while "chronic fatigue syndrome" is listed only in the index. Since postviral fatigue syndrome is seldom used in scientific research and clinical practice, some argue it should be removed as a concept title. [[Mary Dimmock]] and Suzy Chapman for example propose to list PVFS in the upcoming ICD-11 as a synonym term under a new concept title "Myalgic encephalomyelitis".<ref>{{Cite web|url=https://dxrevisionwatch.files.wordpress.com/2017/03/icd-11-proposal-g93-3-suzy-chapman-mary-dimmock-final2.pdf | title = Proposal for the ICD-10 G93.3 legacy terms for ICD-11 | last = Chapman | first = Suzy | last2 = Dimmock | first2 = Mary | date = 2017 | website = dxrevisionwatch.files.wordpress.com|archive-url=|archive-date=|url-status=|access-date= | authorlink2 = Mary Dimmock}}</ref> The proposal of the IACFS/ME, written by Lily Chu<ref>{{Cite web|url=http://iacfsme.org/ME-CFS-Primer-Education/NewsLetters/Volume-10,-Issue-2-%E2%80%A2-April-2017.aspx | title = IACFS/ME Newsletter Volume 10, Issue 2 – April 2017 | last = Bested | first=Alison M. | author-link = Alison Bested| date = Apr 18, 2017 | website = IACFS/ME|archive-url=|archive-date=|url-status=|access-date=}}</ref>, however suggests to retain the term PVFS as a concept title and to simply elevate the terms "chronic fatigue syndrome" (CFS) and "myalgic encephalomyelitis" (ME) to concept titles at the same level, with each of the three terms given a unique code. Both proposals to the ICD-11 advocate to maintain the classification of these three terms in the neurological chapter. === Post-infectious Fatigue Syndrome === The [[Oxford criteria]] has a [[Post-infectious Fatigue Syndrome|post-infectious fatigue syndrome]] (PIFS) as one of its definitions.<ref name="Oxfordcriteria">{{Cite journal|url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1293107/| title = A report - chronic fatigue syndrome: guidelines for research|journal=Journal of the Royal Society of Medicine|volume=84 | date = Feb 1991|pages=118-121|pmc = 1293107 | author-link = Michael Sharpe | first1 = Michael | last1 = Sharpe | first2 = Len | last2 = Archard | authorlink2 = Len Archard | first3 = Jangu | last3 = Banatvala | authorlink3 = | first4 = Leszek | last4 = Borysiewicz | authorlink4 = | first5 = Anthony| last5 = Clare | authorlink5 = Anthony Clare | first6 = Anthony | last6 = David | authorlink6 = Anthony David | first7 = Richard | last7 = Edwards | authorlink7 = | first8 = Keith | last8 = Hawton | first9 = Harold | last9 = Lambert | first10 = Russell | last10 = Lane}}</ref> ''The Argus Report'' article ''US NIH Report Calls for UK Definition of ME/CFS to be Scrapped'' states: "The [[NIH]] has issued a draft report that highlights the dire need for scientific research that will help find a cure for the millions of people suffering from [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)]] worldwide. The report also highlights the fact that the decades-old UK Royal Society of Medicine’s [[Oxford criteria]] for ME/CFS are severely “flawed,” and that continuing to use these criteria may “cause harm.” Further, the [[National Institutes of Health|NIH]] report says that the Royal Society definition should “be retired” and replaced with a single case definition agreed to by the ME/CFS community."<ref>{{Cite web|url=http://theargusreport.com/us-nih-report-calls-uk-definition-mecfs-scrapped/ | title = US NIH Report Calls for UK Definition of ME/CFS to be Scrapped | last = Swift | first=Penny | date = |website=theargusreport.com|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-08-24}}</ref><ref name="seid" /> ==Post-EBV ME/CFS == Several studies have performed an extensive follow-up on adolescents with [[Mononucleosis|infectious mononucleosis]] resulting from the [[Epstein-Barr virus]] (EBV). In general these studies have found that approximately 10% of the sample meets the diagnosis of ME/CFS after 6 months, though the percentage decreases as time moves on. Research has not been able to identify significant predictors of ME/CFS diagnosis except for the severity of the acute [[Epstein-Barr virus]] (EBV) infection. === More fatigue after EBV compared to other infections === [[Peter White|White]] et al. showed the percentage of patients developing [[chronic fatigue syndrome]] to be significantly higher after an infection with EBV (9-47%) than after an upper respiratory tract infection (0-6%).<ref name=":0">{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Crawford | first4 = D.H. | last5 = Grover | first5 = S.A. | last6 = Kangro | first6 = H.O. | last7 = Clare | first7 = A.W. | date = Dec 1998 | title = Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/9926075|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=173 | pages = 475–481|issn=0007-1250|pmid=9926075|issue=|quote= | author-link = Peter White|via=}}</ref> Other research has shown that persistent fatigue is much more common after infectious mononucleosis than after other infectious diseases such as [[influenza]] or [[tonsillitis]].<ref>{{Cite journal | last = Petersen | first = I. | last2 = Thomas | first2 = J.M. | last3 = Hamilton | first3 = W.T. | last4 = White | first4 = P. D. | date = Jan 2006 | title = Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort|url=https://www.ncbi.nlm.nih.gov/pubmed/16330509|journal=QJM: monthly journal of the Association of Physicians|volume=99|issue=1 | pages = 49–55|doi=10.1093/qjmed/hci149|issn=1460-2725|pmid=16330509|quote= | authorlink3 = | authorlink4 = Peter White | authorlink5 = |via=}}</ref> === Independent of psychological factors === The study by White et al. demonstrated that EBV does not cause an increase in psychiatric disorder<ref name=":0" /> and that psychosocial factors were not predictors of persistent complaints.<ref>{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Kangro | first3 = H.O. | last4 = Bruce-Jones | first4 = W. D. | last5 = Amess | first5 = J. | last6 = Crawford | first6 = D.H. | last7 = Grover | first7 = S.A. | last8 = Clare | first8 = A.W. | date = 2001-12-08 | title = Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis|url=https://www.ncbi.nlm.nih.gov/pubmed/11747919|journal=Lancet (London, England)|volume=358|issue=9297|pages=1946–1954|doi=10.1016/S0140-6736(01)06961-6|issn=0140-6736|pmid=11747919|quote= | author-link = Peter White|via=}}</ref> This indicated that the postviral fatigue syndrome is a distinct disease category.<ref>{{Cite journal | last = White | first = P. D. | last2 = Grover | first2 = S.A. | last3 = Kangro | first3 = H.O. | last4 = Thomas | first4 = J.M. | last5 = Amess | first5 = J. | last6 = Clare | first6 = A.W. | date = Sep 1995 | title = The validity and reliability of the fatigue syndrome that follows glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/8588010|journal=Psychological Medicine|volume=25|issue=5 | pages = 917–924|issn=0033-2917|pmid=8588010|quote= | author-link = Peter White|via=}}</ref> According to the authors, patients with the postviral fatigue syndrome reported more severe physical fatigue, especially after exertion, than patients with psychiatric disorders. A similiar conclusion was drawn by [[Dedra Buchwald|Buchwald]] et al., who followed up on 150 patients with infectious mononucleosis in the Seattle area. After six months, 12% of the patient sample said they still were not recovered. In agreement with White, the authors stated that they “do not believe that the postinfectious fatigue syndrome after infectious mononucleosis can be explained primarily by psychologic factors.”<ref>{{Cite journal | last = Buchwald | first= D. S. | last2 = Rea | first2 = T. D. | last3 = Katon | first3 = W.J. | last4 = Russo | first4 = J.E. | last5 = Ashley | first5 = R.L. | date=Nov 2000 | title = Acute infectious mononucleosis: characteristics of patients who report failure to recover |url =https://www.ncbi.nlm.nih.gov/pubmed/11063953|journal=The American Journal of Medicine|volume=109|issue=7 | pages = 531–537|issn=0002-9343|pmid=11063953|quote= | author-link = Dedra Buchwald|via=}}</ref> ===Only severity of the acute illness predicts ME/CFS === The most comprehensive study of postviral fatigue syndrome was organized and funded by the [[Centers for Disease Control and Prevention|CDC]] in the 2000s. The study focused on Dubbo a remote township in [[Australia]] where it is easier to follow up on medical records; 253 patients with either an acute infection with [[Epstein-Barr virus]] (EBV), [[coxiella burnetti]] (the bacteria that causes [[Q fever|Q-fever]]) or [[Ross River virus]] were studied.<ref name="Hickie2006">{{Cite journal | last = Hickie | first = Ian | authorlink = Ian Hickie | last2 = Davenport | first2 = Tracey | authorlink2 = Tracey Davenport | last3 = Wakefield | first3 = Denis | authorlink3 = Denis Wakefield | last4 = Vollmer-Conna | first4 = Ute | authorlink4 = Uté Vollmer-Conna | last5 = Cameron | first5 = Barbara | authorlink5 = Suzanne Vernon | last6 = Vernon | first6 = Suzanne D | authorlink6 = | last7 = Reeves | first7 = William C | authorlink7 = William Reeves | last8 = Lloyd | first8 = Andrew | authorlink8 = Andrew Lloyd| date = 2006-09-16 | title = Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569956/|journal=BMJ : British Medical Journal|volume=333|issue=7568 | pages = 575|doi=10.1136/bmj.38933.585764.AE|issn=0959-8138|pmc=1569956|pmid=16950834|access-date=|quote=|via=}}</ref> After six months, 11% of the patient sample met diagnostic criteria for chronic fatigue syndrome, with no significant differences in prevalence between the different infections. ME/CFS was predicted mostly by the severity of the acute infection, rather than by demographic, psychological or microbiological factors. There was no significant difference in [[cytokine]] expression<ref>{{Cite journal | last = Vollmer-Conna | first=Uté | last2 = Cameron | first2 = Barbara | last3 = Hadzi-Pavlovic | first3 = Dusan | last4 = Singletary | first4 = Kristi | last5 = Davenport | first5 = Tracey | last6 = Vernon | first6 = Suzanne | last7 = Reeves | first7 = William C. | last8 = Hickie | first8 = Ian | last9 = Wakefield | first9 = Denis| date = 2007-09-15 | title = Postinfective fatigue syndrome is not associated with altered cytokine production|url=https://www.ncbi.nlm.nih.gov/pubmed/17712757|journal=Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America|volume=45|issue=6 | pages = 732–735|doi=10.1086/520990|issn=1537-6591|pmid=17712757|quote= | author-link = Uté Vollmer-Conna | authorlink2 = Barbara Cameron | author-link3 = | authorlink4 = | authorlink5 = Tracey Davenport|via= | authorlink6 = Suzanne Vernon | authorlink7 = William Reeves | authorlink8 = Ian Hickie | authorlink9 = Denis Wakefield}}</ref> or reactivation of [[herpesviruses]] ([[Epstein-Barr virus|EBV]], [[Human herpesvirus 6|HHV-6]], [[Cytomegalovirus|CMV]])<ref>{{Cite journal | last = Cameron | first = Barbara | last2 = Flamand | first2 = Louis | last3 = Juwana | first3 = Hedy | last4 = Middeldorp | first4 = Jaap | last5 = Naing | first5 = Zin | last6 = Rawlinson | first6 = William | last7 = Ablashi | first7 = Dharam | last8 = Lloyd | first8 = Andrew| date = Oct 2010 | title = Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/20827765|journal=Journal of Medical Virology|volume=82|issue=10|pages=1684–1688|doi=10.1002/jmv.21873|issn=1096-9071|pmid=20827765|quote=|via= | authorlink7 = Dharam Ablashi | authorlink8 = Andrew Lloyd}}</ref> between the group that did or did not recover. ===ME/CFS cases decrease over time=== A study in the Chicago area showed that the percentage of patients meeting ME/CFS criteria after infectious mononucleosis decreases as time moves on. While 13% met ME/CFS criteria at the six-month time interval, this decreased to 7% at 12 months and only 4% at 24 months.<ref>{{Cite journal | last = Katz | first = Ben Z. | last2 = Jason | first2 = Leonard A. | date = Feb 2013 | title = Chronic fatigue syndrome following infections in adolescents|url=https://www.ncbi.nlm.nih.gov/pubmed/23263024|journal=Current Opinion in Pediatrics|volume=25|issue=1 | pages = 95–102|doi=10.1097/MOP.0b013e32835c1108|issn=1531-698X|pmid=23263024|quote= | author-link = Ben Katz | authorlink2 = Leonard Jason|via=}}</ref> The most important predictors of ME/CFS caseness were [[Autonomic nervous system|autonomic]] symptoms and days spent in bed since mono.<ref>{{Cite journal | last= Jason | first = Leonard A. | last2 = Katz | first2 = Ben Z. | last3 = Shiraishi | first3 = Yukiko | last4 = Mears | first4 = Cynthia J. | last5 = Im | first5 = Young | last6 = Taylor | first6 = Renee R. | date = 2014-01-01 | title = Predictors of post-infectious chronic fatigue syndrome in adolescents|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956649/|journal=Health Psychology and Behavioral Medicine|volume=2|issue=1 | pages = 41–51|doi=10.1080/21642850.2013.869176|issn=2164-2850|pmc=3956649|pmid=24660116|quote= | author-link = Leonard Jason | authorlink2 = Ben Katz|via= | authorlink6 = Renee Taylor}}</ref> This confirmed the main conclusion of the Dubbo studies, namely that the severity of the acute infection is the main predictor of ME/CFS. In the Chicago study however, cytokine expression indicated differences in [[Th17]] function in patients with post-infectious ME/CFS.<ref>{{Cite journal | last = Broderick | first = Gordon | last2 = Katz | first2 = Ben Z. | last3 = Fernandes | first3 = Henrique | last4 = Fletcher | first4 = Mary Ann | last5 = Klimas | first5 = Nancy | last6 = Smith | first6 = Frederick A. | last7 = O'Gorman | first7 = Maurice R.G. | last8 = Vernon | first8 = Suzanne D. | last9 = Taylor | first9 = Renee | date = 2012-09-13 | title = Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/22973830|journal=Journal of Translational Medicine|volume=10|pages=191|doi=10.1186/1479-5876-10-191|issn=1479-5876|pmc=3480896|pmid=22973830|issue=|quote= | author-link = Gordon Broderick | authorlink2 = Ben Katz | authorlink3 = | authorlink4 = Mary Ann Fletcher | authorlink5 = Nancy Klimas|via= | authorlink8 = Suzanne Vernon | authorlink9 = Renee Taylor}}</ref> ===Psychosocial factors determine persistent fatigue but not ME/CFS === Studies that looked at a broader definition of fatigue after an [[Epstein-Barr virus|EBV]] infection have reached different conclusions. Candy et al. (2003) for example found that persistent fatigue six months after infectious mononucleosis was predicted by certain illness perceptions such as the belief that the illness would take more than one month to recover from and would have serious consequences.<ref>{{Cite journal | last = Candy | first = B. | last2 = Chalder | first2 = T. | last3 = Cleare | first3 = A.J. | last4 = Peakman | first4 = A. | last5 = Skowera | first5 = A. | last6 = Wessely | first6 = S. | last7 = Weinman | first7 = J. | last8 = Zuckerman | first8 = M. | last9 = Hotopf | first9 = M. | date = Jul 2003 | title = Predictors of fatigue following the onset of infectious mononucleosis|url=https://www.ncbi.nlm.nih.gov/pubmed/12877399|journal=Psychological Medicine|volume=33|issue=5 | pages = 847–855|issn=0033-2917|pmid=12877399 | author-link = | author-link2 = Trudie Chalder|via= | authorlink6 = Simon Wessely}}</ref> [[Rona Moss-Morris|Moss-Morris]] et al. followed-up on 246 patients with [[Mononucleosis|glandular fever]] from [[New Zealand]]. After six months, 7.8% still reported severe fatigue. [[Depression]], [[anxiety]] and [[perfectionism]] were associated with persistent complaints though perceived stress and limiting activity were not.<ref>{{Cite journal | last = Moss-Morris | first = R. | last2 = Spence | first2 = M.J. | last3 = Hou | first3 = R. | date = May 2011 | title = The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?|url=https://www.ncbi.nlm.nih.gov/pubmed/20663256|journal=Psychological Medicine|volume=41|issue=5|pages=1099–1107|doi=10.1017/S003329171000139X|issn=1469-8978|pmid=20663256|quote= | author-link = Rona Moss-Morris|via=}}</ref> A [[Norway|Norwegian]] study found that [[fatigue]] after acute EBV was predicted by variables related to symptoms and negative emotions instead of immune processes.<ref>{{Cite journal | last = Pedersen | first = Maria | authorlink = Maria Pedersen | last2 = Asprusten | first2 = Tarjei Tørre | last3 = Godang | first3 = Kristin | last4 = Leegaard | first4 = Truls Michael | last5 = Osnes | first5 = Liv Toril | last6 = Skovlund | first6 = Eva | last7 = Tjade | first7 = Trygve | last8 = Øie | first8 = Merete Glenne | last9 = Wyller | first9 = Vegard Bruun Bratholm| date = 2018-09-25 | title = Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study|url=https://www.ncbi.nlm.nih.gov/pubmed/30261303|journal=Brain, Behavior, and Immunity|doi=10.1016/j.bbi.2018.09.023|issn=1090-2139|pmid=30261303}}</ref> These findings would later be disrupted, and [[Personality traits and patient attitudes in ME/CFS|patient attitudes beliefs]] are no longer considered influence outcomes.<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> {{See also|Biopsychosocial model}} ==Books== *1992, [[Post-Viral Fatigue Syndrome (book)|Post-Viral Fatigue Syndrome]], [[James Mowbray]], [[Rachel Jenkins]] (Eds). ISBN 978-0471938798. *1999, [[Living with ME|Living with Me: the Chronic, Post-viral Fatigue Syndrome]], [[Charles Shepherd]]. ISBN 0091816793. ==Articles and blogs == *May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ *[https://www.youtube.com/watch?feature=youtu.be&v=e3Pd0o-rwrU I got a virus, but I didn't die] - [[Millions Missing]] campaign video about Graded exercise therapy ==Learn more== *[https://adc.bmj.com/content/archdischild/65/11/1198.full.pdf Postviral fatigue syndrome] - Lask and Dillon (1990) ==See also== *[[International Consensus Criteria]] for ME *[[Myalgic encephalomyelitis]] *[[Fukuda criteria]] for chronic fatigue syndrome *[[Chronic fatigue]] *[[Epstein-Barr virus]] == References == {{Reflist}} [[Category:Disease names]]
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