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Vagus nerve infection hypothesis
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==Theory== As explained by Dr. [[Michael VanElzakker]]: "The vagus nerve infection hypothesis of CFS contends that CFS symptoms are a pathologically exaggerated version of normal sickness behavior that can occur when sensory [[vagal ganglia]] [structures containing a number of nerve cell bodies] or [[paraganglia]] [non-nerve cells that surround nerves] are themselves infected with any [[virus]] or [[bacteria]].... [The] [[glial cell]]s [cells that support and protect neurons] can bombard the sensory vagus nerve with proinflammatory [[cytokine]]s and other neuroexcitatory substances, initiating an exaggerated and intractable sickness behavior signal. According to this hypothesis, any pathogenic infection of the vagus nerve can cause CFS, which resolves the ongoing controversy about finding a single [[pathogen]]." The neuroimmune cells whose job is to protect the nerve, such as [[mast cell]]s and glial cells, can sense an infectious agent and become activated, in turn signaling the vagus nerve to tell the [[brain]] there is an infection present, causing a systemic reaction.<ref name="VanElzakker2013" /> In 2015, VanElzakker stated he believed that any infectious agent with an affinity for nerve tissues can cause a vagus nerve infection, including [[Human herpesvirus 6]], [[Epstein-Barr virus]], [[Varicella zoster virus]], [[chickenpox]], certain kinds of [[enterovirus]]es and even [[Borrelia burgdorferi|borrelia]], the bacterium that causes [[Lyme disease]]. He thinks this could explain why no single infective agent has been isolated as the cause of CFS, even though all of these agents have been associated with disease.<ref name="lowhistchef-vnih">{{cite web | last1 = Ykelenstam | first1 = Yasmina | authorlink1 = Yasmina Ykelenstam | last2 = VanElzakker | first2 = MB | authorlink2 = Michael VanElzakker|title = Harvard Neuroscientist Dr. Michael VanElzakker: Chronic Fatigue Vagus Nerve Link|website = The Low Histamine Chef | date = Dec 8, 2015 | url = http://thelowhistaminechef.com/harvard-neuroscientist-dr-michael-van-elzakker-chronic-fatigue-vagus-nerve-link }}</ref> To test his hypothesis, VanElzakker is using a combined [[MRI]] and [[PET scan]] with radio labeled antibodies to look for "increased cellular activity in the [[brain stem]] in a place called the nucleus of the solitary tract, which is where about 80 percent of these sensory vagus nerve fibers have their cell bodies...The idea is that if we can see extra signal there, there’s more activity there in Chronic Fatigue Syndrome patients than there is in healthy people, that would be evidence that there’s an exaggerated signal coming from the vagus nerve into the brain."<ref name="lowhistchef-vnih" /> In addition, he suggests that one possibility is vagus nerve biopsy samples from CFS patients who have died prematurely from other causes.<ref name="hhv6f-vnih" /> However, given the size and highly intricate branching of the vagus nerve, direct evidence of infection would be difficult to demonstrate.
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