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Epidemic myalgic encephalomyelitis
(section)
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== Findings == Findings varied considerably based on the technology of the time and what tests physicians attending to these outbreaks chose or were able to run: * Low-grade [[fever]]<ref name="Sigurdsson1956" /><ref name="Jackson1957" /><ref name="Albrecht1964" /><ref name="Hill1959" /> * Abnormal electromyogram showing generalized, mild, lower motor neuron changes indicative of a radiculopathy.<ref name="Parish1978" /><ref name="Marinacci1965">{{Cite journal | last = Marinacci | first = AA | date = October 1965 | title = The value of the electromyogram in the diagnosis of Iceland disease | url =https://www.ncbi.nlm.nih.gov/pubmed/5889546|journal=Electromyography|volume=5 | pages = 241-51|via=}}</ref> * [[Paresis|Muscle weakness]] measured via quantitative muscular-testing<ref name="Shelokov, 1957">{{Cite journal | last1 = Shelokov | first1 = Alexis | author-link1 = | last2 = Habel | first2 = Karl | authorlink2 = | last3 = Verder | first3 = Elizabeth | authorlink3 = | last4 = Welsh | first4 = William | author-link4 = | title = Epidemic Neuromyasthenia β An Outbreak of Poliomyelitis-like Illness in Student Nurses | journal = New England Journal of Medicine | volume = | issue = 257 | page = 345-355 | date = August 1957 | url = https://www.cabdirect.org/cabdirect/mobile/abstract/19582700721 | doi = 10.1056/NEJM195708222570801 }}</ref> * Normal or minimal [[cerebrospinal fluid]] findings<ref name="Sigurdsson1956" /><ref name="Shelokov, 1957" /><ref name="Hill1959" /><ref>{{Cite journal| url = https://www.sciencedirect.com/science/article/pii/S0033350657800225 | title = Encephalomyelitis simulating poliomyelitis | last = Ramsay | first = Melvin | date = May 26, 1956|journal=The Lancet|volume=270 | pages = 761-764|via= | last2 = O'Sullivan | first2 = E}}</ref> * Normal or mildly increased [[erythrocyte sedimentation rate]]<ref name="Jackson1957" /><ref name="Hill1959" /><ref name="Ramsay1978" /> * Mild increase in white blood cell count<ref name="Hill1959" /> * [[Dysautonomia|Autonomic nervous system dysfunction]], [[Hypothalamus|hypothalamic]] dysfunction * [[Postural orthostatic tachycardia syndrome|Orthostatic tachycardia]]<ref name="Hill1959" /> * Ulnar neuritis, neuropathy or lesion<ref name="Sigurdsson1950" /><ref name="Levine1994">{{Cite journal | last = Levine | first = PH | date = January 1994 | title = Epidemic neuromyasthenia and chronic fatigue syndrome: epidemiological importance of a cluster definition | url = https://www.ncbi.nlm.nih.gov/pubmed/8148446|pmid=8148446|journal=Clinical Infectious Diseases|volume=18| pages=S16-20|via=}}</ref><ref name="White1954">{{Cite journal | last = White | first = D | last2 = Burtch | first2 = Robert | date = July 1, 1954 | title = Iceland Disease: A New Infection Simulating Acute Anterior Poliomyelitis |url = http://n.neurology.org/content/4/7/506.short|journal=Neurology|volume=4| pages=|via=}}</ref> * Microscopic infiltration of nerve roots with [[lymphocyte]]s and [[Mononuclear cell|mononuclear cell]]s; patchy damage to the myelin sheaths and axon swellings (in monkeys infected with unidentified virus from the [[1949-53 Adelaide outbreak|Adelaide]] outbreak) * Raised urinary [[creatine]] excretion<ref name="Albrecht1964" /><ref name="White1954" /> * abnormally high [[lactic dehydrogenase]] and [[glutamic oxaloacetic transaminase]]<ref name="Ramsay1978" /> In the majority of early epidemics, no viral or bacterial infectious agent was successfully cultured.<ref name="Sigurdsson1956" /><ref name="Jackson1957" /><ref name="Hill1959" /> In a small number of epidemics [[Coxsackie B]]<ref name="Fegan1983">{{Cite journal | last1 = Fegan | first1 = KG | author-link1 = KG Fegan | last2 = Behan | first2 = PO | authorlink2 = Peter Behan | last3 = Bell | first3 = EJ | authorlink3 = Eleanor Bell | title = Myalgic encephalomyelitis β report of an epidemic | journal = J R Coll Gen Pract | volume = 33 | issue = 251| pages = 335β337 | date = Jun 1, 1983 | pmid = 6310104 | url = http://bjgp.org/content/33/251/335 }}</ref><ref name="Calder1984">{{Cite journal | last1 = Calder | first1 = BD | author-link1 = BD Calder | last2 = Warnock | first2 = PJ | authorlink2 = PJ Warnock | title = Coxsackie B infection in a Scottish general practice | journal = Jrnl Royal Coll Gen Pract | volume = 34 | issue = 258| pages = 15β19 | date = Jan 1984 | pmid = 6319691 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959663/ }}</ref> or [[Bethesda-Ballerup paracolon organism]]<ref name="Shelokov, 1957" /> were found. In others, infection of animal models with samples from patients results in identifiable nervous system damage on autopsy and in one case, [[myocarditis]], in spite of being unable to identify the agent.<ref name="Parish1978" /><ref name="Pellew1955">{{Cite journal| url = https://www.ncbi.nlm.nih.gov/pubmed/13272481 | title = Further Investigations on a Disease Resembling Poliomyelitis Seen in Adelaide | last = Pellew | first = R.A.A. | date = September 24, 1955|journal=The Medical Journal of Australia|volume=2 | pages = 480-2|via=}}</ref>
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