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Myalgic encephalomyelitis/he
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==גורמי סיכון וסיבות אפשריות== {{Main article | page_name =Epidemiology of myalgic encephalomyelitis and chronic fatigue syndrome}} ===סיכונים גנטיים=== דווח כי מיאלגי'ק אינספלומיאליטיס/תסמונת התשישות הכרונית הופיעו בקרב משפחות. למרות שמיאלג'יק אינספלומיאליטיס ותסמונות התשישות הכרונית אינן נחשבות למחלות תורשתיות, יש עדויות לנטייה גנטית.<ref name="Schlaub, 2016"/> {{Main article|page_name=Genetics of chronic fatigue syndrome}} ===Potential causes=== Although risk factors for myalgic encephalomyelitis have been identified, no single definitive virus has been found in all cases, which has led to the claim that ME is a common end path of a variety of infectious insults.<ref>{{Cite web|url=http://via.library.depaul.edu/csh_etd/117/ | title = Onset Patterns of Chronic Fatigue Syndrome and Myalgic Encephalomyelitis: A Mixed Method Approach | last = Evans | first = Meredyth | date = Aug 23, 2015 | website = via.library.depaul.edu|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref>{{Cite web|url=http://www.clevelandclinicmeded.com/online/casebased/decisionmaking/chronic-fatigue/case3.htm | title = Case Presentation - Chronic Fatigue Syndrome | website = clevelandclinicmeded.com|access-date=2018-09-08}}</ref><ref>{{Cite journal | last = Magnus | first = Per | last2 = Gunnes | first2 = Nina | last3 = Tveito | first3 = Kari | last4 = Bakken | first4 = Inger Johanne | last5 = Ghaderi | first5 = Sara | last6 = Stoltenberg | first6 = Camilla | last7 = Hornig | first7 = Mady | last8 = Lipkin | first8 = W. Ian | last9 = Trogstad | first9 = Lill | date = 2015-11-17 | title = Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine|url=https://www.ncbi.nlm.nih.gov/pubmed/26475444/|journal=Vaccine|volume=33|issue=46 | pages = 6173–6177|doi=10.1016/j.vaccine.2015.10.018|issn=1873-2518|pmid=26475444}}</ref> It is still possible ME involves some combination of both environmental and genetic factors. Various theories try to combine the known data into plausible explanations.<ref>{{Cite journal | last = Underhill | first = R.A. | date = 2015 | title=Myalgic encephalomyelitis, chronic fatigue syndrome: An infectious disease|url=https://www.ncbi.nlm.nih.gov/pubmed/26604026|journal=Medical Hypotheses|volume=85|issue=6 | pages = 765–773|doi=10.1016/j.mehy.2015.10.011|issn=1532-2777|pmid=26604026|via=}}</ref><ref name="Schlauch, 2016">{{Citation | 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 | pmid = | doi = 10.1038/tp.2015.208 }}</ref> Several theories suggest that ME is an inappropriate immune response to an infection, a theory bolstered by the observation that there is sometimes a family history of [[autoimmune disease]].<ref>{{Cite web|url=https://www.facebook.com/permalink.php?story_fbid=564532390371988&id=564526123705948 | title = Klimas ME CFS Genes Study | last = | first = | date = Nov 23, 2015 | website = facebook.com|language=en|archive-url=|archive-date=|url-status=|access-date=2018-09-08}}</ref> There is also a shift from the [[Th1]] type of helper [[T cell]]s, which fight infection, to the [[Th2]] type, which are more active in [[allergy]] and more likely to attack the body.<ref>{{Cite journal | date = 2015-03-01 | title = Cytokine expression provides clues to the pathophysiology of Gulf War illness and myalgic encephalomyelitis|url=https://www.sciencedirect.com/science/article/abs/pii/S1043466614006024|journal=Cytokine|language=en|volume=72|issue=1|pages=1–8|doi=10.1016/j.cyto.2014.11.019|issn=1043-4666}}</ref><ref>{{Cite web|url=http://www.m-hikari.com/bmgt/bmgt2014/bmgt1-4-2014/hardcastleBMGT1-4-2014.pdf | title=Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and the Potential Role of T Cells | last = Hardcastle | first = S.L. | last2 = Brenu | first2 = E.W. | date = 2014 | website = m-hikari.com|archive-url=|archive-date=|url-status=|access-date= | last3 = Staines | first3 = D.R. | last4 = Marshall-Gradisni | first4 = S.}}</ref> [[File:Naomi Whittingham .png|300px|thumb|[[Naomi Whittingham]] lives in the UK with a [[Severe and very severe ME|severe case of ME]]. Naomi became ill at [[Pediatric myalgic encephalomyelitis and chronic fatigue syndrome|age 12]] with a routine virus and never recovered. She advocates for ME by doing interviews, writing the blog [[A Life Hidden]], and supporting her brother [[Tom Whittingham]]'s marathon fund raising for [[ME Research UK]]]] ===Viruses=== {{Main article |page_name = Virus}} Other theories describe ME as an immune response to a chronic infection. The association between ME and the [[Coxsackie B]], [[Human herpesvirus 6]], and [[HHV-7]] viruses<ref>{{Cite journal | last = Bell | first = E.J. | last2 = McCartney | first2 = R.A. | last3 = Riding | first3 = M.H. | date = 1988 | title = Coxsackie B viruses and myalgic encephalomyelitis|url=https://www.ncbi.nlm.nih.gov/pubmed/2841461|journal=Journal of the Royal Society of Medicine|volume=81|issue=6|pages=329–331|doi=10.1177/014107688808100609|issn=0141-0768|pmid=2841461|via=}}</ref><ref>{{Cite news | url=http://solvecfs.org/ramsay-research-team-5-the-potential-role-of-hhv-6-in-mecfs/ | title = Ramsay Research Team 5 – The Potential Role of HHV-6 in ME/CFS - Solve ME/CFS Initiative | last = | first = | date = 2016-12-16|work=Solve ME/CFS Initiative|access-date=2018-09-08|archive-url=|archive-date=|url-status=|publisher=VOLKMEDIA|language=en-US}}</ref><ref>{{Cite journal | last = Chapenko | first = Svetlana | last2 = Krumina | first2 = Angelika | last3 = Logina | first3 = Inara | last4 = Rasa | first4 = Santa | last5 = Chistjakovs | first5 = Maksims | last6 = Sultanova | first6 = Alina | last7 = Viksna | first7 = Ludmila | last8 = Murovska | first8 = Modra | date = 2012 | title = Association of active human herpesvirus-6, -7 and parvovirus b19 infection with clinical outcomes in patients with myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/22927850|journal=Advances in Virology|volume=|pages=205085|doi=10.1155/2012/205085|issn=1687-8647|pmid=22927850|via=}}</ref> suggests a potential viral contribution in at least some individuals. Evidence from [[epidemic myalgic encephalomyelitis]] strongly point to an enterovirus, however, in most outbreaks, no virus was successfully isolated. === Bacteria === {{Main article |page_name = Bacteria}} Others believe ME may sometimes result from a chronic infection with spirochetal bacteria, such as [[lyme disease]]. Another bacterium that has been implicated in ME is [[chlamydia pneumoniae]].<ref>{{Cite journal | date = 2018-09-05|vauthors=Tovey JE | title = Chlamydia pneumoniae infection a treatable cause of Chronic Fatigue Syndrome|url=https://www.bmj.com/rapid-response/2011/11/01/chlamydia-pneumoniae-infection-treatable-cause-chronic-fatigue-syndrome|journal=The BMJ|language=en|volume=|pages=|via=}}</ref><ref>{{Cite news | url=https://www.prohealth.com/library/new-me-cfs-study-at-stanford-dr-montoya-to-test-for-scores-of-infections-27346 | title = New ME/CFS Study at Stanford: Dr. Montoya to test for scores of Infections - Prohealth | date = 2010-06-04|work=Prohealth|access-date=2018-09-08|language=en-US}}</ref> Protein findings relating to several infections have seen found in the oligoclonal bands ME of patients.<ref>{{Cite web|url=http://www.bjmp.org/content/role-chronic-bacterial-and-viral-infections-neurodegenerative-neurobehavioral-psychiatric-au | title = Role of Chronic Bacterial and Viral Infections in Neurodegenerative, Neurobehavioral, Psychiatric, Autoimmune and Fatiguing Illnesses: Part 1 {{!}} British Journal of Medical Practitioners | last = | first = | date = 2009 | website = bjmp.org|language=en|archive-url=|archive-date=|url-status=|access-date=2018-09-08}}</ref> The [[vagus nerve infection hypothesis]] (VNIH) accounts for why so many different infectious onsets could be responsible. The [[vagus nerve]] runs from the brain stem and throughout the body and has an impact on many body systems. Given the uncertainty regarding the cause, ME and CFS patients are barred from donating blood or organs in the [[United Kingdom]], [[United States]] and [[New Zealand]] while symptoms persist.<ref>{{Cite web|url=http://www.meassociation.org.uk/2010/08/people-with-mecfs-to-be-permanently-excluded-from-giving-blood-in-the-uk-from-1-november-this-year-department-of-health-announcement/ | title = People with ME/CFS to be permanently excluded from giving blood in the UK from 1 November this year – Department of Health announcement | last = | first = | date = Aug 2010 | website = [[The ME Association]]|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-09-08}}</ref><ref>{{Cite news | url=http://www.washingtonpost.com/wp-dyn/content/article/2010/12/03/AR2010120305888.html | title = Chronic fatigue patients barred from blood donation | last = Stein | first = Rob | date = 2010-12-03|access-date=2018-09-08|language=en-US|issn=0190-8286}}</ref><ref>{{Cite web|url=http://www.nzblood.co.nz/Give-blood/Donating/Detailed-eligibility-criteria#C | title = Detailed eligibility criteria | website = nzblood.co.nz|language=en-NZ|access-date=2018-09-08}}</ref>
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