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Viral onset hypothesis
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== Evidence == [[File:MEViralOnsetHypothesis.png|alt=Viral Onset Hypothesis in ME. Viral involvement is supported by an infectious initiating trigger in at least half of the patients (21), and by confirmed findings of biochemical dysregulation of the 2-5A synthetase/ribonuclease L (RNase L) antiviral defense pathway in monocytes (22,23,24,25,26), a pathway which is activated in viral disorders (27). - Canadian Consensus Criteria|thumb|Some evidence has exists supporting the viral onset hypothesis, but no pathogen has been identified yet.]] {{Clear}} ===Chronic infection=== Some think that there may be a low grade, chronic infection whereby the initial virus continues to provoke an immune response, especially in key areas such as the [[gastrointestinal tract]], [[muscle]], and the [[brain]], [[brain stem]], and [[spinal cord]]; an example is [[enterovirus infection hypothesis|enterovirus infection]].{{citation needed | date = 2022}} ===Autoimmune disease=== Some think that symptoms are caused by an [[inflammatory]] process that is triggered by an initial infection and continues even after the initial [[virus]] is no longer replicating. It is possible that [[ME/CFS]] is an [[autoimmune disease|autoimmune]] response that can be triggered by many different infections.{{citation needed | date = 2022}} ===Viral reactivation=== Some people think that an immune deficiency allows otherwise common or benign viruses to reactive after lying dormant, for instance [[Human herpesvirus 6]] and other common herpesviruses have been investigated.{{citation needed | date = 2022}} ===Dysbiosis=== [[Viral infection]] may trigger intestinal [[dysbiosis]] leading to alterations in the [[immune system]] and [[gut-brain axis]] and causing the symptoms of the disease.{{citation needed | date = 2022}} ===Outbreaks=== {{main article|page_name=List of outbreaks}} There have been dozens of reported clusters and [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|outbreaks]] of ME, which all suggest a role of either a communicable [[pathogen]] or in some cases, a toxic agent, however some of these have been non-viral infections e.g. bacterial.<ref name="ICC2011primer"/>
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