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List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:28:56Z

YellowWaterLilly:/* Muscular system */ Minor spelling edits.

[[Myalgic encephalomyelitis]]/[[chronic fatigue syndrome]] is a complex multi-system disease and biological abnormalities in patients have been found affecting multiple bodily systems. No single [[diagnostic biomarker|biomarker]]-based diagnostic test has been validated but patients have a range abnormal physical findings affecting multiple bodily systems.<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> The CDC states that diagnosing ME/CFS relies on a physical and psychiatric assessment, observations, medical history, clinical interview, and results from a mix of blood and urine tests.<ref name="CDC2020diagnosis">{{Cite web|url=https://www.cdc.gov/me-cfs/symptoms-diagnosis/diagnosis.html | title = Diagnosis of ME/CFS {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = Centers of Disease Control|first = | authorlink = Centers for Disease Control and Prevention | date = 2019-05-15 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2020-09-26}}</ref>

== Nervous system ==
===Brain ===
{{Main article|Brain}}
*Progressive brain changes<ref name="Shan2016"/>

=== Central nervous system ===
{{Main article |page_name =Central nervous system}}
* increased [[Ventricular system|ventricular]] [[lactate]]<ref name="Mathew2009">{{Cite journal | last = Mathew|first = Sanjay J. | last2 = Mao | first2 = Xiangling | last3 = Keegan | first3 = Kathryn A. | last4 = Levine | first4 = Susan M. | authorlink4 = Susan Levine | last5 = Smith | first5 = Eric L.P. | last6 = Heier | first6 = Linda A. | last7 = Otcheretko | first7 = Viktor | last8 = Coplan | first8 = Jeremy D. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Apr 2009 | title = Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: anin vivo3.0 T1H MRS imaging study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/nbm.1315|journal=NMR in Biomedicine|language=en|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480}}</ref><ref name="Murrough2010">{{Cite journal | last = Murrough|first = James W. | last2 = Mao | first2 = Xiangling | last3 = Collins | first3 = Katherine A. | last4 = Kelly | first4 = Chris | last5 = Andrade | first5 = Gizely | last6 = Nestadt | first6 = Paul | last7 = Levine | first7 = Susan M. | authorlink7 = Susan Levine | last8 = Mathew | first8 = Sanjay J. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Jul 2010 | title = Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder | url =https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in Biomedicine|volume=23|issue=6 | pages = 643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref><ref name="Shungu2012">{{Cite journal | last = Shungu | first = Dikoma C. | authorlink1 = Dikoma Shungu | last2 = Weiduschat | first2 = Nora | last3 = Murrough | first3 = James W. | last4 = Mao | first4 = Xiangling | last5 = Pillemer | first5 = Sarah | last6 = Dyke | first6 = Jonathan P. | last7 = Medow | first7 = Marvin S. | last8 = Natelson | first8 = Benjamin H. | authorlink8 = Benjamin Natelson | last9 = Stewart | first9 = Julian M. | date = Sep 2012 | title = Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name="Natelson2017">{{Cite journal | last = Natelson | first = Benjamin H. | authorlink1 = Benjamin Natelson | last2 = Vu | first2 = Diana | last3 = Coplan | first3 = Jeremy D. | last4 = Mao | first4 = Xiangling | last5 = Blate | first5 = Michelle | last6 = Kang | first6 = Guoxin | last7 = Soto | first7 = Eli | last8 = Kapusuz | first8 = Tolga | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = 2017-01-02 | title = Elevations of ventricular lactate levels occur in both chronic fatigue syndrome and fibromyalgia|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1280114?journalCode=rftg20|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref>
* neuroinflammation<ref name="Nakatomi2014">{{Cite journal | last = Nakatomi|first = Yasuhito | last2 = Mizuno | first2 = Kei | last3 = Ishii | first3 = Akira | last4 = Wada | first4 = Yasuhiro | last5 = Tanaka | first5 = Masaaki | last6 = Tazawa | first6 = Shusaku | last7 = Onoe | first7 = Kayo | last8 = Fukuda | first8 = Sanae | last9 = Kawabe | first9 = Joji | date = 2014-06-01 | title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study|url=http://jnm.snmjournals.org/content/55/6/945|journal=Journal of Nuclear Medicine|language=en|volume=55|issue=6 | pages = 945–950|doi=10.2967/jnumed.113.131045|issn=0161-5505|pmid=24665088}}</ref><ref name="Zeineh2014">{{citation | last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh | last2 = Kang | first2 = James | authorlink2 = James Kang | last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas | last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman | last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss | last6 =Norris | first6 = Jane L | authorlink6 = Jane Norris | last7 =Valencia | first7 = Ian | authorlink7 = Ian Valencia | last8 =Montoya | first8 = Jose G | authorlink8 = Jose Montoya | title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome| journal = Radiology | volume = 274 | issue = 2| pages = 517–526 | date = 2014-10-29| doi = 10.1148/radiol.14141079| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079}}</ref><ref name="Mueller2019">{{Cite journal|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4 | title = Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy | last = Mueller | first = Christina | authorlink=Christina Mueller | last2 = Lin | first2 = Joanne C | authorlink2 = Joanne Lin | date = 2019 | doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|url-status=|access-date=2019-01-17 | authorlink3 = Sulaiman Sheriff | authorlink4 = Andrew Maudsley | authorlink5 = Jarred Younger | last3 = Sheriff | last4 = Maudsley | last5 = Younger | first3 = Sulaiman | first4 = Andrew A | first5 = Jarred W|volume=|issue=|pages= | page = |journal=Brain Imaging and Behavior}}</ref><ref name="RamsayAward20190117">{{Cite web|url=http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 | title = Brain Imaging and Behavior publication from Dr. Jarred Younger’s SMCI Ramsay pilot study supports involvement of neuroinflammation in ME/CFS|website=go.solvecfs.org|access-date=2019-01-17 | date = | last = | first = | authorlink = |archive-url=|archive-date=|url-status=}}</ref>
* reduced [[Grey matter|grey]]<ref name="Puri2012">{{Cite journal | last = Puri|first = B K | last2 = Jakeman | first2 = P M | last3 = Agour | first3 = M | last4 = Gunatilake | first4 = K D R | last5 = Fernando | first5 = K A C | last6 = Gurusinghe | first6 = A I | last7 = Treasaden | first7 = I H | last8 = Waldman | first8 = A D | last9 = Gishen | first9 = P | date = Jul 2012 | title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study|url=https://www.birpublications.org/doi/full/10.1259/bjr/93889091|journal=The British Journal of Radiology|language=en|volume=85|issue=1015| pages = e270–e273|doi=10.1259/bjr/93889091|issn=0007-1285|pmc=3474083|pmid=22128128}}</ref> and [[white matter]]<ref name="Shan2016">{{Cite journal | last = Shan | first = Zack Y. | authorlink = Zack Shan | last2 = Kwiatek | first2 = Richard | last3 = Burnet | first3 = Richard | last4 = Del Fante | first4 = Peter | last5 = Staines | first5 = Donald R. | last6 = Marshall-Gradisnik | first6 = Sonya M. | last7 = Barnden | first7 = Leighton R. | date = 2016-04-28 | title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/jmri.25283|journal=Journal of Magnetic Resonance Imaging|language=en|volume=44|issue=5|pages=1301–1311|doi=10.1002/jmri.25283|issn=1053-1807|pmc=5111735|pmid=27123773}}</ref><ref name="Puri2012" />
* [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|widespread metabolite abnormalities]]<ref name="Mueller2019"/>

=== Autonomic nervous system ===
{{Main article |page_name =Autonomic nervous system}}
* Orthostatic intolerance<ref>Gerwin Morris, Michael Maes, see citations 12 through 27 in [http://www.biomedcentral.com/1741-7015/11/205 "Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics"] BMC Medicine, 17 September 2013</ref><ref>{{Cite journal | last = Miwa | first = K | date = Jul 2015 | title = Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle|url=https://www.ncbi.nlm.nih.gov/pubmed/24736946|journal=Heart and Vessels|volume=30|issue=4 | pages = 484–489|via=}}</ref>

=== Peripheral nervous system ===
{{Main article |page_name =Peripheral nervous system}}

== Muscular system ==
{{Main article |page_name =Muscle}}
*[[Mitochondrion|mitochondria]]l abnormalities found via [[muscle biopsy]] including: mitochondrial degeneration,<ref>{{Cite journal | last = Behan | first = W. M.H. | last2 = More | first2 = I.A.R. | last3 = Behan | first3 = P.O. | date = Dec 1991 | title = Mitochondrial abnormalities in the postviral fatigue syndrome|url=https://link.springer.com/article/10.1007/BF00294431|journal=Acta Neuropathologica|language=en|volume=83|issue=1 | pages = 61–65|doi=10.1007/bf00294431|issn=0001-6322}}</ref> deletions of mitochondrial DNA,<ref name=":0">{{Cite journal | date = 1996-04-19 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/abs/pii/0304394096125593|journal=Neuroscience Letters|language=en|volume=208|issue=2|pages=117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940}}</ref><ref>{{Cite journal | last = Zhang|first = C. | last2 = Baumer | first2 = A. | last3 = Mackay | first3 = I.R. | last4 = Linnane | first4 = A.W. | last5 = Nagley | first5 = P. | date = Apr 1995 | title = Unusual pattern of mitochondrial DNA deletions in skeletal muscle of an adult human with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/7633428|journal=Human Molecular Genetics|volume=4|issue=4 | pages = 751–754|issn=0964-6906|pmid=7633428}}</ref> the reduction of mitochondrial activity<ref name=":0" />
*Increased urinary [[creatine]] excretion during relapses<ref>{{Cite journal | last = Albrecht | first = Robert | date = March 21, 1964 | title = Epidemic Neuromyasthenia Outbreak in a Convent in New York State|url=https://www.ncbi.nlm.nih.gov/pubmed/14100144|journal=Journal of the American Medical Association|volume=187 | pages = 904-907|via=}}</ref>
*Increased [[creatine kinase]] ([[postviral fatigue syndrome]])
*Persistence of [[enterovirus]]es in muscle tissue<ref name=":1">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W. M.H. | last3 = Simpson | first3 = K. | last4 = McGarry | first4 = F. | last5 = Keir | first5 = S. | last6 = Behan | first6 = P.O. | date = 1994-01-01 | title = Studies on Enterovirus in Patients with Chronic Fatigue Syndrome|url=https://academic.oup.com/cid/article-abstract/18/Supplement_1/S126/316946|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Suppl 1|pages=S126–S129|doi=10.1093/clinids/18.Supplement_1.S126|issn=1537-6591}}</ref><ref name=":2">{{Cite journal | last = Cunningham|first = Louise | last2 = Bowles | first2 = N.E. | last3 = Lane | first3 = R. J.M. | last4 = Dubowitz | first4 = V. | last5 = Archard | first5 = L.C. | date = 1990 | title = Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA|url=http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/0022-1317-71-6-1399|journal=Journal of General Virology|volume=71|issue=6|pages=1399–1402|doi=10.1099/0022-1317-71-6-1399}}</ref><ref name=":3">{{Cite journal | last = Archard | first = LC | last2 = Bowles | first2 = NE | last3 = Behan | first3 = PO | last4 = Bell | first4 = EJ | last5 = Doyle | first5 = D | date = 1988-06-01 | title = Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase, Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase|url=https://doi.org/10.1177/014107688808100608|journal=Journal of the Royal Society of Medicine|language=en|volume=81|issue=6 | pages = 326–329|doi=10.1177/014107688808100608|issn=0141-0768|pmc=1291623|pmid=3404526}}</ref><ref name=":4">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W.M. | last3 = Clements | first3 = G.B. | last4 = Woodall | first4 = C. | last5 = Riding | first5 = M. | last6 = Behan | first6 = P.O. | date = 1991-03-23 | title = Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome.|url=https://www.bmj.com/content/302/6778/692|journal=BMJ|language=en|volume=302|issue=6778 | pages = 692–696|doi=10.1136/bmj.302.6778.692|issn=0959-8138|pmid=1850635}}</ref>
*Abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | authorlink1 = Audrey Brown | last2 = Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = 2 Apr 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref><ref name="Wellness20150420">{{citation | last1 = Dobberstein | first1 = Linda J. | authorlink1 = | title = Master Enzyme Switch Deactivated In Chronic Fatigue Syndrome and Fibromyalgia | journal = Wellness Resources | date = 20 Apr 2015 | url = http://www.wellnessresources.com/health/articles/master_enzyme_switch_deactivated_in_chronic_fatigue_syndrome_and_fibromyalg/ }}</ref>
*Reduced serum [[creatine kinase]] in people with severe ME.<ref>{{Cite journal|title=Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study|date=April 10, 2019|url=https://www.mdpi.com/2075-4418/9/2/41|journal=Biomedical Insights that Inform the Diagnosis of ME/CFS|last=Nacul|first=Luis|author-link=Luis Nacul|last2=de Barros|first2=Barbara|last3=Kingdon|first3=Caroline C.|author-link3=Caroline Kingdon|last4=Cliff|first4=Jacqueline M.|author-link4=Jacqueline Cliff|last5=Clark|first5=Taane G.|author-link5=Taane Clark|last6=Mudie|first6=Kathleen|last7=Dockrell|first7=Hazel M.|author-link7=Hazel Dockrell|last8=Lacerda|first8=Eliana M.|author-link8=Eliana Lacerda|access-date=September 11, 2025|via=Diagnostics}}</ref>

== Immune system ==
{{Main article |page_name =Immune system}}
=== Immune dysregulation ===
* [[Natural killer cell]] function is reduced<ref>{{Cite journal | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology | date = Apr 2014|issn=1460-2377|pmid=24343819|pages=233–242|volume=26|issue=4|doi=10.1093/intimm/dxt068|first = Ekua Weba | last = Brenu | first2 = Teilah K. | last2 = Huth | first3 = Sharni L. | last3 = Hardcastle | first4 = Kirsty | last4 = Fuller | first5 = Manprit | last5 = Kaur | first6 = Samantha | last6 = Johnston | first7 = Sandra B. | last7 = Ramos | first8 = Don R. | last8 = Staines | first9 = Sonya M. | last9 = Marshall-Gradisnik}}</ref><ref>{{Cite journal | last = Victoria Scott | first = David Strayer | date = 2015 | title=Low NK Cell Activity in Chronic Fatigue Syndrome (CFS) and Relationship to Symptom Severity|url=https://www.omicsonline.org/open-access/low-nk-cell-activity-in-chronic-fatigue-syndrome-cfs-and-relationship-to-symptom-severity-2155-9899-1000348.php?aid=59415|journal=Journal of Clinical & Cellular Immunology|language=en|volume=6|issue=4|doi=10.4172/2155-9899.1000348|issn=2155-9899}}</ref>
* [[Cytokine]] dysregulation<ref name="Montoya, 2017">{{citation | last1 = Montoya | first1 = Jose G. | authorlink1 = Jose Montoya | last2 = Holmes | first2 = Tyson H. | authorlink2 = | last3 = Anderson | first3 = Jill N. | authorlink3 = | last4 = Maecker | first4 = Holden T. | authorlink4 = | last5 = Rosenberg-Hasson | first5 = Yael | authorlink5 = | last6 = Valencia | first6 = Ian J. | authorlink6 = | last7 = Chu | first7 = Lily | authorlink7 = Lily Chu | last8 =Younger | first8 = Jarred W. | authorlink8 = Jarred Younger | last9 =Tato | first9 = Cristina M. | authorlink9 = | last10 = Davis | first10 = Mark M. | authorlink10 = Mark Davis | title = Cytokine signature associated with disease severity in chronic fatigue syndrome patients | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 34 | pages = E7150-E7158 | date = 2017 | pmid = | doi = 10.1073/pnas.1710519114 }}</ref><ref>[http://www.meaction.net/2015/12/07/study-finds-evidence-of-downregulated-immune-system-in-mecfs-patients Study finds evidence of downregulated immune system in ME/CFS patients - MEAction - Landi, et al.]</ref><ref>[http://microbediscovery.org/2017/04/04/new-research-discovers-evidence-of-atypical-classical-mecfs/ New Research Discovers Evidence of Atypical & Classical ME/CFS - The Microbe Discovery Project - Apr 4, 2017]</ref>
* Elevated [[regulatory T cell]]s<ref>{{Cite journal | last = Brenu|first = Ekua Weba | last2 = Huth | first2 = Teilah K. | last3 = Hardcastle | first3 = Sharni L. | last4 = Fuller | first4 = Kirsty | last5 = Kaur | first5 = Manprit | last6 = Johnston | first6 = Samantha | last7 = Ramos | first7 = Sandra B. | last8 = Staines | first8 = Don R. | last9 = Marshall-Gradisnik | first9 = Sonya M. | date = Apr 2014 | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology|volume=26|issue=4|pages=233–242|doi=10.1093/intimm/dxt068|issn=1460-2377|pmid=24343819}}</ref>
* increased [[mast cell]] populations<ref>{{Cite journal | last = Rönnberg|first = E | last2 = Calounova | first2 = G | last3 = Pejler | first3 = G | date = June 2017 | title = Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients|url=https://www.ncbi.nlm.nih.gov/pubmed/27362406|journal=Asian Pac J Allergy Immunol|volume=35|issue=2 | pages = 75-81|via=}}</ref>
* elevated anti-cholinergic [[Muscarinic acetylcholine receptor|muscarinic]], Β-adrenergic,<ref>{{Cite journal | last = Loebel|first = Madlen | last2 = Grabowski | first2 = Patricia | last3 = Heidecke | first3 = Harald | last4 = Bauer | first4 = Sandra | last5 = Hanitsch | first5 = Leif G. | last6 = Wittke | first6 = Kirsten | last7 = Meisel | first7 = Christian | last8 = Reinke | first8 = Petra | last9 = Volk | first9 = Hans-Dieter | date = Feb 2016 | title = Antibodies to β adrenergic and muscarinic cholinergic receptors in patients with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/26399744|journal=Brain, Behavior, and Immunity|volume=52 | pages = 32–39|doi=10.1016/j.bbi.2015.09.013|issn=1090-2139|pmid=26399744}}</ref> [[phosphatidylinositol]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivanka | last3 = Leunis | first3 = Jean-Claude | date = Dec 2007 | title = Increased serum IgM antibodies directed against phosphatidyl inositol (Pi) in chronic fatigue syndrome (CFS) and major depression: evidence that an IgM-mediated immune response against Pi is one factor underpinning the comorbidity between both CFS and depression | url =https://www.ncbi.nlm.nih.gov/pubmed/18063934|journal=Neuro Endocrinology Letters|volume=28|issue=6 | pages = 861–867|issn=0172-780X|pmid=18063934}}</ref> and [[serotonin]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Ringel | first2 = Karl | last3 = Kubera | first3 = Marta | last4 = Anderson | first4 = George | last5 = Morris | first5 = Gerwyn | last6 = Galecki | first6 = Piotr | last7 = Geffard | first7 = Michel | date = 2013-09-05 | title = In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation | url =https://www.ncbi.nlm.nih.gov/pubmed/23664637|journal=Journal of Affective Disorders|volume=150|issue=2|pages=223–230|doi=10.1016/j.jad.2013.03.029|issn=1573-2517|pmid=23664637}}</ref> autoantibodies
* Reduced CD4+ function<ref name=":5">{{Cite journal|title=Myalgic encephalomyelitis/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations|date=2020-03-02|url=https://pubmed.ncbi.nlm.nih.gov/31830003/|journal=The Journal of Clinical Investigation|volume=130|issue=3|pages=1491–1505|last=Mandarano|first=Alexandra H.|last2=Maya|first2=Jessica|last3=Giloteaux|first3=Ludovic|last4=Peterson|first4=Daniel L.|last5=Maynard|first5=Marco|last6=Gottschalk|first6=C. Gunnar|last7=Hanson|first7=Maureen R.|doi=10.1172/JCI132185|pmc=7269566|pmid=31830003|issn=1558-8238}}</ref> and reduced CD4+ count<ref name=":6">{{Cite journal|title=Study of immune alterations in patients with chronic fatigue syndrome with different etiologies|date=2004|url=https://pubmed.ncbi.nlm.nih.gov/15345193/|journal=International Journal of Immunopathology and Pharmacology|volume=17|issue=2 Suppl|pages=57–62|last=Racciatti|first=D.|last2=Dalessandro|first2=M.|last3=Delle Donne|first3=L.|last4=Falasca|first4=K.|last5=Zingariello|first5=P.|last6=Paganelli|first6=R.|last7=Pizzigallo|first7=E.|last8=Vecchiet|first8=J.|doi=10.1177/03946320040170S210|pmid=15345193|issn=0394-6320}}</ref>
* Reduced CD8+ function<ref name=":5" /> and reduced CD8+ count<ref name=":6" />
* Lowered CD4+/CD8+ ratio<ref>{{Cite journal|title=Increased expression of activation antigens on CD8+ T lymphocytes in Myalgic Encephalomyelitis/chronic fatigue syndrome: inverse associations with lowered CD19+ expression and CD4+/CD8+ ratio, but no associations with (auto)immune, leaky gut, oxidative and nitrosative stress biomarkers|date=2015-01-01|url=https://europepmc.org/article/med/26707044|journal=Neuro endocrinology letters|volume=36|issue=5|pages=439–446|last=Maes|first=Michael|last2=Bosmans|first2=Eugene|last3=Kubera|first3=Marta|pmid=26707044|issn=2354-4716}}</ref>
* Increased proportions of effector memory CD8+ T cells<ref name=":9">{{Cite journal|title=Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|date=2019-04-16|url=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00796/full|journal=Frontiers in Immunology|volume=10|last=M.|first=Cliff, Jacqueline|last2=C.|first2=King, Elizabeth|last3=Ji-Sook|first3=Lee,|last4=Nuno|first4=Sepúlveda,|last5=Asia-Sophia|first5=Wolf,|last6=Caroline|first6=Kingdon,|last7=Erinna|first7=Bowman,|last8=M.|first8=Dockrell, Hazel|last9=Luis|first9=Nacul,|last10=Eliana|first10=Lacerda,|last11=M.|first11=Riley, Eleanor|language=English|doi=10.3389/fimmu.2019.00796/full|issn=1664-3224}}</ref> (these are rapid responders)
* Decreased proportions of terminally differentiated effector CD8+ T cells<ref name=":9" /> (these kill infected or cancerous cells)
* Significantly increased proportion of mucosal associated invariant T cells (MAIT) cells (these cells control infections to stop from spreading), especially in severely affected patients<ref name=":9" />

=== Chronic infection ===
* [[Enterovirus]]: Persistence of [[enterovirus]]es in muscle tissue;<ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name=":4" /> brain;<ref name="McGarry19942">{{citation | last1 = McGarry | first1 = Frances | author-link1 = Frances McGarry | last2 = Gow | first2 = John | authorlink2 = John Gow | last3 = Behan | first3 = Peter O | authorlink3 = Peter O Behan | title = Enterovirus in the Chronic Fatigue Syndrome | journal = Annals of Internal Medicine | volume = 120 | issue = 11| pages = 972–973 | date = Jun 1, 1994 | doi = 10.7326/0003-4819-120-11-199406010-00020 | url = http://www.ncbi.nlm.nih.gov/pubmed/8172448 }}</ref> and gut;<ref name="ChiaJKS2016">{{Cite journal | last1 = Chia | first1 = JKS | authorlink1 = John Chia | last2 = Chia | first2 = AY | authorlink2 = Andrew Chia | title = Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach | journal = Journal of Clinical Pathology | volume = 61 | issue = 1| pages = 43–48 | date = Jan 1, 2008 | pmid = 17872383 | doi = 10.1136/jcp.2007.050054 | url = http://jcp.bmj.com/content/61/1/43 }}</ref> increased detection of viral [[RNA]] via PCR; increased [[:Category:Antibodies|antibodies]]
* [[Herpesvirus]]{{citation needed}}

== Lymphatic system ==

== Cardiovascular system ==

{{Main article|page_name =Cardiovascular system}}{{Main article|page_name =Cardiac problems in ME/CFS}}

=== Heart ===
* Smaller than normal [[left ventricle]] of the [[heart]],<ref name=":8">Miwa K., [http://www.ncbi.nlm.nih.gov/pubmed/24736946 "Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle"] Heart Vessels, July 2015</ref><ref>Hollingsworth K.G [http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1365-2796.2011.02429.x/ "Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging"] J Intern Med 2012; 271: 264–270.</ref><ref name="Olimulder, 2016">{{Cite journal | last1 = Olimulder | first1 = M.A.G.M. | authorlink1 = | last2 = Galjee | first2 = M.A. | authorlink2 = | last3 = Wagenaar | first3 = L.J. | authorlink3 = | last4 = van Es | first4 = J. | authorlink4 = | last5 = van der Palen | first5 = J. | authorlink5 = | last6 = Visser | first6 = F.C. | authorlink6 = | last7 =Vermeulen | first7 = R.C.W. | authorlink7 = | last8 = von Birgelen | first8 = C. | authorlink8 = | title = Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging | journal = Netherlands Heart Journal | volume = 24 | pages = 709–716 | date = 2016 | url = https://link.springer.com/article/10.1007/s12471-016-0885-8 | doi = 10.1007/s12471-016-0885-8 }}</ref><ref>[http://openheart.bmj.com/content/3/1/e000381.long Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study]</ref> [[small heart syndrome]],<ref name=":8" /> and low [[Cardiovascular system|cardiac]] output.<ref>Miwa K., Fujita M., [http://www.ncbi.nlm.nih.gov/pubmed/19881233 "Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome"] Intern Med, 2009;48(21):1849-54</ref>
* Mean age of death from heart failure of [[chronic fatigue syndrome|CFS]] patients is 58.7 years as compared to 83.1 years for the general population.<ref>Jason LA, Corradi K, Gress S, Williams S, Torres-Harding S, [http://www.ncbi.nlm.nih.gov/pubmed/16844674 "Causes of death among patients with chronic fatigue syndrome"] Health Care Women Int., 27(7): 615-626. 2006</ref>
=== Circulation ===
* reduced blood flow to the [[Brain|brain,]]<ref name="Natelson, 2017">{{Cite journal | last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson | last2 = Mao | first2 = Xiangling | last3 = Stegner | first3 = Aaron J | last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange | last5 = Vu | first5 = Diana | last6 = Blate | first6 = Michelle | last7 = Kang | first7 = Guoxin | last8 = Soto | first8 = Eli | last9 = Kapusuz | first9 = Tolga | last10 = Shungu | first10 = Dikoma C | authorlink10 = Dikoma Shungu | title=Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity | date = 2017 | journal=Journal of the Neurological Sciences|volume=375|issue= | page = 411-416|doi=10.1016/j.jns.2017.02.046|pmid=|quote=}}</ref><ref name=":32">{{Cite journal | last = Costa|first = D.C. | last2 = Tannock | first2 = C. | last3 = Brostoff | first3 = J. | date = Nov 1995 | title = Brainstem perfusion is impaired in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8542261|journal=QJM: monthly journal of the Association of Physicians|volume=88|issue=11 | pages = 767–773|issn=1460-2725|pmid=8542261}}</ref><ref name=":10">{{Cite journal | last = Barnden | first = Leighton R. | last2 = Crouch | first2 = Benjamin | last3 = Kwiatek | first3 = Richard | last4 = Burnet | first4 = Richard | last5 = Mernone | first5 = Anacleto | last6 = Chryssidis | first6 = Steve | last7 = Scroop | first7 = Garry | last8 = Del Fante | first8 = Peter | date = 2011 | title = A brain MRI study of chronic fatigue syndrome: evidence of brainstem dysfunction and altered homeostasis|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/nbm.1692|journal=NMR in Biomedicine|language=en|volume=24|issue=10|pages=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc = 4369126|pmid=21560176}}</ref><ref>{{Cite journal | last = Biswal|first = Bharat | last2 = Kunwar | first2 = Pratap | last3 = Natelson | first3 = Benjamin H. | authorlink1 = Benjamin Natelson | date = 2011-02-15 | title = Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling | url =http://www.sciencedirect.com/science/article/pii/S0022510X10005666|journal=Journal of the Neurological Sciences|volume=301|issue=1 | pages = 9–11 |doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{Cite journal | last = Yoshiuchi|first = Kazuhiro | last2 = Farkas | first2 = Jeffrey | last3 = Natelson | first3 = Benjamin H. | authorlink3 = Benjamin Natelson | date = 2006 | title=Patients with chronic fatigue syndrome have reduced absolute cortical blood flow | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-097X.2006.00649.x|journal=Clinical Physiology and Functional Imaging|language=en|volume=26|issue=2 | pages = 83–86|doi=10.1111/j.1475-097X.2006.00649.x|issn=1475-097X}}</ref><ref>{{Cite journal | last = Freedman | first = M. | last2 = Kirsh | first2 = J.C. | last3 = Gray | first3 = B. | last4 = Chung | first4 = D.G. | last5 = Abbey | first5 = S.E. | last6 = Salit | first6 = I.E. | last7 = Ichise | first7 = M. | date = Oct 1992 | title = Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome.|url=http://europepmc.org/abstract/med/1491843|journal=Nuclear medicine communications|volume=13|issue=10 | pages = 767–772|issn=0143-3636|pmid=1491843}}</ref><ref>{{Cite journal | last = Chao|first = C.C. | last2 = Hu | first2 = S. | last3 = Pheley | first3 = A.M. | last4 = Schenck | first4 = C.H. | last5 = Grammith | first5 = F.C. | last6 = Sirr | first6 = S.A. | last7 = Peterson | first7 = P.K. | date = 1994-03-01 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://cvi.asm.org/content/1/2/222|journal=Clinical and Diagnostic Laboratory Immunology|language=en|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref><ref>{{Cite journal | last = Lange | first = Gudrun | last2 = Wang | first2 = Samuel | last3 = DeLuca | first3 = John | last4 = Natelson | first4 = Benjamin H. | date = 1998-09-28 | title = Neuroimaging in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S0002934398001752|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1 | pages = 50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> even in the absence of [[Postural orthostatic tachycardia syndrome|POTS]]/[[Neurally mediated hypotension|NMH]]<ref>{{Citation | title = CMRC Conference 2017 day 1- Prof Dr Frans Visser |url =https://www.youtube.com/watch?v=IWRA23D_MUg|language=en|access-date=2019-09-03}}</ref>
* reduced blood flow to the heart<ref>{{Cite journal | last = Patrick Neary|first = J. | last2 = Roberts | first2 = Andy D.W. | last3 = Leavins | first3 = Nina | last4 = Harrison | first4 = Michael F. | last5 = Croll | first5 = James C. | last6 = Sexsmith | first6 = James R. | date = Nov 2008 | title = Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-097X.2008.00822.x|journal=Clinical Physiology and Functional Imaging|volume=28|issue=6 | pages = 364–372|doi=10.1111/j.1475-097x.2008.00822.x|issn=1475-0961}}</ref><ref>{{Cite journal | last = Peterson | first = PK | last2 = Sirr | first2 = SA | last3 = Grammith | first3 = FC | last4 = Schenck | first4 = CH | last5 = Pheley | first5 = AM | last6 = Hu | first6 = S | last7 = Chao | first7 = C C | date = Mar 1994 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/|journal=Clinical and Diagnostic Laboratory Immunology|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref>
*peripheral endothelial dysfunction, which is an established risk factor for cardiovascular disease<ref name="endothelial2020">{{Cite journal | last = Scherbakov|first = Nadja | authorlink = | last2 = Szklarski | first2 = Marvin | author-link2 = | last3 = Hartwig | first3 = Jelka | author-link3 = | last4 = Sotzny | first4 = Franziska | author-link4 = Franziska Sotzny | last5 = Lorenz | first5 = Sebastian | author-link5 = | last6 = Meyer | first6 = Antje | authorlink6 = Antje Meyer | last7 = Grabowski | first7 = Patricia | last8 = Doehner | first8 = Wolfram | last9 = Scheibenbogen | first9 = Carmen | authorlink9 = Carmen Scheibenbogen | date = 2020 | title=Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12633|journal=ESC Heart Failure|language=en|volume=7|issue=3|pages=1064–1071|doi=10.1002/ehf2.12633|issn=2055-5822|pmc = 7261521|pmid=32154656|access-date=|quote=|via=}}</ref>

=== Blood vessels ===

=== Blood ===
{{Main article|Brain}}
* reduced [[blood]] volume<ref>{{Cite journal | last = Hurwitz|first = BE | last2 = Coryell | first2 = VT | last3 = Parker | first3 = M | last4 = Martin | first4 = P | last5 = LaPerriere .... | first5 = A | last6 = Bilsker | first6 = MS | date = | title = Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function | url =http://www.clinsci.org/content/118/2/125|journal=Clinical Science|volume=118|issue=2|pages=125-135|via=}}</ref><ref>{{Cite journal | last = Streeten | first = DHP | last2 = Bell | first2 = D | date = 1998 | title=Circulating Blood Volume in Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v04n01_02|journal=Journal of Chronic Fatigue Syndrome|volume=4 | pages = 3-11|via=}}</ref>
* abnormally shaped of [[Red blood cell|red blood cells]]<ref name="Simpson1989">{{Citation | last1 = Simpson | first1 = LO | authorlink1 = Leslie Simpson | title = Nondiscocytic erythrocytes in myalgic encephalomyelitis | journal = The New Zealand Medical Journal | volume = 102 | issue = 864 | pages = 126-127 | date = 1989 | pmid = 2927808 | doi = }}</ref><ref>{{Cite journal | last = Richards | first = RS | last2 = Wang | first2 = L | last3 = Jelinek | first3 = H | date = Jan 2007 | title = Erythrocyte oxidative damage in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S0188440906002992|journal=Archives of Medical Research|volume=38|issue=1 | pages = 94-98|via=}}</ref>
* reduced oxygen uptake in [[hemoglobin]]<ref>{{Cite journal | last = Miller | first = Ruth R | last2 = Reid | first2 = W Darlene | last3 = Mattman | first3 = Andre | last4 = Yamabayashi | first4 = Cristiane | last5 = Steiner | first5 = Theodore | last6 = Parker | first6 = Shoshana | last7 = Gardy | first7 = Jennifer | last8 = Tang | first8 = Patrick | last9 = Patrick | first9 = David M | date = 2015-05-20 | title = Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case–control study|url=http://doi.org/10.1186/s12967-015-0527-8|journal=Journal of Translational Medicine|language=en|volume=13|issue=1|doi=10.1186/s12967-015-0527-8|issn=1479-5876|pmc=4438583|pmid=25990639}}</ref>

== Digestive system ==

=== Gastrointestinal tract ===
{{Main article |page_name = Gastrointestinal tract}}
* lower levels of [[Bifidobacteria]], [[Escherichia coli]] and higher levels of [[aerobic bacteria]],<ref>{{Cite journal | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value|url=http://www.medical-hypotheses.com/article/S0306-9877(03)00096-3/abstract|journal=Medical Hypotheses | date = Jun 2003|issn=0306-9877 | pages = 915–923|volume=60|issue=6|doi=10.1016/S0306-9877(03)00096-3|language=English|first = Alan C | last = Logan | first2 = A | last2 = Venket Rao | first3 = Dinaz | last3 = Irani}}</ref> in particular [[Enterococcus]] and [[Streptococcus]] species<ref>{{Cite journal | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=http://www.ncbi.nlm.nih.gov/pubmed/19567398|journal=In Vivo (Athens, Greece) | date = Jul 2009|issn=0258-851X|pmid=19567398 | pages = 621–628|volume=23|issue=4|first = John R. | last = Sheedy | first2 = Richard E.H. | last2 = Wettenhall | first3 = Denis | last3 = Scanlon | first4 = Paul R. | last4 = Gooley | first5 = Donald P. | last5 = Lewis | first6 = Neil | last6 = McGregor | first7 = David I. | last7 = Stapleton | first8 = Henry L. | last8 = Butt | first9 = Kenny L. | last9 = DE Meirleir}}</ref>
* higher levels of enterococcus bacteria in CFS patients were associated with more severe neurological and cognitive dysfunction<ref>https://getinfo.de/en/search/id/BLCP%3ACN055885616/%60Bacterial-Colonosis-in-Patients-with-Persistent/</ref>
* Significantly increased proportions of Firmicutes<ref>{{Cite journal | title = High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients|url=https://www.sciencedirect.com/science/article/pii/S1075996413000929|journal=Anaerobe | date = 2013-08-01|issn=1075-9964 | pages = 50–56|volume=22|doi=10.1016/j.anaerobe.2013.06.002|language=en}}</ref><ref name=":7">{{Cite journal | last = Giloteaux | first = Ludovic | last2 = Goodrich | first2 = Julia K. | last3 = Walters | first3 = William A. | last4 = Levine | first4 = Susan M. | author-link4 = Susan Levine | last5 = Ley | first5 = Ruth E. | last6 = Hanson | first6 = Maureen R. | date = 2016-06-23 | title = Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918027/|journal=Microbiome|volume=4|doi=10.1186/s40168-016-0171-4|issn=2049-2618|pmc=4918027|pmid=27338587}}</ref> and Bacteroides<ref name=":7" />
* CFS patients may suffer from [[small intestinal bacterial overgrowth]] (SIBO) at high rates<ref name="Pimentel2000">{{Citation | last1 = Pimentel | first1 = M | authorlink1 = Mark Pimentel | last2 = Hallegua | first2 = D | authorlink2 = David Hallegua | last3 = Chow | first3 = EJ | authorlink3 = Evelyn Chow | last4 = Wallace | first4 = D | authorlink4 = Daniel Wallace | last5 = Bonorris | first5 = G | authorlink5 = George Bonorris | last6 = Lin | first6 = HC | authorlink6 = Henry Lin | title = Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study | journal = Gastroenterology | volume = 118 | issue = 4| pages = 414 | date = 1 Apr 2000 | doi = 10.1016/S0016-5085(00)83765-8 | url = http://www.gastrojournal.org/article/S0016508500837658/abstract }}</ref>
* Higher levels of serum [[Immunoglobulin A|IgA]] and [[Immunoglobulin M|IgM]] against [[lipopolysaccharide]]s (LPS), a major component of the outer membrane of [[gram-negative bacteria]], indicating translocation.<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivana | last3 = Leunis | first3 = Jean-Claude | date = 2007-04-01 | title = Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): Indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut–intestinal permeability|url=http://www.sciencedirect.com/science/article/pii/S0165032706003557|journal=Journal of Affective Disorders|language=en|volume=99|issue=1|pages=237–240|doi=10.1016/j.jad.2006.08.021|issn=0165-0327}}</ref> Serum [[Immunoglobulin A|IgA]] was significantly correlated to the severity of illness.

=== Liver ===
* Reduced [[liver]] volume<ref>{{Cite journal | title = Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1488525|journal=Fatigue: Biomedicine, Health & Behavior | date = 2018-06-18|issn=2164-1846|pages=141–152|volume=6|issue=3|doi=10.1080/21641846.2018.1488525|language=en | first = Pawel | last = Zalewski | first2 = Andreas | last2 = Finkelmeyer | first3 = James | last3 = Frith | first4 = Laura | last4 = Maclachlan | first5 = Andrew | last5 = Blamire | first6 = Julia L. | last6 = Newton}}</ref>

== Nutrition ==
* low red blood cell [[magnesium]]<ref name="cfs_and_blood_mg">{{Citation | last1 = I.M. | first1 = Cox | authorlink1 = | last2 = M.J. | first2 = Campbell | authorlink2 = | last3 = D. |first3 = Dowson | authorlink3 = | title = Red blood cell magnesium and chronic fatigue syndrome | journal = The Lancet
| year = 1991 | pmid = 1672392 | doi = 10.1016/0140-6736(91)91371-Z }}</ref>
* low serum [[carnitine]]<ref>{{Cite journal | last = Plioplys | first = A.V. | last2 = Plioplys | first2 = S. | date = 1995 | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates|url=https://www.ncbi.nlm.nih.gov/pubmed/8544970|journal=Neuropsychobiology|volume=32|issue=3|pages=132–138|doi=10.1159/000119226|issn=0302-282X|pmid=8544970}}</ref><ref>{{Citation| issn = 1058-4838| volume = 18 | issue =Suppl 1| pages = 62-67| last1 = Kuratsune | first1 = H. | last2 = Yamaguti | first2 = K. | last3 = Takahashi | first3 = M. | last4 = Misaki | first4 = H. | last5 = Tagawa | first5 = S. | last6 = Kitani | first6 = T.| title = Acylcarnitine deficiency in chronic fatigue syndrome| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = January 1994 | pmid = 8148455}}</ref><ref>{{Citation| doi = 10.1111/j.1468-1331.1995.tb00151.x| issn = 1351-5101| volume = 2 | issue = 5| pages = 425–428| last1 = Majeed | first1 = T. | last2 = de Simone | first2 = C. | last3 = Famularo | first3 = G. | last4 = Marcellini | first4 = S. | last5 = Behan | first5 = P.O. | title = Abnormalities of carnitine metabolism in chronic fatigue syndrome| journal = European Journal of Neurology | date = November 1995 | pmid = 24283722}}</ref>

== Metabolism ==
* Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review<ref>{{Cite journal | last = Tomas | first = Cara | last2 = Newton | first2 = Julia | date = 2018-06-19 | title = Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review | url =https://portlandpress.com/biochemsoctrans/article-abstract/46/3/547/67402/Metabolic-abnormalities-in-chronic-fatigue?redirectedFrom=fulltext|journal=Biochemical Society Transactions|language=en|volume=46|issue=3 | pages = 547–553|doi=10.1042/BST20170503|issn=0300-5127}}</ref>
* Analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model of deficient ATP production in ME/CFS.<ref name="Sweetman2020">{{Cite journal | last = Sweetman | first = Eiren | authorlink = | last2 = Kleffmann | first2 = Torsten | authorlink2 = | last3 = Edgar | first3 = Christina | authorlink3 = | last4 = de Lange | first4 = Michel | authorlink4 = | last5 = Vallings | first5 = Rosamund | authorlink5 = Rosamund Vallings | last6 = Tate | first6 = Warren | authorlink6 = Warren Tate | date = 2020-09-24 | title = A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction | url =https://doi.org/10.1186/s12967-020-02533-3|journal=Journal of Translational Medicine|volume=18|issue=1 | pages = 365|doi=10.1186/s12967-020-02533-3|issn=1479-5876|pmc = 7512220|pmid=|access-date=|quote=|via=}}</ref>
=== Cellular respiration ===
* abnormalities in [[cellular respiration]] including a reduction in [[glycolysis]],<ref>{{Cite journal | last = Armstrong | first = Christopher W. | last2 = McGregor | first2 = Neil R. | last3 = Lewis | first3 = Donald P. | last4 = Butt | first4 = Henry L. | last5 = Gooley | first5 = Paul R. | date = 2015-05-30 | title = Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s11306-015-0816-5 | journal=Metabolomics|language=en | volume=11 | issue=6 | pages=1626–1639 | doi=10.1007/s11306-015-0816-5 | issn=1573-3882}}</ref> including impaired [[pyruvate dehydrogenase]]<ref>{{Cite journal | last = Fluge | first = Øystein | last2 = Mella | first2 = Olav | last3 = Bruland | first3 = Ove | last4 = Risa | first4 = Kristin | last5 = Dyrstad | first5 = Sissel E. | last6 = Alme | first6 = Kine | last7 = Rekeland | first7 = Ingrid G. | last8 = Sapkota | first8 = Dipak | last9 = Røsland | first9 = Gro V. | date = 2016-12-22 | title = Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/28018972 | journal=JCI insight|volume=1 | issue=21 | pages = e89376 | doi=10.1172/jci.insight.89376 | issn=2379-3708 | pmc=5161229 | pmid=28018972}}</ref>
* increased [[lactic acid]]<ref name="Plioplys1995">{{cite journal | last1 = Plioplys | first1 = AV | authorlink1 = | last2 = Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates | journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | pages = 132-8 | pmid = 8544970 | url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref><ref name="LaneRJ1998">{{cite journal | last1 = Lane | first1 = RJ | authorlink1 = | last2 = Barrett | first2 = MC | authorlink2 = Michael Barrett | last3 = Taylor | first3 = DJ | authorlink3 = Doris Taylor | last4 = Kemp | first4 = GJ | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle | journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | pages = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref><ref name="JonesDE2010">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome | journal = J Intern Med | volume = 267 | issue = 4 | pages = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref><ref name="LengertN2015">{{cite journal | last1 = Lengert | first1 = Nicor | authorlink1 = Nicor Lengert | last2 = Drossel | first2 = Barbara | authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome | journal = Biophysical Chemistry | volume = 202 | pages = 21–31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009 | url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref><ref name="Mathew2009"/>
* reduction in metabolites reflecting a slowed metabolism<ref>{{Cite journal | last = Naviaux | first = Robert K. | authorlink1 = Robert Naviaux | last2 = Naviaux | first2 = Jane C. | last3 = Li | first3 = Kefeng | last4 = Bright | first4 = A. Taylor | last5 = Alaynick | first5 = William A. | last6 = Wang | first6 = Lin | last7 = Baxter | first7 = Asha | last8 = Nathan | first8 = Neil | last9 = Anderson | first9 = Wayne | date = 2016-09-13 | title = Metabolic features of chronic fatigue syndrome|url=http://www.pnas.org/content/113/37/E5472 | journal=Proceedings of the National Academy of Sciences|language=en | volume=113 | issue=37 | pages = E5472–E5480 | doi=10.1073/pnas.1607571113 | issn=0027-8424 | pmid=27573827}}</ref>
*analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model...that would suggest an elevation of oxidative stress.<ref name="Sweetman2020" />

=== Exercise ===
* reduced pain threshold<ref name="Whiteside, 2004">{{Cite journal | last1 = Whiteside | first1 = Alan | authorlink1 = | last2 = Hansen | first2 = Stig | authorlink2 = | last3 = Chaudhuri | first3 = Abhijit | authorlink3 = Abhijit Chaudhuri | title = Exercise lowers pain threshold in chronic fatigue syndrome | journal = Pain | volume = 109 | issue = 3 | pages = 497-499 | date = 2004 | pmid = 15157711 | doi = 10.1016/j.pain.2004.02.029 }}</ref>
* translocation of bacteria<ref name="ShuklaS2015">{{cite journal | last1 = Shukla | first1 = Sanjay K | authorlink1 = Sanjay Shukla | last2 = Cook | first2 = Dane | authorlink2 = Dane Cook | last3 = Meyer | first3 = Jacob | authorlink3 = Jacob Meyer | last4 = Vernon | first4 = Suzanne D | authorlink4 = Suzanne Vernon | last5 = Le | first5 = Thao | authorlink5 = Thao Le | last6 = Clevidence | first6 = Derek | authorlink6 = Derek Clevidence | last7 = Robertson | first7 = Charles E | authorlink7 = Charles Robertson | last8 =Schrodi | first8 = Steven J | authorlink8 = Steven Schrodi | last9 = Yale | first9 = Steven | authorlink9 = Steven Yale | last10 = Frank | first10 = Daniel N | authorlink10 = Daniel Frank | title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | journal = PLoS ONE | date = Dec 18, 2015 | pmid = 26683192 | doi = 10.1371/journal.pone.0145453 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453 }}</ref>
* loss of capacity to recover from acidosis on repeat exercise<ref name="JonesDE2012">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = David Jones | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 = Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | authorlink7 = Michael Trenell | last8 = Newton | first8 = Julia L | authorlink8 = Julia Newton | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | pages = 186-94 | date = 12 Jul 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref>
* increased expression of sensory, adrenergic and immune genes following [[muscle]] exertion<ref name="LightAR2009">{{cite journal | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = White | first2 = Andrea T | authorlink2 = | last3 = Hughen | first3 = Ronald W | authorlink3 = | last4 = Light | first4 = Kathleen C | authorlink4 = Kathleen Light | title = Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects | journal = J Pain | volume = 10 | issue = 10 | pages = 1099-112 | date = Jul 31, 2009 | pmid = 19647494 | doi = 10.1016/j.jpain.2009.06.003 | url = http://www.jpain.org/article/S1526-5900(09)00574-4/abstract }}</ref><ref name="LightAR2011">{{citation | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = Bateman | first2 = Lucinda| authorlink2 = Lucinda Bateman | last3 = Jo | first3 = D | authorlink3 = Daehyun Jo | last4 = Hughen | first4 = Ronald W | authorlink4 = Ronald Hughen | last5 = Vanhaitsma | first5 = TA | authorlink5 = Timothy VanHaitsma | last6 = White | first6 = Andrea T | authorlink6 = Andrea White | last7 =Light | first7 = Kathleen C | authorlink7 = Kathleen Light | title = Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome | journal = J Intern Med | volume = 271 | issue = 1 | pages = 64-81 | date = Jul 13, 2011 | pmid = 21615807 | doi = 10.1111/j.1365-2796.2011.02405.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/abstract }}</ref><ref name="WhiteAT2012">{{citation | last1 = White | first1 = Andrea T | authorlink1 = Andrea White | last2 = Light | first2 = Alan R | authorlink2 = Alan Light | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 = Timothy A | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C | authorlink5 = Kathleen Light | title = Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls | journal = Psychosom Med | volume = 74 | issue = 1 | pages = 46-54 | date = Dec 30, 2011 | pmid = 22210239 | doi = 10.1097/PSY.0b013e31824152ed | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/ }}</ref>
* decreased [[oxygen]] utilization<ref>{{Cite journal | last = Vermeulen | first = Ruud CW | authorlink = Ruud Vermeulen | last2 = Vermeulen van Eck | first2 = Ineke WG| date = 2014 | title = Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome|url=https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-20|journal=Journal of Translational Medicine|language=en|volume=12|issue=1|pages=20|doi=10.1186/1479-5876-12-20|issn=1479-5876|pmc=3903040|pmid=24456560}}</ref>

[[File:Abnormal findings in CFS ME.png|thumb|center|alt=Abnormal findings in Chronic fatigue syndrome and myalgic encephalomyelitis. There is no single biomarker, but tests have found differences in blood flow to the brain, hand grip strength, metabolite and mitochondria abnormalities, reduced heart output, white and red blood cell differences, reduced blood volume, differences in gut bacteria, neuroinflammation, abnormal responses to exercise, and other abnormalities.]]

== See also ==
* [[Myalgic encephalomyelitis]]
* [[List of systematic reviews about ME/CFS]]
* [[:Category:Abnormal findings|Abnormal findings (images)]]

== Learn more ==
* [https://www.mdpi.com/2075-4418/9/2/41 Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (2019)] - original research article
* [http://www.meaction.net/wp-content/uploads/2015/05/ME2FCFS-RESEARCH-SUMMARY-Jamie-Seltzer.pdf #MEAction ME/CFS Research Summary]

==References==
{{Reflist}}

[[Category:Signs and symptoms]]
[[Category:Lists]]

Talk:List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:27:33Z

YellowWaterLilly:/* Neurological */ fixed heading

== Studies to add ==

===Neurological===
*2020, A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques<ref>{{Cite journal | last =Maksoud | first = Rebekah | last2 = Preez | first2 = Stanley du | last3 = Eaton-Fitch | first3 = Natalie | author-link3 = Natalie Eaton-Fitch | last4 = Thapaliya | first4 = Kiran | last5 = Barnden | first5 = Leighton|last6 = Cabanas | first6 = Hélène | last7 = Staines | first7 = Donald | last8 = Marshall-Gradisnik | first8 = Sonya | date = 2020-04-30 | title = A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475|journal=PLOS ONE|language=en|volume=15|issue=4| pages = e0232475|doi=10.1371/journal.pone.0232475|issn=1932-6203|pmc = 7192498|pmid=32353033}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475 (Full text)]
*2019, Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis<ref>{{Cite journal | last =Nelson | first = Maximillian J. | last2 = Bahl | first2 = Jasvir S. | last3 = Buckley | first3 = Jonathan D. | last4 = Thomson | first4=Rebecca L. | last5 = Davison | first5 = Kade | date = 2019-10-25 | title = Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/|journal=Medicine|volume=98|issue=43|doi=10.1097/MD.0000000000017600|issn=0025-7974|pmc=6824690|pmid=31651868}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/ (Full text)]
*2014, Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review<ref>{{Cite journal | last =Cauwenbergh | first = Deborah Van | last2 = Nijs | first2=Jo | last3 = Kos | first3=Daphne | last4 = Weijnen | first4 = Laura Van | last5 = Struyf | first5 = Filip|last6 = Meeus | first6 = Mira | date = 2014 | title =Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12256|journal=European Journal of Clinical Investigation|language=en|volume=44|issue=5|pages=516–526|doi=10.1111/eci.12256|issn=1365-2362}}</ref> - [https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.12256 (Full text)]
*2014, Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies<ref>https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx</ref> - [https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx (Full text)]
*1994, A comparative review of systemic and neurological symptomatology in 12 outbreaks collectively described as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis<ref>{{Cite journal | last =Briggs | first = Nathaniel C. | last2 = Levine | first2 = Paul H. | date = 1994-01-01 | title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis|url=https://academic.oup.com/cid/article/18/Supplement_1/S32/317003|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Supplement_1|pages=S32–S42|doi=10.1093/clinids/18.Supplement_1.S32|issn=1058-4838}}</ref> - [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.346&rep=rep1&type=pdf (Full text)]

==References==
{{Reflist}}

Talk:List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:27:10Z

YellowWaterLilly:Fixed Heading

== Studies to add ==

==Neurological==
*2020, A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques<ref>{{Cite journal | last =Maksoud | first = Rebekah | last2 = Preez | first2 = Stanley du | last3 = Eaton-Fitch | first3 = Natalie | author-link3 = Natalie Eaton-Fitch | last4 = Thapaliya | first4 = Kiran | last5 = Barnden | first5 = Leighton|last6 = Cabanas | first6 = Hélène | last7 = Staines | first7 = Donald | last8 = Marshall-Gradisnik | first8 = Sonya | date = 2020-04-30 | title = A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475|journal=PLOS ONE|language=en|volume=15|issue=4| pages = e0232475|doi=10.1371/journal.pone.0232475|issn=1932-6203|pmc = 7192498|pmid=32353033}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475 (Full text)]
*2019, Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis<ref>{{Cite journal | last =Nelson | first = Maximillian J. | last2 = Bahl | first2 = Jasvir S. | last3 = Buckley | first3 = Jonathan D. | last4 = Thomson | first4=Rebecca L. | last5 = Davison | first5 = Kade | date = 2019-10-25 | title = Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/|journal=Medicine|volume=98|issue=43|doi=10.1097/MD.0000000000017600|issn=0025-7974|pmc=6824690|pmid=31651868}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/ (Full text)]
*2014, Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review<ref>{{Cite journal | last =Cauwenbergh | first = Deborah Van | last2 = Nijs | first2=Jo | last3 = Kos | first3=Daphne | last4 = Weijnen | first4 = Laura Van | last5 = Struyf | first5 = Filip|last6 = Meeus | first6 = Mira | date = 2014 | title =Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12256|journal=European Journal of Clinical Investigation|language=en|volume=44|issue=5|pages=516–526|doi=10.1111/eci.12256|issn=1365-2362}}</ref> - [https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.12256 (Full text)]
*2014, Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies<ref>https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx</ref> - [https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx (Full text)]
*1994, A comparative review of systemic and neurological symptomatology in 12 outbreaks collectively described as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis<ref>{{Cite journal | last =Briggs | first = Nathaniel C. | last2 = Levine | first2 = Paul H. | date = 1994-01-01 | title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis|url=https://academic.oup.com/cid/article/18/Supplement_1/S32/317003|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Supplement_1|pages=S32–S42|doi=10.1093/clinids/18.Supplement_1.S32|issn=1058-4838}}</ref> - [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.346&rep=rep1&type=pdf (Full text)]

==References==
{{Reflist}}

Talk:List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:26:36Z

YellowWaterLilly:Removed Compeletes Articles

== Studies to add --

==Neurological==
*2020, A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques<ref>{{Cite journal | last =Maksoud | first = Rebekah | last2 = Preez | first2 = Stanley du | last3 = Eaton-Fitch | first3 = Natalie | author-link3 = Natalie Eaton-Fitch | last4 = Thapaliya | first4 = Kiran | last5 = Barnden | first5 = Leighton|last6 = Cabanas | first6 = Hélène | last7 = Staines | first7 = Donald | last8 = Marshall-Gradisnik | first8 = Sonya | date = 2020-04-30 | title = A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475|journal=PLOS ONE|language=en|volume=15|issue=4| pages = e0232475|doi=10.1371/journal.pone.0232475|issn=1932-6203|pmc = 7192498|pmid=32353033}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475 (Full text)]
*2019, Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis<ref>{{Cite journal | last =Nelson | first = Maximillian J. | last2 = Bahl | first2 = Jasvir S. | last3 = Buckley | first3 = Jonathan D. | last4 = Thomson | first4=Rebecca L. | last5 = Davison | first5 = Kade | date = 2019-10-25 | title = Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/|journal=Medicine|volume=98|issue=43|doi=10.1097/MD.0000000000017600|issn=0025-7974|pmc=6824690|pmid=31651868}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/ (Full text)]
*2014, Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review<ref>{{Cite journal | last =Cauwenbergh | first = Deborah Van | last2 = Nijs | first2=Jo | last3 = Kos | first3=Daphne | last4 = Weijnen | first4 = Laura Van | last5 = Struyf | first5 = Filip|last6 = Meeus | first6 = Mira | date = 2014 | title =Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12256|journal=European Journal of Clinical Investigation|language=en|volume=44|issue=5|pages=516–526|doi=10.1111/eci.12256|issn=1365-2362}}</ref> - [https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.12256 (Full text)]
*2014, Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies<ref>https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx</ref> - [https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx (Full text)]
*1994, A comparative review of systemic and neurological symptomatology in 12 outbreaks collectively described as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis<ref>{{Cite journal | last =Briggs | first = Nathaniel C. | last2 = Levine | first2 = Paul H. | date = 1994-01-01 | title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis|url=https://academic.oup.com/cid/article/18/Supplement_1/S32/317003|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Supplement_1|pages=S32–S42|doi=10.1093/clinids/18.Supplement_1.S32|issn=1058-4838}}</ref> - [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.346&rep=rep1&type=pdf (Full text)]

==References==
{{Reflist}}

Talk:List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:22:25Z

YellowWaterLilly:/* Immunological */ Informing that study suggested has been added

== Studies to add -- ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 15:09, May 25, 2020 (EDT) ==
* 2019, Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study<ref>{{Cite journal | last =Nacul | first = Luis | author-link=Luis Nacul | last2 = de Barros | first2=Barbara|author-link2 = | last3 = Kingdon | first3=Caroline C. | author-link3 = Caroline Kingdon | last4 = Cliff | first4 = Jacqueline M. | author-link4 = Jacqueline Cliff | last5 = Clark | first5 = Taane G. | authorlink5 = |last6 = Mudie | first6 = Kathleen | last7 = Dockrell | first7 = Hazel M. | authorlink7 = Hazel Dockrell | last8 = Lacerda | first8 = Eliana M. | authorlink8 = Eliana Lacerda | date = 2019-04-10 | title = Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study|url=https://www.mdpi.com/2075-4418/9/2/41|journal=Diagnostics|language=en|volume=9|issue=2|pages=41|doi=10.3390/diagnostics9020041|issn=2075-4418|quote=|via=}}</ref> - [https://www.mdpi.com/2075-4418/9/2/41 (Abstract)]

===Re: Studies to add -- [[User:YellowWaterLilly|YellowWaterLilly]] ([[User talk:YellowWaterLilly|talk]]) 02:08, September 12, 2025 (UTC)===

: Done!

==Immunological==
* 2019, Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref>{{Cite journal | last =Cliff | first = Jacqueline M.|author-link=Jacqueline Cliff | last2 = King | first2 = Elizabeth C.|author-link2 = | last3 = Lee | first3 = Ji-Sook | authorlink3 = | last4 = Sepúlveda | first4 = Nuno | author-link4 = Nuno Sepúlveda | last5 = Wolf | first5 = Asia-Sophia | authorlink5 = |last6 = Kingdon | first6 = Caroline | authorlink6 = Caroline Kingdon | last7 = Bowman | first7 = Erinna | authorlink7 = Erinna Bowman | last8 = Dockrell | first8 = Hazel M. | authorlink8 = Hazel Dockrell | last9 = Nacul | first9 = Luis | authorlink9 = Luis Nacul | last10 = Lacerda | first10 = Eliana | authorlink10 = Eliana Lacerda | last11 = Riley | first11 = Eleanor | authorlink11 = Eleanor Riley | date = 2019-04-16|title=Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.frontiersin.org/article/10.3389/fimmu.2019.00796/full|journal=Frontiers in Immunology|volume=10|issue=|pages=|doi=10.3389/fimmu.2019.00796|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2019.00796/full (Full text)]

===Re: Immunological -- [[User:YellowWaterLilly|YellowWaterLilly]] ([[User talk:YellowWaterLilly|talk]]) 02:22, September 12, 2025 (UTC)===

: Done!

==Neurological==
*2020, A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques<ref>{{Cite journal | last =Maksoud | first = Rebekah | last2 = Preez | first2 = Stanley du | last3 = Eaton-Fitch | first3 = Natalie | author-link3 = Natalie Eaton-Fitch | last4 = Thapaliya | first4 = Kiran | last5 = Barnden | first5 = Leighton|last6 = Cabanas | first6 = Hélène | last7 = Staines | first7 = Donald | last8 = Marshall-Gradisnik | first8 = Sonya | date = 2020-04-30 | title = A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475|journal=PLOS ONE|language=en|volume=15|issue=4| pages = e0232475|doi=10.1371/journal.pone.0232475|issn=1932-6203|pmc = 7192498|pmid=32353033}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475 (Full text)]
*2019, Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis<ref>{{Cite journal | last =Nelson | first = Maximillian J. | last2 = Bahl | first2 = Jasvir S. | last3 = Buckley | first3 = Jonathan D. | last4 = Thomson | first4=Rebecca L. | last5 = Davison | first5 = Kade | date = 2019-10-25 | title = Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/|journal=Medicine|volume=98|issue=43|doi=10.1097/MD.0000000000017600|issn=0025-7974|pmc=6824690|pmid=31651868}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/ (Full text)]
*2014, Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review<ref>{{Cite journal | last =Cauwenbergh | first = Deborah Van | last2 = Nijs | first2=Jo | last3 = Kos | first3=Daphne | last4 = Weijnen | first4 = Laura Van | last5 = Struyf | first5 = Filip|last6 = Meeus | first6 = Mira | date = 2014 | title =Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12256|journal=European Journal of Clinical Investigation|language=en|volume=44|issue=5|pages=516–526|doi=10.1111/eci.12256|issn=1365-2362}}</ref> - [https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.12256 (Full text)]
*2014, Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies<ref>https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx</ref> - [https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx (Full text)]
*1994, A comparative review of systemic and neurological symptomatology in 12 outbreaks collectively described as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis<ref>{{Cite journal | last =Briggs | first = Nathaniel C. | last2 = Levine | first2 = Paul H. | date = 1994-01-01 | title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis|url=https://academic.oup.com/cid/article/18/Supplement_1/S32/317003|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Supplement_1|pages=S32–S42|doi=10.1093/clinids/18.Supplement_1.S32|issn=1058-4838}}</ref> - [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.346&rep=rep1&type=pdf (Full text)]

==References==
{{Reflist}}

List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:21:36Z

YellowWaterLilly:/* Immune dysregulation */ Added information from study found here: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00796/full a study about immune function, thanks to the advice on the discussion page

[[Myalgic encephalomyelitis]]/[[chronic fatigue syndrome]] is a complex multi-system disease and biological abnormalities in patients have been found affecting multiple bodily systems. No single [[diagnostic biomarker|biomarker]]-based diagnostic test has been validated but patients have a range abnormal physical findings affecting multiple bodily systems.<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> The CDC states that diagnosing ME/CFS relies on a physical and psychiatric assessment, observations, medical history, clinical interview, and results from a mix of blood and urine tests.<ref name="CDC2020diagnosis">{{Cite web|url=https://www.cdc.gov/me-cfs/symptoms-diagnosis/diagnosis.html | title = Diagnosis of ME/CFS {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = Centers of Disease Control|first = | authorlink = Centers for Disease Control and Prevention | date = 2019-05-15 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2020-09-26}}</ref>

== Nervous system ==
===Brain ===
{{Main article|Brain}}
*Progressive brain changes<ref name="Shan2016"/>

=== Central nervous system ===
{{Main article |page_name =Central nervous system}}
* increased [[Ventricular system|ventricular]] [[lactate]]<ref name="Mathew2009">{{Cite journal | last = Mathew|first = Sanjay J. | last2 = Mao | first2 = Xiangling | last3 = Keegan | first3 = Kathryn A. | last4 = Levine | first4 = Susan M. | authorlink4 = Susan Levine | last5 = Smith | first5 = Eric L.P. | last6 = Heier | first6 = Linda A. | last7 = Otcheretko | first7 = Viktor | last8 = Coplan | first8 = Jeremy D. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Apr 2009 | title = Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: anin vivo3.0 T1H MRS imaging study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/nbm.1315|journal=NMR in Biomedicine|language=en|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480}}</ref><ref name="Murrough2010">{{Cite journal | last = Murrough|first = James W. | last2 = Mao | first2 = Xiangling | last3 = Collins | first3 = Katherine A. | last4 = Kelly | first4 = Chris | last5 = Andrade | first5 = Gizely | last6 = Nestadt | first6 = Paul | last7 = Levine | first7 = Susan M. | authorlink7 = Susan Levine | last8 = Mathew | first8 = Sanjay J. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Jul 2010 | title = Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder | url =https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in Biomedicine|volume=23|issue=6 | pages = 643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref><ref name="Shungu2012">{{Cite journal | last = Shungu | first = Dikoma C. | authorlink1 = Dikoma Shungu | last2 = Weiduschat | first2 = Nora | last3 = Murrough | first3 = James W. | last4 = Mao | first4 = Xiangling | last5 = Pillemer | first5 = Sarah | last6 = Dyke | first6 = Jonathan P. | last7 = Medow | first7 = Marvin S. | last8 = Natelson | first8 = Benjamin H. | authorlink8 = Benjamin Natelson | last9 = Stewart | first9 = Julian M. | date = Sep 2012 | title = Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name="Natelson2017">{{Cite journal | last = Natelson | first = Benjamin H. | authorlink1 = Benjamin Natelson | last2 = Vu | first2 = Diana | last3 = Coplan | first3 = Jeremy D. | last4 = Mao | first4 = Xiangling | last5 = Blate | first5 = Michelle | last6 = Kang | first6 = Guoxin | last7 = Soto | first7 = Eli | last8 = Kapusuz | first8 = Tolga | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = 2017-01-02 | title = Elevations of ventricular lactate levels occur in both chronic fatigue syndrome and fibromyalgia|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1280114?journalCode=rftg20|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref>
* neuroinflammation<ref name="Nakatomi2014">{{Cite journal | last = Nakatomi|first = Yasuhito | last2 = Mizuno | first2 = Kei | last3 = Ishii | first3 = Akira | last4 = Wada | first4 = Yasuhiro | last5 = Tanaka | first5 = Masaaki | last6 = Tazawa | first6 = Shusaku | last7 = Onoe | first7 = Kayo | last8 = Fukuda | first8 = Sanae | last9 = Kawabe | first9 = Joji | date = 2014-06-01 | title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study|url=http://jnm.snmjournals.org/content/55/6/945|journal=Journal of Nuclear Medicine|language=en|volume=55|issue=6 | pages = 945–950|doi=10.2967/jnumed.113.131045|issn=0161-5505|pmid=24665088}}</ref><ref name="Zeineh2014">{{citation | last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh | last2 = Kang | first2 = James | authorlink2 = James Kang | last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas | last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman | last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss | last6 =Norris | first6 = Jane L | authorlink6 = Jane Norris | last7 =Valencia | first7 = Ian | authorlink7 = Ian Valencia | last8 =Montoya | first8 = Jose G | authorlink8 = Jose Montoya | title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome| journal = Radiology | volume = 274 | issue = 2| pages = 517–526 | date = 2014-10-29| doi = 10.1148/radiol.14141079| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079}}</ref><ref name="Mueller2019">{{Cite journal|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4 | title = Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy | last = Mueller | first = Christina | authorlink=Christina Mueller | last2 = Lin | first2 = Joanne C | authorlink2 = Joanne Lin | date = 2019 | doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|url-status=|access-date=2019-01-17 | authorlink3 = Sulaiman Sheriff | authorlink4 = Andrew Maudsley | authorlink5 = Jarred Younger | last3 = Sheriff | last4 = Maudsley | last5 = Younger | first3 = Sulaiman | first4 = Andrew A | first5 = Jarred W|volume=|issue=|pages= | page = |journal=Brain Imaging and Behavior}}</ref><ref name="RamsayAward20190117">{{Cite web|url=http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 | title = Brain Imaging and Behavior publication from Dr. Jarred Younger’s SMCI Ramsay pilot study supports involvement of neuroinflammation in ME/CFS|website=go.solvecfs.org|access-date=2019-01-17 | date = | last = | first = | authorlink = |archive-url=|archive-date=|url-status=}}</ref>
* reduced [[Grey matter|grey]]<ref name="Puri2012">{{Cite journal | last = Puri|first = B K | last2 = Jakeman | first2 = P M | last3 = Agour | first3 = M | last4 = Gunatilake | first4 = K D R | last5 = Fernando | first5 = K A C | last6 = Gurusinghe | first6 = A I | last7 = Treasaden | first7 = I H | last8 = Waldman | first8 = A D | last9 = Gishen | first9 = P | date = Jul 2012 | title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study|url=https://www.birpublications.org/doi/full/10.1259/bjr/93889091|journal=The British Journal of Radiology|language=en|volume=85|issue=1015| pages = e270–e273|doi=10.1259/bjr/93889091|issn=0007-1285|pmc=3474083|pmid=22128128}}</ref> and [[white matter]]<ref name="Shan2016">{{Cite journal | last = Shan | first = Zack Y. | authorlink = Zack Shan | last2 = Kwiatek | first2 = Richard | last3 = Burnet | first3 = Richard | last4 = Del Fante | first4 = Peter | last5 = Staines | first5 = Donald R. | last6 = Marshall-Gradisnik | first6 = Sonya M. | last7 = Barnden | first7 = Leighton R. | date = 2016-04-28 | title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/jmri.25283|journal=Journal of Magnetic Resonance Imaging|language=en|volume=44|issue=5|pages=1301–1311|doi=10.1002/jmri.25283|issn=1053-1807|pmc=5111735|pmid=27123773}}</ref><ref name="Puri2012" />
* [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|widespread metabolite abnormalities]]<ref name="Mueller2019"/>

=== Autonomic nervous system ===
{{Main article |page_name =Autonomic nervous system}}
* Orthostatic intolerance<ref>Gerwin Morris, Michael Maes, see citations 12 through 27 in [http://www.biomedcentral.com/1741-7015/11/205 "Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics"] BMC Medicine, 17 September 2013</ref><ref>{{Cite journal | last = Miwa | first = K | date = Jul 2015 | title = Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle|url=https://www.ncbi.nlm.nih.gov/pubmed/24736946|journal=Heart and Vessels|volume=30|issue=4 | pages = 484–489|via=}}</ref>

=== Peripheral nervous system ===
{{Main article |page_name =Peripheral nervous system}}

== Muscular system ==
{{Main article |page_name =Muscle}}
*[[Mitochondrion|mitochondria]]l abnormalities found via [[muscle biopsy]] including: mitochondrial degeneration,<ref>{{Cite journal | last = Behan | first = W. M.H. | last2 = More | first2 = I.A.R. | last3 = Behan | first3 = P.O. | date = Dec 1991 | title = Mitochondrial abnormalities in the postviral fatigue syndrome|url=https://link.springer.com/article/10.1007/BF00294431|journal=Acta Neuropathologica|language=en|volume=83|issue=1 | pages = 61–65|doi=10.1007/bf00294431|issn=0001-6322}}</ref> deletions of mitochondrial DNA,<ref name=":0">{{Cite journal | date = 1996-04-19 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/abs/pii/0304394096125593|journal=Neuroscience Letters|language=en|volume=208|issue=2|pages=117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940}}</ref><ref>{{Cite journal | last = Zhang|first = C. | last2 = Baumer | first2 = A. | last3 = Mackay | first3 = I.R. | last4 = Linnane | first4 = A.W. | last5 = Nagley | first5 = P. | date = Apr 1995 | title = Unusual pattern of mitochondrial DNA deletions in skeletal muscle of an adult human with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/7633428|journal=Human Molecular Genetics|volume=4|issue=4 | pages = 751–754|issn=0964-6906|pmid=7633428}}</ref> the reduction of mitochondrial activity<ref name=":0" />
*Increased urinary [[creatine]] excretion during relapses<ref>{{Cite journal | last = Albrecht | first = Robert | date = March 21, 1964 | title = Epidemic Neuromyasthenia Outbreak in a Convent in New York State|url=https://www.ncbi.nlm.nih.gov/pubmed/14100144|journal=Journal of the American Medical Association|volume=187 | pages = 904-907|via=}}</ref>
*Increased [[creatine kinase]] ([[postviral fatigue syndrome]])
*Persistence of [[enterovirus]]es in muscle tissue<ref name=":1">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W. M.H. | last3 = Simpson | first3 = K. | last4 = McGarry | first4 = F. | last5 = Keir | first5 = S. | last6 = Behan | first6 = P.O. | date = 1994-01-01 | title = Studies on Enterovirus in Patients with Chronic Fatigue Syndrome|url=https://academic.oup.com/cid/article-abstract/18/Supplement_1/S126/316946|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Suppl 1|pages=S126–S129|doi=10.1093/clinids/18.Supplement_1.S126|issn=1537-6591}}</ref><ref name=":2">{{Cite journal | last = Cunningham|first = Louise | last2 = Bowles | first2 = N.E. | last3 = Lane | first3 = R. J.M. | last4 = Dubowitz | first4 = V. | last5 = Archard | first5 = L.C. | date = 1990 | title = Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA|url=http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/0022-1317-71-6-1399|journal=Journal of General Virology|volume=71|issue=6|pages=1399–1402|doi=10.1099/0022-1317-71-6-1399}}</ref><ref name=":3">{{Cite journal | last = Archard | first = LC | last2 = Bowles | first2 = NE | last3 = Behan | first3 = PO | last4 = Bell | first4 = EJ | last5 = Doyle | first5 = D | date = 1988-06-01 | title = Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase, Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase|url=https://doi.org/10.1177/014107688808100608|journal=Journal of the Royal Society of Medicine|language=en|volume=81|issue=6 | pages = 326–329|doi=10.1177/014107688808100608|issn=0141-0768|pmc=1291623|pmid=3404526}}</ref><ref name=":4">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W.M. | last3 = Clements | first3 = G.B. | last4 = Woodall | first4 = C. | last5 = Riding | first5 = M. | last6 = Behan | first6 = P.O. | date = 1991-03-23 | title = Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome.|url=https://www.bmj.com/content/302/6778/692|journal=BMJ|language=en|volume=302|issue=6778 | pages = 692–696|doi=10.1136/bmj.302.6778.692|issn=0959-8138|pmid=1850635}}</ref>
*Abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | authorlink1 = Audrey Brown | last2 = Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = 2 Apr 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref><ref name="Wellness20150420">{{citation | last1 = Dobberstein | first1 = Linda J. | authorlink1 = | title = Master Enzyme Switch Deactivated In Chronic Fatigue Syndrome and Fibromyalgia | journal = Wellness Resources | date = 20 Apr 2015 | url = http://www.wellnessresources.com/health/articles/master_enzyme_switch_deactivated_in_chronic_fatigue_syndrome_and_fibromyalg/ }}</ref>
*Reduce serum [[creatine kinase]] in people with severe ME.<ref>{{Cite journal|title=Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study|date=April 10, 2019|url=https://www.mdpi.com/2075-4418/9/2/41|journal=Biomedical Insights that Inform the Diagnosis of ME/CFS|last=Nacul|first=Luis|author-link=Luis Nacul|last2=de Barros|first2=Barbara|last3=Kingdon|first3=Caroline C.|author-link3=Caroline Kingdon|last4=Cliff|first4=Jacqueline M.|author-link4=Jacqueline Cliff|last5=Clark|first5=Taane G.|author-link5=Taane Clark|last6=Mudie|first6=Kathleen|last7=Dockrell|first7=Hazel M.|author-link7=Hazel Dockrell|last8=Lacerda|first8=Eliana M.|author-link8=Eliana Lacerda|access-date=September 11, 2025|via=Diagnostics}}</ref>

== Immune system ==
{{Main article |page_name =Immune system}}
=== Immune dysregulation ===
* [[Natural killer cell]] function is reduced<ref>{{Cite journal | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology | date = Apr 2014|issn=1460-2377|pmid=24343819|pages=233–242|volume=26|issue=4|doi=10.1093/intimm/dxt068|first = Ekua Weba | last = Brenu | first2 = Teilah K. | last2 = Huth | first3 = Sharni L. | last3 = Hardcastle | first4 = Kirsty | last4 = Fuller | first5 = Manprit | last5 = Kaur | first6 = Samantha | last6 = Johnston | first7 = Sandra B. | last7 = Ramos | first8 = Don R. | last8 = Staines | first9 = Sonya M. | last9 = Marshall-Gradisnik}}</ref><ref>{{Cite journal | last = Victoria Scott | first = David Strayer | date = 2015 | title=Low NK Cell Activity in Chronic Fatigue Syndrome (CFS) and Relationship to Symptom Severity|url=https://www.omicsonline.org/open-access/low-nk-cell-activity-in-chronic-fatigue-syndrome-cfs-and-relationship-to-symptom-severity-2155-9899-1000348.php?aid=59415|journal=Journal of Clinical & Cellular Immunology|language=en|volume=6|issue=4|doi=10.4172/2155-9899.1000348|issn=2155-9899}}</ref>
* [[Cytokine]] dysregulation<ref name="Montoya, 2017">{{citation | last1 = Montoya | first1 = Jose G. | authorlink1 = Jose Montoya | last2 = Holmes | first2 = Tyson H. | authorlink2 = | last3 = Anderson | first3 = Jill N. | authorlink3 = | last4 = Maecker | first4 = Holden T. | authorlink4 = | last5 = Rosenberg-Hasson | first5 = Yael | authorlink5 = | last6 = Valencia | first6 = Ian J. | authorlink6 = | last7 = Chu | first7 = Lily | authorlink7 = Lily Chu | last8 =Younger | first8 = Jarred W. | authorlink8 = Jarred Younger | last9 =Tato | first9 = Cristina M. | authorlink9 = | last10 = Davis | first10 = Mark M. | authorlink10 = Mark Davis | title = Cytokine signature associated with disease severity in chronic fatigue syndrome patients | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 34 | pages = E7150-E7158 | date = 2017 | pmid = | doi = 10.1073/pnas.1710519114 }}</ref><ref>[http://www.meaction.net/2015/12/07/study-finds-evidence-of-downregulated-immune-system-in-mecfs-patients Study finds evidence of downregulated immune system in ME/CFS patients - MEAction - Landi, et al.]</ref><ref>[http://microbediscovery.org/2017/04/04/new-research-discovers-evidence-of-atypical-classical-mecfs/ New Research Discovers Evidence of Atypical & Classical ME/CFS - The Microbe Discovery Project - Apr 4, 2017]</ref>
* Elevated [[regulatory T cell]]s<ref>{{Cite journal | last = Brenu|first = Ekua Weba | last2 = Huth | first2 = Teilah K. | last3 = Hardcastle | first3 = Sharni L. | last4 = Fuller | first4 = Kirsty | last5 = Kaur | first5 = Manprit | last6 = Johnston | first6 = Samantha | last7 = Ramos | first7 = Sandra B. | last8 = Staines | first8 = Don R. | last9 = Marshall-Gradisnik | first9 = Sonya M. | date = Apr 2014 | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology|volume=26|issue=4|pages=233–242|doi=10.1093/intimm/dxt068|issn=1460-2377|pmid=24343819}}</ref>
* increased [[mast cell]] populations<ref>{{Cite journal | last = Rönnberg|first = E | last2 = Calounova | first2 = G | last3 = Pejler | first3 = G | date = June 2017 | title = Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients|url=https://www.ncbi.nlm.nih.gov/pubmed/27362406|journal=Asian Pac J Allergy Immunol|volume=35|issue=2 | pages = 75-81|via=}}</ref>
* elevated anti-cholinergic [[Muscarinic acetylcholine receptor|muscarinic]], Β-adrenergic,<ref>{{Cite journal | last = Loebel|first = Madlen | last2 = Grabowski | first2 = Patricia | last3 = Heidecke | first3 = Harald | last4 = Bauer | first4 = Sandra | last5 = Hanitsch | first5 = Leif G. | last6 = Wittke | first6 = Kirsten | last7 = Meisel | first7 = Christian | last8 = Reinke | first8 = Petra | last9 = Volk | first9 = Hans-Dieter | date = Feb 2016 | title = Antibodies to β adrenergic and muscarinic cholinergic receptors in patients with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/26399744|journal=Brain, Behavior, and Immunity|volume=52 | pages = 32–39|doi=10.1016/j.bbi.2015.09.013|issn=1090-2139|pmid=26399744}}</ref> [[phosphatidylinositol]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivanka | last3 = Leunis | first3 = Jean-Claude | date = Dec 2007 | title = Increased serum IgM antibodies directed against phosphatidyl inositol (Pi) in chronic fatigue syndrome (CFS) and major depression: evidence that an IgM-mediated immune response against Pi is one factor underpinning the comorbidity between both CFS and depression | url =https://www.ncbi.nlm.nih.gov/pubmed/18063934|journal=Neuro Endocrinology Letters|volume=28|issue=6 | pages = 861–867|issn=0172-780X|pmid=18063934}}</ref> and [[serotonin]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Ringel | first2 = Karl | last3 = Kubera | first3 = Marta | last4 = Anderson | first4 = George | last5 = Morris | first5 = Gerwyn | last6 = Galecki | first6 = Piotr | last7 = Geffard | first7 = Michel | date = 2013-09-05 | title = In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation | url =https://www.ncbi.nlm.nih.gov/pubmed/23664637|journal=Journal of Affective Disorders|volume=150|issue=2|pages=223–230|doi=10.1016/j.jad.2013.03.029|issn=1573-2517|pmid=23664637}}</ref> autoantibodies
* Reduced CD4+ function<ref name=":5">{{Cite journal|title=Myalgic encephalomyelitis/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations|date=2020-03-02|url=https://pubmed.ncbi.nlm.nih.gov/31830003/|journal=The Journal of Clinical Investigation|volume=130|issue=3|pages=1491–1505|last=Mandarano|first=Alexandra H.|last2=Maya|first2=Jessica|last3=Giloteaux|first3=Ludovic|last4=Peterson|first4=Daniel L.|last5=Maynard|first5=Marco|last6=Gottschalk|first6=C. Gunnar|last7=Hanson|first7=Maureen R.|doi=10.1172/JCI132185|pmc=7269566|pmid=31830003|issn=1558-8238}}</ref> and reduced CD4+ count<ref name=":6">{{Cite journal|title=Study of immune alterations in patients with chronic fatigue syndrome with different etiologies|date=2004|url=https://pubmed.ncbi.nlm.nih.gov/15345193/|journal=International Journal of Immunopathology and Pharmacology|volume=17|issue=2 Suppl|pages=57–62|last=Racciatti|first=D.|last2=Dalessandro|first2=M.|last3=Delle Donne|first3=L.|last4=Falasca|first4=K.|last5=Zingariello|first5=P.|last6=Paganelli|first6=R.|last7=Pizzigallo|first7=E.|last8=Vecchiet|first8=J.|doi=10.1177/03946320040170S210|pmid=15345193|issn=0394-6320}}</ref>
* Reduced CD8+ function<ref name=":5" /> and reduced CD8+ count<ref name=":6" />
* Lowered CD4+/CD8+ ratio<ref>{{Cite journal|title=Increased expression of activation antigens on CD8+ T lymphocytes in Myalgic Encephalomyelitis/chronic fatigue syndrome: inverse associations with lowered CD19+ expression and CD4+/CD8+ ratio, but no associations with (auto)immune, leaky gut, oxidative and nitrosative stress biomarkers|date=2015-01-01|url=https://europepmc.org/article/med/26707044|journal=Neuro endocrinology letters|volume=36|issue=5|pages=439–446|last=Maes|first=Michael|last2=Bosmans|first2=Eugene|last3=Kubera|first3=Marta|pmid=26707044|issn=2354-4716}}</ref>
* Increased proportions of effector memory CD8+ T cells<ref name=":9">{{Cite journal|title=Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|date=2019-04-16|url=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00796/full|journal=Frontiers in Immunology|volume=10|last=M.|first=Cliff, Jacqueline|last2=C.|first2=King, Elizabeth|last3=Ji-Sook|first3=Lee,|last4=Nuno|first4=Sepúlveda,|last5=Asia-Sophia|first5=Wolf,|last6=Caroline|first6=Kingdon,|last7=Erinna|first7=Bowman,|last8=M.|first8=Dockrell, Hazel|last9=Luis|first9=Nacul,|last10=Eliana|first10=Lacerda,|last11=M.|first11=Riley, Eleanor|language=English|doi=10.3389/fimmu.2019.00796/full|issn=1664-3224}}</ref> (these are rapid responders)
* Decreased proportions of terminally differentiated effector CD8+ T cells<ref name=":9" /> (these kill infected or cancerous cells)
* Significantly increased proportion of mucosal associated invariant T cells (MAIT) cells (these cells control infections to stop from spreading), especially in severely affected patients<ref name=":9" />

=== Chronic infection ===
* [[Enterovirus]]: Persistence of [[enterovirus]]es in muscle tissue;<ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name=":4" /> brain;<ref name="McGarry19942">{{citation | last1 = McGarry | first1 = Frances | author-link1 = Frances McGarry | last2 = Gow | first2 = John | authorlink2 = John Gow | last3 = Behan | first3 = Peter O | authorlink3 = Peter O Behan | title = Enterovirus in the Chronic Fatigue Syndrome | journal = Annals of Internal Medicine | volume = 120 | issue = 11| pages = 972–973 | date = Jun 1, 1994 | doi = 10.7326/0003-4819-120-11-199406010-00020 | url = http://www.ncbi.nlm.nih.gov/pubmed/8172448 }}</ref> and gut;<ref name="ChiaJKS2016">{{Cite journal | last1 = Chia | first1 = JKS | authorlink1 = John Chia | last2 = Chia | first2 = AY | authorlink2 = Andrew Chia | title = Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach | journal = Journal of Clinical Pathology | volume = 61 | issue = 1| pages = 43–48 | date = Jan 1, 2008 | pmid = 17872383 | doi = 10.1136/jcp.2007.050054 | url = http://jcp.bmj.com/content/61/1/43 }}</ref> increased detection of viral [[RNA]] via PCR; increased [[:Category:Antibodies|antibodies]]
* [[Herpesvirus]]{{citation needed}}

== Lymphatic system ==

== Cardiovascular system ==

{{Main article|page_name =Cardiovascular system}}{{Main article|page_name =Cardiac problems in ME/CFS}}

=== Heart ===
* Smaller than normal [[left ventricle]] of the [[heart]],<ref name=":8">Miwa K., [http://www.ncbi.nlm.nih.gov/pubmed/24736946 "Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle"] Heart Vessels, July 2015</ref><ref>Hollingsworth K.G [http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1365-2796.2011.02429.x/ "Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging"] J Intern Med 2012; 271: 264–270.</ref><ref name="Olimulder, 2016">{{Cite journal | last1 = Olimulder | first1 = M.A.G.M. | authorlink1 = | last2 = Galjee | first2 = M.A. | authorlink2 = | last3 = Wagenaar | first3 = L.J. | authorlink3 = | last4 = van Es | first4 = J. | authorlink4 = | last5 = van der Palen | first5 = J. | authorlink5 = | last6 = Visser | first6 = F.C. | authorlink6 = | last7 =Vermeulen | first7 = R.C.W. | authorlink7 = | last8 = von Birgelen | first8 = C. | authorlink8 = | title = Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging | journal = Netherlands Heart Journal | volume = 24 | pages = 709–716 | date = 2016 | url = https://link.springer.com/article/10.1007/s12471-016-0885-8 | doi = 10.1007/s12471-016-0885-8 }}</ref><ref>[http://openheart.bmj.com/content/3/1/e000381.long Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study]</ref> [[small heart syndrome]],<ref name=":8" /> and low [[Cardiovascular system|cardiac]] output.<ref>Miwa K., Fujita M., [http://www.ncbi.nlm.nih.gov/pubmed/19881233 "Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome"] Intern Med, 2009;48(21):1849-54</ref>
* Mean age of death from heart failure of [[chronic fatigue syndrome|CFS]] patients is 58.7 years as compared to 83.1 years for the general population.<ref>Jason LA, Corradi K, Gress S, Williams S, Torres-Harding S, [http://www.ncbi.nlm.nih.gov/pubmed/16844674 "Causes of death among patients with chronic fatigue syndrome"] Health Care Women Int., 27(7): 615-626. 2006</ref>
=== Circulation ===
* reduced blood flow to the [[Brain|brain,]]<ref name="Natelson, 2017">{{Cite journal | last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson | last2 = Mao | first2 = Xiangling | last3 = Stegner | first3 = Aaron J | last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange | last5 = Vu | first5 = Diana | last6 = Blate | first6 = Michelle | last7 = Kang | first7 = Guoxin | last8 = Soto | first8 = Eli | last9 = Kapusuz | first9 = Tolga | last10 = Shungu | first10 = Dikoma C | authorlink10 = Dikoma Shungu | title=Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity | date = 2017 | journal=Journal of the Neurological Sciences|volume=375|issue= | page = 411-416|doi=10.1016/j.jns.2017.02.046|pmid=|quote=}}</ref><ref name=":32">{{Cite journal | last = Costa|first = D.C. | last2 = Tannock | first2 = C. | last3 = Brostoff | first3 = J. | date = Nov 1995 | title = Brainstem perfusion is impaired in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8542261|journal=QJM: monthly journal of the Association of Physicians|volume=88|issue=11 | pages = 767–773|issn=1460-2725|pmid=8542261}}</ref><ref name=":10">{{Cite journal | last = Barnden | first = Leighton R. | last2 = Crouch | first2 = Benjamin | last3 = Kwiatek | first3 = Richard | last4 = Burnet | first4 = Richard | last5 = Mernone | first5 = Anacleto | last6 = Chryssidis | first6 = Steve | last7 = Scroop | first7 = Garry | last8 = Del Fante | first8 = Peter | date = 2011 | title = A brain MRI study of chronic fatigue syndrome: evidence of brainstem dysfunction and altered homeostasis|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/nbm.1692|journal=NMR in Biomedicine|language=en|volume=24|issue=10|pages=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc = 4369126|pmid=21560176}}</ref><ref>{{Cite journal | last = Biswal|first = Bharat | last2 = Kunwar | first2 = Pratap | last3 = Natelson | first3 = Benjamin H. | authorlink1 = Benjamin Natelson | date = 2011-02-15 | title = Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling | url =http://www.sciencedirect.com/science/article/pii/S0022510X10005666|journal=Journal of the Neurological Sciences|volume=301|issue=1 | pages = 9–11 |doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{Cite journal | last = Yoshiuchi|first = Kazuhiro | last2 = Farkas | first2 = Jeffrey | last3 = Natelson | first3 = Benjamin H. | authorlink3 = Benjamin Natelson | date = 2006 | title=Patients with chronic fatigue syndrome have reduced absolute cortical blood flow | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-097X.2006.00649.x|journal=Clinical Physiology and Functional Imaging|language=en|volume=26|issue=2 | pages = 83–86|doi=10.1111/j.1475-097X.2006.00649.x|issn=1475-097X}}</ref><ref>{{Cite journal | last = Freedman | first = M. | last2 = Kirsh | first2 = J.C. | last3 = Gray | first3 = B. | last4 = Chung | first4 = D.G. | last5 = Abbey | first5 = S.E. | last6 = Salit | first6 = I.E. | last7 = Ichise | first7 = M. | date = Oct 1992 | title = Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome.|url=http://europepmc.org/abstract/med/1491843|journal=Nuclear medicine communications|volume=13|issue=10 | pages = 767–772|issn=0143-3636|pmid=1491843}}</ref><ref>{{Cite journal | last = Chao|first = C.C. | last2 = Hu | first2 = S. | last3 = Pheley | first3 = A.M. | last4 = Schenck | first4 = C.H. | last5 = Grammith | first5 = F.C. | last6 = Sirr | first6 = S.A. | last7 = Peterson | first7 = P.K. | date = 1994-03-01 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://cvi.asm.org/content/1/2/222|journal=Clinical and Diagnostic Laboratory Immunology|language=en|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref><ref>{{Cite journal | last = Lange | first = Gudrun | last2 = Wang | first2 = Samuel | last3 = DeLuca | first3 = John | last4 = Natelson | first4 = Benjamin H. | date = 1998-09-28 | title = Neuroimaging in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S0002934398001752|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1 | pages = 50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> even in the absence of [[Postural orthostatic tachycardia syndrome|POTS]]/[[Neurally mediated hypotension|NMH]]<ref>{{Citation | title = CMRC Conference 2017 day 1- Prof Dr Frans Visser |url =https://www.youtube.com/watch?v=IWRA23D_MUg|language=en|access-date=2019-09-03}}</ref>
* reduced blood flow to the heart<ref>{{Cite journal | last = Patrick Neary|first = J. | last2 = Roberts | first2 = Andy D.W. | last3 = Leavins | first3 = Nina | last4 = Harrison | first4 = Michael F. | last5 = Croll | first5 = James C. | last6 = Sexsmith | first6 = James R. | date = Nov 2008 | title = Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-097X.2008.00822.x|journal=Clinical Physiology and Functional Imaging|volume=28|issue=6 | pages = 364–372|doi=10.1111/j.1475-097x.2008.00822.x|issn=1475-0961}}</ref><ref>{{Cite journal | last = Peterson | first = PK | last2 = Sirr | first2 = SA | last3 = Grammith | first3 = FC | last4 = Schenck | first4 = CH | last5 = Pheley | first5 = AM | last6 = Hu | first6 = S | last7 = Chao | first7 = C C | date = Mar 1994 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/|journal=Clinical and Diagnostic Laboratory Immunology|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref>
*peripheral endothelial dysfunction, which is an established risk factor for cardiovascular disease<ref name="endothelial2020">{{Cite journal | last = Scherbakov|first = Nadja | authorlink = | last2 = Szklarski | first2 = Marvin | author-link2 = | last3 = Hartwig | first3 = Jelka | author-link3 = | last4 = Sotzny | first4 = Franziska | author-link4 = Franziska Sotzny | last5 = Lorenz | first5 = Sebastian | author-link5 = | last6 = Meyer | first6 = Antje | authorlink6 = Antje Meyer | last7 = Grabowski | first7 = Patricia | last8 = Doehner | first8 = Wolfram | last9 = Scheibenbogen | first9 = Carmen | authorlink9 = Carmen Scheibenbogen | date = 2020 | title=Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12633|journal=ESC Heart Failure|language=en|volume=7|issue=3|pages=1064–1071|doi=10.1002/ehf2.12633|issn=2055-5822|pmc = 7261521|pmid=32154656|access-date=|quote=|via=}}</ref>

=== Blood vessels ===

=== Blood ===
{{Main article|Brain}}
* reduced [[blood]] volume<ref>{{Cite journal | last = Hurwitz|first = BE | last2 = Coryell | first2 = VT | last3 = Parker | first3 = M | last4 = Martin | first4 = P | last5 = LaPerriere .... | first5 = A | last6 = Bilsker | first6 = MS | date = | title = Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function | url =http://www.clinsci.org/content/118/2/125|journal=Clinical Science|volume=118|issue=2|pages=125-135|via=}}</ref><ref>{{Cite journal | last = Streeten | first = DHP | last2 = Bell | first2 = D | date = 1998 | title=Circulating Blood Volume in Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v04n01_02|journal=Journal of Chronic Fatigue Syndrome|volume=4 | pages = 3-11|via=}}</ref>
* abnormally shaped of [[Red blood cell|red blood cells]]<ref name="Simpson1989">{{Citation | last1 = Simpson | first1 = LO | authorlink1 = Leslie Simpson | title = Nondiscocytic erythrocytes in myalgic encephalomyelitis | journal = The New Zealand Medical Journal | volume = 102 | issue = 864 | pages = 126-127 | date = 1989 | pmid = 2927808 | doi = }}</ref><ref>{{Cite journal | last = Richards | first = RS | last2 = Wang | first2 = L | last3 = Jelinek | first3 = H | date = Jan 2007 | title = Erythrocyte oxidative damage in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S0188440906002992|journal=Archives of Medical Research|volume=38|issue=1 | pages = 94-98|via=}}</ref>
* reduced oxygen uptake in [[hemoglobin]]<ref>{{Cite journal | last = Miller | first = Ruth R | last2 = Reid | first2 = W Darlene | last3 = Mattman | first3 = Andre | last4 = Yamabayashi | first4 = Cristiane | last5 = Steiner | first5 = Theodore | last6 = Parker | first6 = Shoshana | last7 = Gardy | first7 = Jennifer | last8 = Tang | first8 = Patrick | last9 = Patrick | first9 = David M | date = 2015-05-20 | title = Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case–control study|url=http://doi.org/10.1186/s12967-015-0527-8|journal=Journal of Translational Medicine|language=en|volume=13|issue=1|doi=10.1186/s12967-015-0527-8|issn=1479-5876|pmc=4438583|pmid=25990639}}</ref>

== Digestive system ==

=== Gastrointestinal tract ===
{{Main article |page_name = Gastrointestinal tract}}
* lower levels of [[Bifidobacteria]], [[Escherichia coli]] and higher levels of [[aerobic bacteria]],<ref>{{Cite journal | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value|url=http://www.medical-hypotheses.com/article/S0306-9877(03)00096-3/abstract|journal=Medical Hypotheses | date = Jun 2003|issn=0306-9877 | pages = 915–923|volume=60|issue=6|doi=10.1016/S0306-9877(03)00096-3|language=English|first = Alan C | last = Logan | first2 = A | last2 = Venket Rao | first3 = Dinaz | last3 = Irani}}</ref> in particular [[Enterococcus]] and [[Streptococcus]] species<ref>{{Cite journal | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=http://www.ncbi.nlm.nih.gov/pubmed/19567398|journal=In Vivo (Athens, Greece) | date = Jul 2009|issn=0258-851X|pmid=19567398 | pages = 621–628|volume=23|issue=4|first = John R. | last = Sheedy | first2 = Richard E.H. | last2 = Wettenhall | first3 = Denis | last3 = Scanlon | first4 = Paul R. | last4 = Gooley | first5 = Donald P. | last5 = Lewis | first6 = Neil | last6 = McGregor | first7 = David I. | last7 = Stapleton | first8 = Henry L. | last8 = Butt | first9 = Kenny L. | last9 = DE Meirleir}}</ref>
* higher levels of enterococcus bacteria in CFS patients were associated with more severe neurological and cognitive dysfunction<ref>https://getinfo.de/en/search/id/BLCP%3ACN055885616/%60Bacterial-Colonosis-in-Patients-with-Persistent/</ref>
* Significantly increased proportions of Firmicutes<ref>{{Cite journal | title = High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients|url=https://www.sciencedirect.com/science/article/pii/S1075996413000929|journal=Anaerobe | date = 2013-08-01|issn=1075-9964 | pages = 50–56|volume=22|doi=10.1016/j.anaerobe.2013.06.002|language=en}}</ref><ref name=":7">{{Cite journal | last = Giloteaux | first = Ludovic | last2 = Goodrich | first2 = Julia K. | last3 = Walters | first3 = William A. | last4 = Levine | first4 = Susan M. | author-link4 = Susan Levine | last5 = Ley | first5 = Ruth E. | last6 = Hanson | first6 = Maureen R. | date = 2016-06-23 | title = Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918027/|journal=Microbiome|volume=4|doi=10.1186/s40168-016-0171-4|issn=2049-2618|pmc=4918027|pmid=27338587}}</ref> and Bacteroides<ref name=":7" />
* CFS patients may suffer from [[small intestinal bacterial overgrowth]] (SIBO) at high rates<ref name="Pimentel2000">{{Citation | last1 = Pimentel | first1 = M | authorlink1 = Mark Pimentel | last2 = Hallegua | first2 = D | authorlink2 = David Hallegua | last3 = Chow | first3 = EJ | authorlink3 = Evelyn Chow | last4 = Wallace | first4 = D | authorlink4 = Daniel Wallace | last5 = Bonorris | first5 = G | authorlink5 = George Bonorris | last6 = Lin | first6 = HC | authorlink6 = Henry Lin | title = Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study | journal = Gastroenterology | volume = 118 | issue = 4| pages = 414 | date = 1 Apr 2000 | doi = 10.1016/S0016-5085(00)83765-8 | url = http://www.gastrojournal.org/article/S0016508500837658/abstract }}</ref>
* Higher levels of serum [[Immunoglobulin A|IgA]] and [[Immunoglobulin M|IgM]] against [[lipopolysaccharide]]s (LPS), a major component of the outer membrane of [[gram-negative bacteria]], indicating translocation.<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivana | last3 = Leunis | first3 = Jean-Claude | date = 2007-04-01 | title = Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): Indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut–intestinal permeability|url=http://www.sciencedirect.com/science/article/pii/S0165032706003557|journal=Journal of Affective Disorders|language=en|volume=99|issue=1|pages=237–240|doi=10.1016/j.jad.2006.08.021|issn=0165-0327}}</ref> Serum [[Immunoglobulin A|IgA]] was significantly correlated to the severity of illness.

=== Liver ===
* Reduced [[liver]] volume<ref>{{Cite journal | title = Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1488525|journal=Fatigue: Biomedicine, Health & Behavior | date = 2018-06-18|issn=2164-1846|pages=141–152|volume=6|issue=3|doi=10.1080/21641846.2018.1488525|language=en | first = Pawel | last = Zalewski | first2 = Andreas | last2 = Finkelmeyer | first3 = James | last3 = Frith | first4 = Laura | last4 = Maclachlan | first5 = Andrew | last5 = Blamire | first6 = Julia L. | last6 = Newton}}</ref>

== Nutrition ==
* low red blood cell [[magnesium]]<ref name="cfs_and_blood_mg">{{Citation | last1 = I.M. | first1 = Cox | authorlink1 = | last2 = M.J. | first2 = Campbell | authorlink2 = | last3 = D. |first3 = Dowson | authorlink3 = | title = Red blood cell magnesium and chronic fatigue syndrome | journal = The Lancet
| year = 1991 | pmid = 1672392 | doi = 10.1016/0140-6736(91)91371-Z }}</ref>
* low serum [[carnitine]]<ref>{{Cite journal | last = Plioplys | first = A.V. | last2 = Plioplys | first2 = S. | date = 1995 | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates|url=https://www.ncbi.nlm.nih.gov/pubmed/8544970|journal=Neuropsychobiology|volume=32|issue=3|pages=132–138|doi=10.1159/000119226|issn=0302-282X|pmid=8544970}}</ref><ref>{{Citation| issn = 1058-4838| volume = 18 | issue =Suppl 1| pages = 62-67| last1 = Kuratsune | first1 = H. | last2 = Yamaguti | first2 = K. | last3 = Takahashi | first3 = M. | last4 = Misaki | first4 = H. | last5 = Tagawa | first5 = S. | last6 = Kitani | first6 = T.| title = Acylcarnitine deficiency in chronic fatigue syndrome| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = January 1994 | pmid = 8148455}}</ref><ref>{{Citation| doi = 10.1111/j.1468-1331.1995.tb00151.x| issn = 1351-5101| volume = 2 | issue = 5| pages = 425–428| last1 = Majeed | first1 = T. | last2 = de Simone | first2 = C. | last3 = Famularo | first3 = G. | last4 = Marcellini | first4 = S. | last5 = Behan | first5 = P.O. | title = Abnormalities of carnitine metabolism in chronic fatigue syndrome| journal = European Journal of Neurology | date = November 1995 | pmid = 24283722}}</ref>

== Metabolism ==
* Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review<ref>{{Cite journal | last = Tomas | first = Cara | last2 = Newton | first2 = Julia | date = 2018-06-19 | title = Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review | url =https://portlandpress.com/biochemsoctrans/article-abstract/46/3/547/67402/Metabolic-abnormalities-in-chronic-fatigue?redirectedFrom=fulltext|journal=Biochemical Society Transactions|language=en|volume=46|issue=3 | pages = 547–553|doi=10.1042/BST20170503|issn=0300-5127}}</ref>
* Analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model of deficient ATP production in ME/CFS.<ref name="Sweetman2020">{{Cite journal | last = Sweetman | first = Eiren | authorlink = | last2 = Kleffmann | first2 = Torsten | authorlink2 = | last3 = Edgar | first3 = Christina | authorlink3 = | last4 = de Lange | first4 = Michel | authorlink4 = | last5 = Vallings | first5 = Rosamund | authorlink5 = Rosamund Vallings | last6 = Tate | first6 = Warren | authorlink6 = Warren Tate | date = 2020-09-24 | title = A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction | url =https://doi.org/10.1186/s12967-020-02533-3|journal=Journal of Translational Medicine|volume=18|issue=1 | pages = 365|doi=10.1186/s12967-020-02533-3|issn=1479-5876|pmc = 7512220|pmid=|access-date=|quote=|via=}}</ref>
=== Cellular respiration ===
* abnormalities in [[cellular respiration]] including a reduction in [[glycolysis]],<ref>{{Cite journal | last = Armstrong | first = Christopher W. | last2 = McGregor | first2 = Neil R. | last3 = Lewis | first3 = Donald P. | last4 = Butt | first4 = Henry L. | last5 = Gooley | first5 = Paul R. | date = 2015-05-30 | title = Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s11306-015-0816-5 | journal=Metabolomics|language=en | volume=11 | issue=6 | pages=1626–1639 | doi=10.1007/s11306-015-0816-5 | issn=1573-3882}}</ref> including impaired [[pyruvate dehydrogenase]]<ref>{{Cite journal | last = Fluge | first = Øystein | last2 = Mella | first2 = Olav | last3 = Bruland | first3 = Ove | last4 = Risa | first4 = Kristin | last5 = Dyrstad | first5 = Sissel E. | last6 = Alme | first6 = Kine | last7 = Rekeland | first7 = Ingrid G. | last8 = Sapkota | first8 = Dipak | last9 = Røsland | first9 = Gro V. | date = 2016-12-22 | title = Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/28018972 | journal=JCI insight|volume=1 | issue=21 | pages = e89376 | doi=10.1172/jci.insight.89376 | issn=2379-3708 | pmc=5161229 | pmid=28018972}}</ref>
* increased [[lactic acid]]<ref name="Plioplys1995">{{cite journal | last1 = Plioplys | first1 = AV | authorlink1 = | last2 = Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates | journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | pages = 132-8 | pmid = 8544970 | url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref><ref name="LaneRJ1998">{{cite journal | last1 = Lane | first1 = RJ | authorlink1 = | last2 = Barrett | first2 = MC | authorlink2 = Michael Barrett | last3 = Taylor | first3 = DJ | authorlink3 = Doris Taylor | last4 = Kemp | first4 = GJ | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle | journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | pages = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref><ref name="JonesDE2010">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome | journal = J Intern Med | volume = 267 | issue = 4 | pages = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref><ref name="LengertN2015">{{cite journal | last1 = Lengert | first1 = Nicor | authorlink1 = Nicor Lengert | last2 = Drossel | first2 = Barbara | authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome | journal = Biophysical Chemistry | volume = 202 | pages = 21–31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009 | url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref><ref name="Mathew2009"/>
* reduction in metabolites reflecting a slowed metabolism<ref>{{Cite journal | last = Naviaux | first = Robert K. | authorlink1 = Robert Naviaux | last2 = Naviaux | first2 = Jane C. | last3 = Li | first3 = Kefeng | last4 = Bright | first4 = A. Taylor | last5 = Alaynick | first5 = William A. | last6 = Wang | first6 = Lin | last7 = Baxter | first7 = Asha | last8 = Nathan | first8 = Neil | last9 = Anderson | first9 = Wayne | date = 2016-09-13 | title = Metabolic features of chronic fatigue syndrome|url=http://www.pnas.org/content/113/37/E5472 | journal=Proceedings of the National Academy of Sciences|language=en | volume=113 | issue=37 | pages = E5472–E5480 | doi=10.1073/pnas.1607571113 | issn=0027-8424 | pmid=27573827}}</ref>
*analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model...that would suggest an elevation of oxidative stress.<ref name="Sweetman2020" />

=== Exercise ===
* reduced pain threshold<ref name="Whiteside, 2004">{{Cite journal | last1 = Whiteside | first1 = Alan | authorlink1 = | last2 = Hansen | first2 = Stig | authorlink2 = | last3 = Chaudhuri | first3 = Abhijit | authorlink3 = Abhijit Chaudhuri | title = Exercise lowers pain threshold in chronic fatigue syndrome | journal = Pain | volume = 109 | issue = 3 | pages = 497-499 | date = 2004 | pmid = 15157711 | doi = 10.1016/j.pain.2004.02.029 }}</ref>
* translocation of bacteria<ref name="ShuklaS2015">{{cite journal | last1 = Shukla | first1 = Sanjay K | authorlink1 = Sanjay Shukla | last2 = Cook | first2 = Dane | authorlink2 = Dane Cook | last3 = Meyer | first3 = Jacob | authorlink3 = Jacob Meyer | last4 = Vernon | first4 = Suzanne D | authorlink4 = Suzanne Vernon | last5 = Le | first5 = Thao | authorlink5 = Thao Le | last6 = Clevidence | first6 = Derek | authorlink6 = Derek Clevidence | last7 = Robertson | first7 = Charles E | authorlink7 = Charles Robertson | last8 =Schrodi | first8 = Steven J | authorlink8 = Steven Schrodi | last9 = Yale | first9 = Steven | authorlink9 = Steven Yale | last10 = Frank | first10 = Daniel N | authorlink10 = Daniel Frank | title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | journal = PLoS ONE | date = Dec 18, 2015 | pmid = 26683192 | doi = 10.1371/journal.pone.0145453 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453 }}</ref>
* loss of capacity to recover from acidosis on repeat exercise<ref name="JonesDE2012">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = David Jones | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 = Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | authorlink7 = Michael Trenell | last8 = Newton | first8 = Julia L | authorlink8 = Julia Newton | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | pages = 186-94 | date = 12 Jul 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref>
* increased expression of sensory, adrenergic and immune genes following [[muscle]] exertion<ref name="LightAR2009">{{cite journal | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = White | first2 = Andrea T | authorlink2 = | last3 = Hughen | first3 = Ronald W | authorlink3 = | last4 = Light | first4 = Kathleen C | authorlink4 = Kathleen Light | title = Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects | journal = J Pain | volume = 10 | issue = 10 | pages = 1099-112 | date = Jul 31, 2009 | pmid = 19647494 | doi = 10.1016/j.jpain.2009.06.003 | url = http://www.jpain.org/article/S1526-5900(09)00574-4/abstract }}</ref><ref name="LightAR2011">{{citation | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = Bateman | first2 = Lucinda| authorlink2 = Lucinda Bateman | last3 = Jo | first3 = D | authorlink3 = Daehyun Jo | last4 = Hughen | first4 = Ronald W | authorlink4 = Ronald Hughen | last5 = Vanhaitsma | first5 = TA | authorlink5 = Timothy VanHaitsma | last6 = White | first6 = Andrea T | authorlink6 = Andrea White | last7 =Light | first7 = Kathleen C | authorlink7 = Kathleen Light | title = Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome | journal = J Intern Med | volume = 271 | issue = 1 | pages = 64-81 | date = Jul 13, 2011 | pmid = 21615807 | doi = 10.1111/j.1365-2796.2011.02405.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/abstract }}</ref><ref name="WhiteAT2012">{{citation | last1 = White | first1 = Andrea T | authorlink1 = Andrea White | last2 = Light | first2 = Alan R | authorlink2 = Alan Light | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 = Timothy A | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C | authorlink5 = Kathleen Light | title = Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls | journal = Psychosom Med | volume = 74 | issue = 1 | pages = 46-54 | date = Dec 30, 2011 | pmid = 22210239 | doi = 10.1097/PSY.0b013e31824152ed | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/ }}</ref>
* decreased [[oxygen]] utilization<ref>{{Cite journal | last = Vermeulen | first = Ruud CW | authorlink = Ruud Vermeulen | last2 = Vermeulen van Eck | first2 = Ineke WG| date = 2014 | title = Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome|url=https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-20|journal=Journal of Translational Medicine|language=en|volume=12|issue=1|pages=20|doi=10.1186/1479-5876-12-20|issn=1479-5876|pmc=3903040|pmid=24456560}}</ref>

[[File:Abnormal findings in CFS ME.png|thumb|center|alt=Abnormal findings in Chronic fatigue syndrome and myalgic encephalomyelitis. There is no single biomarker, but tests have found differences in blood flow to the brain, hand grip strength, metabolite and mitochondria abnormalities, reduced heart output, white and red blood cell differences, reduced blood volume, differences in gut bacteria, neuroinflammation, abnormal responses to exercise, and other abnormalities.]]

== See also ==
* [[Myalgic encephalomyelitis]]
* [[List of systematic reviews about ME/CFS]]
* [[:Category:Abnormal findings|Abnormal findings (images)]]

== Learn more ==
* [https://www.mdpi.com/2075-4418/9/2/41 Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (2019)] - original research article
* [http://www.meaction.net/wp-content/uploads/2015/05/ME2FCFS-RESEARCH-SUMMARY-Jamie-Seltzer.pdf #MEAction ME/CFS Research Summary]

==References==
{{Reflist}}

[[Category:Signs and symptoms]]
[[Category:Lists]]

List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:09:35Z

YellowWaterLilly:/* Muscular system */ Added information from study found here: https://www.mdpi.com/2075-4418/9/2/41 thanks to the suggestion on discussion page

[[Myalgic encephalomyelitis]]/[[chronic fatigue syndrome]] is a complex multi-system disease and biological abnormalities in patients have been found affecting multiple bodily systems. No single [[diagnostic biomarker|biomarker]]-based diagnostic test has been validated but patients have a range abnormal physical findings affecting multiple bodily systems.<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> The CDC states that diagnosing ME/CFS relies on a physical and psychiatric assessment, observations, medical history, clinical interview, and results from a mix of blood and urine tests.<ref name="CDC2020diagnosis">{{Cite web|url=https://www.cdc.gov/me-cfs/symptoms-diagnosis/diagnosis.html | title = Diagnosis of ME/CFS {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = Centers of Disease Control|first = | authorlink = Centers for Disease Control and Prevention | date = 2019-05-15 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2020-09-26}}</ref>

== Nervous system ==
===Brain ===
{{Main article|Brain}}
*Progressive brain changes<ref name="Shan2016"/>

=== Central nervous system ===
{{Main article |page_name =Central nervous system}}
* increased [[Ventricular system|ventricular]] [[lactate]]<ref name="Mathew2009">{{Cite journal | last = Mathew|first = Sanjay J. | last2 = Mao | first2 = Xiangling | last3 = Keegan | first3 = Kathryn A. | last4 = Levine | first4 = Susan M. | authorlink4 = Susan Levine | last5 = Smith | first5 = Eric L.P. | last6 = Heier | first6 = Linda A. | last7 = Otcheretko | first7 = Viktor | last8 = Coplan | first8 = Jeremy D. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Apr 2009 | title = Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: anin vivo3.0 T1H MRS imaging study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/nbm.1315|journal=NMR in Biomedicine|language=en|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480}}</ref><ref name="Murrough2010">{{Cite journal | last = Murrough|first = James W. | last2 = Mao | first2 = Xiangling | last3 = Collins | first3 = Katherine A. | last4 = Kelly | first4 = Chris | last5 = Andrade | first5 = Gizely | last6 = Nestadt | first6 = Paul | last7 = Levine | first7 = Susan M. | authorlink7 = Susan Levine | last8 = Mathew | first8 = Sanjay J. | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = Jul 2010 | title = Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder | url =https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in Biomedicine|volume=23|issue=6 | pages = 643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref><ref name="Shungu2012">{{Cite journal | last = Shungu | first = Dikoma C. | authorlink1 = Dikoma Shungu | last2 = Weiduschat | first2 = Nora | last3 = Murrough | first3 = James W. | last4 = Mao | first4 = Xiangling | last5 = Pillemer | first5 = Sarah | last6 = Dyke | first6 = Jonathan P. | last7 = Medow | first7 = Marvin S. | last8 = Natelson | first8 = Benjamin H. | authorlink8 = Benjamin Natelson | last9 = Stewart | first9 = Julian M. | date = Sep 2012 | title = Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name="Natelson2017">{{Cite journal | last = Natelson | first = Benjamin H. | authorlink1 = Benjamin Natelson | last2 = Vu | first2 = Diana | last3 = Coplan | first3 = Jeremy D. | last4 = Mao | first4 = Xiangling | last5 = Blate | first5 = Michelle | last6 = Kang | first6 = Guoxin | last7 = Soto | first7 = Eli | last8 = Kapusuz | first8 = Tolga | last9 = Shungu | first9 = Dikoma C. | authorlink9 = Dikoma Shungu | date = 2017-01-02 | title = Elevations of ventricular lactate levels occur in both chronic fatigue syndrome and fibromyalgia|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1280114?journalCode=rftg20|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref>
* neuroinflammation<ref name="Nakatomi2014">{{Cite journal | last = Nakatomi|first = Yasuhito | last2 = Mizuno | first2 = Kei | last3 = Ishii | first3 = Akira | last4 = Wada | first4 = Yasuhiro | last5 = Tanaka | first5 = Masaaki | last6 = Tazawa | first6 = Shusaku | last7 = Onoe | first7 = Kayo | last8 = Fukuda | first8 = Sanae | last9 = Kawabe | first9 = Joji | date = 2014-06-01 | title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study|url=http://jnm.snmjournals.org/content/55/6/945|journal=Journal of Nuclear Medicine|language=en|volume=55|issue=6 | pages = 945–950|doi=10.2967/jnumed.113.131045|issn=0161-5505|pmid=24665088}}</ref><ref name="Zeineh2014">{{citation | last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh | last2 = Kang | first2 = James | authorlink2 = James Kang | last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas | last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman | last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss | last6 =Norris | first6 = Jane L | authorlink6 = Jane Norris | last7 =Valencia | first7 = Ian | authorlink7 = Ian Valencia | last8 =Montoya | first8 = Jose G | authorlink8 = Jose Montoya | title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome| journal = Radiology | volume = 274 | issue = 2| pages = 517–526 | date = 2014-10-29| doi = 10.1148/radiol.14141079| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079}}</ref><ref name="Mueller2019">{{Cite journal|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4 | title = Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy | last = Mueller | first = Christina | authorlink=Christina Mueller | last2 = Lin | first2 = Joanne C | authorlink2 = Joanne Lin | date = 2019 | doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|url-status=|access-date=2019-01-17 | authorlink3 = Sulaiman Sheriff | authorlink4 = Andrew Maudsley | authorlink5 = Jarred Younger | last3 = Sheriff | last4 = Maudsley | last5 = Younger | first3 = Sulaiman | first4 = Andrew A | first5 = Jarred W|volume=|issue=|pages= | page = |journal=Brain Imaging and Behavior}}</ref><ref name="RamsayAward20190117">{{Cite web|url=http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 | title = Brain Imaging and Behavior publication from Dr. Jarred Younger’s SMCI Ramsay pilot study supports involvement of neuroinflammation in ME/CFS|website=go.solvecfs.org|access-date=2019-01-17 | date = | last = | first = | authorlink = |archive-url=|archive-date=|url-status=}}</ref>
* reduced [[Grey matter|grey]]<ref name="Puri2012">{{Cite journal | last = Puri|first = B K | last2 = Jakeman | first2 = P M | last3 = Agour | first3 = M | last4 = Gunatilake | first4 = K D R | last5 = Fernando | first5 = K A C | last6 = Gurusinghe | first6 = A I | last7 = Treasaden | first7 = I H | last8 = Waldman | first8 = A D | last9 = Gishen | first9 = P | date = Jul 2012 | title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study|url=https://www.birpublications.org/doi/full/10.1259/bjr/93889091|journal=The British Journal of Radiology|language=en|volume=85|issue=1015| pages = e270–e273|doi=10.1259/bjr/93889091|issn=0007-1285|pmc=3474083|pmid=22128128}}</ref> and [[white matter]]<ref name="Shan2016">{{Cite journal | last = Shan | first = Zack Y. | authorlink = Zack Shan | last2 = Kwiatek | first2 = Richard | last3 = Burnet | first3 = Richard | last4 = Del Fante | first4 = Peter | last5 = Staines | first5 = Donald R. | last6 = Marshall-Gradisnik | first6 = Sonya M. | last7 = Barnden | first7 = Leighton R. | date = 2016-04-28 | title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study|url=https://onlinelibrary.wiley.com/doi/full/10.1002/jmri.25283|journal=Journal of Magnetic Resonance Imaging|language=en|volume=44|issue=5|pages=1301–1311|doi=10.1002/jmri.25283|issn=1053-1807|pmc=5111735|pmid=27123773}}</ref><ref name="Puri2012" />
* [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|widespread metabolite abnormalities]]<ref name="Mueller2019"/>

=== Autonomic nervous system ===
{{Main article |page_name =Autonomic nervous system}}
* Orthostatic intolerance<ref>Gerwin Morris, Michael Maes, see citations 12 through 27 in [http://www.biomedcentral.com/1741-7015/11/205 "Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics"] BMC Medicine, 17 September 2013</ref><ref>{{Cite journal | last = Miwa | first = K | date = Jul 2015 | title = Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle|url=https://www.ncbi.nlm.nih.gov/pubmed/24736946|journal=Heart and Vessels|volume=30|issue=4 | pages = 484–489|via=}}</ref>

=== Peripheral nervous system ===
{{Main article |page_name =Peripheral nervous system}}

== Muscular system ==
{{Main article |page_name =Muscle}}
*[[Mitochondrion|mitochondria]]l abnormalities found via [[muscle biopsy]] including: mitochondrial degeneration,<ref>{{Cite journal | last = Behan | first = W. M.H. | last2 = More | first2 = I.A.R. | last3 = Behan | first3 = P.O. | date = Dec 1991 | title = Mitochondrial abnormalities in the postviral fatigue syndrome|url=https://link.springer.com/article/10.1007/BF00294431|journal=Acta Neuropathologica|language=en|volume=83|issue=1 | pages = 61–65|doi=10.1007/bf00294431|issn=0001-6322}}</ref> deletions of mitochondrial DNA,<ref name=":0">{{Cite journal | date = 1996-04-19 | title = Sensory characterization of somatic parietal tissues in humans with chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/abs/pii/0304394096125593|journal=Neuroscience Letters|language=en|volume=208|issue=2|pages=117–120|doi=10.1016/0304-3940(96)12559-3|issn=0304-3940}}</ref><ref>{{Cite journal | last = Zhang|first = C. | last2 = Baumer | first2 = A. | last3 = Mackay | first3 = I.R. | last4 = Linnane | first4 = A.W. | last5 = Nagley | first5 = P. | date = Apr 1995 | title = Unusual pattern of mitochondrial DNA deletions in skeletal muscle of an adult human with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/7633428|journal=Human Molecular Genetics|volume=4|issue=4 | pages = 751–754|issn=0964-6906|pmid=7633428}}</ref> the reduction of mitochondrial activity<ref name=":0" />
*Increased urinary [[creatine]] excretion during relapses<ref>{{Cite journal | last = Albrecht | first = Robert | date = March 21, 1964 | title = Epidemic Neuromyasthenia Outbreak in a Convent in New York State|url=https://www.ncbi.nlm.nih.gov/pubmed/14100144|journal=Journal of the American Medical Association|volume=187 | pages = 904-907|via=}}</ref>
*Increased [[creatine kinase]] ([[postviral fatigue syndrome]])
*Persistence of [[enterovirus]]es in muscle tissue<ref name=":1">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W. M.H. | last3 = Simpson | first3 = K. | last4 = McGarry | first4 = F. | last5 = Keir | first5 = S. | last6 = Behan | first6 = P.O. | date = 1994-01-01 | title = Studies on Enterovirus in Patients with Chronic Fatigue Syndrome|url=https://academic.oup.com/cid/article-abstract/18/Supplement_1/S126/316946|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Suppl 1|pages=S126–S129|doi=10.1093/clinids/18.Supplement_1.S126|issn=1537-6591}}</ref><ref name=":2">{{Cite journal | last = Cunningham|first = Louise | last2 = Bowles | first2 = N.E. | last3 = Lane | first3 = R. J.M. | last4 = Dubowitz | first4 = V. | last5 = Archard | first5 = L.C. | date = 1990 | title = Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA|url=http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/0022-1317-71-6-1399|journal=Journal of General Virology|volume=71|issue=6|pages=1399–1402|doi=10.1099/0022-1317-71-6-1399}}</ref><ref name=":3">{{Cite journal | last = Archard | first = LC | last2 = Bowles | first2 = NE | last3 = Behan | first3 = PO | last4 = Bell | first4 = EJ | last5 = Doyle | first5 = D | date = 1988-06-01 | title = Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase, Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase|url=https://doi.org/10.1177/014107688808100608|journal=Journal of the Royal Society of Medicine|language=en|volume=81|issue=6 | pages = 326–329|doi=10.1177/014107688808100608|issn=0141-0768|pmc=1291623|pmid=3404526}}</ref><ref name=":4">{{Cite journal | last = Gow|first = J.W. | last2 = Behan | first2 = W.M. | last3 = Clements | first3 = G.B. | last4 = Woodall | first4 = C. | last5 = Riding | first5 = M. | last6 = Behan | first6 = P.O. | date = 1991-03-23 | title = Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome.|url=https://www.bmj.com/content/302/6778/692|journal=BMJ|language=en|volume=302|issue=6778 | pages = 692–696|doi=10.1136/bmj.302.6778.692|issn=0959-8138|pmid=1850635}}</ref>
*Abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | authorlink1 = Audrey Brown | last2 = Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = 2 Apr 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref><ref name="Wellness20150420">{{citation | last1 = Dobberstein | first1 = Linda J. | authorlink1 = | title = Master Enzyme Switch Deactivated In Chronic Fatigue Syndrome and Fibromyalgia | journal = Wellness Resources | date = 20 Apr 2015 | url = http://www.wellnessresources.com/health/articles/master_enzyme_switch_deactivated_in_chronic_fatigue_syndrome_and_fibromyalg/ }}</ref>
*Reduce serum [[creatine kinase]] in people with severe ME.<ref>{{Cite journal|title=Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study|date=April 10, 2019|url=https://www.mdpi.com/2075-4418/9/2/41|journal=Biomedical Insights that Inform the Diagnosis of ME/CFS|last=Nacul|first=Luis|author-link=Luis Nacul|last2=de Barros|first2=Barbara|last3=Kingdon|first3=Caroline C.|author-link3=Caroline Kingdon|last4=Cliff|first4=Jacqueline M.|author-link4=Jacqueline Cliff|last5=Clark|first5=Taane G.|author-link5=Taane Clark|last6=Mudie|first6=Kathleen|last7=Dockrell|first7=Hazel M.|author-link7=Hazel Dockrell|last8=Lacerda|first8=Eliana M.|author-link8=Eliana Lacerda|access-date=September 11, 2025|via=Diagnostics}}</ref>

== Immune system ==
{{Main article |page_name =Immune system}}
=== Immune dysregulation ===
* [[Natural killer cell]] function is reduced<ref>{{Cite journal | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology | date = Apr 2014|issn=1460-2377|pmid=24343819|pages=233–242|volume=26|issue=4|doi=10.1093/intimm/dxt068|first = Ekua Weba | last = Brenu | first2 = Teilah K. | last2 = Huth | first3 = Sharni L. | last3 = Hardcastle | first4 = Kirsty | last4 = Fuller | first5 = Manprit | last5 = Kaur | first6 = Samantha | last6 = Johnston | first7 = Sandra B. | last7 = Ramos | first8 = Don R. | last8 = Staines | first9 = Sonya M. | last9 = Marshall-Gradisnik}}</ref><ref>{{Cite journal | last = Victoria Scott | first = David Strayer | date = 2015 | title=Low NK Cell Activity in Chronic Fatigue Syndrome (CFS) and Relationship to Symptom Severity|url=https://www.omicsonline.org/open-access/low-nk-cell-activity-in-chronic-fatigue-syndrome-cfs-and-relationship-to-symptom-severity-2155-9899-1000348.php?aid=59415|journal=Journal of Clinical & Cellular Immunology|language=en|volume=6|issue=4|doi=10.4172/2155-9899.1000348|issn=2155-9899}}</ref>
* [[Cytokine]] dysregulation<ref name="Montoya, 2017">{{citation | last1 = Montoya | first1 = Jose G. | authorlink1 = Jose Montoya | last2 = Holmes | first2 = Tyson H. | authorlink2 = | last3 = Anderson | first3 = Jill N. | authorlink3 = | last4 = Maecker | first4 = Holden T. | authorlink4 = | last5 = Rosenberg-Hasson | first5 = Yael | authorlink5 = | last6 = Valencia | first6 = Ian J. | authorlink6 = | last7 = Chu | first7 = Lily | authorlink7 = Lily Chu | last8 =Younger | first8 = Jarred W. | authorlink8 = Jarred Younger | last9 =Tato | first9 = Cristina M. | authorlink9 = | last10 = Davis | first10 = Mark M. | authorlink10 = Mark Davis | title = Cytokine signature associated with disease severity in chronic fatigue syndrome patients | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 34 | pages = E7150-E7158 | date = 2017 | pmid = | doi = 10.1073/pnas.1710519114 }}</ref><ref>[http://www.meaction.net/2015/12/07/study-finds-evidence-of-downregulated-immune-system-in-mecfs-patients Study finds evidence of downregulated immune system in ME/CFS patients - MEAction - Landi, et al.]</ref><ref>[http://microbediscovery.org/2017/04/04/new-research-discovers-evidence-of-atypical-classical-mecfs/ New Research Discovers Evidence of Atypical & Classical ME/CFS - The Microbe Discovery Project - Apr 4, 2017]</ref>
* Elevated [[regulatory T cell]]s<ref>{{Cite journal | last = Brenu|first = Ekua Weba | last2 = Huth | first2 = Teilah K. | last3 = Hardcastle | first3 = Sharni L. | last4 = Fuller | first4 = Kirsty | last5 = Kaur | first5 = Manprit | last6 = Johnston | first6 = Samantha | last7 = Ramos | first7 = Sandra B. | last8 = Staines | first8 = Don R. | last9 = Marshall-Gradisnik | first9 = Sonya M. | date = Apr 2014 | title = Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis|url=http://www.ncbi.nlm.nih.gov/pubmed/24343819|journal=International Immunology|volume=26|issue=4|pages=233–242|doi=10.1093/intimm/dxt068|issn=1460-2377|pmid=24343819}}</ref>
* increased [[mast cell]] populations<ref>{{Cite journal | last = Rönnberg|first = E | last2 = Calounova | first2 = G | last3 = Pejler | first3 = G | date = June 2017 | title = Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients|url=https://www.ncbi.nlm.nih.gov/pubmed/27362406|journal=Asian Pac J Allergy Immunol|volume=35|issue=2 | pages = 75-81|via=}}</ref>
* elevated anti-cholinergic [[Muscarinic acetylcholine receptor|muscarinic]], Β-adrenergic,<ref>{{Cite journal | last = Loebel|first = Madlen | last2 = Grabowski | first2 = Patricia | last3 = Heidecke | first3 = Harald | last4 = Bauer | first4 = Sandra | last5 = Hanitsch | first5 = Leif G. | last6 = Wittke | first6 = Kirsten | last7 = Meisel | first7 = Christian | last8 = Reinke | first8 = Petra | last9 = Volk | first9 = Hans-Dieter | date = Feb 2016 | title = Antibodies to β adrenergic and muscarinic cholinergic receptors in patients with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/26399744|journal=Brain, Behavior, and Immunity|volume=52 | pages = 32–39|doi=10.1016/j.bbi.2015.09.013|issn=1090-2139|pmid=26399744}}</ref> [[phosphatidylinositol]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivanka | last3 = Leunis | first3 = Jean-Claude | date = Dec 2007 | title = Increased serum IgM antibodies directed against phosphatidyl inositol (Pi) in chronic fatigue syndrome (CFS) and major depression: evidence that an IgM-mediated immune response against Pi is one factor underpinning the comorbidity between both CFS and depression | url =https://www.ncbi.nlm.nih.gov/pubmed/18063934|journal=Neuro Endocrinology Letters|volume=28|issue=6 | pages = 861–867|issn=0172-780X|pmid=18063934}}</ref> and [[serotonin]]<ref>{{Cite journal | last = Maes | first = Michael | last2 = Ringel | first2 = Karl | last3 = Kubera | first3 = Marta | last4 = Anderson | first4 = George | last5 = Morris | first5 = Gerwyn | last6 = Galecki | first6 = Piotr | last7 = Geffard | first7 = Michel | date = 2013-09-05 | title = In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation | url =https://www.ncbi.nlm.nih.gov/pubmed/23664637|journal=Journal of Affective Disorders|volume=150|issue=2|pages=223–230|doi=10.1016/j.jad.2013.03.029|issn=1573-2517|pmid=23664637}}</ref> autoantibodies
* Reduced CD4+ function<ref name=":5">{{Cite journal|title=Myalgic encephalomyelitis/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations|date=2020-03-02|url=https://pubmed.ncbi.nlm.nih.gov/31830003/|journal=The Journal of Clinical Investigation|volume=130|issue=3|pages=1491–1505|last=Mandarano|first=Alexandra H.|last2=Maya|first2=Jessica|last3=Giloteaux|first3=Ludovic|last4=Peterson|first4=Daniel L.|last5=Maynard|first5=Marco|last6=Gottschalk|first6=C. Gunnar|last7=Hanson|first7=Maureen R.|doi=10.1172/JCI132185|pmc=7269566|pmid=31830003|issn=1558-8238}}</ref> and reduced CD4+ count<ref name=":6">{{Cite journal|title=Study of immune alterations in patients with chronic fatigue syndrome with different etiologies|date=2004|url=https://pubmed.ncbi.nlm.nih.gov/15345193/|journal=International Journal of Immunopathology and Pharmacology|volume=17|issue=2 Suppl|pages=57–62|last=Racciatti|first=D.|last2=Dalessandro|first2=M.|last3=Delle Donne|first3=L.|last4=Falasca|first4=K.|last5=Zingariello|first5=P.|last6=Paganelli|first6=R.|last7=Pizzigallo|first7=E.|last8=Vecchiet|first8=J.|doi=10.1177/03946320040170S210|pmid=15345193|issn=0394-6320}}</ref>
* Reduced CD8+ function<ref name=":5" /> and reduced CD8+ count<ref name=":6" />
* Lowered CD4+/CD8+ ratio<ref>{{Cite journal|title=Increased expression of activation antigens on CD8+ T lymphocytes in Myalgic Encephalomyelitis/chronic fatigue syndrome: inverse associations with lowered CD19+ expression and CD4+/CD8+ ratio, but no associations with (auto)immune, leaky gut, oxidative and nitrosative stress biomarkers|date=2015-01-01|url=https://europepmc.org/article/med/26707044|journal=Neuro endocrinology letters|volume=36|issue=5|pages=439–446|last=Maes|first=Michael|last2=Bosmans|first2=Eugene|last3=Kubera|first3=Marta|pmid=26707044|issn=2354-4716}}</ref>

=== Chronic infection ===
* [[Enterovirus]]: Persistence of [[enterovirus]]es in muscle tissue;<ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name=":4" /> brain;<ref name="McGarry19942">{{citation | last1 = McGarry | first1 = Frances | author-link1 = Frances McGarry | last2 = Gow | first2 = John | authorlink2 = John Gow | last3 = Behan | first3 = Peter O | authorlink3 = Peter O Behan | title = Enterovirus in the Chronic Fatigue Syndrome | journal = Annals of Internal Medicine | volume = 120 | issue = 11| pages = 972–973 | date = Jun 1, 1994 | doi = 10.7326/0003-4819-120-11-199406010-00020 | url = http://www.ncbi.nlm.nih.gov/pubmed/8172448 }}</ref> and gut;<ref name="ChiaJKS2016">{{Cite journal | last1 = Chia | first1 = JKS | authorlink1 = John Chia | last2 = Chia | first2 = AY | authorlink2 = Andrew Chia | title = Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach | journal = Journal of Clinical Pathology | volume = 61 | issue = 1| pages = 43–48 | date = Jan 1, 2008 | pmid = 17872383 | doi = 10.1136/jcp.2007.050054 | url = http://jcp.bmj.com/content/61/1/43 }}</ref> increased detection of viral [[RNA]] via PCR; increased [[:Category:Antibodies|antibodies]]
* [[Herpesvirus]]{{citation needed}}

== Lymphatic system ==

== Cardiovascular system ==

{{Main article|page_name =Cardiovascular system}}{{Main article|page_name =Cardiac problems in ME/CFS}}

=== Heart ===
* Smaller than normal [[left ventricle]] of the [[heart]],<ref name=":8">Miwa K., [http://www.ncbi.nlm.nih.gov/pubmed/24736946 "Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle"] Heart Vessels, July 2015</ref><ref>Hollingsworth K.G [http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1365-2796.2011.02429.x/ "Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging"] J Intern Med 2012; 271: 264–270.</ref><ref name="Olimulder, 2016">{{Cite journal | last1 = Olimulder | first1 = M.A.G.M. | authorlink1 = | last2 = Galjee | first2 = M.A. | authorlink2 = | last3 = Wagenaar | first3 = L.J. | authorlink3 = | last4 = van Es | first4 = J. | authorlink4 = | last5 = van der Palen | first5 = J. | authorlink5 = | last6 = Visser | first6 = F.C. | authorlink6 = | last7 =Vermeulen | first7 = R.C.W. | authorlink7 = | last8 = von Birgelen | first8 = C. | authorlink8 = | title = Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging | journal = Netherlands Heart Journal | volume = 24 | pages = 709–716 | date = 2016 | url = https://link.springer.com/article/10.1007/s12471-016-0885-8 | doi = 10.1007/s12471-016-0885-8 }}</ref><ref>[http://openheart.bmj.com/content/3/1/e000381.long Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study]</ref> [[small heart syndrome]],<ref name=":8" /> and low [[Cardiovascular system|cardiac]] output.<ref>Miwa K., Fujita M., [http://www.ncbi.nlm.nih.gov/pubmed/19881233 "Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome"] Intern Med, 2009;48(21):1849-54</ref>
* Mean age of death from heart failure of [[chronic fatigue syndrome|CFS]] patients is 58.7 years as compared to 83.1 years for the general population.<ref>Jason LA, Corradi K, Gress S, Williams S, Torres-Harding S, [http://www.ncbi.nlm.nih.gov/pubmed/16844674 "Causes of death among patients with chronic fatigue syndrome"] Health Care Women Int., 27(7): 615-626. 2006</ref>
=== Circulation ===
* reduced blood flow to the [[Brain|brain,]]<ref name="Natelson, 2017">{{Cite journal | last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson | last2 = Mao | first2 = Xiangling | last3 = Stegner | first3 = Aaron J | last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange | last5 = Vu | first5 = Diana | last6 = Blate | first6 = Michelle | last7 = Kang | first7 = Guoxin | last8 = Soto | first8 = Eli | last9 = Kapusuz | first9 = Tolga | last10 = Shungu | first10 = Dikoma C | authorlink10 = Dikoma Shungu | title=Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity | date = 2017 | journal=Journal of the Neurological Sciences|volume=375|issue= | page = 411-416|doi=10.1016/j.jns.2017.02.046|pmid=|quote=}}</ref><ref name=":32">{{Cite journal | last = Costa|first = D.C. | last2 = Tannock | first2 = C. | last3 = Brostoff | first3 = J. | date = Nov 1995 | title = Brainstem perfusion is impaired in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8542261|journal=QJM: monthly journal of the Association of Physicians|volume=88|issue=11 | pages = 767–773|issn=1460-2725|pmid=8542261}}</ref><ref name=":10">{{Cite journal | last = Barnden | first = Leighton R. | last2 = Crouch | first2 = Benjamin | last3 = Kwiatek | first3 = Richard | last4 = Burnet | first4 = Richard | last5 = Mernone | first5 = Anacleto | last6 = Chryssidis | first6 = Steve | last7 = Scroop | first7 = Garry | last8 = Del Fante | first8 = Peter | date = 2011 | title = A brain MRI study of chronic fatigue syndrome: evidence of brainstem dysfunction and altered homeostasis|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/nbm.1692|journal=NMR in Biomedicine|language=en|volume=24|issue=10|pages=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc = 4369126|pmid=21560176}}</ref><ref>{{Cite journal | last = Biswal|first = Bharat | last2 = Kunwar | first2 = Pratap | last3 = Natelson | first3 = Benjamin H. | authorlink1 = Benjamin Natelson | date = 2011-02-15 | title = Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling | url =http://www.sciencedirect.com/science/article/pii/S0022510X10005666|journal=Journal of the Neurological Sciences|volume=301|issue=1 | pages = 9–11 |doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{Cite journal | last = Yoshiuchi|first = Kazuhiro | last2 = Farkas | first2 = Jeffrey | last3 = Natelson | first3 = Benjamin H. | authorlink3 = Benjamin Natelson | date = 2006 | title=Patients with chronic fatigue syndrome have reduced absolute cortical blood flow | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-097X.2006.00649.x|journal=Clinical Physiology and Functional Imaging|language=en|volume=26|issue=2 | pages = 83–86|doi=10.1111/j.1475-097X.2006.00649.x|issn=1475-097X}}</ref><ref>{{Cite journal | last = Freedman | first = M. | last2 = Kirsh | first2 = J.C. | last3 = Gray | first3 = B. | last4 = Chung | first4 = D.G. | last5 = Abbey | first5 = S.E. | last6 = Salit | first6 = I.E. | last7 = Ichise | first7 = M. | date = Oct 1992 | title = Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome.|url=http://europepmc.org/abstract/med/1491843|journal=Nuclear medicine communications|volume=13|issue=10 | pages = 767–772|issn=0143-3636|pmid=1491843}}</ref><ref>{{Cite journal | last = Chao|first = C.C. | last2 = Hu | first2 = S. | last3 = Pheley | first3 = A.M. | last4 = Schenck | first4 = C.H. | last5 = Grammith | first5 = F.C. | last6 = Sirr | first6 = S.A. | last7 = Peterson | first7 = P.K. | date = 1994-03-01 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://cvi.asm.org/content/1/2/222|journal=Clinical and Diagnostic Laboratory Immunology|language=en|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref><ref>{{Cite journal | last = Lange | first = Gudrun | last2 = Wang | first2 = Samuel | last3 = DeLuca | first3 = John | last4 = Natelson | first4 = Benjamin H. | date = 1998-09-28 | title = Neuroimaging in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S0002934398001752|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1 | pages = 50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> even in the absence of [[Postural orthostatic tachycardia syndrome|POTS]]/[[Neurally mediated hypotension|NMH]]<ref>{{Citation | title = CMRC Conference 2017 day 1- Prof Dr Frans Visser |url =https://www.youtube.com/watch?v=IWRA23D_MUg|language=en|access-date=2019-09-03}}</ref>
* reduced blood flow to the heart<ref>{{Cite journal | last = Patrick Neary|first = J. | last2 = Roberts | first2 = Andy D.W. | last3 = Leavins | first3 = Nina | last4 = Harrison | first4 = Michael F. | last5 = Croll | first5 = James C. | last6 = Sexsmith | first6 = James R. | date = Nov 2008 | title = Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-097X.2008.00822.x|journal=Clinical Physiology and Functional Imaging|volume=28|issue=6 | pages = 364–372|doi=10.1111/j.1475-097x.2008.00822.x|issn=1475-0961}}</ref><ref>{{Cite journal | last = Peterson | first = PK | last2 = Sirr | first2 = SA | last3 = Grammith | first3 = FC | last4 = Schenck | first4 = CH | last5 = Pheley | first5 = AM | last6 = Hu | first6 = S | last7 = Chao | first7 = C C | date = Mar 1994 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients.|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/|journal=Clinical and Diagnostic Laboratory Immunology|volume=1|issue=2|pages=222–226|issn=1071-412X|pmid=7496949}}</ref>
*peripheral endothelial dysfunction, which is an established risk factor for cardiovascular disease<ref name="endothelial2020">{{Cite journal | last = Scherbakov|first = Nadja | authorlink = | last2 = Szklarski | first2 = Marvin | author-link2 = | last3 = Hartwig | first3 = Jelka | author-link3 = | last4 = Sotzny | first4 = Franziska | author-link4 = Franziska Sotzny | last5 = Lorenz | first5 = Sebastian | author-link5 = | last6 = Meyer | first6 = Antje | authorlink6 = Antje Meyer | last7 = Grabowski | first7 = Patricia | last8 = Doehner | first8 = Wolfram | last9 = Scheibenbogen | first9 = Carmen | authorlink9 = Carmen Scheibenbogen | date = 2020 | title=Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12633|journal=ESC Heart Failure|language=en|volume=7|issue=3|pages=1064–1071|doi=10.1002/ehf2.12633|issn=2055-5822|pmc = 7261521|pmid=32154656|access-date=|quote=|via=}}</ref>

=== Blood vessels ===

=== Blood ===
{{Main article|Brain}}
* reduced [[blood]] volume<ref>{{Cite journal | last = Hurwitz|first = BE | last2 = Coryell | first2 = VT | last3 = Parker | first3 = M | last4 = Martin | first4 = P | last5 = LaPerriere .... | first5 = A | last6 = Bilsker | first6 = MS | date = | title = Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function | url =http://www.clinsci.org/content/118/2/125|journal=Clinical Science|volume=118|issue=2|pages=125-135|via=}}</ref><ref>{{Cite journal | last = Streeten | first = DHP | last2 = Bell | first2 = D | date = 1998 | title=Circulating Blood Volume in Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v04n01_02|journal=Journal of Chronic Fatigue Syndrome|volume=4 | pages = 3-11|via=}}</ref>
* abnormally shaped of [[Red blood cell|red blood cells]]<ref name="Simpson1989">{{Citation | last1 = Simpson | first1 = LO | authorlink1 = Leslie Simpson | title = Nondiscocytic erythrocytes in myalgic encephalomyelitis | journal = The New Zealand Medical Journal | volume = 102 | issue = 864 | pages = 126-127 | date = 1989 | pmid = 2927808 | doi = }}</ref><ref>{{Cite journal | last = Richards | first = RS | last2 = Wang | first2 = L | last3 = Jelinek | first3 = H | date = Jan 2007 | title = Erythrocyte oxidative damage in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S0188440906002992|journal=Archives of Medical Research|volume=38|issue=1 | pages = 94-98|via=}}</ref>
* reduced oxygen uptake in [[hemoglobin]]<ref>{{Cite journal | last = Miller | first = Ruth R | last2 = Reid | first2 = W Darlene | last3 = Mattman | first3 = Andre | last4 = Yamabayashi | first4 = Cristiane | last5 = Steiner | first5 = Theodore | last6 = Parker | first6 = Shoshana | last7 = Gardy | first7 = Jennifer | last8 = Tang | first8 = Patrick | last9 = Patrick | first9 = David M | date = 2015-05-20 | title = Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case–control study|url=http://doi.org/10.1186/s12967-015-0527-8|journal=Journal of Translational Medicine|language=en|volume=13|issue=1|doi=10.1186/s12967-015-0527-8|issn=1479-5876|pmc=4438583|pmid=25990639}}</ref>

== Digestive system ==

=== Gastrointestinal tract ===
{{Main article |page_name = Gastrointestinal tract}}
* lower levels of [[Bifidobacteria]], [[Escherichia coli]] and higher levels of [[aerobic bacteria]],<ref>{{Cite journal | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value|url=http://www.medical-hypotheses.com/article/S0306-9877(03)00096-3/abstract|journal=Medical Hypotheses | date = Jun 2003|issn=0306-9877 | pages = 915–923|volume=60|issue=6|doi=10.1016/S0306-9877(03)00096-3|language=English|first = Alan C | last = Logan | first2 = A | last2 = Venket Rao | first3 = Dinaz | last3 = Irani}}</ref> in particular [[Enterococcus]] and [[Streptococcus]] species<ref>{{Cite journal | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=http://www.ncbi.nlm.nih.gov/pubmed/19567398|journal=In Vivo (Athens, Greece) | date = Jul 2009|issn=0258-851X|pmid=19567398 | pages = 621–628|volume=23|issue=4|first = John R. | last = Sheedy | first2 = Richard E.H. | last2 = Wettenhall | first3 = Denis | last3 = Scanlon | first4 = Paul R. | last4 = Gooley | first5 = Donald P. | last5 = Lewis | first6 = Neil | last6 = McGregor | first7 = David I. | last7 = Stapleton | first8 = Henry L. | last8 = Butt | first9 = Kenny L. | last9 = DE Meirleir}}</ref>
* higher levels of enterococcus bacteria in CFS patients were associated with more severe neurological and cognitive dysfunction<ref>https://getinfo.de/en/search/id/BLCP%3ACN055885616/%60Bacterial-Colonosis-in-Patients-with-Persistent/</ref>
* Significantly increased proportions of Firmicutes<ref>{{Cite journal | title = High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients|url=https://www.sciencedirect.com/science/article/pii/S1075996413000929|journal=Anaerobe | date = 2013-08-01|issn=1075-9964 | pages = 50–56|volume=22|doi=10.1016/j.anaerobe.2013.06.002|language=en}}</ref><ref name=":7">{{Cite journal | last = Giloteaux | first = Ludovic | last2 = Goodrich | first2 = Julia K. | last3 = Walters | first3 = William A. | last4 = Levine | first4 = Susan M. | author-link4 = Susan Levine | last5 = Ley | first5 = Ruth E. | last6 = Hanson | first6 = Maureen R. | date = 2016-06-23 | title = Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918027/|journal=Microbiome|volume=4|doi=10.1186/s40168-016-0171-4|issn=2049-2618|pmc=4918027|pmid=27338587}}</ref> and Bacteroides<ref name=":7" />
* CFS patients may suffer from [[small intestinal bacterial overgrowth]] (SIBO) at high rates<ref name="Pimentel2000">{{Citation | last1 = Pimentel | first1 = M | authorlink1 = Mark Pimentel | last2 = Hallegua | first2 = D | authorlink2 = David Hallegua | last3 = Chow | first3 = EJ | authorlink3 = Evelyn Chow | last4 = Wallace | first4 = D | authorlink4 = Daniel Wallace | last5 = Bonorris | first5 = G | authorlink5 = George Bonorris | last6 = Lin | first6 = HC | authorlink6 = Henry Lin | title = Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study | journal = Gastroenterology | volume = 118 | issue = 4| pages = 414 | date = 1 Apr 2000 | doi = 10.1016/S0016-5085(00)83765-8 | url = http://www.gastrojournal.org/article/S0016508500837658/abstract }}</ref>
* Higher levels of serum [[Immunoglobulin A|IgA]] and [[Immunoglobulin M|IgM]] against [[lipopolysaccharide]]s (LPS), a major component of the outer membrane of [[gram-negative bacteria]], indicating translocation.<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivana | last3 = Leunis | first3 = Jean-Claude | date = 2007-04-01 | title = Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): Indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut–intestinal permeability|url=http://www.sciencedirect.com/science/article/pii/S0165032706003557|journal=Journal of Affective Disorders|language=en|volume=99|issue=1|pages=237–240|doi=10.1016/j.jad.2006.08.021|issn=0165-0327}}</ref> Serum [[Immunoglobulin A|IgA]] was significantly correlated to the severity of illness.

=== Liver ===
* Reduced [[liver]] volume<ref>{{Cite journal | title = Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1488525|journal=Fatigue: Biomedicine, Health & Behavior | date = 2018-06-18|issn=2164-1846|pages=141–152|volume=6|issue=3|doi=10.1080/21641846.2018.1488525|language=en | first = Pawel | last = Zalewski | first2 = Andreas | last2 = Finkelmeyer | first3 = James | last3 = Frith | first4 = Laura | last4 = Maclachlan | first5 = Andrew | last5 = Blamire | first6 = Julia L. | last6 = Newton}}</ref>

== Nutrition ==
* low red blood cell [[magnesium]]<ref name="cfs_and_blood_mg">{{Citation | last1 = I.M. | first1 = Cox | authorlink1 = | last2 = M.J. | first2 = Campbell | authorlink2 = | last3 = D. |first3 = Dowson | authorlink3 = | title = Red blood cell magnesium and chronic fatigue syndrome | journal = The Lancet
| year = 1991 | pmid = 1672392 | doi = 10.1016/0140-6736(91)91371-Z }}</ref>
* low serum [[carnitine]]<ref>{{Cite journal | last = Plioplys | first = A.V. | last2 = Plioplys | first2 = S. | date = 1995 | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates|url=https://www.ncbi.nlm.nih.gov/pubmed/8544970|journal=Neuropsychobiology|volume=32|issue=3|pages=132–138|doi=10.1159/000119226|issn=0302-282X|pmid=8544970}}</ref><ref>{{Citation| issn = 1058-4838| volume = 18 | issue =Suppl 1| pages = 62-67| last1 = Kuratsune | first1 = H. | last2 = Yamaguti | first2 = K. | last3 = Takahashi | first3 = M. | last4 = Misaki | first4 = H. | last5 = Tagawa | first5 = S. | last6 = Kitani | first6 = T.| title = Acylcarnitine deficiency in chronic fatigue syndrome| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = January 1994 | pmid = 8148455}}</ref><ref>{{Citation| doi = 10.1111/j.1468-1331.1995.tb00151.x| issn = 1351-5101| volume = 2 | issue = 5| pages = 425–428| last1 = Majeed | first1 = T. | last2 = de Simone | first2 = C. | last3 = Famularo | first3 = G. | last4 = Marcellini | first4 = S. | last5 = Behan | first5 = P.O. | title = Abnormalities of carnitine metabolism in chronic fatigue syndrome| journal = European Journal of Neurology | date = November 1995 | pmid = 24283722}}</ref>

== Metabolism ==
* Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review<ref>{{Cite journal | last = Tomas | first = Cara | last2 = Newton | first2 = Julia | date = 2018-06-19 | title = Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review | url =https://portlandpress.com/biochemsoctrans/article-abstract/46/3/547/67402/Metabolic-abnormalities-in-chronic-fatigue?redirectedFrom=fulltext|journal=Biochemical Society Transactions|language=en|volume=46|issue=3 | pages = 547–553|doi=10.1042/BST20170503|issn=0300-5127}}</ref>
* Analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model of deficient ATP production in ME/CFS.<ref name="Sweetman2020">{{Cite journal | last = Sweetman | first = Eiren | authorlink = | last2 = Kleffmann | first2 = Torsten | authorlink2 = | last3 = Edgar | first3 = Christina | authorlink3 = | last4 = de Lange | first4 = Michel | authorlink4 = | last5 = Vallings | first5 = Rosamund | authorlink5 = Rosamund Vallings | last6 = Tate | first6 = Warren | authorlink6 = Warren Tate | date = 2020-09-24 | title = A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction | url =https://doi.org/10.1186/s12967-020-02533-3|journal=Journal of Translational Medicine|volume=18|issue=1 | pages = 365|doi=10.1186/s12967-020-02533-3|issn=1479-5876|pmc = 7512220|pmid=|access-date=|quote=|via=}}</ref>
=== Cellular respiration ===
* abnormalities in [[cellular respiration]] including a reduction in [[glycolysis]],<ref>{{Cite journal | last = Armstrong | first = Christopher W. | last2 = McGregor | first2 = Neil R. | last3 = Lewis | first3 = Donald P. | last4 = Butt | first4 = Henry L. | last5 = Gooley | first5 = Paul R. | date = 2015-05-30 | title = Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s11306-015-0816-5 | journal=Metabolomics|language=en | volume=11 | issue=6 | pages=1626–1639 | doi=10.1007/s11306-015-0816-5 | issn=1573-3882}}</ref> including impaired [[pyruvate dehydrogenase]]<ref>{{Cite journal | last = Fluge | first = Øystein | last2 = Mella | first2 = Olav | last3 = Bruland | first3 = Ove | last4 = Risa | first4 = Kristin | last5 = Dyrstad | first5 = Sissel E. | last6 = Alme | first6 = Kine | last7 = Rekeland | first7 = Ingrid G. | last8 = Sapkota | first8 = Dipak | last9 = Røsland | first9 = Gro V. | date = 2016-12-22 | title = Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/28018972 | journal=JCI insight|volume=1 | issue=21 | pages = e89376 | doi=10.1172/jci.insight.89376 | issn=2379-3708 | pmc=5161229 | pmid=28018972}}</ref>
* increased [[lactic acid]]<ref name="Plioplys1995">{{cite journal | last1 = Plioplys | first1 = AV | authorlink1 = | last2 = Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates | journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | pages = 132-8 | pmid = 8544970 | url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref><ref name="LaneRJ1998">{{cite journal | last1 = Lane | first1 = RJ | authorlink1 = | last2 = Barrett | first2 = MC | authorlink2 = Michael Barrett | last3 = Taylor | first3 = DJ | authorlink3 = Doris Taylor | last4 = Kemp | first4 = GJ | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle | journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | pages = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref><ref name="JonesDE2010">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome | journal = J Intern Med | volume = 267 | issue = 4 | pages = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref><ref name="LengertN2015">{{cite journal | last1 = Lengert | first1 = Nicor | authorlink1 = Nicor Lengert | last2 = Drossel | first2 = Barbara | authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome | journal = Biophysical Chemistry | volume = 202 | pages = 21–31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009 | url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref><ref name="Mathew2009"/>
* reduction in metabolites reflecting a slowed metabolism<ref>{{Cite journal | last = Naviaux | first = Robert K. | authorlink1 = Robert Naviaux | last2 = Naviaux | first2 = Jane C. | last3 = Li | first3 = Kefeng | last4 = Bright | first4 = A. Taylor | last5 = Alaynick | first5 = William A. | last6 = Wang | first6 = Lin | last7 = Baxter | first7 = Asha | last8 = Nathan | first8 = Neil | last9 = Anderson | first9 = Wayne | date = 2016-09-13 | title = Metabolic features of chronic fatigue syndrome|url=http://www.pnas.org/content/113/37/E5472 | journal=Proceedings of the National Academy of Sciences|language=en | volume=113 | issue=37 | pages = E5472–E5480 | doi=10.1073/pnas.1607571113 | issn=0027-8424 | pmid=27573827}}</ref>
*analysis of peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction, supporting a model...that would suggest an elevation of oxidative stress.<ref name="Sweetman2020" />

=== Exercise ===
* reduced pain threshold<ref name="Whiteside, 2004">{{Cite journal | last1 = Whiteside | first1 = Alan | authorlink1 = | last2 = Hansen | first2 = Stig | authorlink2 = | last3 = Chaudhuri | first3 = Abhijit | authorlink3 = Abhijit Chaudhuri | title = Exercise lowers pain threshold in chronic fatigue syndrome | journal = Pain | volume = 109 | issue = 3 | pages = 497-499 | date = 2004 | pmid = 15157711 | doi = 10.1016/j.pain.2004.02.029 }}</ref>
* translocation of bacteria<ref name="ShuklaS2015">{{cite journal | last1 = Shukla | first1 = Sanjay K | authorlink1 = Sanjay Shukla | last2 = Cook | first2 = Dane | authorlink2 = Dane Cook | last3 = Meyer | first3 = Jacob | authorlink3 = Jacob Meyer | last4 = Vernon | first4 = Suzanne D | authorlink4 = Suzanne Vernon | last5 = Le | first5 = Thao | authorlink5 = Thao Le | last6 = Clevidence | first6 = Derek | authorlink6 = Derek Clevidence | last7 = Robertson | first7 = Charles E | authorlink7 = Charles Robertson | last8 =Schrodi | first8 = Steven J | authorlink8 = Steven Schrodi | last9 = Yale | first9 = Steven | authorlink9 = Steven Yale | last10 = Frank | first10 = Daniel N | authorlink10 = Daniel Frank | title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | journal = PLoS ONE | date = Dec 18, 2015 | pmid = 26683192 | doi = 10.1371/journal.pone.0145453 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453 }}</ref>
* loss of capacity to recover from acidosis on repeat exercise<ref name="JonesDE2012">{{cite journal | last1 = Jones | first1 = David EJ | authorlink1 = David Jones | last2 = Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 = Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | authorlink7 = Michael Trenell | last8 = Newton | first8 = Julia L | authorlink8 = Julia Newton | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | pages = 186-94 | date = 12 Jul 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref>
* increased expression of sensory, adrenergic and immune genes following [[muscle]] exertion<ref name="LightAR2009">{{cite journal | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = White | first2 = Andrea T | authorlink2 = | last3 = Hughen | first3 = Ronald W | authorlink3 = | last4 = Light | first4 = Kathleen C | authorlink4 = Kathleen Light | title = Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects | journal = J Pain | volume = 10 | issue = 10 | pages = 1099-112 | date = Jul 31, 2009 | pmid = 19647494 | doi = 10.1016/j.jpain.2009.06.003 | url = http://www.jpain.org/article/S1526-5900(09)00574-4/abstract }}</ref><ref name="LightAR2011">{{citation | last1 = Light | first1 = Alan R | authorlink1 = Alan Light | last2 = Bateman | first2 = Lucinda| authorlink2 = Lucinda Bateman | last3 = Jo | first3 = D | authorlink3 = Daehyun Jo | last4 = Hughen | first4 = Ronald W | authorlink4 = Ronald Hughen | last5 = Vanhaitsma | first5 = TA | authorlink5 = Timothy VanHaitsma | last6 = White | first6 = Andrea T | authorlink6 = Andrea White | last7 =Light | first7 = Kathleen C | authorlink7 = Kathleen Light | title = Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome | journal = J Intern Med | volume = 271 | issue = 1 | pages = 64-81 | date = Jul 13, 2011 | pmid = 21615807 | doi = 10.1111/j.1365-2796.2011.02405.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/abstract }}</ref><ref name="WhiteAT2012">{{citation | last1 = White | first1 = Andrea T | authorlink1 = Andrea White | last2 = Light | first2 = Alan R | authorlink2 = Alan Light | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 = Timothy A | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C | authorlink5 = Kathleen Light | title = Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls | journal = Psychosom Med | volume = 74 | issue = 1 | pages = 46-54 | date = Dec 30, 2011 | pmid = 22210239 | doi = 10.1097/PSY.0b013e31824152ed | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/ }}</ref>
* decreased [[oxygen]] utilization<ref>{{Cite journal | last = Vermeulen | first = Ruud CW | authorlink = Ruud Vermeulen | last2 = Vermeulen van Eck | first2 = Ineke WG| date = 2014 | title = Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome|url=https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-20|journal=Journal of Translational Medicine|language=en|volume=12|issue=1|pages=20|doi=10.1186/1479-5876-12-20|issn=1479-5876|pmc=3903040|pmid=24456560}}</ref>

[[File:Abnormal findings in CFS ME.png|thumb|center|alt=Abnormal findings in Chronic fatigue syndrome and myalgic encephalomyelitis. There is no single biomarker, but tests have found differences in blood flow to the brain, hand grip strength, metabolite and mitochondria abnormalities, reduced heart output, white and red blood cell differences, reduced blood volume, differences in gut bacteria, neuroinflammation, abnormal responses to exercise, and other abnormalities.]]

== See also ==
* [[Myalgic encephalomyelitis]]
* [[List of systematic reviews about ME/CFS]]
* [[:Category:Abnormal findings|Abnormal findings (images)]]

== Learn more ==
* [https://www.mdpi.com/2075-4418/9/2/41 Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (2019)] - original research article
* [http://www.meaction.net/wp-content/uploads/2015/05/ME2FCFS-RESEARCH-SUMMARY-Jamie-Seltzer.pdf #MEAction ME/CFS Research Summary]

==References==
{{Reflist}}

[[Category:Signs and symptoms]]
[[Category:Lists]]

Talk:List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis

2025-09-12T02:08:49Z

YellowWaterLilly:Informing that study was added

== Studies to add -- ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 15:09, May 25, 2020 (EDT) ==
* 2019, Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study<ref>{{Cite journal | last =Nacul | first = Luis | author-link=Luis Nacul | last2 = de Barros | first2=Barbara|author-link2 = | last3 = Kingdon | first3=Caroline C. | author-link3 = Caroline Kingdon | last4 = Cliff | first4 = Jacqueline M. | author-link4 = Jacqueline Cliff | last5 = Clark | first5 = Taane G. | authorlink5 = |last6 = Mudie | first6 = Kathleen | last7 = Dockrell | first7 = Hazel M. | authorlink7 = Hazel Dockrell | last8 = Lacerda | first8 = Eliana M. | authorlink8 = Eliana Lacerda | date = 2019-04-10 | title = Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study|url=https://www.mdpi.com/2075-4418/9/2/41|journal=Diagnostics|language=en|volume=9|issue=2|pages=41|doi=10.3390/diagnostics9020041|issn=2075-4418|quote=|via=}}</ref> - [https://www.mdpi.com/2075-4418/9/2/41 (Abstract)]

===Re: Studies to add -- [[User:YellowWaterLilly|YellowWaterLilly]] ([[User talk:YellowWaterLilly|talk]]) 02:08, September 12, 2025 (UTC)===

: Done!

==Immunological==
* 2019, Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref>{{Cite journal | last =Cliff | first = Jacqueline M.|author-link=Jacqueline Cliff | last2 = King | first2 = Elizabeth C.|author-link2 = | last3 = Lee | first3 = Ji-Sook | authorlink3 = | last4 = Sepúlveda | first4 = Nuno | author-link4 = Nuno Sepúlveda | last5 = Wolf | first5 = Asia-Sophia | authorlink5 = |last6 = Kingdon | first6 = Caroline | authorlink6 = Caroline Kingdon | last7 = Bowman | first7 = Erinna | authorlink7 = Erinna Bowman | last8 = Dockrell | first8 = Hazel M. | authorlink8 = Hazel Dockrell | last9 = Nacul | first9 = Luis | authorlink9 = Luis Nacul | last10 = Lacerda | first10 = Eliana | authorlink10 = Eliana Lacerda | last11 = Riley | first11 = Eleanor | authorlink11 = Eleanor Riley | date = 2019-04-16|title=Cellular Immune Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.frontiersin.org/article/10.3389/fimmu.2019.00796/full|journal=Frontiers in Immunology|volume=10|issue=|pages=|doi=10.3389/fimmu.2019.00796|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2019.00796/full (Full text)]

==Neurological==
*2020, A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques<ref>{{Cite journal | last =Maksoud | first = Rebekah | last2 = Preez | first2 = Stanley du | last3 = Eaton-Fitch | first3 = Natalie | author-link3 = Natalie Eaton-Fitch | last4 = Thapaliya | first4 = Kiran | last5 = Barnden | first5 = Leighton|last6 = Cabanas | first6 = Hélène | last7 = Staines | first7 = Donald | last8 = Marshall-Gradisnik | first8 = Sonya | date = 2020-04-30 | title = A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475|journal=PLOS ONE|language=en|volume=15|issue=4| pages = e0232475|doi=10.1371/journal.pone.0232475|issn=1932-6203|pmc = 7192498|pmid=32353033}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232475 (Full text)]
*2019, Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis<ref>{{Cite journal | last =Nelson | first = Maximillian J. | last2 = Bahl | first2 = Jasvir S. | last3 = Buckley | first3 = Jonathan D. | last4 = Thomson | first4=Rebecca L. | last5 = Davison | first5 = Kade | date = 2019-10-25 | title = Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/|journal=Medicine|volume=98|issue=43|doi=10.1097/MD.0000000000017600|issn=0025-7974|pmc=6824690|pmid=31651868}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824690/ (Full text)]
*2014, Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review<ref>{{Cite journal | last =Cauwenbergh | first = Deborah Van | last2 = Nijs | first2=Jo | last3 = Kos | first3=Daphne | last4 = Weijnen | first4 = Laura Van | last5 = Struyf | first5 = Filip|last6 = Meeus | first6 = Mira | date = 2014 | title =Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12256|journal=European Journal of Clinical Investigation|language=en|volume=44|issue=5|pages=516–526|doi=10.1111/eci.12256|issn=1365-2362}}</ref> - [https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.12256 (Full text)]
*2014, Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies<ref>https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx</ref> - [https://journals.lww.com/jclinrheum/fulltext/2014/04000/sympathetic_nervous_system_dysfunction_in.7.aspx (Full text)]
*1994, A comparative review of systemic and neurological symptomatology in 12 outbreaks collectively described as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis<ref>{{Cite journal | last =Briggs | first = Nathaniel C. | last2 = Levine | first2 = Paul H. | date = 1994-01-01 | title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis|url=https://academic.oup.com/cid/article/18/Supplement_1/S32/317003|journal=Clinical Infectious Diseases|language=en|volume=18|issue=Supplement_1|pages=S32–S42|doi=10.1093/clinids/18.Supplement_1.S32|issn=1058-4838}}</ref> - [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.346&rep=rep1&type=pdf (Full text)]

==References==
{{Reflist}}

Jennifer Brea

2025-05-18T20:56:22Z

YellowWaterLilly:/* See also */ Added links to related MEpedia pages

[[File:Jennifer Brea.png|thumb|right|]]

'''Jennifer Brea''' is a filmmaker, activist and [[Myalgic encephalomyelitis|myalgic encephalomyelitus]] (ME) patient. Along with [[Beth Mazur]], she co-founded #[[MEAction]]. Jennifer is also the founder of [[MEpedia]] and director of ''[[Unrest]]'', an award-winning documentary film about living with [[Myalgic encephalomyelitis|ME]].

Jennifer was initially misdiagnosed with "[[conversion disorder]]" instead of ME; she was seriously harmed after a walk home from her neurologist's office when she should have been ordered to get complete [[bed rest]] for her best chance of recovery.<ref name="BBC2017">{{Cite web | url = https://www.bbc.co.uk/news/stories-41888146 | title = I made a film from my bed to show my illness is real | date = November 9, 2017|publisher=BBC News}}</ref>[http://www.blogtalkradio.com/thecoffeeklatch/2013/10/26/jennifer-brea--canary-in-a-coal-mine Jennifer Brea - Canary In A Coal Mine - The Coffee Klatch - Listen @4:00]</ref>

In 2012 Jennifer married Omar Wasow<ref>[https://www.nytimes.com/2012/09/02/fashion/weddings/jennifer-brea-omar-wasow-weddings.html Jennifer Bréa, Omar Wasow]</ref>, a famous TV talk show, film producer<ref>[https://www.imdb.com/name/nm1717399/ Omar Wasow IMDB]</ref> and founder of Blackplanet.<ref>[https://en.wikipedia.org/wiki/Blackplanet Blackplanet]</ref>

==''Unrest'' documentary film==
[[File:J Brea TED.JPG|200px|thumb|right|Jen uses a [[Severe and very severe ME|use a wheelchair]] keeping her legs up due to [[Postural orthostatic tachycardia syndrome|POTS]] as her blood pools into her legs]]
Jennifer directed and produced the film ''Unrest'' which premiered at the ''Sundance Film Festival'' in January 2017 and was on the shortlist for the 2017 Academy Awards.

==Articles==
*Nov 9, 2017 - [https://www.bbc.co.uk/news/stories-41888146 I made a film from my bed to show my illness is real]
*Dec 27, 2017 - [https://www.bostonglobe.com/magazine/2017/12/27/they-told-illness-was-all-head-was-because-woman/47zuihgBfZqPdNe7S40hSJ/amp.html ''They told me my illness was all in my head. Was it because I’m a woman?'']<ref>{{Cite web | url = https://www.bostonglobe.com/magazine/2017/12/27/they-told-illness-was-all-head-was-because-woman/47zuihgBfZqPdNe7S40hSJ/amp.html | title = They told me my illness was all in my head. Was it because I’m a woman? - The Boston Globe | last = Brea | first = Jennifer | date = Dec 27, 2017 | website = bostonglobe.com|language=en|archive-url=|archive-date=|url-status=|access-date=2018-10-12}}</ref>

== Talks and interviews ==
*Jan 2017, [https://www.youtube.com/watch?v=b4695rbOZIg&app=desktop Sundance Film Festival - Meet the Artist '17: Jennifer Brea]<ref>{{Cite web | url = https://www.youtube.com/watch?v=b4695rbOZIg&app=desktop | title = Meet the Artist '17: Jennifer Brea | last = Brea | first = Jennifer | date = Jan 18, 2017 | website = Youtube|publisher=Sundance Institiute|archive-url=|archive-date=|url-status=|access-date=}}</ref>
*Jan 2017, [[What happens when you have a disease doctors can't diagnose - TED Talk (2016)|What happens when you have a disease doctors can't diagnose]] (TED Talk)
*Jan 20, 2017, [http://www.kpcw.org/post/sundance-reel-hour-one-january-20-2017#stream/0 Sundance Reel hour one - Jan 20, 2017]<ref>{{Cite news | url=http://www.kpcw.org/post/sundance-reel-hour-one-january-20-2017#stream/0 | title = Sundance Reel hour one - January 20, 2017 | last = Wells | first = John | date = Jan 20, 2017|work=|access-date=2018-10-12|archive-url=|archive-date=|url-status=|publisher=KPCW | last2 = Larson | first2 = Nell|at=31 min|language=en}}</ref> Audio interview with Jennifer Brea and Omar Wasow about ''Unrest'' (31mins in)
*Feb 10 2017, [https://www.npr.org/transcripts/514158225 Jennifer Brea: Can The Internet Help You Get The Right Diagnosis?] - NPR (transcript)
*May 18, 2017 - [https://www.youtube.com/watch?v=Najd5O7usnQ Congressional Briefing on ME/CFS]<ref>{{Cite web | url = https://www.youtube.com/watch?v=Najd5O7usnQ | title = Congressional Briefing on ME/CFS | last = Markey | first = Ed | date = May 26, 2017 | website = YouTube|publisher=SolveCFS|archive-url=|archive-date=|url-status=|access-date=}}</ref> ([http://solvecfs.org/wp-content/uploads/2017/05/InvisibleCrisis_wide_051817-print.pdf Slides of briefing])<ref>{{Cite web | url = http://solvecfs.org/wp-content/uploads/2017/05/InvisibleCrisis_wide_051817-print.pdf | title=Slides of Congressional Briefing on ME/CFS | last = | first = | date = May 2017 | website = solvecfs.org|archive-url=|archive-date=|url-status=|access-date=}}</ref>
*May 6, 2018, [https://www.meassociation.org.uk/podcast/ Episode One] [[The ME Show]] podcast by [[Gary Burgess]]<ref>{{Cite web | url = https://www.meassociation.org.uk/podcast/ | title = The ME Show | last = Burgess | first = Gary | date = Apr 20, 2018 | website = [[ME Association]]|publisher=ME Association|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-10-12}}</ref>

*[http://jenbrea.com/media List of talks and interviews at jenbrea.com]

== Awards ==
*2013, [https://www.prohealth.com/library/prohealths-2013-advocate-of-the-year-jennifer-brea-32242?site=articles ProHealth’s 2013 Advocate of the Year – Jennifer Brea]<ref>{{Cite web | url = https://www.prohealth.com/library/prohealths-2013-advocate-of-the-year-jennifer-brea-32242?site=articles | title = ProHealth’s 2013 Advocate of the Year – Jennifer Brea | last = Verrillo | first = Erica | date = Jan 25, 2014 | website = prohealth|archive-url=|archive-date=|url-status=|access-date=}}</ref>
*2015, [https://www.indiewire.com/2013/12/congrats-to-canary-in-a-coal-mine-novembers-project-of-the-month-241464/ Congrats to ‘Canary in a Coal Mine,’ November’s Project of the Month!]<ref>{{Cite news | url=https://www.indiewire.com/2013/12/congrats-to-canary-in-a-coal-mine-novembers-project-of-the-month-241464/ | title = Congrats to ‘Canary in a Coal Mine,’ November’s Project of the Month! | last = Indiewire | date = 2013-12-09|work=IndieWire|access-date=2018-10-12|language=en-US}}</ref>
*2017, [https://www.prohealth.com/library/prohealth-is-proud-to-announce-its-2017-advocate-of-the-year-jennifer-brea-43998 ProHealth is proud to announce its 2017 Patient Advocate of the Year – Jennifer Brea]<ref>{{Cite web | url = https://www.prohealth.com/library/prohealth-is-proud-to-announce-its-2017-advocate-of-the-year-jennifer-brea-43998 | title = ProHealth is proud to announce its 2017 Patient Advocate of the Year – Jennifer Brea | last = Verrillo | first = Erica | date = Mar 5, 2018 | website = prohealth.com|archive-url=|archive-date=|url-status=|access-date=}}</ref>

==Learn more==

*[https://en.wikipedia.org/wiki/Jennifer_Brea Wikipedia - Jennifer Brea]
*2016, [http://blog.ted.com/the-story-of-a-baffling-illness-jen-brea-speaks-at-tedsummit/ The story and stigma of a baffling illness: Jen Brea speaks at TEDSummit]<ref>{{Cite news | url=https://blog.ted.com/the-story-of-a-baffling-illness-jen-brea-speaks-at-tedsummit/ | title = The story and stigma of a baffling illness: Jen Brea speaks at TEDSummit | last = Colman | first = David | date = 2016-06-27|work=TED Blog|access-date=2018-10-12|archive-url=|archive-date=|url-status=|language=en-US}}</ref>
*2016, [http://hwcdn.libsyn.com/p/1/c/3/1c390d4707a99658/WMCLive_Episode159.mp3?c_id=11198959&expiration=1458653445&hwt=a2af508e00d7e147da703b67289fe339 Women's Media Center with Robin Morgan]<ref>{{Cite web | url = https://secure-hwcdn.libsyn.com/p/1/c/3/1c390d4707a99658/WMCLive_Episode159.mp3?c_id=11198959&cs_id=11198959&expiration=1539364834&hwt=8358265220c7cbb5ffd9b71178756e50 | title = Interview With Jen Brea | last = Morgan | first = Robine | date = 2016 | website = |publisher=Women's Media Center Live|archive-url=|archive-date=|url-status=|access-date=}}</ref> (Audio)

==Online presence==

*[http://www.twitter.com/jenbrea Twitter]
*[http://www.jenniferbrea.com Website]

== See also ==
* [[Severe and very severe ME]]
* [[International ME Awareness Day]]
* [[Ryan Prior]]
* [[Whitney Dafoe]]
* [[James Strazza]]

== References ==
{{Reflist}}
[[Category:People with ME, CFS, and/or FMS]]
[[Category:Advocates or allies]]
[[Category:American advocates or allies]]

Ryan Prior

2025-05-18T20:53:31Z

YellowWaterLilly:/* See also */ Added Jennifer Brea, James Strazza, for intrest

[[File:Ryan Prior.jpg|thumb|right|Photo from ProHealth]]

'''Ryan Prior''' is an advocate who wrote and co-directed the documentary, ''[[Forgotten Plague]]'', based on his experiences as well as others living with [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]] (ME/CFS). The topics of science and politics of [[ME/CFS]] were also included. He is the founder of [[The Blue Ribbon Foundation]].

Ryan is a Cross-Platform Associate Producer at CNN.<ref>{{Cite web|url=https://www.linkedin.com/in/ryantprior | title = Ryan Prior - Journalist at CNN/Co-Director of "Forgotten Plague" | last = Prior | first = Ryan | authorlink= | date = |website=LinkedIn|archive-url=|archive-date=|url-status=|access-date=}}</ref>

== Illness onset leads to advocacy ==
In 2006 Ryan Prior was a healthy, athletic high school student when he became ill with [[ME/CFS]]. After graduating college and becoming a journalist he wrote an article for [http://college.usatoday.com/2013/06/10/opinion-telling-the-hidden-story-of-chronic-fatigue-syndrome/ USA Today: College] [http://college.usatoday.com/2012/10/02/opinion-the-real-story-of-chronic-fatigue-syndrome/ ''Viewpoint: The real story of chronic fatigue syndrome'']<ref>{{Cite news | url=http://college.usatoday.com/2012/10/02/opinion-the-real-story-of-chronic-fatigue-syndrome/ | title = Viewpoint: The real story of chronic fatigue syndrome | last = Prior | first = Ryan | date = 2012-10-02|work=USA TODAY College|access-date=2018-08-10|archive-url=|archive-date=|url-status=|language=en-US}}</ref> and received so much feedback that he realized he needed to do more to report on the disease and produced a documentary: "A Film That Tells The Great Under-Reported Medical Story Of Our Time." His crowdfund raised $120,000 for ''[[Forgotten Plague]]''. Prior and his then-girlfriend, [[Nicole Castillo]], co-directed.<ref>{{Cite news | url=http://mecfsdocumentary.com/fundraising/ | title = Fundraise | date = 2013-10-05|work=Forgotten Plague|access-date=2018-08-10|language=en-US}}</ref>

Prior also founded the [[The Blue Ribbon Fellowship]] to educate students in the disease [[ME/CFS]]. Currently only 5% of medical schools have proper curricular, research and clinical standards of care for the disease.<ref>{{Cite news | url=http://theblueribbonfoundation.org/fellowship-details/ | title = Fellowship Details | date = 2013-12-09|work=The Blue Ribbon Foundation|access-date=2018-08-10|language=en-US}}</ref>

== Production credits on ME/CFS ==
* 2015, [[Forgotten Plague]]

* Oct 2018, [https://www.cnn.com/2018/10/05/health/chronic-fatigue-stuart-murdoch-belle-sebastian-turning-points/index.html Indie pop sensation's disease became his muse]<ref>{{Cite news | url=https://www.cnn.com/2018/10/05/health/chronic-fatigue-stuart-murdoch-belle-sebastian-turning-points/index.html | title = Indie pop sensation's disease became his muse | last = CNN | first = Ryan Prior|work=CNN|access-date=2018-10-09}}</ref> Produced Dr. Sanjay Gupta's ''Turning Points'' interview with [[Stuart Murdoch]], a short segment and an article.

== Awards ==
*2014, [http://medicinex.stanford.edu/conf/a/medx2014/conference/speaker/247 ePatient Scholar; Executive Producer, The Blue Ribbon]<ref>{{Cite web|url=https://medicinex.stanford.edu/conf/a/medx2014/conference/speaker/247 | title = Speaker Profile: Ryan Prior | last= | first = | date = |website=medicinex.stanford.edu|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-08-10}}</ref>
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=19960 ProHealth's Advocate of the Year]<ref>{{Cite news | url=https://www.prohealth.com/library/prohealths-2014-advocate-of-the-year-ryan-prior-34892 | title = ProHealth's 2014 Advocate of the Year – Ryan Prior - Prohealth | date = 2015-04-05|work=Prohealth|access-date=2018-08-10|language=en-US}}</ref>
*2017, [https://www.marketwatch.com/press-release/ruth-libby-2017-grand-prize-winner-for-rare-life-award-2017-02-28 Eagle Rare Life ''Leadership Category'' Award]<ref>{{Cite news | url=https://www.marketwatch.com/press-release/ruth-libby-2017-grand-prize-winner-for-rare-life-award-2017-02-28 | title = Ruth Libby 2017 Grand Prize Winner for Rare Life Award | last = | first = | date = |work=MarketWatch|access-date=2018-08-10|archive-url=|archive-date=|url-status=|language=en-US}}</ref> $5K Prize

== Nominations ==
*2017, [https://en.wikipedia.org/wiki/Eagle_Rare Eagle Rare] ''Rare Life Honor''<ref>{{Cite web|url=https://eaglerarelife.com/node/60 | title = Ryan Prior {{!}} Eagle Rare Life|website=eaglerarelife.com|language=en|access-date=2018-08-10}}</ref> *Won Leadership category and $5K Award*

== Talks and interviews ==
*Jan 23, 2014, [https://soundcloud.com/ryan-prior-1/jimbo ME/CFS on Nationally Syndicated "Jim Bohannon Show"]<ref>{{Cite web|url=https://soundcloud.com/ryan-prior-1/jimbo | title = ME/CFS on Nationally Syndicated "Jim Bohannon Show" | last = Bohannon | first = Jim | date = |website=Soundcloud|archive-url=|archive-date=|url-status=|access-date=Aug 8, 2018}}</ref> Appearing, Dr. [[Andreas Kogelnik]], Ryan Prior, and [[Llewellyn King]] of [[ME/CFS Alert]].
*2014, [https://www.youtube.com/watch?v=XJbSpdy7Kek ME/CFS Alert Episode 58 - Ryan Prior and the Blue Ribbon Foundation]<ref>{{Cite web|url=https://www.youtube.com/watch?v=XJbSpdy7Kek | title = MECFS Alert Episode 58: Ryan Prior and the Blue Ribbon Foundation | last = King | first = Llewellyn | date = Mar 23, 2014 | website = YouTube|publisher=ME/CFS Alert|archive-url=|archive-date=|url-status=|access-date=Aug 10, 2018}}</ref>
*2014, [https://www.youtube.com/watch?v=eoj_0uXp68I ME/CFS Alert Episode 57 - Patient Perspectives - Ryan Prior and the Blue Ribbon Fellowship]<ref>{{Cite web|url=https://www.youtube.com/watch?v=eoj_0uXp68I | title = MECFS Alert Episode 57: Patient Perspectives - Ryan Prior and the Blue Ribbon Fellowship | last = King | first = Llewellyn | date = Mar 12, 2014 | website = YouTube|publisher=ME/CFS Alert|archive-url=|archive-date=|url-status=|access-date=Aug 10, 2018}}</ref>
*2016, [http://www.insicknesspod.com/blog/10-21-ryanprior In Sickness + In Health - Podcast 36 - ME/CFS & POTS w Ryan Prior]<ref>{{Cite web|url=http://www.insicknesspod.com/blog/10-21-ryanprior | title = 36 ME/CFS & POTS w Ryan Prior | last=Gael O'Regan | first = Cara | date = Oct 21, 2016 | website = |archive-url=|archive-date=|url-status=|access-date=Aug 10, 2018}}</ref> (Begins at 11:45)
*2016, [https://justtalkingpodcast.com/2016/10/11/with-ryan-prior/ Just Talking Podcast]<ref>{{Cite web|url=https://justtalkingpodcast.com/2016/10/11/with-ryan-prior/ | title = With Ryan Prior | last=X | first = Christopher | date = Oct 11, 2016 | website = YouTube | archive-url=|archive-date=|url-status=|access-date=}}</ref>

==Media exposure==
*Jun 17, 2013, [https://whchronicle.com/a-young-man-a-big-disease-and-a-big-idea/ A Young Man, a Big Disease and a Big Idea]<ref>{{Cite news | url=https://whchronicle.com/a-young-man-a-big-disease-and-a-big-idea/ | title = A Young Man, a Big Disease and a Big Idea | last = King | first = Llewellyn | date = Jun 17, 2013|work=White House Chronicle|access-date=|archive-url=|archive-date=|url-status=}}</ref>
*Aug 8, 2018, [https://www.cnn.com/2018/08/08/health/iyw-ryan-me-cfs-story/index.html Millions suffer from an invisible disease: My ME/CFS story]<ref>{{Cite news | url=https://edition.cnn.com/2018/08/08/health/iyw-ryan-me-cfs-story/index.html | title = Millions suffer from an invisible disease: My ME/CFS story | last = Prior | first = Ryan|work=CNN|access-date=2018-08-10 | date = |archive-url=|archive-date=|url-status=}}</ref>

== Online presence ==
*[https://twitter.com/r_prior Twitter]

*[https://www.facebook.com/ryan.prior.144 Facebook]
*[https://www.linkedin.com/in/ryantprior LinkedIn]

*[http://rtprior.com/ Website]

== See also ==
*[[The Blue Ribbon Foundation]]
*[[Nicole Castillo]]
*[[Jennifer Brea]]
*[[James Strazza]]

== References ==
{{Reflist}}

[[Category:Journalists]]
[[Category:People with ME, CFS, and/or FMS]]
[[Category:Advocates or allies]]
[[Category:American advocates or allies]]

Severe and very severe ME

2025-05-18T20:47:46Z

YellowWaterLilly:/* People with Severe or Very Severe ME */ Added James Strazza

[[File:Linda Crowhurst.JPG|300x300px|thumb|[[Linda Crowhurst]] is very severely ill with ME. Her husband [[Greg Crowhurst]] is Linda's full-time carer. This still is from the music video ''[https://www.youtube.com/watch?v=Z1z5O_cgQ7I Wasteland]'' which delicately documents Linda's very severe ME]]

'''Severe and very severe ME''' affects about 25% of people with [[myalgic encephalomyelitis|myalgic encephalomyelitis]] (ME), with patients being housebound or bedbound at some point in their illness,<ref name="IOM2015">{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK284903/ | title = Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness | last = ((Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome;Board on the Health of Select Populations; Institute of Medicine (U.S.))) | first = |publisher=National Academies Press|others=| year = 2015 |isbn=9780309316903|location=Washington, D.C.|oclc=906233426|editor-link=|chapter=|quote= | page = 32}}</ref> typically needing to use a [[wheelchair]], unable to do any kind of work or study, and often unable to do basic self-care activities unaided.<ref name="severeME-25">{{Cite web|url=https://25megroup.org/me | title = Severe M.E.|website=25% M.E. Group|language=en|access-date=2022-03-17}}</ref> Some people have died of severe ME, including [[Emily Collingridge]], [[Merryn Crofts]], [[Sophia Mirza]].<ref name="Guardian30Mar2012"/><ref name="Vindication"/><ref name="suicidality2021">{{Cite journal | last = Chu | first = Lily | authorlink = Lily Chu | last2 = Elliott | first2 = Meghan | authorlink2 = | last3 = Stein | first3 = Eleanor | authorlink3 = Eleanor Stein | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | title = Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227525/|journal=Healthcare|volume=9|issue=6 | pages = 629|doi=10.3390/healthcare9060629|issn=2227-9032|pmc=PMC8227525|pmid=34070367 | date = 2021 | quote=|via=}}</ref>

==What is Severe ME?==
There is no generally agreed upon description of severe or very severe ME, but different clinical scales can be used to measure the degree of disability.<ref name="ICC2011primer">{{Cite journal | last = Carruthers | first=Bruce M. | author-link = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie I. | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Klimas | first4 = Nancy G. | author-link4 = Nancy Klimas | last5 = Broderick | first5 = Gordon | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = Terry | authorlink6 = Terry Mitchell | last7 = Staines | first7 = Donald | author-link7 = Donald Staines | last8 = Powles | first8 = A.C. Peter | author-link8 = A C Peter Powles | last9 = Speight | first9 = Nigel | authorlink9 = Nigel Speight | last10 = Vallings | first10 = Rosamund | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = Lucinda | authorlink11 = Lucinda Bateman | last12 = Baumgarten-Austrheim | first12 = Barbara | authorlink12 = Barbara Baumgarten-Austrheim | last13 = Bell | first13 = David | author-link13 = David Bell | last14 = Carlo-Stella | first14 = Nicoletta | author-link14 = Nicoletta Carlo-Stella | last15 = Chia | first15 = John | author-link15 = John Chia | last16 = Darragh | first16 = Austin | author-link16 = Austin Darragh | last17 = Jo | first17 = Daehyun | author-link17 = Daehyun Jo | last18 = Lewis | first18 = Donald | author-link18 = Donald Lewis | last19 = Light | first19 = Alan | author-link19 = Alan Light | last20 = Marshall-Gradisnik | first20 = Sonya | author-link20 = Sonya Marshall-Gradisnik | last21 = Mena | first21 = Ismael | author-link21 = Ismael Mena | last22 = Mikovits | first22 = Judy | author-link22 = Judy Mikovits | last23 = Miwa | first23 = Kunihisa | author-link23 = Kunihisa Miwa | last24 = Murovska | first24 = Modra | author-link24 = Modra Murovska | last25 = Pall | first25 = Martin | author-link25 = Martin Pall | last26 = Stevens | first26 = Staci | author-link26 = Staci Stevens | date = 2011-08-22 | title=Myalgic encephalomyelitis: International Consensus Criteria|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2011.02428.x|journal=Journal of Internal Medicine|language=en|volume=270|issue=4|pages=327–338|doi=10.1111/j.1365-2796.2011.02428.x|issn=0954-6820|pmc=3427890|pmid=21777306|via=}}</ref><ref name="NBK284903">{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK284903/|chapter=Questionnaires and Tools That May Be Useful for Assessing ME/CFS Symptoms | title = Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness | last = ((Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome;Board on the Health of Select Populations; Institute of Medicine (U.S.))) | first = |publisher=National Academies Press|others=| year = 2015 |isbn=9780309316903|location=Washington, D.C.|oclc=906233426|pages=|title-link=|access-date= | author-link = Institute of Medicine|quote=|archive-url=|archive-date=}}</ref> Very little research has described the symptoms and experiences of patients with severe ME or very severe ME, much of what is known comes from patient and advocacy groups.

A study of 19 bedbound patients with severe ME and [[orthostatic intolerance]] by van Campen et al (2020) found an average 27% decrease in blood flow to the brain during a 20 degree [[tilt table test]] that lasted just 15 minutes. Some patients could not tolerate the orthostatic symptoms for 15 mins and had to finish the test early. The patients average 35 years of age and had been ill on average 14 years. All the severely ill patients had abnormal drops in blood flow to the brain.<ref name="CBF2020" />

<embedvideo service="youtube" description="''Hope for a Better Moment'' by Linda Crowhurst. This video clearly documents Linda's [[neurological]] symptoms of her very severe ME" dimensions="400" alignment="right" container="frame">https://www.youtube-nocookie.com/watch?v=rVsOeZjhMFY&autoplay=0</embedvideo>{{clear}}
==Severe ME symptom scales==
Substantial impairment and disability in adults can be measured using the following scales:
* [[Energy Index Point Score]]
* [http://fiqrinfo.ipage.com/FIQR%20FORM.pdf Fibromyalgia Impact Questionnaire Revised (FIQR)]<ref name="NBK284903" />
* Katz Index of Independence in Activities of Daily Living<ref>{{Cite web|url=https://consultgeri.org/try-this/general-assessment/issue-2.pdf | title = Katz Index of Independence in Activities of Daily Living (ADL) | last = Shelkey | first = Mary | last2 = Wallace | first2 = Meredith | date = 2012 | website = |archive-url=|archive-date=|url-status=|access-date= | author-link =| authorlink2 = }}</ref>
* The Lawton Instrumental Activities of Daily Living (IADL) Scale<ref>{{Cite news | url=https://consultgeri.org/try-this/general-assessment/issue-23 | title = The Lawton Instrumental Activities of Daily Living (IADL) Scale {{!}} ConsultGeri Assessment Tool | last = Graf | first = Carla | date = 2015-11-23|work=ConsultGeri|access-date=2018-10-13|archive-url=|archive-date=|url-status=|language=en}}</ref>
* [[Short Form 36-Item Health Survey|Short-Form 36 Item Health Survey]] which is not specific to ME/CFS
* [https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html RAND-36 - available as a free version of SF-36]<ref>{{Cite web|url=https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html | title = 36-Item Short Form Survey from the RAND Medical Outcomes Study|website=rand.org|language=en|access-date=2018-10-13}}</ref>

* [http://serene.me.uk/tests/wsas.pdf Work and Social Adjustment Scale]<ref>{{Cite web|url=http://serene.me.uk/tests/wsas.pdf | title = Work and Social Adjustment Scale | last = | first = | date = |website=serene.me|archive-url=|archive-date=|url-status=|access-date=}}</ref> (WSAS)

===Scales developed by patient organizations===
* [[HFME 3 Part ME Ability and Severity Scale|HFME 3 Part M.E. Ability and Severity Scale]]

==Comparison==
Some scales have a "ceiling effect" that means severe ME can not adequately be distinguished from very severe ME, or from moderate ME, including the [[Chalder fatigue scale]].<ref name="jason2011">{{Cite journal | last= Jason | first = Leonard A. | author-link = Leonard Jason | last2 = Evans | first2 = Meredyth | authorlink2 = Meredyth Evans | last3 = Brown | first3 = Molly | author-link3 = Molly Brown | last4 = Porter | first4 = Nicole | authorlink4 = Nicole Porter | last5 = Brown | first5 = Abigail | authorlink5 = Abigail Brown | last6 = Hunnell | first6 = Jessica | authorlink6 = Jessica Hunnell | last7 = Anderson | first7 = Valerie | authorlink7 = Valerie Anderson | last8 = Lerch | first8 = Athena | authorlink8 = Athena Lurch | date = 2011 | title=Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181109/|journal=Disability studies quarterly : DSQ|volume=31|issue=1|pages=|issn=1041-5718|pmc=3181109|pmid=21966179|quote=|via=}}</ref>

Some patients who are severely ill may not have enough concentration to complete a questionnaire, or may be too ill to communicate, these patients may need another person to complete the rating scale instead, for example a carer or health professional. A pilot study of patients with severe CFS/ME in North East England found that even when visiting patients at home, some were unable to complete a questionnaire or to even attempt to stand.<ref name="northeast" /> 
[[File:Naomi Whittingham .png|300px|thumb|left|[[Naomi Whittingham]] lives in the [[United Kingdom|UK]] with a 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 fundraising for [[ME Research UK]]]]
{{Clear|both}}
==Very severe ME==
[[File:Merry Crofts sick.JPG|250px|thumb|right|[[Merryn Crofts]] was bedbound and unable to eat before she died of very severe ME.]]
Merryn weighed six stone (84 lbs) and was just 21 years old when she died; her autopsy revealed [[Dorsal root ganglia|ganglia]] [[inflammation]]. It is suspected that in the later years of her illness Merryn also suffered from [[Ehlers-Danlos syndrome|EDS]] and [[Mast cell activation disorder|MCAD]]. Her death certificate was reported to be the second in the [[United Kingdom|UK]] to attribute a death to [[myalgic encephalomyelitis]] (M.E.).<ref name="Vindication">{{Cite news | publisher=BBC Radio 5 Live|url=https://www.bbc.co.uk/news/health-44969741 | title = 'Vindication' for woman who wanted ME on death certificate | first = Jim | last = Taylor| date = July 27, 2018}}</ref>

Doctors initially suggested that Merryn was having panic attacks, and her family were later told that she may have conversion disorder, a mental condition formerly known as hysteria.
"I knew it wasn't. I work with people who have panic attacks and I can talk them down," said Clare.
"Merryn was starting to think 'What if it is in my head?' It made her doubt herself, which is awful."
Eventually a private doctor diagnosed Merryn with ME and she began to receive treatment on the NHS.
Within six months of falling ill she was using a wheelchair, and within a year she was housebound. 
A very severe ME patient's experience photo shows clear signs of [[muscle atrophy|muscle wasting]] and [[disability]] - but for the majority of patients it remains an [[invisible illness]].
[[File:Whitney.JPG|300px|thumb|[[Whitney Dafoe]] is an American photographer who has very severe ME. Whitney can no longer speak or handle contact with anyone but his parents due to [[visual dysfunction]]. His father is [[Ronald Davis|Ron Davis]], a world-renowned geneticist who is working to solve his son's disease.]] 

People with very severe ME are totally '''bedbound''' and unable to stand at all.<ref name="northeast" /><ref name="StrassheimLambson2017" /> Some people with very severe ME have improved over time, or after surgery from [[cervical spinal stenosis]].<ref name="cagedbird2016">{{Cite web|url=https://www.youtube.com/watch?v=ZzUo0v5lf9c | title = ME Awareness May 2016 | last = The Caged Bird | first= | author-link =| date = 2016 | website = YouTube|publisher=[[Let's Do It for ME]]|archive-url=|archive-date=|url-status=|access-date=2019-01-28}}</ref><ref name="Rowe2018" />
{{clear}}

==Notable studies==
* 2021, Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Brownlie2021">{{Cite journal | title = Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2021-11-12|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623195|journal=Healthcare|volume=9|issue=11|pages=1546 | last = Brownlie | first = Helen | authorlink = | last2 = Speight | first2 = Nigel | author-link2 = Nigel Speight|doi=10.3390/healthcare9111546|pmc=PMC8623195|pmid=34828592|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623195 (Full text)]
::IV Immunoglobulin G may be effective for some with severe ME
*2021, Life-Threatening Malnutrition in Very Severe ME/CFS<ref name="malnutrition2021">{{Cite journal | last = Baxter | first=Helen | authorlink = | last2 = Speight | first2 = Nigel | author-link2 = Nigel Speight | last3 = Weir | first3 = William | authorlink3 = William Weir| date = Apr 2021 | title = Life-Threatening Malnutrition in Very Severe ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213|journal=Healthcare|language=en|volume=9|issue=4 | pages = 459|doi=10.3390/healthcare9040459|pmc=PMC8070213|pmid=33919671|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213 (Full text)]
*2021, Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Montoya2021">{{Cite journal | title = Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2021-10-06|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544443|journal=Healthcare|volume=9|issue=10|pages=1331 | last = Montoya | first=Jose | authorlink = Jose Montoya | last2 = Dowell | first2 = Theresa | author-link2 = | last3 = Mooney | first3 = Amy | author-link3 = | last4 = Dimmock | first4 = Mary | author-link4 = Mary Dimmock | last5 = Chu | first5 = Lily | authorlink5 = Lily Chu|doi=10.3390/healthcare9101331|pmc=PMC8544443|pmid=34683011|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544443 (Full text)]
* 2021, Comprehensive Examination of Severely Ill ME/CFS Patients<ref name="Chang2021-Ex">{{Cite journal | last = Chang | first = Chia-Jung | authorlink = | last2 = Hung | first2 = Li-Yuan | authorlink2 = | last3 = Kogelnik | first3 = Andreas M. | authorlink3 = Andreas Kogelnik | last4 = Kaufman | first4 = David | author-link4 = David Kaufman | last5 = Aiyar | first5 = Raeka S. | authorlink5 = | last6 = Chu | first6 = Angela M. | authorlink6 = | last7 = Wilhelmy | first7 = Julie | last8 = Li | first8 = Peng | last9 = Tannenbaum | first9 = Linda | date = Oct 2021 | title = A Comprehensive Examination of Severely Ill ME/CFS Patients|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535418|journal=Healthcare|language=en|volume=9|issue=10|pages=1290|doi=10.3390/healthcare9101290|pmc=PMC8535418|pmid=34682970|access-date=|quote=|via= | authorlink9 = Linda Tannenbaum | authorlink7 = Julie Wilhelmy}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535418 (Full text)]
* 2021, The Impact of Severe ME/CFS on Student Learning and K–12 Educational Limitations<ref name="Newton2021">{{Cite journal | last = Newton | first = Faith R. | author-link = | date = Jun 2021 | title = The Impact of Severe ME/CFS on Student Learning and K–12 Educational Limitations|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225090|journal=Healthcare|language=en|volume=9|issue=6 | pages = 627|doi=10.3390/healthcare9060627|pmc=PMC8225090|pmid=34070286|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225090 (Full text)]
*2021, Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected<ref name="Fennell2021">{{Cite journal | title = Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected| date = 2021-05-09|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150911|journal=Healthcare (Basel, Switzerland)|volume=9|issue=5|pages=553 | last = Fennell | first = Patricia A. | author-link = Patricia Fennell | last2 = Dorr | first2 = Nancy | author-link2 = | last3 = George | first3 = Shane S. | authorlink3 = |doi=10.3390/healthcare9050553|pmc=PMC8150911|pmid=34065069|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150911 (Full text)]
*2021, CFS patients remain severely disabled after specialist treatment with CBT in the UK<ref name="Vink2021-CBT">{{Cite journal | title = CFS patients remain severely disabled after specialist treatment with CBT in the UK| date = 2021-05-27|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212546|journal=Journal of the Royal Society of Medicine|volume=114|issue=6|pages=284–284 | last = Vink | first = Mark | authorlink = Mark Vink | last2 = Vink-Niese | first2 = Alexandra | author-link2 = |doi=10.1177/01410768211013447|pmc=PMC8212546|pmid=34042529|access-date=|issn=0141-0768|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212546 (Full text)]
*2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Maksoud2021">{{Cite journal | last = Maksoud | first = Rebekah | authorlink = | last2 = Eaton-Fitch | first2 = Natalie | authorlink2 = Natalie Eaton-Fitch | last3 = Matula | first3 = Michael | authorlink3 = | last4 = Cabanas | first4 = Hélène | authorlink4 = Hélène Cabanas | last5 = Staines | first5 = Donald | authorlink5 = Donald Staines | last6 = Marshall-Gradisnik | first6 = Sonya | authorlink6 = Sonya Marshall-Gradisnik| date = May 2021 | title = Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8150292/|journal=Healthcare|language=en|volume=9|issue=5|pages=568|doi=10.3390/healthcare9050568|pmc=PMC8150292|pmid=34065013|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8150292/ (Full text)]
*2021, Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis<ref name="Strassheim2021">{{Cite journal | title = Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis| date = 2021-02-05|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914910/|journal=Healthcare|volume=9|issue=2|pages=168 | last = Strassheim | first = Victoria | authorlink = Victoria Strassheim | last2 = Newton | first2 = Julia L. | authorlink2 = Julia Newton | last3 = Collins | first3 = Tracy | author-link3 = |doi=10.3390/healthcare9020168|pmc=7914910|pmid=33562474|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914910/ (Full text)]
*2020, Two-Day Cardiopulmonary Exercise Testing in Females with a Severe Grade of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Comparison with Patients with Mild and Moderate Disease<ref name="Campen2020-mms">{{Cite journal | title = Two-Day Cardiopulmonary Exercise Testing in Females with a Severe Grade of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Comparison with Patients with Mild and Moderate Disease | date = 2020-06-30|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551790|journal=Healthcare|volume=8|issue=3|pages=192 | last = van Campen | first = C (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser|doi=10.3390/healthcare8030192|pmc=PMC7551790|pmid=32629923|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551790 (Full text)]
* 2020, Severe ME in children<ref name="Speight2020">{{Cite journal | last = Speight | first = Nigel | authorlink = Nigel Speight | date = Sep 2020 | title = Severe ME in Children|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551866|journal=Healthcare|language=en|volume=8|issue=3|pages=211|doi=10.3390/healthcare8030211|pmc=PMC7551866|pmid=32674263|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551866/ (Full text)]
*2020, Reductions in Cerebral Blood Flow Can Be Provoked by Sitting in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients<ref name="SittingvanCampen2020">{{Cite journal | last = van Campen | first = C. (Linda) MC | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = 2020-10-12 | title = Reductions in Cerebral Blood Flow Can Be Provoked by Sitting in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712289|journal=Healthcare|language=en|volume=8|issue=4|pages=394|doi=10.3390/healthcare8040394|pmc=PMC7712289|pmid=33050553|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712289 (Full text)]
*2020, Cardiac Dimensions and Function are Not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Iversen2021">{{Cite journal | last = Iversen | first=Per Ole | authorlink = | last2 = Lueder | first2 = Thomas Gero von | authorlink2 = | last3 = Kardel | first3 = Kristin Reimers | authorlink3 = | last4 = Lien | first4 = Katarina | author-link4 = | date = Dec 2020 | title = Cardiac Dimensions and Function are Not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712104|journal=Healthcare|language=en|volume=8|issue=4 | pages = 406|doi=10.3390/healthcare8040406|pmc=PMC7712104|pmid=33081294|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712104 (Full text)]
*2020, The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Boulazreg2021">{{Cite journal | last = Boulazreg | first = Samir | authorlink = | last2 = Rokach | first2 = Ami | author-link2 = | date = Dec 2020 | title = The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711762|journal=Healthcare|language=en|volume=8|issue=4 | pages = 413|doi=10.3390/healthcare8040413|pmc=PMC7711762|pmid=33092097|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711762 (Full text)]
* 2020, Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36<ref>{{Cite journal | last = van Campen | first = C. (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = Sep 2020 | title = Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36|url=https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7551321/|journal=Healthcare|language=en|volume=8|issue=3|pages=273|doi=10.3390/healthcare8030273|pmc=PMC7551321|pmid=32823979|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7551321/ (Full text)]
*2021, Health Care Responsibility and Compassion-Visiting the Housebound Patient Severely Affected by ME/CFS<ref name="Kingdon2020">{{Cite journal | last = Kingdon | first = Caroline | authorlink = Caroline Kingdon | last2 = Giotas | first2 = Dionysius | authorlink2 = Dionysius Giotas | last3 = Nacul | first3 = Luis | authorlink3 = Luis Nacul | last4 = Lacerda | first4 = Eliana | author-link4 = Eliana Lacerda | date = Sep 2020 | title = Health Care Responsibility and Compassion-Visiting the Housebound Patient Severely Affected by ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551603|journal=Healthcare|language=en|volume=8|issue=3|pages=197|doi=10.3390/healthcare8030197|pmc=PMC7551603|pmid=32635535|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551603 (Full text)]
*2021, Homebound versus Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Conroy2021">{{Cite journal | last = Conroy | first = Karl | authorlink = | last2 = Bhatia | first2 = Shaun | authorlink2 = | last3 = Islam | first3 = Mohammed | authorlink3 = | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | date = Feb 2021 | title = Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909520|journal=Healthcare|language=en|volume=9|issue=2|pages=106|doi=10.3390/healthcare9020106|pmc=PMC7909520|pmid=33498489|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909520 (Full text)]
*2021, Three Cases of Severe ME/CFS in Adults<ref name="Williams2021">{{Cite journal | last = Williams | first = Leah R. | author-link = | last2 = Isaacson-Barash | first2 = Carol | author-link2 = | date = Feb 2021 | title = Three Cases of Severe ME/CFS in Adults|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920463|journal=Healthcare|language=en|volume=9|issue=2|pages=215|doi=10.3390/healthcare9020215|pmc=PMC7920463|pmid=33669438|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920463 (Full text)]
*2021, Extremely Severe ME/CFS—A Personal Account<ref name="Dafoe2021">{{Cite journal | last = Dafoe | first = Whitney | authorlink = Whitney Dafoe | date = May 2021 | title = Extremely Severe ME/CFS—A Personal Account|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145314|journal=Healthcare|language=en|volume=9|issue=5|pages=504|doi=10.3390/healthcare9050504|pmc=PMC8145314|pmid=33925566|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145314 (Full text)]
* 2020, Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing<ref name="CBF2020">{{Cite journal | last = van Campen | first = C. (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = Jun 2020 | title = Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349207|journal=Healthcare|language=en|volume=8|issue=2|pages=169|doi=10.3390/healthcare8020169|pmc=PMC7349207|pmid=32545797|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349207 (Full text)]

* 2020, [https://www.mdpi.com/journal/healthcare/special_issues/me_cfs_issue Special Issue: "ME/CFS: The Severely and Very Severely Affected" Healthcare]<ref name="specialissue2020">{{Cite web|url=https://www.mdpi.com/journal/healthcare/special_issues/me_cfs_issue | title = Special Issue: ME/CFS ― The Severely and Very Severely Affected | last = Healthcare | first = | author-link =| date = 2021 | website = Healthcare|language=en|archive-url=|archive-date=|url-status=|access-date=2021-02-19}}</ref>

*2020, The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function<ref name="Tomas2020">{{Cite journal | last = Tomas | first = Cara | authorlink = Cara Tomas | first2 = Joanna L. | last2 = Elson | authorlink2 = Joanna Elson | last3 = Newton | first3 = Julia L. | authorlink3 = Julia Newton | last4 = Strassheim | first4 = Victoria | author-link4 = Victoria Strassheim | last5 = Walker | first5 = Mark | authorlink5 = Mark Walker| date = 2020-04-10 | title = The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231136 |journal=PLoS ONE |language=en|volume=15|issue=4| pages = e0231136|doi=10.1371/journal.pone.0231136|issn=|quote=|via=}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231136 (Full text)]

* 2018, Improvement of severe ME/CFS symptoms following surgical treatment of cervical spinal stenosis<ref name="Rowe2018">{{Cite journal | last = Rowe | first = Peter C. | author-link = Peter Rowe | last2 = Marden | first2 = Colleen L. | authorlink2 = Colleen Marden | last3 = Heinlein | first3 = Scott | author-link3 = Scott Heinlein | last4 = Edwards | first4 = Charles C. | authorlink4 = Charles Edwards | authorlink5 = | date = 2018-02-02 | title = Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/5796598|journal=Journal of Translational Medicine|language=en|volume=16|issue=1|pages=21|doi=10.1186/s12967-018-1397-7|issn=1479-5876|pmc=5796598|pmid=29391028|quote=|via=}}</ref> - [https://link.springer.com/article/10.1186/s12967-018-1397-7 (Full text)]
* 2018, Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England.<ref name="northeast">{{Cite journal|url=https://bmjopen.bmj.com/content/bmjopen/8/9/e020775.full.pdf | title = Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England | last = Strassheim | first = Victoria Jane | last2 = Sunquist | first2 = Madison | date = 2018 | journal=BMJ open|volume=8|issue=9| pages = e020775|archive-url=|archive-date=|url-status=|access-date= | last3 = Jason | first3 = Leonard A | last4 = Newton | first4 = Julia|doi=10.1136/bmjopen-2017-020775|authorlink=Victoria Strassheim | authorlink2 = Madison Sunnquist | authorlink3 = Leonard Jason | authorlink4 = Julia Newton}}</ref> - [https://link.springer.com/article/10.1186/s12967-018-1397-7 (Full text)]
* 2017, What is known about severe and very severe chronic fatigue syndrome: A scoping review<ref name="StrassheimLambson2017">{{Cite journal | last = Strassheim | first = Victoria | last2 = Lambson | first2 = Rebecca | last3 = Hackett | first3 = Katie L. | last4 = Newton | first4 = Julia L. | date = 2017-06-19 | title = What is known about severe and very severe chronic fatigue syndrome? A scoping review | url =https://www.tandfonline.com/doi/full/10.1080/21641846.2017.1333185|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=5|issue=3|pages=167–183|doi=10.1080/21641846.2017.1333185|issn=2164-1846|quote= | author-link = Victoria Strassheim | authorlink2 = Rebecca Lambson | authorlink3 = Katie Hackett | author-link4 = Julia Newton | authorlink5 = |via=}}</ref> - [https://www.tandfonline.com/doi/full/10.1080/21641846.2017.1333185 (Full text)]
* 2017, Understanding severely affected chronic fatigue syndrome: CFS the gravity of the situation<ref name="Strassheim2017a">{{Cite journal|url=https://www.tandfonline.com/doi/full/10.1080/10833196.2017.1327131|journal=Physical Therapy Reviews | title = Understanding severely affected chronic fatigue syndrome (CFS): the gravity of the situation | last = Strassheim | first = Victoria Jane | last2 = Lambson | first2 = Rebecca | date = 2017 | volume=22|issue=3-4|language=en|archive-url=|archive-date=|url-status=|access-date=2018-10-20 | last3 = Hackett | first3 = Katie | last4 = Newton | first4 = Julia L|pages=197-201|doi=10.1080/10833196.2017.1327131|authorlink=Victoria Strassheim | authorlink2 = Rebecca Lambson | authorlink3 = Katie Hackett | authorlink4 = Julia Newton}}</ref> - [https://www.tandfonline.com/doi/full/10.1080/10833196.2017.1327131 (Full text)]
*2016, Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome<ref name="Pendergrast2016">{{Cite journal | last = Pendergrast | first=Tricia | authorlink = Tricia Pendergrast | last2 = Brown | first2 = Abigail | author-link2 = Abigail Brown | last3 = Sunnquist | first3 = Madison | authorlink3 = Madison Sunnquist | last4 = Jantke | first4 = Rachel | author-link4 = Rachel Jantke | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | last6 = Strand | first6 = Elin Bolle | authorlink6 = Elin Strand | last7 = Jason | first7 = Leonard A | authorlink7 = Leonard Jason | date = Dec 2016 | title = Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/|journal=Chronic illness|volume=12|issue=4|pages=292–307|doi=10.1177/1742395316644770|issn=1742-3953|pmc=5464362|pmid=27127189|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/ (Full text)]
* 2016, Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents' Experiences<ref name="Mihelicova2016">{{Cite journal | last = Mihelicova | first = Martina | authorlink = Martina Mihelicova | last2 = Siegel | first2 = Zachary | author-link2 = Zachary Siegel | last3 = Evans | first3 = Meredyth | authorlink3 = Meredyth Evans | last4 = Brown | first4 = Abigail | author-link4 = Abigail Brown | last5 = Jason | first5 = Leonard | authorlink5 = Leonard Jason | date = Dec 2016 | title = Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents' Experiences|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/|journal=Journal of health psychology|volume=21|issue=12|pages=2824–2837|doi=10.1177/1359105315587137|issn=1359-1053|pmc=4675701|pmid=26063209|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/ (Full text)]
*2014, What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise<ref name="McDermott2014">{{Cite journal | last = McDermott | first = Clare | authorlink = | last2 = Al Haddabi | first2 = Atheer | authorlink2 = | last3 = Akagi | first3 = Hiroko | authorlink3 = | last4 = Selby | first4 = Michelle | authorlink4 = | last5 = Cox | first5 = Diane | authorlink5 = Diane Cox | last6 = Lewith | first6 = George | authorlink6 = | date = 2014-06-19 | title = What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078780/|journal=BMJ Open|volume=4|issue=6|pages=292-307|doi=10.1136/bmjopen-2014-005083|issn=2044-6055|pmc=4078780|pmid=24984956|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078780/ (Full text)]
* 2010, Being homebound with chronic fatigue syndrome: a multidimensional comparison with outpatients<ref name="Wiborg2010">{{Cite journal | last = Wiborg | first = Jan F. | author-link = Jan Wiborg | last2 = van der Werf | first2 = Sieberen | authorlink2 = Sieberen van der Werf | last3 = Prins | first3 = Judith B. | authorlink3 = Judith Prins | last4 = Bleijenberg | first4 = Gijs | authorlink4 = Gijs Bleijenberg | authorlink5 = | date = May 2010 | title = Being homebound with chronic fatigue syndrome: A multidimensional comparison with outpatients|url=https://linkinghub.elsevier.com/retrieve/pii/S0165178110000569|journal=Psychiatry Research|volume=177|issue=1-2|pages=246–249|doi=10.1016/j.psychres.2010.02.010|issn=0165-1781|quote=|via=}}</ref> - [https://www.sciencedirect.com/science/article/pii/S0165178110000569?via%3Dihub (Full text)]
*2009, Risk factors for severe ME/CFS<ref name="Pheby2009">{{Cite journal | last = Pheby | first = Derek | authorlink = Derek Pheby | last2 = Saffron | first2 = Lisa | author-link2 = | date = 2009 | title = Risk factors for severe ME/CFS|url=https://bucks.repository.guildhe.ac.uk/id/eprint/9823/|journal=Biology and Medicine|volume=1|issue=4|pages=50-74|doi=|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Derek-Pheby/publication/285145361_Risk_factors_for_severe_MECFS/links/0912f511a913223cb6000000/Risk-factors-for-severe-ME-CFS.pdf (Full text)]
* 2007, Severe Chronic Fatigue Syndrome: Recovery is possible<ref name="Burley2007">{{Cite web|url=https://www.researchgate.net/profile/Diane_Cox2/publication/257764167_Severe_Chronic_Fatigue_Syndrome_CFSME_Recovery_is_possible/links/00b49525d3a11018ad000000/Severe-Chronic-Fatigue-Syndrome-CFS-ME-Recovery-is-possible.pdf | title = Severe Chronic Fatigue Syndrome: Recovery is Possible | last = Burley | first = Lucy | authorlink=Lucy Burley | last2 = Cox | first2 = Diane | authorlink2 = Diane Cox | last3 = Findley | first3 = Leslie | authorlink3 = Leslie Findley|journal=British Journal of Occupational Therapy|volume=70|issue=8 | date = Aug 1, 2007|pages=339-344|language=en|doi=10.1177/030802260707000803|archive-url=|archive-date=|url-status=|access-date=2019-02-11}}</ref> - [https://www.researchgate.net/profile/Diane_Cox2/publication/257764167_Severe_Chronic_Fatigue_Syndrome_CFSME_Recovery_is_possible/links/00b49525d3a11018ad000000/Severe-Chronic-Fatigue-Syndrome-CFS-ME-Recovery-is-possible.pdf (Full text)]
* 2000, The course of severe chronic fatigue syndrome in childhood<ref name="Rangel2001">{{Cite journal|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297949/pdf/10741312.pdf | title = The course of severe chronic fatigue syndrome in childhood | last = Rangel | first = L | last2 = Garralda | first2 = M E | date = 2000 | journal=Journal of the Royal Society of Medicine|pages=129-134|volume=93|issue=3|archive-url=|archive-date=|url-status=|access-date= | last3 = Levin | first3 = M | last4 = Roberts | first4 = H|doi=10.1177/014107680009300306|pmid=10741312|authorlink=Luiza Rangel | authorlink2 = Elena Garralda}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297949/pdf/10741312.pdf (Full text)]
* 2000, Severe and Very Severe Patients with chronic fatigue syndrome: perceived outcome following an inpatient programme<ref name="Cox2000">{{Cite journal | last = Cox | first=Diane L. | author-link = Diane Cox | authorlink2 = Leslie Findley | last2 = Findley | first2 = Leslie J. | date = 2000 | title = Severe and Very Severe Patients with Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v07n03_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=7|issue=3|pages=33–47|doi=10.1300/j092v07n03_04|issn=1057-3321|via=|quote=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1300/J092v07n03_04 (Full text)]

==News articles and interviews==
* 2022, [https://eu.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ Epstein-Barr derails NJ man's life; he's pushing for better care: "Trapped in the dark: How chronic fatigue syndrome derailed a NJ musician's life"]
* 2021, [https://eu.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ ME has left me bedbound for eight years – I feel forgotten by the world], North Jersey
* 2020, [https://www.dailymail.co.uk/health/article-7886679/Three-patients-reveal-daily-struggle-crippling-condition.html Three ME patients reveal their daily struggle with the crippling condition], Daily Mail Online
* 2020, [https://meassociation.org.uk/2020/08/how-it-feels-to-have-very-severe-m-e-by-ruth-braham/ How it feels to have Very Severe M.E.] by Ruth Braham, via The ME Association
* 2020, [https://www.bbc.co.uk/news/uk-england-derbyshire-53648296 Kara Jane Spencer: Musicians help severely ill singer finish album], BBC News

* 2019, [https://www.meaction.net/2019/07/24/uk-teenager-with-severe-me-threatened-with-forced-institutionalized/ UK Teenager with Severe ME Threatened with Forced Institutionalization], #MEAction Network”
* 2019, [https://meassociation.org.uk/2019/08/severe-me-day-life-in-a-nursing-home-light-sensitivity-and-very-severe-m-e-by-eira-stuart-08-august-2019 Severe ME Day: Life in a Nursing Home, Light Sensitivity and Very Severe M.E.] by Eira Stuart, via The ME Association
* 2018, [https://www.dailymail.co.uk/news/article-6281435/Woman-33-living-dementia-ward-FIVE-years.html Woman, 33, has been living in a dementia ward for FIVE years after falling ill with crippling condition], Daily Mail<ref name="DailyMailOct2018">{{Cite news | url=https://www.dailymail.co.uk/news/article-6281435/Woman-33-living-dementia-ward-FIVE-years.html | title = Woman, 33, has been living on a dementia ward for FIVE years | last = Rolfe | first = Brooke | date = Oct 16, 2018|work=Mail Online|access-date=2018-10-17|archive-url=|archive-date=|url-status=}}</ref>
* 2018, [https://www.mirror.co.uk/news/real-life-stories/chronic-fatigue-syndrome-left-bedbound-13091318 "I can barely walk and I'm bed-bound 23 hours a day - M.E. nearly killed me"] - positive story of partial recovery from very severe ME by [[Jessica Taylor-Bearman]], Mirror Online
* 2017, [https://www.thescottishsun.co.uk/news/1445538/singer-amanda-hendrie-me-battle/ Bed-bound singer living in silence opens up about how ME stripped her of her voice just weeks after her mum died], The Scottish Sun
* February 27, 2012, [https://meassociation.org.uk/2012/02/tragic-tale-of-woman-with-chronic-fatigue-syndrome-too-tired-to-eat-derby-telegraph-27-february-2012/ Tragic tale of woman with chronic fatigue syndrome 'too tired' to eat], Derby Telegraph
* 2012, [https://www.theguardian.com/commentisfree/2012/mar/30/me-emily-collingridge-chronic-fatigue-syndrome ME is often dismissed – but sufferers like Emily Collingridge], The Guardian<ref name="Guardian30Mar2012">{{Cite news | url=https://www.theguardian.com/commentisfree/2012/mar/30/me-emily-collingridge-chronic-fatigue-syndrome | title = ME is often dismissed – but sufferers like Emily Collingridge are dying | first = Scott Jordan | last = Harris|publisher=The Guardian | date = Mar 30, 2012|access-date=2022-03-17}}</ref>
* 2010, [https://www.dailymail.co.uk/health/article-1093016/Ive-seen-patients-paralysed-dying-Aids-victims-starving-children--Ive-seen-ill-Lynn.html I've seen patients paralysed, dying Aids victims, starving children... but I've never seen anyone as ill as Lynn], Daily Mail

==Patient group surveys ==
* 2014, Severe M.E. Time to Deliver report by Action For ME<ref name="AfME2014">{{Cite web|url=https://www.actionforme.org.uk/uploads/pdfs/my-life-stopped-severe-ME-report.pdf | title = My life stopped... | last = Pates | first=Andrew| date = Nov 14, 2014 | website = [[Action for ME]]|archive-url=|archive-date=|url-status=|access-date=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/ (Full text)]

==See also==
* [[HFME 3 Part ME Ability and Severity Scale|HFME 3 Part M.E. Ability and Severity Scale]]
*[[List of deaths caused by myalgic encephalomyelitis or chronic fatigue syndrome]]
* [[Myalgic encephalomyelitis]]
* [[Rare and uncommon symptoms]]
* [[:Category:Symptom scales|Symptom scales]]
* [[Stigma]]
* [[Causes of death]]
* [[Medical neglect and abuse]]
* [[Periodic paralysis]]
* [[Healthcare, Special Issue: ME/CFS ― The Severely and Very Severely Affected]]

===Severe ME patient groups===
* [[25 Percent ME Group]]
* [[The Hummingbirds' Foundation for ME|The Hummingbirds Foundation for M.E.]]

===People with Severe or Very Severe ME===
* [[Jodi Bassett]] (deceased)
* [[Olaf Bodden]] Former professional soccer player<ref name="olaf">{{Cite news | url=https://www.welt.de/sport/gallery118782921/Benefizspiel-fuer-den-schwer-kranken-Olaf-Bodden.html | title = Benefizspiel für den schwer kranken Olaf Bodden | last = | first = | date = 2021 | language=de|website=Die Welt|archive-url=|archive-date=|url-status=|access-date=2021-11-17}}</ref>
* [[Maeve Boothby-O'Neill]] (deceased)
* [[Emily Collingridge]] (deceased)
* [[Merryn Crofts]] (deceased)
* [[Linda Crowhurst]]
* [[Whitney Dafoe]]
* [[Lynn Gilderdale]] (deceased)
* [[Sophia Mirza]] (deceased)
* [[Jessica Taylor-Bearman]]
* [[Naomi Whittingham]]
* [[Andrew Williams]] (deceased)
* [[James Strazza]]

===Severe ME blogs and websites===
* [[A Life Hidden]]
* [[Stonebird]] [[Greg Crowhurst|(Greg Crowhurst]] and [[Linda Crowhurst]])

==Advocacy appeals ==
*[http://www.blogistan.co.uk/blog/mt.php/2011/05/28/me-awareness-emily-collingridges-appeal Emily Collingridge severe ME Appeal 2011]
* [https://www.healthrising.org/blog/2021/07/12/we-are-failing-people-with-very-severe-me-cfs/ We are Failing People with Very Severe ME/CFS - Health Rising 2021]

==Learn more==
* [https://www.hfme.org/PDF/Comprehensive_ME_Symptom_List.pdf Comprehensive list of M.E.Symptoms]<ref name="HFMEsymptoms">{{Cite web|url=https://www.hfme.org/PDF/Comprehensive_ME_Symptom_List.pdf | title = The comprehensive M.E. symptom list | last = Bassett | first=Jodi | date = Jun 2012 | website = The Hummingbirds' Foundation for M.E. (HFME)|publisher=|archive-url=|archive-date=|url-status=|access-date=2018-12-12|authorlink=Jodi Bassett}}</ref> - Hummingbirds' Foundation for M.E.
* [https://25megroup.org/download/2527/ Knowledge in the Hope of Protecting M.E. Sufferers from Unnecessary Sectioning]<ref name="PreventUnnecessarySectioning">{{Cite web|url=https://25megroup.org/download/2527/ | title = Knowledge in the Hope of Protecting M.E. Sufferers from Unnecessary Sectioning | last2 = 25% ME Group | first2 = | authorlink2 = 25 Percent ME Group | last = The Grace Charity for M.E. | first= | authorlink = The Grace Charity for M.E. | date = Jan 2019 | website = |archive-url=|archive-date=|url-status=|access-date=2019-07-12}}</ref> - Preventing the unnecessary forced mental health sectioning of severely ill patients - [[The Grace Charity for M.E.]] with [[25 Percent ME Group|25% ME Group]]
* [https://www.actionforme.org.uk/uploads/pdfs/my-life-stopped-severe-ME-report.pdf My life stopped - Severe M.E. report]<ref name="AfME2014"/> - Action for ME
* [https://25megroup.org/me/symptoms Severe M.E. symptoms]<ref name="symptoms">{{Cite news | url=https://25megroup.org/me/symptoms | title = Symptoms - 25% M.E. Group|work=25% M.E. Group|access-date=2018-10-20|language=en-US}}</ref> - 25% ME Group
* [http://me-foreningen.dk/wp-content/uploads/2016/10/Crowhurst-Severely-affected-i-Nursing-Standard.pdf Supporting people with severe Myalgic Encephalomyelitis]<ref name="Crowhurst2016">{{Cite web|url=http://me-foreningen.dk/wp-content/uploads/2016/10/Crowhurst-Severely-affected-i-Nursing-Standard.pdf | title = Supporting people with severe myalgic encephalomyelitis | last = Crowhurst | first=Greg | authorlink = Greg Crowhurst | date = 2005|publisher=Nursing Standard|website=ME Foreningen|archive-url=|archive-date=|url-status=|access-date=}}</ref> - Greg Crowhurst

==References==
{{Reflist}}

[[Category:Definitions]]

ME and CFS music

2025-05-18T20:46:55Z

YellowWaterLilly:/* Community musicians */ Added James Strazza

==Commercial musicians==

[[Belle and Sebastian]], "Nobody's Empire"

==Groups==

[[Homebound Music]], founded by [[Greg Crowhurst]]

==Community musicians==

===Laura Vitale===

[[Laura Vitale]]'s songs about [[Myalgic encephalomyelitis|ME]] include "[https://soundcloud.com/lauravitalemusic/hey-fauci-7/comment-272490696 Hey Fauci]," "[https://soundcloud.com/lauravitalemusic/broken-for-karina Broken (For Karina)]," and "[https://soundcloud.com/lauravitalemusic/red-shoes Red Shoes]."

=== James Strazza ===

* [[James Strazza]]'s singles include "I Don't Want to be a Loon" and "Doe Eyes".

==See also==

*[[ME and CFS in popular culture]]

==References==

{{Reflist}}
[[Category:ME and CFS in popular culture]]

James Strazza

2025-05-18T20:36:03Z

YellowWaterLilly:/* Books and music */ Added new book, links to some songs, plus other minor edits throughout page.

{{NeedsImage}}
'''Chronic fatigue sufferer: 'Life was kicked out from under me like a skateboard''''. February 2022.

'''James Strazza''' is an American independent music professional, musician and poet with [[Very severe myalgic encephalomyelitis or chronic fatigue syndrome|very severe]] [[myalgic encephalomyelitis|Myalgic Encephalomyelitis]]/[[chronic fatigue syndrome|Chronic Fatigue Syndrome]].<ref name="fb">{{Cite web | url = https://www.facebook.com/jamesstrazzapoetry/ | title = James Strazza | last = | first = | date = |website=Facebook|language=en|archive-url=|archive-date=|url-status=|access-date=2022-06-12}}</ref><ref name="QA2022" /> Strazza developed CFS in 2008, which became severe in 2000. He has been totally [[Severe_and_very_severe ME#veryservere|bedbound]] for years and is cared for by his mother, [[Galen Warden]].<ref name="kicked2022">{{Cite web | url = https://www.northjersey.com/videos/news/health/2022/02/06/chronic-fatigue-sufferer-life-kicked-out-under-me-like-skateboard/6664016001/ | title = Chronic fatigue sufferer: 'Life was kicked out from under me like a skateboard' | last = Burkhart | first = Richard | authorlink= | date = 2022-02-06 | website = North Jersey Media Group|language=en-US|archive-url=|archive-date=|url-status=|access-date=2022-06-12}}</ref><ref name="QA2022">{{Cite web | url = https://www.northjersey.com/story/news/2022/02/06/chronic-fatigue-system-q-a-new-jersey-rockaway-james-strazza/6674765001/ | title = 'It has taken everything from me': Q&A with former NJ man with chronic fatigue syndrome | last = Myers | first = Gene | date = 2022-02-06 | website = North Jersey Media Group|language=en-US|access-date=2022-06-12}}</ref> He published his first book of poetry, ''Lyrical'', in 2020.<ref name="website">{{Cite web|url=https://www.jamesstrazza.com/|title=James Strazza, Poet and Musician {{!}} Books|website=James Strazza|language=en|access-date=2025-05-18}}</ref> At various times, James was able to draw on an iPad, record his voice from his bed, and play a little keyboard music on his lap, yet these creative pleasures did not last.<ref name="website" />

==History ==
Strazza developed chronic fatigue syndrome after developing [[mononucleosis]] from the [[Epstein-Barr virus]] in 2008.<ref name="EBV2022">{{Cite web | url = https://www.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ | title = Trapped in the dark: How chronic fatigue syndrome derailed a NJ musician's life | last = Myers | first = Gene|website=North Jersey Media Group | date = 2022-02-06|language=en-US|access-date=2022-06-12}}</ref> He struggled to get a diagnosis and was advised to keep [[pushing through symptoms]] his symptoms, which resulted in his ME/CFS becoming very severe.<ref name="QA2022" />

==CFS symptoms ==
Strazza's neurological symptoms include severe [[photophobia]], [[noise sensitivity]], and [[allodynia]] and lives in almost total darkness, with [[noise canceling headphones]] and a minimum of touch to avoid increasing his waves of severe [[chronic pain]]. His noise intolerance has forced him to give up playing music.<ref name="EBV2022" /><ref name="QA2022" />

He has profound and debilitating [[fatigue]] and his limbs are too heavy to lift.<ref name="kicked2022" />

{{Quote|text=I had a friend who became severe and he told me "James, this is the worst day of my life, and I can still get up to use the bathroom and use a wheelchair, how do you do it?" It puts you in a position where you feel like [[suicide]] is the only way out. Every day is the worst day of your life, and the scary part is it can always get worse.<ref name="QA2022"/> | author = James Strazza}}

Galen Warden, Strazza's mother and full-time carer states:
<blockquote>"It's like a frog being dropped in cold water and then you gradually raise the heat. At first these things didn't raise huge alarm," said Warden, 64. "There was nothing out there that talks about this, so we didn't have a reference of any kind. We kept telling him shake it off. You can do it. [[Exercise]] more." - Galen Warden<ref name="QA2022" /></blockquote>

==Advocacy ==

Strazza has featured in a number of interviews, raising awareness of ME/CFS and the lack of medical knowledge in particular. His songs from when he his ME/CFS was less severe, and his recent poetry raise awareness of what it is like for him.

Strazza is critical of the lack of funding for medical research into ME/CFS, and of the extremely low [[disability]] payments made in the [[United States]] to those have been ill since [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome|childhood]], adolescence or as a young adult.<ref name="QA2022" />

{{Quote|text=The second thing I want people to know is how little the government and medical industry cares for people with ME and [[chronic illness]] in general. It took me eight years and thousands of dollars to get a diagnosis. The dozens of doctors I saw in that time gave me advice that has ruined my life; I blame their ignorance for my severity that is potentially permanent. Most doctors don't know anything about ME, and the few who do [[Biopsychosocial model|think it's a psychological illness]]. It is unbelievably difficult to find help.<ref name="QA2022"/> | author = James Strazza}}

==Talks and interviews==
* Video: 2022, [https://www.northjersey.com/videos/news/health/2022/02/06/chronic-fatigue-sufferer-life-kicked-out-under-me-like-skateboard/6664016001/ Chronic fatigue sufferer: 'Life was kicked out from under me like a skateboard'] - Richard Burkhart
::For the last two years, musician James Strazza has been experiencing a debilitating form of chronic fatigue. Still, he says he tries to create beauty in the darkness.
* 2022, [https://northjersey.com/story/news/2022/02/06/chronic-fatigue-system-q-a-new-jersey-rockaway-james-strazza/6674765001/ 'It has taken everything from me': Q&A with former NJ man with chronic fatigue syndrome] - Gene Myers - NorthJersey.com
* 2022, [https://www.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ Trapped in the dark: How chronic fatigue syndrome derailed a musician's life] - Gene Myers - NorthJersey.com
* Aug 8, 2020, [https://www.meaction.net/2020/08/08/let-us-honor-the-most-severe-in-our-community-today/ Let Us Honor the Most Severe in our Community Today!] - MEAction

== Books ==
* 2020, [https://www.jamesstrazza.com/ Lyrical]: Poems that will blow you a kiss or punch you in the stomach. ISBN-10 [[Tel:1735971804|1735971804]], ISBN-13 978-1735971803.
* March 31, 2025, [https://www.jamesstrazza.com/ Unsung]: Poems Written in the Dark Paperback<ref>{{Cite web|url=https://www.jamesstrazza.com/|title=James Strazza, Poet and Musician {{!}} Books|website=James Strazza|language=en|access-date=2025-05-18}}</ref>

== Music ==

* James Strazza has produced an album called "[https://open.spotify.com/album/17TU2c5BAOgRJtAiVktsUI The Attic Tapes]".<ref name=":0">{{Cite web|url=https://www.jamesstrazza.com/music-art|title=Music and Art|website=James Strazza|language=en|access-date=2025-05-18}}</ref>
* His singles include "[https://open.spotify.com/track/0OxEpI29WfrAP8g2W8r3A1 I Don't Want to be a Loon]" and "[https://open.spotify.com/track/0uLqAAOGnxtb5YKjcfHaLk Doe Eyes]".<ref name=":0" />

==Online presence==
* [https://www.twitter.com/strazzajames Twitter]
* [https://www.facebook.com/jamesstrazzapoetry/ Facebook]
* [https://instagram.com/james_strazza Instagram]
* [https://www.linkedin.com/in/james-strazza-09769235 LinkedIn]
* [http://www.jamesstrazza.com/ Website]
* [https://www.patreon.com/jslyrical Patreon]
* [https://m.youtube.com/user/strazza555 YouTube]
* [https://jamesstrazza.bigcartel.com/product/lyrical-signed Lyrical book, signed]
*[https://www.gofundme.com/f/treatment-for-james GoFundme]

==See also==
* [[Severe ME Awareness Day]]
* [[ME Awareness Day]]
* [[Severe and very severe ME]]
* [[Depression]]
* [[Suicide]]
* [[Primer for family, friends and care providers]]
* [[ME and CFS music]]

==Interviews and articles==
*2022, [https://northjersey.com/story/news/2022/02/06/chronic-fatigue-system-q-a-new-jersey-rockaway-james-strazza/6674765001/ 'It has taken everything from me': Q&A with former NJ man with chronic fatigue syndrome] - Gene Myers - NorthJersey.com

==Learn more==

==References==
{{reflist}}

[[Category:People with ME, CFS, and/or FMS]]
[[Category:Advocates or allies]]
[[Category:American advocates or allies]]
[[Category:Psychological paradigm critics]]

Severe and very severe ME

2025-05-17T02:39:16Z

YellowWaterLilly:/* See also */ Added link to related MEpedia page - Healthcare, Special Issue: ME/CFS ― The Severely and Very Severely Affected

[[File:Linda Crowhurst.JPG|300x300px|thumb|[[Linda Crowhurst]] is very severely ill with ME. Her husband [[Greg Crowhurst]] is Linda's full-time carer. This still is from the music video ''[https://www.youtube.com/watch?v=Z1z5O_cgQ7I Wasteland]'' which delicately documents Linda's very severe ME]]

'''Severe and very severe ME''' affects about 25% of people with [[myalgic encephalomyelitis|myalgic encephalomyelitis]] (ME), with patients being housebound or bedbound at some point in their illness,<ref name="IOM2015">{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK284903/ | title = Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness | last = ((Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome;Board on the Health of Select Populations; Institute of Medicine (U.S.))) | first = |publisher=National Academies Press|others=| year = 2015 |isbn=9780309316903|location=Washington, D.C.|oclc=906233426|editor-link=|chapter=|quote= | page = 32}}</ref> typically needing to use a [[wheelchair]], unable to do any kind of work or study, and often unable to do basic self-care activities unaided.<ref name="severeME-25">{{Cite web|url=https://25megroup.org/me | title = Severe M.E.|website=25% M.E. Group|language=en|access-date=2022-03-17}}</ref> Some people have died of severe ME, including [[Emily Collingridge]], [[Merryn Crofts]], [[Sophia Mirza]].<ref name="Guardian30Mar2012"/><ref name="Vindication"/><ref name="suicidality2021">{{Cite journal | last = Chu | first = Lily | authorlink = Lily Chu | last2 = Elliott | first2 = Meghan | authorlink2 = | last3 = Stein | first3 = Eleanor | authorlink3 = Eleanor Stein | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | title = Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227525/|journal=Healthcare|volume=9|issue=6 | pages = 629|doi=10.3390/healthcare9060629|issn=2227-9032|pmc=PMC8227525|pmid=34070367 | date = 2021 | quote=|via=}}</ref>

==What is Severe ME?==
There is no generally agreed upon description of severe or very severe ME, but different clinical scales can be used to measure the degree of disability.<ref name="ICC2011primer">{{Cite journal | last = Carruthers | first=Bruce M. | author-link = Bruce Carruthers | last2 = van de Sande | first2 = Marjorie I. | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Klimas | first4 = Nancy G. | author-link4 = Nancy Klimas | last5 = Broderick | first5 = Gordon | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = Terry | authorlink6 = Terry Mitchell | last7 = Staines | first7 = Donald | author-link7 = Donald Staines | last8 = Powles | first8 = A.C. Peter | author-link8 = A C Peter Powles | last9 = Speight | first9 = Nigel | authorlink9 = Nigel Speight | last10 = Vallings | first10 = Rosamund | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = Lucinda | authorlink11 = Lucinda Bateman | last12 = Baumgarten-Austrheim | first12 = Barbara | authorlink12 = Barbara Baumgarten-Austrheim | last13 = Bell | first13 = David | author-link13 = David Bell | last14 = Carlo-Stella | first14 = Nicoletta | author-link14 = Nicoletta Carlo-Stella | last15 = Chia | first15 = John | author-link15 = John Chia | last16 = Darragh | first16 = Austin | author-link16 = Austin Darragh | last17 = Jo | first17 = Daehyun | author-link17 = Daehyun Jo | last18 = Lewis | first18 = Donald | author-link18 = Donald Lewis | last19 = Light | first19 = Alan | author-link19 = Alan Light | last20 = Marshall-Gradisnik | first20 = Sonya | author-link20 = Sonya Marshall-Gradisnik | last21 = Mena | first21 = Ismael | author-link21 = Ismael Mena | last22 = Mikovits | first22 = Judy | author-link22 = Judy Mikovits | last23 = Miwa | first23 = Kunihisa | author-link23 = Kunihisa Miwa | last24 = Murovska | first24 = Modra | author-link24 = Modra Murovska | last25 = Pall | first25 = Martin | author-link25 = Martin Pall | last26 = Stevens | first26 = Staci | author-link26 = Staci Stevens | date = 2011-08-22 | title=Myalgic encephalomyelitis: International Consensus Criteria|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2011.02428.x|journal=Journal of Internal Medicine|language=en|volume=270|issue=4|pages=327–338|doi=10.1111/j.1365-2796.2011.02428.x|issn=0954-6820|pmc=3427890|pmid=21777306|via=}}</ref><ref name="NBK284903">{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK284903/|chapter=Questionnaires and Tools That May Be Useful for Assessing ME/CFS Symptoms | title = Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness | last = ((Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome;Board on the Health of Select Populations; Institute of Medicine (U.S.))) | first = |publisher=National Academies Press|others=| year = 2015 |isbn=9780309316903|location=Washington, D.C.|oclc=906233426|pages=|title-link=|access-date= | author-link = Institute of Medicine|quote=|archive-url=|archive-date=}}</ref> Very little research has described the symptoms and experiences of patients with severe ME or very severe ME, much of what is known comes from patient and advocacy groups.

A study of 19 bedbound patients with severe ME and [[orthostatic intolerance]] by van Campen et al (2020) found an average 27% decrease in blood flow to the brain during a 20 degree [[tilt table test]] that lasted just 15 minutes. Some patients could not tolerate the orthostatic symptoms for 15 mins and had to finish the test early. The patients average 35 years of age and had been ill on average 14 years. All the severely ill patients had abnormal drops in blood flow to the brain.<ref name="CBF2020" />

<embedvideo service="youtube" description="''Hope for a Better Moment'' by Linda Crowhurst. This video clearly documents Linda's [[neurological]] symptoms of her very severe ME" dimensions="400" alignment="right" container="frame">https://www.youtube-nocookie.com/watch?v=rVsOeZjhMFY&autoplay=0</embedvideo>{{clear}}
==Severe ME symptom scales==
Substantial impairment and disability in adults can be measured using the following scales:
* [[Energy Index Point Score]]
* [http://fiqrinfo.ipage.com/FIQR%20FORM.pdf Fibromyalgia Impact Questionnaire Revised (FIQR)]<ref name="NBK284903" />
* Katz Index of Independence in Activities of Daily Living<ref>{{Cite web|url=https://consultgeri.org/try-this/general-assessment/issue-2.pdf | title = Katz Index of Independence in Activities of Daily Living (ADL) | last = Shelkey | first = Mary | last2 = Wallace | first2 = Meredith | date = 2012 | website = |archive-url=|archive-date=|url-status=|access-date= | author-link =| authorlink2 = }}</ref>
* The Lawton Instrumental Activities of Daily Living (IADL) Scale<ref>{{Cite news | url=https://consultgeri.org/try-this/general-assessment/issue-23 | title = The Lawton Instrumental Activities of Daily Living (IADL) Scale {{!}} ConsultGeri Assessment Tool | last = Graf | first = Carla | date = 2015-11-23|work=ConsultGeri|access-date=2018-10-13|archive-url=|archive-date=|url-status=|language=en}}</ref>
* [[Short Form 36-Item Health Survey|Short-Form 36 Item Health Survey]] which is not specific to ME/CFS
* [https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html RAND-36 - available as a free version of SF-36]<ref>{{Cite web|url=https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html | title = 36-Item Short Form Survey from the RAND Medical Outcomes Study|website=rand.org|language=en|access-date=2018-10-13}}</ref>

* [http://serene.me.uk/tests/wsas.pdf Work and Social Adjustment Scale]<ref>{{Cite web|url=http://serene.me.uk/tests/wsas.pdf | title = Work and Social Adjustment Scale | last = | first = | date = |website=serene.me|archive-url=|archive-date=|url-status=|access-date=}}</ref> (WSAS)

===Scales developed by patient organizations===
* [[HFME 3 Part ME Ability and Severity Scale|HFME 3 Part M.E. Ability and Severity Scale]]

==Comparison==
Some scales have a "ceiling effect" that means severe ME can not adequately be distinguished from very severe ME, or from moderate ME, including the [[Chalder fatigue scale]].<ref name="jason2011">{{Cite journal | last= Jason | first = Leonard A. | author-link = Leonard Jason | last2 = Evans | first2 = Meredyth | authorlink2 = Meredyth Evans | last3 = Brown | first3 = Molly | author-link3 = Molly Brown | last4 = Porter | first4 = Nicole | authorlink4 = Nicole Porter | last5 = Brown | first5 = Abigail | authorlink5 = Abigail Brown | last6 = Hunnell | first6 = Jessica | authorlink6 = Jessica Hunnell | last7 = Anderson | first7 = Valerie | authorlink7 = Valerie Anderson | last8 = Lerch | first8 = Athena | authorlink8 = Athena Lurch | date = 2011 | title=Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181109/|journal=Disability studies quarterly : DSQ|volume=31|issue=1|pages=|issn=1041-5718|pmc=3181109|pmid=21966179|quote=|via=}}</ref>

Some patients who are severely ill may not have enough concentration to complete a questionnaire, or may be too ill to communicate, these patients may need another person to complete the rating scale instead, for example a carer or health professional. A pilot study of patients with severe CFS/ME in North East England found that even when visiting patients at home, some were unable to complete a questionnaire or to even attempt to stand.<ref name="northeast" /> 
[[File:Naomi Whittingham .png|300px|thumb|left|[[Naomi Whittingham]] lives in the [[United Kingdom|UK]] with a 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 fundraising for [[ME Research UK]]]]
{{Clear|both}}
==Very severe ME==
[[File:Merry Crofts sick.JPG|250px|thumb|right|[[Merryn Crofts]] was bedbound and unable to eat before she died of very severe ME.]]
Merryn weighed six stone (84 lbs) and was just 21 years old when she died; her autopsy revealed [[Dorsal root ganglia|ganglia]] [[inflammation]]. It is suspected that in the later years of her illness Merryn also suffered from [[Ehlers-Danlos syndrome|EDS]] and [[Mast cell activation disorder|MCAD]]. Her death certificate was reported to be the second in the [[United Kingdom|UK]] to attribute a death to [[myalgic encephalomyelitis]] (M.E.).<ref name="Vindication">{{Cite news | publisher=BBC Radio 5 Live|url=https://www.bbc.co.uk/news/health-44969741 | title = 'Vindication' for woman who wanted ME on death certificate | first = Jim | last = Taylor| date = July 27, 2018}}</ref>

Doctors initially suggested that Merryn was having panic attacks, and her family were later told that she may have conversion disorder, a mental condition formerly known as hysteria.
"I knew it wasn't. I work with people who have panic attacks and I can talk them down," said Clare.
"Merryn was starting to think 'What if it is in my head?' It made her doubt herself, which is awful."
Eventually a private doctor diagnosed Merryn with ME and she began to receive treatment on the NHS.
Within six months of falling ill she was using a wheelchair, and within a year she was housebound. 
A very severe ME patient's experience photo shows clear signs of [[muscle atrophy|muscle wasting]] and [[disability]] - but for the majority of patients it remains an [[invisible illness]].
[[File:Whitney.JPG|300px|thumb|[[Whitney Dafoe]] is an American photographer who has very severe ME. Whitney can no longer speak or handle contact with anyone but his parents due to [[visual dysfunction]]. His father is [[Ronald Davis|Ron Davis]], a world-renowned geneticist who is working to solve his son's disease.]] 

People with very severe ME are totally '''bedbound''' and unable to stand at all.<ref name="northeast" /><ref name="StrassheimLambson2017" /> Some people with very severe ME have improved over time, or after surgery from [[cervical spinal stenosis]].<ref name="cagedbird2016">{{Cite web|url=https://www.youtube.com/watch?v=ZzUo0v5lf9c | title = ME Awareness May 2016 | last = The Caged Bird | first= | author-link =| date = 2016 | website = YouTube|publisher=[[Let's Do It for ME]]|archive-url=|archive-date=|url-status=|access-date=2019-01-28}}</ref><ref name="Rowe2018" />
{{clear}}

==Notable studies==
* 2021, Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Brownlie2021">{{Cite journal | title = Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2021-11-12|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623195|journal=Healthcare|volume=9|issue=11|pages=1546 | last = Brownlie | first = Helen | authorlink = | last2 = Speight | first2 = Nigel | author-link2 = Nigel Speight|doi=10.3390/healthcare9111546|pmc=PMC8623195|pmid=34828592|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623195 (Full text)]
::IV Immunoglobulin G may be effective for some with severe ME
*2021, Life-Threatening Malnutrition in Very Severe ME/CFS<ref name="malnutrition2021">{{Cite journal | last = Baxter | first=Helen | authorlink = | last2 = Speight | first2 = Nigel | author-link2 = Nigel Speight | last3 = Weir | first3 = William | authorlink3 = William Weir| date = Apr 2021 | title = Life-Threatening Malnutrition in Very Severe ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213|journal=Healthcare|language=en|volume=9|issue=4 | pages = 459|doi=10.3390/healthcare9040459|pmc=PMC8070213|pmid=33919671|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213 (Full text)]
*2021, Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Montoya2021">{{Cite journal | title = Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2021-10-06|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544443|journal=Healthcare|volume=9|issue=10|pages=1331 | last = Montoya | first=Jose | authorlink = Jose Montoya | last2 = Dowell | first2 = Theresa | author-link2 = | last3 = Mooney | first3 = Amy | author-link3 = | last4 = Dimmock | first4 = Mary | author-link4 = Mary Dimmock | last5 = Chu | first5 = Lily | authorlink5 = Lily Chu|doi=10.3390/healthcare9101331|pmc=PMC8544443|pmid=34683011|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544443 (Full text)]
* 2021, Comprehensive Examination of Severely Ill ME/CFS Patients<ref name="Chang2021-Ex">{{Cite journal | last = Chang | first = Chia-Jung | authorlink = | last2 = Hung | first2 = Li-Yuan | authorlink2 = | last3 = Kogelnik | first3 = Andreas M. | authorlink3 = Andreas Kogelnik | last4 = Kaufman | first4 = David | author-link4 = David Kaufman | last5 = Aiyar | first5 = Raeka S. | authorlink5 = | last6 = Chu | first6 = Angela M. | authorlink6 = | last7 = Wilhelmy | first7 = Julie | last8 = Li | first8 = Peng | last9 = Tannenbaum | first9 = Linda | date = Oct 2021 | title = A Comprehensive Examination of Severely Ill ME/CFS Patients|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535418|journal=Healthcare|language=en|volume=9|issue=10|pages=1290|doi=10.3390/healthcare9101290|pmc=PMC8535418|pmid=34682970|access-date=|quote=|via= | authorlink9 = Linda Tannenbaum | authorlink7 = Julie Wilhelmy}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535418 (Full text)]
* 2021, The Impact of Severe ME/CFS on Student Learning and K–12 Educational Limitations<ref name="Newton2021">{{Cite journal | last = Newton | first = Faith R. | author-link = | date = Jun 2021 | title = The Impact of Severe ME/CFS on Student Learning and K–12 Educational Limitations|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225090|journal=Healthcare|language=en|volume=9|issue=6 | pages = 627|doi=10.3390/healthcare9060627|pmc=PMC8225090|pmid=34070286|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225090 (Full text)]
*2021, Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected<ref name="Fennell2021">{{Cite journal | title = Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected| date = 2021-05-09|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150911|journal=Healthcare (Basel, Switzerland)|volume=9|issue=5|pages=553 | last = Fennell | first = Patricia A. | author-link = Patricia Fennell | last2 = Dorr | first2 = Nancy | author-link2 = | last3 = George | first3 = Shane S. | authorlink3 = |doi=10.3390/healthcare9050553|pmc=PMC8150911|pmid=34065069|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150911 (Full text)]
*2021, CFS patients remain severely disabled after specialist treatment with CBT in the UK<ref name="Vink2021-CBT">{{Cite journal | title = CFS patients remain severely disabled after specialist treatment with CBT in the UK| date = 2021-05-27|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212546|journal=Journal of the Royal Society of Medicine|volume=114|issue=6|pages=284–284 | last = Vink | first = Mark | authorlink = Mark Vink | last2 = Vink-Niese | first2 = Alexandra | author-link2 = |doi=10.1177/01410768211013447|pmc=PMC8212546|pmid=34042529|access-date=|issn=0141-0768|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212546 (Full text)]
*2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Maksoud2021">{{Cite journal | last = Maksoud | first = Rebekah | authorlink = | last2 = Eaton-Fitch | first2 = Natalie | authorlink2 = Natalie Eaton-Fitch | last3 = Matula | first3 = Michael | authorlink3 = | last4 = Cabanas | first4 = Hélène | authorlink4 = Hélène Cabanas | last5 = Staines | first5 = Donald | authorlink5 = Donald Staines | last6 = Marshall-Gradisnik | first6 = Sonya | authorlink6 = Sonya Marshall-Gradisnik| date = May 2021 | title = Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8150292/|journal=Healthcare|language=en|volume=9|issue=5|pages=568|doi=10.3390/healthcare9050568|pmc=PMC8150292|pmid=34065013|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8150292/ (Full text)]
*2021, Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis<ref name="Strassheim2021">{{Cite journal | title = Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis| date = 2021-02-05|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914910/|journal=Healthcare|volume=9|issue=2|pages=168 | last = Strassheim | first = Victoria | authorlink = Victoria Strassheim | last2 = Newton | first2 = Julia L. | authorlink2 = Julia Newton | last3 = Collins | first3 = Tracy | author-link3 = |doi=10.3390/healthcare9020168|pmc=7914910|pmid=33562474|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914910/ (Full text)]
*2020, Two-Day Cardiopulmonary Exercise Testing in Females with a Severe Grade of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Comparison with Patients with Mild and Moderate Disease<ref name="Campen2020-mms">{{Cite journal | title = Two-Day Cardiopulmonary Exercise Testing in Females with a Severe Grade of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Comparison with Patients with Mild and Moderate Disease | date = 2020-06-30|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551790|journal=Healthcare|volume=8|issue=3|pages=192 | last = van Campen | first = C (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser|doi=10.3390/healthcare8030192|pmc=PMC7551790|pmid=32629923|access-date=|issn=2227-9032|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551790 (Full text)]
* 2020, Severe ME in children<ref name="Speight2020">{{Cite journal | last = Speight | first = Nigel | authorlink = Nigel Speight | date = Sep 2020 | title = Severe ME in Children|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551866|journal=Healthcare|language=en|volume=8|issue=3|pages=211|doi=10.3390/healthcare8030211|pmc=PMC7551866|pmid=32674263|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551866/ (Full text)]
*2020, Reductions in Cerebral Blood Flow Can Be Provoked by Sitting in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients<ref name="SittingvanCampen2020">{{Cite journal | last = van Campen | first = C. (Linda) MC | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = 2020-10-12 | title = Reductions in Cerebral Blood Flow Can Be Provoked by Sitting in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712289|journal=Healthcare|language=en|volume=8|issue=4|pages=394|doi=10.3390/healthcare8040394|pmc=PMC7712289|pmid=33050553|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712289 (Full text)]
*2020, Cardiac Dimensions and Function are Not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Iversen2021">{{Cite journal | last = Iversen | first=Per Ole | authorlink = | last2 = Lueder | first2 = Thomas Gero von | authorlink2 = | last3 = Kardel | first3 = Kristin Reimers | authorlink3 = | last4 = Lien | first4 = Katarina | author-link4 = | date = Dec 2020 | title = Cardiac Dimensions and Function are Not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712104|journal=Healthcare|language=en|volume=8|issue=4 | pages = 406|doi=10.3390/healthcare8040406|pmc=PMC7712104|pmid=33081294|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712104 (Full text)]
*2020, The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Boulazreg2021">{{Cite journal | last = Boulazreg | first = Samir | authorlink = | last2 = Rokach | first2 = Ami | author-link2 = | date = Dec 2020 | title = The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711762|journal=Healthcare|language=en|volume=8|issue=4 | pages = 413|doi=10.3390/healthcare8040413|pmc=PMC7711762|pmid=33092097|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711762 (Full text)]
* 2020, Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36<ref>{{Cite journal | last = van Campen | first = C. (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = Sep 2020 | title = Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36|url=https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7551321/|journal=Healthcare|language=en|volume=8|issue=3|pages=273|doi=10.3390/healthcare8030273|pmc=PMC7551321|pmid=32823979|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7551321/ (Full text)]
*2021, Health Care Responsibility and Compassion-Visiting the Housebound Patient Severely Affected by ME/CFS<ref name="Kingdon2020">{{Cite journal | last = Kingdon | first = Caroline | authorlink = Caroline Kingdon | last2 = Giotas | first2 = Dionysius | authorlink2 = Dionysius Giotas | last3 = Nacul | first3 = Luis | authorlink3 = Luis Nacul | last4 = Lacerda | first4 = Eliana | author-link4 = Eliana Lacerda | date = Sep 2020 | title = Health Care Responsibility and Compassion-Visiting the Housebound Patient Severely Affected by ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551603|journal=Healthcare|language=en|volume=8|issue=3|pages=197|doi=10.3390/healthcare8030197|pmc=PMC7551603|pmid=32635535|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551603 (Full text)]
*2021, Homebound versus Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Conroy2021">{{Cite journal | last = Conroy | first = Karl | authorlink = | last2 = Bhatia | first2 = Shaun | authorlink2 = | last3 = Islam | first3 = Mohammed | authorlink3 = | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | date = Feb 2021 | title = Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909520|journal=Healthcare|language=en|volume=9|issue=2|pages=106|doi=10.3390/healthcare9020106|pmc=PMC7909520|pmid=33498489|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909520 (Full text)]
*2021, Three Cases of Severe ME/CFS in Adults<ref name="Williams2021">{{Cite journal | last = Williams | first = Leah R. | author-link = | last2 = Isaacson-Barash | first2 = Carol | author-link2 = | date = Feb 2021 | title = Three Cases of Severe ME/CFS in Adults|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920463|journal=Healthcare|language=en|volume=9|issue=2|pages=215|doi=10.3390/healthcare9020215|pmc=PMC7920463|pmid=33669438|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920463 (Full text)]
*2021, Extremely Severe ME/CFS—A Personal Account<ref name="Dafoe2021">{{Cite journal | last = Dafoe | first = Whitney | authorlink = Whitney Dafoe | date = May 2021 | title = Extremely Severe ME/CFS—A Personal Account|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145314|journal=Healthcare|language=en|volume=9|issue=5|pages=504|doi=10.3390/healthcare9050504|pmc=PMC8145314|pmid=33925566|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145314 (Full text)]
* 2020, Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing<ref name="CBF2020">{{Cite journal | last = van Campen | first = C. (Linda) M.C. | authorlink = Linda van Campen | last2 = Rowe | first2 = Peter C. | authorlink2 = Peter Rowe | last3 = Visser | first3 = Frans C. | authorlink3 = Frans Visser| date = Jun 2020 | title = Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349207|journal=Healthcare|language=en|volume=8|issue=2|pages=169|doi=10.3390/healthcare8020169|pmc=PMC7349207|pmid=32545797|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349207 (Full text)]

* 2020, [https://www.mdpi.com/journal/healthcare/special_issues/me_cfs_issue Special Issue: "ME/CFS: The Severely and Very Severely Affected" Healthcare]<ref name="specialissue2020">{{Cite web|url=https://www.mdpi.com/journal/healthcare/special_issues/me_cfs_issue | title = Special Issue: ME/CFS ― The Severely and Very Severely Affected | last = Healthcare | first = | author-link =| date = 2021 | website = Healthcare|language=en|archive-url=|archive-date=|url-status=|access-date=2021-02-19}}</ref>

*2020, The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function<ref name="Tomas2020">{{Cite journal | last = Tomas | first = Cara | authorlink = Cara Tomas | first2 = Joanna L. | last2 = Elson | authorlink2 = Joanna Elson | last3 = Newton | first3 = Julia L. | authorlink3 = Julia Newton | last4 = Strassheim | first4 = Victoria | author-link4 = Victoria Strassheim | last5 = Walker | first5 = Mark | authorlink5 = Mark Walker| date = 2020-04-10 | title = The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231136 |journal=PLoS ONE |language=en|volume=15|issue=4| pages = e0231136|doi=10.1371/journal.pone.0231136|issn=|quote=|via=}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231136 (Full text)]

* 2018, Improvement of severe ME/CFS symptoms following surgical treatment of cervical spinal stenosis<ref name="Rowe2018">{{Cite journal | last = Rowe | first = Peter C. | author-link = Peter Rowe | last2 = Marden | first2 = Colleen L. | authorlink2 = Colleen Marden | last3 = Heinlein | first3 = Scott | author-link3 = Scott Heinlein | last4 = Edwards | first4 = Charles C. | authorlink4 = Charles Edwards | authorlink5 = | date = 2018-02-02 | title = Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/5796598|journal=Journal of Translational Medicine|language=en|volume=16|issue=1|pages=21|doi=10.1186/s12967-018-1397-7|issn=1479-5876|pmc=5796598|pmid=29391028|quote=|via=}}</ref> - [https://link.springer.com/article/10.1186/s12967-018-1397-7 (Full text)]
* 2018, Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England.<ref name="northeast">{{Cite journal|url=https://bmjopen.bmj.com/content/bmjopen/8/9/e020775.full.pdf | title = Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England | last = Strassheim | first = Victoria Jane | last2 = Sunquist | first2 = Madison | date = 2018 | journal=BMJ open|volume=8|issue=9| pages = e020775|archive-url=|archive-date=|url-status=|access-date= | last3 = Jason | first3 = Leonard A | last4 = Newton | first4 = Julia|doi=10.1136/bmjopen-2017-020775|authorlink=Victoria Strassheim | authorlink2 = Madison Sunnquist | authorlink3 = Leonard Jason | authorlink4 = Julia Newton}}</ref> - [https://link.springer.com/article/10.1186/s12967-018-1397-7 (Full text)]
* 2017, What is known about severe and very severe chronic fatigue syndrome: A scoping review<ref name="StrassheimLambson2017">{{Cite journal | last = Strassheim | first = Victoria | last2 = Lambson | first2 = Rebecca | last3 = Hackett | first3 = Katie L. | last4 = Newton | first4 = Julia L. | date = 2017-06-19 | title = What is known about severe and very severe chronic fatigue syndrome? A scoping review | url =https://www.tandfonline.com/doi/full/10.1080/21641846.2017.1333185|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=5|issue=3|pages=167–183|doi=10.1080/21641846.2017.1333185|issn=2164-1846|quote= | author-link = Victoria Strassheim | authorlink2 = Rebecca Lambson | authorlink3 = Katie Hackett | author-link4 = Julia Newton | authorlink5 = |via=}}</ref> - [https://www.tandfonline.com/doi/full/10.1080/21641846.2017.1333185 (Full text)]
* 2017, Understanding severely affected chronic fatigue syndrome: CFS the gravity of the situation<ref name="Strassheim2017a">{{Cite journal|url=https://www.tandfonline.com/doi/full/10.1080/10833196.2017.1327131|journal=Physical Therapy Reviews | title = Understanding severely affected chronic fatigue syndrome (CFS): the gravity of the situation | last = Strassheim | first = Victoria Jane | last2 = Lambson | first2 = Rebecca | date = 2017 | volume=22|issue=3-4|language=en|archive-url=|archive-date=|url-status=|access-date=2018-10-20 | last3 = Hackett | first3 = Katie | last4 = Newton | first4 = Julia L|pages=197-201|doi=10.1080/10833196.2017.1327131|authorlink=Victoria Strassheim | authorlink2 = Rebecca Lambson | authorlink3 = Katie Hackett | authorlink4 = Julia Newton}}</ref> - [https://www.tandfonline.com/doi/full/10.1080/10833196.2017.1327131 (Full text)]
*2016, Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome<ref name="Pendergrast2016">{{Cite journal | last = Pendergrast | first=Tricia | authorlink = Tricia Pendergrast | last2 = Brown | first2 = Abigail | author-link2 = Abigail Brown | last3 = Sunnquist | first3 = Madison | authorlink3 = Madison Sunnquist | last4 = Jantke | first4 = Rachel | author-link4 = Rachel Jantke | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | last6 = Strand | first6 = Elin Bolle | authorlink6 = Elin Strand | last7 = Jason | first7 = Leonard A | authorlink7 = Leonard Jason | date = Dec 2016 | title = Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/|journal=Chronic illness|volume=12|issue=4|pages=292–307|doi=10.1177/1742395316644770|issn=1742-3953|pmc=5464362|pmid=27127189|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/ (Full text)]
* 2016, Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents' Experiences<ref name="Mihelicova2016">{{Cite journal | last = Mihelicova | first = Martina | authorlink = Martina Mihelicova | last2 = Siegel | first2 = Zachary | author-link2 = Zachary Siegel | last3 = Evans | first3 = Meredyth | authorlink3 = Meredyth Evans | last4 = Brown | first4 = Abigail | author-link4 = Abigail Brown | last5 = Jason | first5 = Leonard | authorlink5 = Leonard Jason | date = Dec 2016 | title = Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents' Experiences|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/|journal=Journal of health psychology|volume=21|issue=12|pages=2824–2837|doi=10.1177/1359105315587137|issn=1359-1053|pmc=4675701|pmid=26063209|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/ (Full text)]
*2014, What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise<ref name="McDermott2014">{{Cite journal | last = McDermott | first = Clare | authorlink = | last2 = Al Haddabi | first2 = Atheer | authorlink2 = | last3 = Akagi | first3 = Hiroko | authorlink3 = | last4 = Selby | first4 = Michelle | authorlink4 = | last5 = Cox | first5 = Diane | authorlink5 = Diane Cox | last6 = Lewith | first6 = George | authorlink6 = | date = 2014-06-19 | title = What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078780/|journal=BMJ Open|volume=4|issue=6|pages=292-307|doi=10.1136/bmjopen-2014-005083|issn=2044-6055|pmc=4078780|pmid=24984956|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078780/ (Full text)]
* 2010, Being homebound with chronic fatigue syndrome: a multidimensional comparison with outpatients<ref name="Wiborg2010">{{Cite journal | last = Wiborg | first = Jan F. | author-link = Jan Wiborg | last2 = van der Werf | first2 = Sieberen | authorlink2 = Sieberen van der Werf | last3 = Prins | first3 = Judith B. | authorlink3 = Judith Prins | last4 = Bleijenberg | first4 = Gijs | authorlink4 = Gijs Bleijenberg | authorlink5 = | date = May 2010 | title = Being homebound with chronic fatigue syndrome: A multidimensional comparison with outpatients|url=https://linkinghub.elsevier.com/retrieve/pii/S0165178110000569|journal=Psychiatry Research|volume=177|issue=1-2|pages=246–249|doi=10.1016/j.psychres.2010.02.010|issn=0165-1781|quote=|via=}}</ref> - [https://www.sciencedirect.com/science/article/pii/S0165178110000569?via%3Dihub (Full text)]
*2009, Risk factors for severe ME/CFS<ref name="Pheby2009">{{Cite journal | last = Pheby | first = Derek | authorlink = Derek Pheby | last2 = Saffron | first2 = Lisa | author-link2 = | date = 2009 | title = Risk factors for severe ME/CFS|url=https://bucks.repository.guildhe.ac.uk/id/eprint/9823/|journal=Biology and Medicine|volume=1|issue=4|pages=50-74|doi=|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Derek-Pheby/publication/285145361_Risk_factors_for_severe_MECFS/links/0912f511a913223cb6000000/Risk-factors-for-severe-ME-CFS.pdf (Full text)]
* 2007, Severe Chronic Fatigue Syndrome: Recovery is possible<ref name="Burley2007">{{Cite web|url=https://www.researchgate.net/profile/Diane_Cox2/publication/257764167_Severe_Chronic_Fatigue_Syndrome_CFSME_Recovery_is_possible/links/00b49525d3a11018ad000000/Severe-Chronic-Fatigue-Syndrome-CFS-ME-Recovery-is-possible.pdf | title = Severe Chronic Fatigue Syndrome: Recovery is Possible | last = Burley | first = Lucy | authorlink=Lucy Burley | last2 = Cox | first2 = Diane | authorlink2 = Diane Cox | last3 = Findley | first3 = Leslie | authorlink3 = Leslie Findley|journal=British Journal of Occupational Therapy|volume=70|issue=8 | date = Aug 1, 2007|pages=339-344|language=en|doi=10.1177/030802260707000803|archive-url=|archive-date=|url-status=|access-date=2019-02-11}}</ref> - [https://www.researchgate.net/profile/Diane_Cox2/publication/257764167_Severe_Chronic_Fatigue_Syndrome_CFSME_Recovery_is_possible/links/00b49525d3a11018ad000000/Severe-Chronic-Fatigue-Syndrome-CFS-ME-Recovery-is-possible.pdf (Full text)]
* 2000, The course of severe chronic fatigue syndrome in childhood<ref name="Rangel2001">{{Cite journal|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297949/pdf/10741312.pdf | title = The course of severe chronic fatigue syndrome in childhood | last = Rangel | first = L | last2 = Garralda | first2 = M E | date = 2000 | journal=Journal of the Royal Society of Medicine|pages=129-134|volume=93|issue=3|archive-url=|archive-date=|url-status=|access-date= | last3 = Levin | first3 = M | last4 = Roberts | first4 = H|doi=10.1177/014107680009300306|pmid=10741312|authorlink=Luiza Rangel | authorlink2 = Elena Garralda}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297949/pdf/10741312.pdf (Full text)]
* 2000, Severe and Very Severe Patients with chronic fatigue syndrome: perceived outcome following an inpatient programme<ref name="Cox2000">{{Cite journal | last = Cox | first=Diane L. | author-link = Diane Cox | authorlink2 = Leslie Findley | last2 = Findley | first2 = Leslie J. | date = 2000 | title = Severe and Very Severe Patients with Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v07n03_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=7|issue=3|pages=33–47|doi=10.1300/j092v07n03_04|issn=1057-3321|via=|quote=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1300/J092v07n03_04 (Full text)]

==News articles and interviews==
* 2022, [https://eu.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ Epstein-Barr derails NJ man's life; he's pushing for better care: "Trapped in the dark: How chronic fatigue syndrome derailed a NJ musician's life"]
* 2021, [https://eu.northjersey.com/story/news/health/2022/02/06/epstein-barr-chronic-fatigue-syndrome-montclair-nj/9291538002/ ME has left me bedbound for eight years – I feel forgotten by the world], North Jersey
* 2020, [https://www.dailymail.co.uk/health/article-7886679/Three-patients-reveal-daily-struggle-crippling-condition.html Three ME patients reveal their daily struggle with the crippling condition], Daily Mail Online
* 2020, [https://meassociation.org.uk/2020/08/how-it-feels-to-have-very-severe-m-e-by-ruth-braham/ How it feels to have Very Severe M.E.] by Ruth Braham, via The ME Association
* 2020, [https://www.bbc.co.uk/news/uk-england-derbyshire-53648296 Kara Jane Spencer: Musicians help severely ill singer finish album], BBC News

* 2019, [https://www.meaction.net/2019/07/24/uk-teenager-with-severe-me-threatened-with-forced-institutionalized/ UK Teenager with Severe ME Threatened with Forced Institutionalization], #MEAction Network”
* 2019, [https://meassociation.org.uk/2019/08/severe-me-day-life-in-a-nursing-home-light-sensitivity-and-very-severe-m-e-by-eira-stuart-08-august-2019 Severe ME Day: Life in a Nursing Home, Light Sensitivity and Very Severe M.E.] by Eira Stuart, via The ME Association
* 2018, [https://www.dailymail.co.uk/news/article-6281435/Woman-33-living-dementia-ward-FIVE-years.html Woman, 33, has been living in a dementia ward for FIVE years after falling ill with crippling condition], Daily Mail<ref name="DailyMailOct2018">{{Cite news | url=https://www.dailymail.co.uk/news/article-6281435/Woman-33-living-dementia-ward-FIVE-years.html | title = Woman, 33, has been living on a dementia ward for FIVE years | last = Rolfe | first = Brooke | date = Oct 16, 2018|work=Mail Online|access-date=2018-10-17|archive-url=|archive-date=|url-status=}}</ref>
* 2018, [https://www.mirror.co.uk/news/real-life-stories/chronic-fatigue-syndrome-left-bedbound-13091318 "I can barely walk and I'm bed-bound 23 hours a day - M.E. nearly killed me"] - positive story of partial recovery from very severe ME by [[Jessica Taylor-Bearman]], Mirror Online
* 2017, [https://www.thescottishsun.co.uk/news/1445538/singer-amanda-hendrie-me-battle/ Bed-bound singer living in silence opens up about how ME stripped her of her voice just weeks after her mum died], The Scottish Sun
* February 27, 2012, [https://meassociation.org.uk/2012/02/tragic-tale-of-woman-with-chronic-fatigue-syndrome-too-tired-to-eat-derby-telegraph-27-february-2012/ Tragic tale of woman with chronic fatigue syndrome 'too tired' to eat], Derby Telegraph
* 2012, [https://www.theguardian.com/commentisfree/2012/mar/30/me-emily-collingridge-chronic-fatigue-syndrome ME is often dismissed – but sufferers like Emily Collingridge], The Guardian<ref name="Guardian30Mar2012">{{Cite news | url=https://www.theguardian.com/commentisfree/2012/mar/30/me-emily-collingridge-chronic-fatigue-syndrome | title = ME is often dismissed – but sufferers like Emily Collingridge are dying | first = Scott Jordan | last = Harris|publisher=The Guardian | date = Mar 30, 2012|access-date=2022-03-17}}</ref>
* 2010, [https://www.dailymail.co.uk/health/article-1093016/Ive-seen-patients-paralysed-dying-Aids-victims-starving-children--Ive-seen-ill-Lynn.html I've seen patients paralysed, dying Aids victims, starving children... but I've never seen anyone as ill as Lynn], Daily Mail

==Patient group surveys ==
* 2014, Severe M.E. Time to Deliver report by Action For ME<ref name="AfME2014">{{Cite web|url=https://www.actionforme.org.uk/uploads/pdfs/my-life-stopped-severe-ME-report.pdf | title = My life stopped... | last = Pates | first=Andrew| date = Nov 14, 2014 | website = [[Action for ME]]|archive-url=|archive-date=|url-status=|access-date=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464362/ (Full text)]

==See also==
* [[HFME 3 Part ME Ability and Severity Scale|HFME 3 Part M.E. Ability and Severity Scale]]
*[[List of deaths caused by myalgic encephalomyelitis or chronic fatigue syndrome]]
* [[Myalgic encephalomyelitis]]
* [[Rare and uncommon symptoms]]
* [[:Category:Symptom scales|Symptom scales]]
* [[Stigma]]
* [[Causes of death]]
* [[Medical neglect and abuse]]
* [[Periodic paralysis]]
* [[Healthcare, Special Issue: ME/CFS ― The Severely and Very Severely Affected]]

===Severe ME patient groups===
* [[25 Percent ME Group]]
* [[The Hummingbirds' Foundation for ME|The Hummingbirds Foundation for M.E.]]

===People with Severe or Very Severe ME===
* [[Jodi Bassett]] (deceased)
* [[Olaf Bodden]] Former professional soccer player<ref name="olaf">{{Cite news | url=https://www.welt.de/sport/gallery118782921/Benefizspiel-fuer-den-schwer-kranken-Olaf-Bodden.html | title = Benefizspiel für den schwer kranken Olaf Bodden | last = | first = | date = 2021 | language=de|website=Die Welt|archive-url=|archive-date=|url-status=|access-date=2021-11-17}}</ref>
* [[Maeve Boothby-O'Neill]] (deceased)
* [[Emily Collingridge]] (deceased)
* [[Merryn Crofts]] (deceased)
* [[Linda Crowhurst]]
* [[Whitney Dafoe]]
* [[Lynn Gilderdale]] (deceased)
* [[Sophia Mirza]] (deceased)
* [[Jessica Taylor-Bearman]]
* [[Naomi Whittingham]]
* [[Andrew Williams]] (deceased)

===Severe ME blogs and websites===
* [[A Life Hidden]]
* [[Stonebird]] [[Greg Crowhurst|(Greg Crowhurst]] and [[Linda Crowhurst]])

==Advocacy appeals ==
*[http://www.blogistan.co.uk/blog/mt.php/2011/05/28/me-awareness-emily-collingridges-appeal Emily Collingridge severe ME Appeal 2011]
* [https://www.healthrising.org/blog/2021/07/12/we-are-failing-people-with-very-severe-me-cfs/ We are Failing People with Very Severe ME/CFS - Health Rising 2021]

==Learn more==
* [https://www.hfme.org/PDF/Comprehensive_ME_Symptom_List.pdf Comprehensive list of M.E.Symptoms]<ref name="HFMEsymptoms">{{Cite web|url=https://www.hfme.org/PDF/Comprehensive_ME_Symptom_List.pdf | title = The comprehensive M.E. symptom list | last = Bassett | first=Jodi | date = Jun 2012 | website = The Hummingbirds' Foundation for M.E. (HFME)|publisher=|archive-url=|archive-date=|url-status=|access-date=2018-12-12|authorlink=Jodi Bassett}}</ref> - Hummingbirds' Foundation for M.E.
* [https://25megroup.org/download/2527/ Knowledge in the Hope of Protecting M.E. Sufferers from Unnecessary Sectioning]<ref name="PreventUnnecessarySectioning">{{Cite web|url=https://25megroup.org/download/2527/ | title = Knowledge in the Hope of Protecting M.E. Sufferers from Unnecessary Sectioning | last2 = 25% ME Group | first2 = | authorlink2 = 25 Percent ME Group | last = The Grace Charity for M.E. | first= | authorlink = The Grace Charity for M.E. | date = Jan 2019 | website = |archive-url=|archive-date=|url-status=|access-date=2019-07-12}}</ref> - Preventing the unnecessary forced mental health sectioning of severely ill patients - [[The Grace Charity for M.E.]] with [[25 Percent ME Group|25% ME Group]]
* [https://www.actionforme.org.uk/uploads/pdfs/my-life-stopped-severe-ME-report.pdf My life stopped - Severe M.E. report]<ref name="AfME2014"/> - Action for ME
* [https://25megroup.org/me/symptoms Severe M.E. symptoms]<ref name="symptoms">{{Cite news | url=https://25megroup.org/me/symptoms | title = Symptoms - 25% M.E. Group|work=25% M.E. Group|access-date=2018-10-20|language=en-US}}</ref> - 25% ME Group
* [http://me-foreningen.dk/wp-content/uploads/2016/10/Crowhurst-Severely-affected-i-Nursing-Standard.pdf Supporting people with severe Myalgic Encephalomyelitis]<ref name="Crowhurst2016">{{Cite web|url=http://me-foreningen.dk/wp-content/uploads/2016/10/Crowhurst-Severely-affected-i-Nursing-Standard.pdf | title = Supporting people with severe myalgic encephalomyelitis | last = Crowhurst | first=Greg | authorlink = Greg Crowhurst | date = 2005|publisher=Nursing Standard|website=ME Foreningen|archive-url=|archive-date=|url-status=|access-date=}}</ref> - Greg Crowhurst

==References==
{{Reflist}}

[[Category:Definitions]]

Emergency room

2025-05-17T02:07:14Z

YellowWaterLilly:Added related resources

[[Orthostatic intolerance]] is the most frequent acute cause for an '''emergency room''' visit for people with ME/CFS.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333158/ </ref>

== Resources ==
* [[Bateman Horne Center]] handout: [https://batemanhornecenter.org/wp-content/uploads/filebase/education/top_resources/ER-and-Urgent-Care-Considerations-for-MECFS-1.19.22-005.pdf “Medical considerations when treating urgently ill patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)”]

* MCAS Resource: [https://tmsforacure.org/wp-content/uploads/2016-TMS-ER-Protocol-Pages-2.pdf The Mastocytosis Society Emergency Room Protocols]
* Bateman Horne Center - [https://batemanhornecenter.org/education/mecfs-guidebook/ Crash Survival Guide] (See Pages 26 and 27 about Emergency Care)

== See also ==

* [[Guide for patients having surgery]]
* [[Best practices for hospitals]]

== References ==
<references />

Talk:Ischemic Cascade

2025-05-17T01:59:15Z

YellowWaterLilly:/* Is this personal opinion? */ new section

== Citations -- [[User:JaimeS|JaimeS]] ([[User talk:JaimeS|talk]]) 13:40, May 9, 2024 (UTC) ==

Please cite sources on your work.

Please revisit the MEpedia Science Guidelines for additional information.

== Is this personal opinion? -- [[User:YellowWaterLilly|YellowWaterLilly]] ([[User talk:YellowWaterLilly|talk]]) 01:59, May 17, 2025 (UTC) ==

If this is from scientific literature citations are needed and otherwise please note that MEpedia is not the proper space to share an unpublished scientific hypothesis. (As interesting as this is!)

Ischemic Cascade

2025-05-17T01:48:00Z

YellowWaterLilly:Formatting, minor spelling edits.

{{DISPLAYTITLE:Ischemic Cascade as May Explain ME/CFS}}{{Cleanup/Citations needed|date=May 2025}}{{Cleanup/Science | date = May 2025}}

The intention of the following article is to provide a theory that may simplify the pathophysiology of CFS/ME symptoms by classifying it under an already-established medical condition called Ischemic Cascade. Ischemic Cascade (IC) is a 16 stage cascade of body reactions aimed at restoring homeostasis in one region of the body, most often the brain being discussed, in response to a local condition of hypoxia.

==Theory==
Hypoxia appears to be the key issue in lack of exertion endurance in both skeletal muscle, and in the cognitive brain. Anecdotal reports have added that lowered emotional tolerance can precede or follow fatigue and "brain fog" in CFS/ME; that any one of the 3 areas of function can bring down either or both of the other two in a situation of exertion intolerance. This is evidence that CFS/ME is not about a single pathogen, and is not about a single tissue. RATHER, as shown in the 2019 SARS-COV2 pandemic and sequelae, this condition can arise from various types of insults to the human body but with the same types of results in the same body systems as seen in CFS/ME and in other autoimmune syndromes.

Leading theory on the subject of Long-Covid sequelae indicates that blood vessel dysfunction, specifically endothelial cell dysfunction, is the key weak link in the otherwise healthy body system. But the blood vessels: capillary, vein, artery, become compromised by systemic infection and SYSTEM-WIDE deficiency. What is NOT much discussed is the possible cause of MODS, multiple organ dysfunction syndrome which is resulting often in Long-Covid. The possible cause postulated in this theory is attack of all smooth muscle organs, not limited to blood vessels, since common receptors preferred by some viruses exist in both areas.

==Evidence==
The reason for the scrutiny of this article on the condition "Ischemic Cascade" in context of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis/ SEID is that this Cascade of responses appears to have been delineated as a local condition in mainstream medicine, and most often as a brain condition... but a system-wide predominance of this condition has not been widely considered as an explanation or definition of CFS/ME/SEID and may well aptly explain the syndrome which as yet has no explained pathology.

Since SEID is a system-wide intolerance to exertion, and since the IC phases closely resemble its symptoms, it appears prudent to consider that system-wide blood vessel damage and system-wide organ damage caused by Covid19 or by previous Influenza pandemics, and even triggered by patient-specific bacterial infections and weakened immune system function, may already have been defined in the definition of Ischemic Cascade, and could quite potentially explain the following definitive symptoms of CFS/ME/SEID, and lately, Long-Covid sequelae. If so, the definition of Ischemic Cascade may lead to the most direct intervention in ceasing the ME/CFS/SEID/Long-Covid obstacle to health.

== Phenomenon ==

The following standards are known to the author of this article: the Canadian Consensus criteria and the Fukuda criteria for diagnosing an ailment as Chronic Fatigue Syndrome.

The appellation SEID or Systemic Exertion Intolerance Disease was established and adopted AFTER the previously mentioned disease monikers for the same condition.

This article seeks to bring to light an already-medically established phenomenon which seems to have been overlooked in the CFS/ME/SEID studies and furthermore overlooked in research as to their mitigation. The key clue that repeating IC may be the condition observed in CFS/ME/SEID is that there is non-restorative sleep with an as-yet unknown cause. The component in IC which can account for hyper-arousal during sleep and prevention of adequate delta phase sleep is an initial Glutamate Excitotoxicity and some amount of feedback sometimes leading to additional Glutamate release outside affected cells.

Chronic Fatigue Syndrome as a medical appellation seems to indicate the obvious, that the symptoms have lasted past the 3-month appellation time limit for a disease being considered to be in the ACUTE stage of up to 3 months. It indicates a chronic state of feelings of physical fatigue, coupled with bouts of Post Exertional Malaise and also Unrefreshing sleep, as the 3 indisputable symptoms. This leaves two other symptoms of which one or the other must be present in order for the condition to qualify or be diagnosed as CFS/ME/SEID:

Either cognitive impairment

or

Orthostatic intolerance.

or both.

These 5 current criteria have been redacted by the medical community from the original mandatory 10 symptoms

POTS, or Postural Orthostatic Tachycardia Syndrome is the official name for such orthostatic intolerance.

What do ME/CFS/SEID/Long-Covid/POTS have in common?

INTOLERANCE.

And intolerance is a breach of homeostatic recovery.

NOTABLY: the key causative problem in MECFSSEIDLONGCOVID is:

a continued inflammation from a continued pathogen insult, long after the main infection has ceased.

Lastly, before describing the ISCHEMIC CASCADE stages, it is fitting to make a plausible reference

to latent viruses which can be reactivated in cells throughout the course of one's life,

putatively because they evaded the patient's immune reaction and also eradication by

novel antibodies.

THE ISCHEMIC CASCADE of EVENTS in response to Hypoxia:

NOTE: You are free to attempt to read the PubMed explanation of Ischemic Cascade, at your own personal cost.

However, the following is quoted from Wikipedia [[Ischemic cascade|Ischemic cascade - Wikipedia]]<ref>{{Cite journal|title=Ischemic cascade|date=2024-02-09|url=https://en.wikipedia.org/w/index.php?title=Ischemic_cascade&oldid=1205244473|journal=Wikipedia|language=en}}</ref>

== Mechanism ==
A [[Biochemical cascade|cascade]] is a series of events in which one event triggers the next, in a linear fashion. Thus "ischemic cascade" is actually a misnomer, since the events are not always linear: in some cases they are circular, and sometimes one event can cause or be caused by multiple events. In addition, cells receiving different amounts of blood may go through different chemical processes. Despite these facts, the ischemic cascade can be generally characterized as follows:[''[[Wikipedia:Citation needed|citation needed]]'']

# Low blood supply decreases amount of oxygen that reaches tissues, leading to [[Hypoxia (medical)|hypoxia]]
# Deficiency of oxygen causes the neuron's normal process for making [[Adenosine triphosphate|ATP]] for energy to fail.
# The cell switches to [[Fermentation (biochemistry)|anaerobic metabolism]], producing [[lactic acid]].
# ATP-reliant [[Ion pump (biology)|ion transport pumps]] fail, causing the cell to become [[Action potential|depolarized]], allowing [[Ion|ions]], including [[calcium]] (Ca2+), to flow into the [[Cell (biology)|cell]].
# The ion pumps can no longer transport calcium out of the cell, and intracellular calcium levels get too high.
# The presence of calcium triggers the release of the excitatory [[amino acid]] [[neurotransmitter]] [[glutamate]].
# Glutamate stimulates [[AMPA receptor|AMPA receptors]] and Ca2+-permeable [[NMDA receptor|NMDA receptors]], which open to allow more calcium into cells.
# Excess calcium entry overexcites cells and causes the generation of harmful chemicals like [[Free radical|free radicals]], [[reactive oxygen species]] and calcium-dependent [[Enzyme|enzymes]] such as [[calpain]], [[Endonuclease|endonucleases]], [[ATPase|ATPases]], and [[Phospholipase|phospholipases]] in a process called [[excitotoxicity]]. Calcium can also cause the release of more glutamate.
# As the cell's membrane is broken down by phospholipases, it becomes more permeable, and more ions and harmful chemicals flow into the cell.
# [[Mitochondrion|Mitochondria]] break down, releasing toxins and [[Apoptosis|apoptotic]] factors into the cell.
# The [[caspase]]-dependent [[apoptosis]] cascade is initiated, causing cells to "commit suicide."
# If the cell dies through [[necrosis]], it releases glutamate and toxic chemicals into the environment around it. Toxins poison nearby [[Neuron|neurons]], and glutamate can overexcite them.
# If and when the brain is reperfused, a number of factors lead to [[reperfusion injury]].
# An [[Inflammation|inflammatory]] response is mounted, and [[Phagocytosis|phagocytic]] cells engulf damaged but still viable tissue.
# Harmful chemicals damage the [[blood–brain barrier]].
# [[Cerebral edema]] (swelling of the brain) occurs due to leakage of large [[Molecule|molecules]] like [[albumins]] from blood vessels through the damaged [[blood brain barrier]]. These large molecules pull water into the brain tissue after them by [[osmosis]]. This "[[vasogenic edema]]" causes compression of and damage to brain tissue (Freye 2011; Acquired Mitochondropathy-A New Paradigm in Western Medicine Explaining Chronic Diseases)."" ([[Ischemic cascade|Ischemic cascade - Wikipedia]])

The CRUCIAL elements of Ischemic Cascade are:

# this was only considered to be local, such as in the brain or a damaged area: conside this as as SYSTEM-WIDE reaction to system-wide hypoxia and endothelial cell damage as result of Influenza infection via Sialic Acid receptors, and also coronavirus infection by Covid19 via ACE2 receptors.
# NOTE: ACE2 receptor means: Angitension Converting Enzyme receptor with the purpose of converting Angiotensin II vasoconstrictor to Angiotensions 1-7 of which one is a vasodilator, and a trigger of NADPH antioxidant flourishing in the Krebs Cycle. 

__INDEX__
__NEWSECTIONLINK__

==Treatment==

==See also==

==Learn more==

[[Category:Medical Hypothesis]]

Ischemic Cascade

2025-05-17T01:12:06Z

YellowWaterLilly:Added Cleanup template (needs citations)

{{DISPLAYTITLE:Ischemic Cascade as May Explain ME/CFS}}{{Cleanup/Citations needed|date=May 2025}}The intention of the following article provide a theory that maysimplify the pathophysiology of CFS/ME symptoms by classifying it under an already-established medical condition called Ischemic Cascade. Ischemic Cascade (IC) is a 16 stage cascade of body reactions aimed at restoring homeostasis in one region of the body, most often the brain being discussed, in response to a local condition of hypoxia.

Hypoxia appears to be the key issue in lack of exertion endurance in both skeletal muscle, and in the cognitive brain. Anecdotal reports have added that lowered emotional tolerance can precede or follow fatigue and "brain fog" in CFS/ME; that any one of the 3 areas of function can bring down either or both of the other two in a situation of exertion intolerance. This is evidence that CFS/ME is not about a single pathogen, and is not about a single tissue. RATHER, as shown in the 2019 SARS-COV2 pandemic and sequelae, this condition can arise from various types of insults to the human body but with the same types of results in the same body systems as seen in CFS/ME and in other autoimmune syndromes.

Leading theory on the subject of Long-Covid sequelae indicates that blood vessel dysfunction, specifically endothelial cell dysfunction, is the key weak link in the otherwise healthy body system. But the blood vessels: capillary, vein, artery, become compromised by systemic infection and SYSTEM-WIDE deficiency. What is NOT much discussed is the possible cause of MODS, multiple organ dsyfunction syndrome which is resulting often in Long-Covid. The possible cause postulated in this theory is attack of all smooth muscle organs, not limited to blood vessels, since common receptors preferred by some viruses exist in both areas.

The reason for the scrutiny of this article on the condition "Ischemic Cascade" in context of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis/ SEID is that this Cascade of responses appears to have been delineated as a local condition in mainstream medicine, and most often as a brain condition... but a system-wide predominance of this condition has not been widely considered as an explanation or definition of CFS/ME/SEID and may well aptly explain the syndrome which as yet has no explained pathology.

Since SEID is a system-wide intolerance to exertion, and since the IC phases closely resemble its symptoms, it appears prudent to consider that system-wide blood vessel damage and system-wide organ damage caused by Covid19 or by previous Influenza pandemics, and even triggered by patient-specific bacterial infections and weakened immune system function, may already have been defined in the definition of Ischemic Cascade, and could quite potentially explain the following definitive symptoms of CFS/ME/SEID, and lately, Long-Covid sequelae. If so, the definition of Ischemic Cascade may lead to the most direct intervention in ceasing the ME/CFS/SEID/Long-Covid obstacle to health.

The following standards are known to the author of this article: the Canadian Consensus criteria and the Fukuda criteria for diagnosing an ailment as Chronic Fatigue Syndrome.

The appellation SEID or Systemic Exertion Intolerance Disease was established and adopted AFTER the previously mentioned disease monikers for the same condition.

This article seeks to bring to light an already-medically established phenomenon which seems to have been overlooked in the CFS/ME/SEID studies and furthermore overlooked in research as to their mitigation. The key clue that repeating IC may be the condition observed in CFS/ME/SEID is that there is non-restorative sleep with an as-yet unknown cause. The component in IC which can account for hyper-arousal during sleep and prevention of adequate delta phase sleep is an initial Glutamate Excitotoxicity and some amount of feedback sometimes leading to additional Glutamate release outside affected cells.

Chronic Fatigue Syndrome as a medical appellation seems to indicate the obvious, that the symptoms have lasted past the 3-month appellation time limit for a disease being considered to be in the ACUTE stage of up to 3 months. It indicates a chronic state of feelings of physical fatigue, coupled with bouts of Post Exertional Malaise and also Unrefreshing sleep, as the 3 indisputable symptoms. This leaves two other symptoms of which one or the other must be present in order for the condition to qualify or be diagnosed as CFS/ME/SEID:

Either cognitive impairment

or

Orthostatic intolerance.

or both.

These 5 current criteria have been redacted by the medical community from the original mandatory 10 symptoms

POTS, or Postural Orthostatic Tachycardia Syndrome is the official name for such orthostatic intolerance.

What do ME/CFS/SEID/Long-Covid/POTS have in common?

INTOLERANCE.

And intolerance is a breach of homeostatic recovery.

NOTABLY: the key causative problem in MECFSSEIDLONGCOVID is:

a continued inflammation from a continued pathogen insult, long after the main infection has ceased.

Lastly, before describling the ISCHEMIC CASCADE stages, it is fitting to make a plausible reference

to latent viruses which can be reactivated in cells throughout the course of one's life,

putatatively because they evaded the patient's immune reaction and also eradication by

novel antibodies.

THE ISCHEMIC CASCADE of EVENTS in response to Hypoxia:

NOTE: You are free to attempt to read the PubMed explanation of Ischemic Cascade, at your own personal cost.

However, the following is quoted from Wikipedia [[Ischemic cascade|Ischemic cascade - Wikipedia]]<ref>{{Cite journal|title=Ischemic cascade|date=2024-02-09|url=https://en.wikipedia.org/w/index.php?title=Ischemic_cascade&oldid=1205244473|journal=Wikipedia|language=en}}</ref>

== "Mechanism ==
A [[Biochemical cascade|cascade]] is a series of events in which one event triggers the next, in a linear fashion. Thus "ischemic cascade" is actually a misnomer, since the events are not always linear: in some cases they are circular, and sometimes one event can cause or be caused by multiple events. In addition, cells receiving different amounts of blood may go through different chemical processes. Despite these facts, the ischemic cascade can be generally characterized as follows:[''[[Wikipedia:Citation needed|citation needed]]'']

# Low blood supply decreases amount of oxygen that reaches tissues, leading to [[Hypoxia (medical)|hypoxia]]
# Deficiency of oxygen causes the neuron's normal process for making [[Adenosine triphosphate|ATP]] for energy to fail.
# The cell switches to [[Fermentation (biochemistry)|anaerobic metabolism]], producing [[lactic acid]].
# ATP-reliant [[Ion pump (biology)|ion transport pumps]] fail, causing the cell to become [[Action potential|depolarized]], allowing [[Ion|ions]], including [[calcium]] (Ca2+), to flow into the [[Cell (biology)|cell]].
# The ion pumps can no longer transport calcium out of the cell, and intracellular calcium levels get too high.
# The presence of calcium triggers the release of the excitatory [[amino acid]] [[neurotransmitter]] [[glutamate]].
# Glutamate stimulates [[AMPA receptor|AMPA receptors]] and Ca2+-permeable [[NMDA receptor|NMDA receptors]], which open to allow more calcium into cells.
# Excess calcium entry overexcites cells and causes the generation of harmful chemicals like [[Free radical|free radicals]], [[reactive oxygen species]] and calcium-dependent [[Enzyme|enzymes]] such as [[calpain]], [[Endonuclease|endonucleases]], [[ATPase|ATPases]], and [[Phospholipase|phospholipases]] in a process called [[excitotoxicity]]. Calcium can also cause the release of more glutamate.
# As the cell's membrane is broken down by phospholipases, it becomes more permeable, and more ions and harmful chemicals flow into the cell.
# [[Mitochondrion|Mitochondria]] break down, releasing toxins and [[Apoptosis|apoptotic]] factors into the cell.
# The [[caspase]]-dependent [[apoptosis]] cascade is initiated, causing cells to "commit suicide."
# If the cell dies through [[necrosis]], it releases glutamate and toxic chemicals into the environment around it. Toxins poison nearby [[Neuron|neurons]], and glutamate can overexcite them.
# If and when the brain is reperfused, a number of factors lead to [[reperfusion injury]].
# An [[Inflammation|inflammatory]] response is mounted, and [[Phagocytosis|phagocytic]] cells engulf damaged but still viable tissue.
# Harmful chemicals damage the [[blood–brain barrier]].
# [[Cerebral edema]] (swelling of the brain) occurs due to leakage of large [[Molecule|molecules]] like [[albumins]] from blood vessels through the damaged [[blood brain barrier]]. These large molecules pull water into the brain tissue after them by [[osmosis]]. This "[[vasogenic edema]]" causes compression of and damage to brain tissue (Freye 2011; Acquired Mitochondropathy-A New Paradigm in Western Medicine Explaining Chronic Diseases)."" ([[Ischemic cascade|Ischemic cascade - Wikipedia]])

The CRUCIAL elements of Ischemic Cascade are:

# this was only considered to be local, such as in the brain or a damaged area: conside this as as SYSTEM-WIDE reaction to system-wide hypoxia and endothelial cell damage as result of Influenza infection via Sialic Acid receptors, and also coronavirus infection by Covid19 via ACE2 receptors.
# NOTE: ACE2 receptor means: Angitension Converting Enzyme receptor with the purpose of converting Angiotensin II vasoconstrictor to Angiotensions 1-7 of which one is a vasodilator, and a trigger of NADPH antioxidant flourishing in the Krebs Cycle. 

__INDEX__
__NEWSECTIONLINK__

Energy limiting condition

2025-05-16T22:44:44Z

YellowWaterLilly:/* See also */ Linked to related MEpedia page - Glass Ceiling Effect

{{stub}}
'''Energy limiting conditions''' or '''ELCs''' is an umbrella term for a range of health conition that significantly [[energy limit|limits the person's available energy]].

"One in three disabled people has an energy limiting condition yet too often we are identified as 'ill', rather than [[disability|disabled]], or worse, we are [[stigma and discrimination|suspected of faking our disability or cheating]]. This means our disability rights, in [[:Category:social issues|society and at work]], lag far behind."<ref name="ELC-term">{{Cite web | url = https://chronicillnessinclusion.org.uk/|access-date=2022-04-08 | title = Welcome | first = | last = | authorlink=|website=Chronic Illness Inclusion | date = }}</ref> ―[[Chronic Illness Inclusion|Chronic Illness Inclusion project]]

===Energy-limiting chronic illness===
Energy-limiting chronic illnesses (ELCIs) are: 
"health condition(s) that cause symptoms such as physical [[chronic fatigue|fatigue]], [[brain fog|mental fatigue]] and [[chronic pain|pain]], which [[Substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities|significantly restrict your day-to-day activities]]"<ref name="ELC-term">{{Cite web | url = https://chronicillnessinclusion.org.uk/|access-date=2022-04-08 | title = Welcome | first = | last = | authorlink=|website=Chronic Illness Inclusion | date = }}</ref>

==Signs and symptoms==

==Disability==

==Accessibility needs and rights==

==ME/CFS==

==Talks and interviews==

==Reports and notable articles==

==Notable studies==
*2020, Energy Impairment and Disability Inclusion: Towards an Advocacy Movement for Energy Limiting Chronic Illness.<ref name="EID2020">{{Cite book | title = Energy Impairment and Disability Inclusion: Towards an Advocacy Movement for Energy Limiting Chronic Illness. | first =Catherine|last = Hale | authorlink = Catherine Hale | first2 = Stef | last2 = Benstead | first3 = Jenny | last3 = Lyus | first4 = Evan | last4 = Odell | first5 = Anna | last5 = Ruddock | url=https://chronicillnessinclusion.org.uk/wp-content/uploads/2021/04/energy-impairment-and-disability-inclusion.pdf
| publisher = [[Citizen Network| publisher = [[Centre for Welfare Reform]] | date = 2020|isbn=978-1-912712-25-0 }}</ref> [https://chronicillnessinclusion.org.uk/wp-content/uploads/2021/04/energy-impairment-and-disability-inclusion.pdf (Book, Full text)]

==See also==
*[[Disability]]
*[[Stigma and discrimination]]
*[[Access to benefits]]
*[[Fluctuating illness]]
*[[Post-exertional malaise]]
*[[Pacing]]
*[[Glass ceiling effect]]

==Learn more==
*[https://chronicillnessinclusion.org.uk/ Chronic Illness Inclusion project]

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Social issues]]
[[Category:Disability]]

Exercise

2025-05-16T22:40:52Z

YellowWaterLilly:/* See also */ Linked to related MEpedia page - Glass Ceiling Effect

'''Exercise''' is any movement or '''physical activity''' considered to contribute to general health and well-being. Exercise may be recommended as part of a wellness regimen in ''any'' chronic illness.<ref name="Pederson2006">{{Cite journal | last = Pederson | first = B.K. | last2 = Saltin | first2 = B. | date = 2006 | title=Evidence for prescribing exercise as therapy in chronic disease | url=https://www.essa.org.au/wp-content/uploads/2015/06/Chronic-disease_Review-2006.pdf | journal=Scand J Med Sci Sports|volume=16|issue =Suppl 1 | pages = 3-63|via=}}</ref><ref name="Hovanec2015">{{Cite journal | last = Hovanec | first = Nina | last2 = Bellemore | first2 = Derek | last3 = Kuhnow | first3 = Jason | last4 = Miller | first4 = Felicia | last5 = van Vloten | first5 = Alexi | last6 = Vandervoort | first6 = Anthony A. | date = March 3, 2015 | title = Exercise Prescription Considerations for Individuals with Multiple Chronic Diseases: Systematic Review | url =https://www.omicsonline.org/open-access/exercise-prescription-considerations-for-individuals-with-multiple-chronic-diseases-systematic-review-2167-7182-1000201.php?aid=41826|journal=J Gerontol Geriatr Res|volume = 4 | issue = 201 | pages =|via=}}</ref> However, [[Post-exertional malaise|exercise intolerance]] is a central feature of [[ME/CFS]],<ref name=":0">{{Cite web | url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms of ME/CFS {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = | first = | authorlink = | date = 2021-02-09 | website = cdc.gov|language=en-us|archive-url=|archive-date=|url-status=|access-date=2021-12-23}}</ref> and patients show multiple documented abnormal responses to exercise, including significant worsening of all symptoms; this is the opposite response to how healthy people respond to exercise.<ref name="PEM2017" /> Rather than increase health and well-being, evidence from ME/CFS patients shows that exercise or even increased activity significantly reduces their physical ''and'' [[Cognitive dysfunction|mental capacity]] over time, sometimes permanently.<ref name="nodecisions">{{Cite web | url = http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf | title=ME Association illness management report: no decisions about me without me | last = ME Association | first = | date = May 2015 | website = ME Association|archive-url=|archive-date=|url-status=|access-date=25 April 2018}}</ref>

Worsening of symptoms due to exercise in ME/CFS patients cannot be explained by [[deconditioning]] (lack of fitness), or by [[Cognitive behavioral model|psychological theories]] like [[illness beliefs|"symptom focusing"]] or catastrophizing; the effects of exercise or over-exertion in patients include increased immune system symptoms, an increase in inflammatory markers in the blood, increased lactate in blood plasma, an increase in [[lactic acid]] in the muscles, and oxidative damage to DNA.<ref name="Fulle2000">{{citation | last1 = Fulle | first1 = S | author-link1 = Stefania Fulle | last2 =Mecocci | first2 = P | authorlink2 = Patrizia Mecocci | last3 = Fanó | first3 = G | authorlink3 = Giorgio Fanó | last4 =Vecchiet | first4 = I | authorlink4 = Iacopo Vecchiet | last5 = Vecchini | first5 = A | authorlink5 = Alba Vecchini | last6 = Racciotti | first6 = D | authorlink6 = Delia Racciotti | last7 = Cherubini | first7 = A | author-link8 = Antonio Cherubini | last8 = Pizzigallo | first8 = E | author-link8 = Eligio Pizzigallo | last9 = Vecchiet | first9 = L | author-link9 = Leonardo Vecchiet | last10 = Senin | first10 = U | author-link10 = Umberto Senin | last11 = Beal | first11 = MF | author-link11 = M Flint Beal | title = Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome | journal = Free Radical Biology & Medicine | issn = 0891-5849| volume = 29 | issue = 12| pages = 1252–1259 | date = 2000-12-15 | pmid = 11118815 | doi = 10.1016/S0891-5849(00)00419-6 | url = https://www.researchgate.net/profile/Stefania_Fulle/publication/223664992_Specific_oxidative_alterations_in_vastus_lateralis_muscle_of_patients_with_the_diagnosis_of_chronic_fatigue_syndrome/links/54db93eb0cf23fe133ad601d.pdf/download?version=vrp }}</ref>

==Physiological effects of exercise==

Exercise causes a variety of temporary physiological changes in healthy people. This includes an increase in respiratory rate, heart rate, and blood pressure in order to keep up with higher energy demands.<ref name="Burton2004">{{Cite journal | last = Burton | first = Deborah Anne | last2 = Stokes | first2 = Keith | last3 = Hall | first3 = George M | date = December 1, 2004 | title = Physiological effects of exercise | url =https://academic.oup.com/bjaed/article/4/6/185/314696|journal=Continuing Education in Anaesthesia Critical Care & Pain| publisher = |volume=4|issue=6 | pages = 185-8|via=BJA Education}}</ref> The chemical reactions that break down nutrients -- [[glycolysis]], the [[citric acid cycle]], and the [[ion transportation|electron transport]] chain -- move more rapidly to liberate energy, and blood flow to muscles should increase. In healthy individuals, the amount of [[oxygen]] and carbon dioxide present in the blood should not alter significantly.<ref name="Burton2004" />

===Immune system===

In healthy people, exercise induces a variety of temporary changes to immune markers. Immediately after exercise, [[natural killer cell]] activity is decreased and [[Leukotriene]] B4 (LTB4) increase, along with the LTB4/PGE2 ratio. Exercise elevates levels of [[prostaglandin]] E2 (PGE2) for up to five days.<ref name="GrayJB1994">{{citation | last1 = Gray | first1 = J B | author-link1 = J B Gray | last2 =Martinovic | first2 = A M | authorlink2 = Andriya Martinovic | title = Eicosanoids and essential fatty acid modulation in chronic disease and the chronic fatigue syndrome| journal = Medical Hypotheses | volume = 43 | issue = 1 | page = 31–42 | date = Jul 1994 | pmid = 7968718 | doi = 10.1016/0306-9877(94)90046-9 | url = http://www.sciencedirect.com/science/article/pii/0306987794900469 }}</ref>

=== Infection ===
Several studies of a mouse model of [[Coxsackie B3]] [[myocarditis]] have found that exercise increases the virulence of the infection and results in poorer outcomes.<ref name="Cabinian1990">Cabinian AE, Kiel RJ, Smith F, Ho KL, Khatib R, Reyes MR. Modification of exercise-aggravated coxsackie virus B3 murine myocarditis by T-lymphocyte suppression in an inbred model. J. Lab. Clin. Med. 1990; 115: 454– 62.</ref><ref name="Kiel1989">Kiel RJ, Smith FE, Chason J, Khatib R, Reyes MD. Coxsackie B3 myocarditis in C3H/HeJ mice: Description of an inbred model and the effect of exercise on the virulence. Eur. J. Epidemiol. 1989; 5: 248– 67.</ref><ref name="Itback">{{Cite journal | last = Ilbäck | first = NG | date = June 1989 | title = Exercise in coxsackie B3 myocarditis: Effects on heart lymphocyte subpopulations and the inflammatory reaction | url =https://www.ncbi.nlm.nih.gov/pubmed/2543197|journal=American Heart Journal|volume=117 | pages = 1298-302|via=}}</ref><ref name="Gatmaitan1970">{{Cite journal | last = Gatmaitan | first = Bienvenido | date = June 1, 1970 | title = Augmentation of the Virulence of Murine Coxsackie Virus B-3 Myocardiopathy by Exercise | url =http://jem.rupress.org/content/131/6/1121|journal=Journal of Experimental Medicine|volume=131 | pages = 1121|via=}}</ref><ref name="Reyes2976">{{Cite journal | last = Reyes | first = MP | date = February 1976 | title = Interferon and neutralizing antibody in sera of exercised mice with coxsackievirus B-3 myocarditis |url =https://www.ncbi.nlm.nih.gov/pubmed/1250870|journal=Proceedings of the Society for Experimental Biology and Medicine|volume=151 | pages = 333-8|via=}}</ref>

===Neurotransmitters===

[[Acetylcholine]], an important [[neurotransmitter]] that regulates immune response and muscle strength, decreases during exercise.

== Effects of exercise in Chronic Fatigue Syndrome ==

===Post Exertional Malaise===

[[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms, VanNess et al. (2010)|377x377px]]
{{Main article| page_name=Post-exertional malaise}}[[File:2015 IOM report PEM chart.png|right|frame|PEM chart from the 2015 Institute of Medicine report|378x378px]]

[[myalgic encephalomyelitis|ME]] patients who exercise are likely to experience [[Post-exertional malaise]], a worsening of symptoms following physical, cognitive, or sensory [[exertion]].

===Pain threshold===
Pain thresholds, or the point at which a stimulus becomes painful, drop in people with [[chronic fatigue syndrome|CFS]] (as per the [[Fukuda criteria]]) after graded exercise. In healthy controls, pain thresholds rise. This phenomenon has been attributed to a dysfunction of the central anti-nociceptive mechanism in [[chronic fatigue syndrome|CFS]] patients.<ref name="Whiteside, 2004">{{Citation | last1 = Whiteside | first1 = Alan | author-link1 = | last2 =Hansen | first2 = Stig | authorlink2 = | last3 = Chaudhuri | first3 = Abhijit | authorlink3 = Abhijit Chaudhuri | title = Exercise lowers pain threshold in chronic fatigue syndrome| journal = Pain | volume = 109 | issue = 3 | page = 497-9| date = 2004 | pmid = 15157711| doi = 10.1016/j.pain.2004.02.029}}</ref>

===Immune System===
[[Histamine]], a chemical that is released in response to cellular damage and inflammation, is released during exercise in healthy individuals. The histamine dilates blood vessels in order to deliver nutrients to working muscles.<ref name="Romero2016">{{Cite journal | last = Romero | first = S.A. | last2 = Hocker | first2 = A.D. | last3 = Mangum | first3 = J.E. | last4 = Luttrell | first4 = M.J. | last5 = Turnbull | first5 =D.W. | last6 = Halliwill | first6 = J.R. | last7 = Struck | first7 = A.J. | last8 = Ely | first8 = M.R. | last9 = Sieck | first9 = D.C. | last10 =Dreyer | first10 = H.C. | last11 = Halliwill | first11 = J.R | date = 2016 | title=Evidence of a broad histamine footprint on the human exercise transcriptome | url =http://doi.org/10.1113/JP272177|journal=The Journal of Physiology|volume=594|issue=17 | pages = 5009-5023|via=}}</ref> However, patients with ME may experience increased histamine release due to increased mast cell populations at baseline.<ref name="Ronnberg2017">{{Cite journal | last = Rönnberg | first = E | last2 = Calounova | first2 = G | last3 = Pejler | first3 = G | date = June 2017 | title = Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients |url =https://www.ncbi.nlm.nih.gov/pubmed/27362406|journal=Asian Pac J Allergy Immunol|volume=35|issue=2 | pages = 75-81|via=}}</ref>

===Microbiome===

A small study of ten CFS patients found significant changes in the composition of the [[microbiome]] and increased bacterial translocation (movement from the intestine into the [[blood|bloodstream]]) following exercise. The study found increased Clostridium in the blood fifteen minutes after exercise and increased Bacilli 48 hours later.<ref name="ShuklaS2015">{{citation | last1 = Shukla | first1 = Sanjay K | author-link1 = Sanjay Shukla | last2 =Cook | first2 = Dane | authorlink2 = Dane Cook | last3 = Meyer | first3 = Jacob | authorlink3 = Jacob Meyer | last4 =Vernon | first4 = Suzanne D | authorlink4 = Suzanne Vernon | last5 = Le | first5 = Thao | authorlink5 = Thao Le | last6 = Clevidence | first6 = Derek | authorlink6 = Derek Clevidence | last7 =Robertson | first7 = Charles E | author-link8 = Charles Robertson | last8 = Schrodi | first8 = Steven J | author-link8 = Steven Schrodi | last9 =Yale | first9 = Steven | author-link9 = Steven Yale | last10 = Frank | first10 = Daniel N | author-link10 = Daniel Frank | title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)| journal = PLoS ONE | date = Dec 18, 2015 | pmid = 26683192 | doi = 10.1371/journal.pone.0145453 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453 }}</ref>

=== Musculature ===
Exercise has also been found to induce both early and excessive lactic acid formation in the [[muscle fatigability|muscles]]<ref name="Plioplys1995">{{citation | last1 = Plioplys | first1 = AV | author-link1 = | last2 =Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates| journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | page = 132-138 | pmid = 8544970| url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref> with reduced intracellular concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref name="McCully1996">{{citation | last1 = McCully | first1 = KK | author-link1 = | last2 =Natelson | first2 = BH | authorlink2 = Benjamin Natelson | last3 = Iotti | first3 = S | authorlink3 = | last4 = Sisto | first4 = S | authorlink4 = | last5 = Leigh | first5 = JS Jr. | authorlink5 = | title = Reduced oxidative muscle metabolism in chronic fatigue syndrome | journal = Muscle Nerve | volume = 19 | issue = 5 | page = 621-625 | date = May 1996 | pmid = 8618560 | doi =| url = http://www.ncbi.nlm.nih.gov/pubmed/8618560 }}</ref> Several studies have found abnormal increases in plasma [[lactate]] following short period of moderate exercise that cannot be explained by [[deconditioning]].<ref name="LaneRJ1998">{{citation | last1 = Lane | first1 = R J | author-link1 = Russell Lane | last2 =Barrett | first2 = M C | authorlink2 = Michael Barrett | last3 = Taylor | first3 = D J | authorlink3 = Doris Taylor | last4 = Kemp | first4 = G J | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle| journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | page = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref> There are abnormalities in pH handling by peripheral muscle, and possible evidence of an increased acidosis and lactate accumulation.<ref name="JonesDE2010">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome| journal = J Intern Med | volume = 267 | issue = 4 | page = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref>
<ref name="JonesDE2012">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 =Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | author-link8 = Michael Trenell | last8 = Newton | first8 = Julia L | author-link8 = Julia Newton| display-authors = | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | page = 186-94 | date = Jul 12, 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref><ref name="LengertN2015">{{citation | last1 = Lengert | first1 = Nicor | author-link1 = Nicor Lengert | last2 =Drossel | first2 = Barbara| authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome| journal = Biophysical Chemistry | volume = 202 | page = 21–31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009| url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref>

There is also evidence of loss of capacity to recover from acidosis on repeat exercise, as demonstrated by the [[two-day cardiopulmonary exercise test|Two-Day Cardiopulmonary Exercise Test]].<ref name="JonesDE2012" />

Finally, there is evidence of abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | author-link1 = Audrey Brown | last2 =Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = Apr 2, 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref>
[[File:Light2011-geneexpression-figure3.jpg|right|frame|Gene expression changes following moderate exercise (Light et al, 2011)|516x516px]]

=== Gene expression ===
There is evidence of increased expression of certain [[gene]]s following muscular exertion.<ref name="LightAR2009">{{citation | last1 = Light | first1 = Alan R | author-link1 = Alan Light | last2 =White | first2 = Andrea T | authorlink2 = Andrea White | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 =Light | first4 = Kathleen C | authorlink4 = Kathleen Light | title = Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects| journal = J Pain | volume = 10 | issue = 10 | page = 1099-112 | date = Jul 31, 2009 | pmid = 19647494 | doi = 10.1016/j.jpain.2009.06.003 | url = http://www.jpain.org/article/S1526-5900(09)00574-4/abstract}}</ref>
<ref name="LightAR2011">{{citation | last1 = Light | first1 = Alan R | author-link1 = Alan Light | last2 =Bateman | first2 = Lucinda | authorlink2 = Lucinda Bateman | last3 = Jo | first3 = Daehyun | authorlink3 = Daehyun Jo | last4 =Hughen | first4 = Ronald W | authorlink4 = Ronald Hughen | last5 = Vanhaitsma | first5 = TA | authorlink5 = Timothy VanHaitsma | last6 = White | first6 = Andrea T | authorlink6 = Andrea White | last7 =Light | first7 = Kathleen C | author-link8 = Kathleen Light | title = Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome | journal = J Intern Med | volume = 271 | issue = 1 | page = 64-81 | date = Jul 13, 2011 | pmid = 21615807 | doi = 10.1111/j.1365-2796.2011.02405.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/abstract }}</ref><ref name="WhiteAT2012">{{citation | last1 = White | first1 = Andrea T | author-link1 = Andrea White | last2 =Light | first2 = Alan R | authorlink2 = Alan Light | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 =Timothy A | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C | authorlink5 = Kathleen Light | title = Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls | journal = Psychosom Med | volume = 74 | issue = 1 | page = 46-54 | date = Dec 30, 2011 | pmid = 22210239 | doi = 10.1097/PSY.0b013e31824152ed | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/}}</ref> A 2011 study found that moderate exercise in CFS increased the expression of 13 genes (sensory, adrenergic and 1 [[cytokine]]) for 48 hours, and the increases correlated with fatigue and pain levels (see graph).<ref name="LightAR2011" />

=== Second day exercise test ===
{{Main article| page_name=Two-day cardiopulmonary exercise test}}

The seminal study on the response of chronic fatigue syndrome patients to a two-day cardiopulmonary exercise test was published by [[Mark VanNess]], [[Christopher Snell]] and [[Staci Stevens]] in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise".<ref name="VanNess2007">{{citation | last1 = VanNess | first1 = J Mark| author-link1 = Mark VanNess | last2 =Snell | first2 = Christopher R | authorlink2 = Christopher Snell | last3 = Stevens | first3 = Staci R | authorlink3 = Staci Stevens| title = Diminished Cardiopulmonary Capacity During Post-Exertional Malaise| journal = Journal of Chronic Fatigue Syndrome | volume = 14 | issue = 2 | page = 77-85 | date = 2007| doi = 10.1300/J092v14n02_07 | url = http://www.tandfonline.com/doi/abs/10.1300/J092v14n02_07 }}</ref> While people with CFS responded similarly to healthy controls on a first test, on a follow-up 24 hours later, they were unable to replicate their original normal results. Instead, they had significantly lower values for VO2 peak and AT; these differences could be used to identify the CFS patient over 90% of the time. A repeat study in 2013 confirmed these results.<ref name="SnellCR2013">{{citation | last1 = Snell | first1 = Christopher R | author-link1 = Christopher Snell | last2 =Stevens | first2 = Staci R | authorlink2 = Staci Stevens | last3 = Davenport | first3 = Todd E | authorlink3 = Todd Davenport | last4 =VanNess | first4 = J Mark | author-link4 = Mark VanNess| title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | journal = Physical Therapy (APTA) | volume = 93 | issue = 11 | page = 1484-1492 | date = Oct 31, 2013 | pmid = 23813081 | doi = 10.2522/ptj.20110368 | url = https://academic.oup.com/ptj/article-lookup/doi/10.2522/ptj.20110368}}</ref>

In a confirmation study, Doctor [[Betsy Keller]] also found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.<ref name="KellerBA2014">{{citation | last1 = Keller | first1 = Betsy A | author-link1 = Betsy Keller | last2 =Pryor | first2 = John Luke | authorlink2 = John Pryor | last3 = Giloteaux | first3 = Ludovic| authorlink3 = Ludovic Giloteaux | title = Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment | journal = J Transl Med | volume = | issue = 12 | page = 104 | date = Apr 23, 2014 | pmid = 24755065 | doi = 10.1186/1479-5876-12-104 | url = http://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-104 }}</ref>

A review by [[Jo Nijs|Nijs]] et al. found that multiple studies showed reduced peak heart rate, reduced endurance, reduced peak work rate, reduced peak oxygen uptake, lower blood lactate values, and an increased respiratory exchange ratio in people with ME, ME/CFS, or CFS; see [[#Oxidative_impairement|Oxidative impairment]].<ref name="Nijs2014">{{Citation | last1 = Nijs | first1 = J | author-link1 = Jo Nijs | last2 =Nees | first2 = A | authorlink2 = | last3 = Paul | first3 = L | authorlink3 = | last4 = De Kooning | first4 = M | authorlink4 = | last5 = Ickmans | first5 = K | authorlink5 = | last6 = Meeus | first6 = M | authorlink6 = Mira Meeus | last7 =Van Oosterwijck | first7 = J | author-link8 = Jessica Van Oosterwijck | title = Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review | url = https://repository.uantwerpen.be/docman/irua/338b0c/9322.pdf | journal = Exercise Immunology Review | volume = | issue = 20 | page = 94-116 | date = 2014 | pmid = 24974723}}</ref>

It is important to note that CPET testing oxygen uptake (VO2), carbon dioxide output (VCO2), tidal volume (VT), blood pressure, and oxygen saturation are objective measures, and cannot be invalidated with inadequate effort.
{{Main article|Two-day cardiopulmonary exercise test}}

===Oxidative impairment===

DeBecker et al (2000) and VanNess et al (2003) found low VO2 during exercise testing;<ref name="DeBecker2000">{{Citation | last1 = De Becker | first1 = P | author-link1 = Pascale De Becker | last2 =Roeykens | first2 = J | authorlink2 = Johan Roeykens | last3 = Reynders | first3 = M | authorlink3 = Masha Reynders | last4 =McGregor | first4 = N | authorlink4 = Neil McGregor | last5 = De Meirleir | first5 = K | authorlink5 = Kenny de Meirleir| display-authors = | title = Exercise capacity in chronic fatigue syndrome | journal = Archives of Internal Medicine | issn = 0003-9926| volume = 160 | issue = 21| pages = 3270–3277 | date = 2000-11-27 | pmid = 11088089 | doi = 10.1001/archinte.160.21.3270 | url = http://archinte.jamanetwork.com/article.aspx?articleid=485564 }}</ref><ref name="Vanness2003">{{citation | last1 = VanNess | first1 = JM | author-link1 = Mark VanNess | last2 =Snell | first2 = CR | authorlink2 = Christopher Snell | last3 = Strayer | first3 = DR | authorlink3 = David Strayer | last4 = Dempsey | first4 = L | authorlink4 = Line Dempsey | last5 = Stevens | first5 = SR | authorlink5 = Staci Stevens | title = Subclassifying chronic fatigue syndrome through exercise testing | journal = Medicine and Science in Sports and Exercise | issn = 0195-9131| volume = 35 | issue = 6| pages = 908–913 | date = June 2003 | pmid = 12783037 | doi = 10.1249/01.MSS.0000069510.58763.E8 | url = https://www.researchgate.net/profile/Mark_Van_Ness/publication/10728803_Subclassifying_chronic_fatigue_syndrome_through_exercise_testing/links/0c96051793fc9a83e4000000.pdf }}</ref> Fulle et al. (2000) demonstrated oxidative damage to DNA<ref name="Fulle2000" />; and Wong et al. (1992) showed defects in oxidative metabolism and poor recovery of ATP after exercise.<ref name="Wong1992">{{citation | last1 = Wong | first1 = R | author-link1 = Roger Wong | last2 = Lopaschuk | first2 = G | authorlink2 = Gary Lopaschuk | last3 = Zhu | first3 = G | authorlink3 = Gang Zhu | last4 =Walker | first4 = D | authorlink4 = Dorothy Walker | last5 = Catellier | first5 = D | authorlink5 = Dianne Catellier | last6 = Burton | first6 = D | authorlink6 = David Burton | last7 =Teo | first7 = K | author-link8 = Koon Teo | last8 = Collins-Nakai | first8 = R | author-link8 = Ruth Collins-Nakai | last9 =Montague | first9 = T | author-link9 = Terrence Montague | title = Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy| journal = Chest | issn = 0012-3692| volume = 102 | issue = 6| pages = 1716–1722 | date = Dec 1992 | pmid = 1446478 | doi = 10.1378/chest.102.6.1716 | url = http://www.sciencedirect.com/science/article/pii/S0012369216408469}}</ref>

== Graded exercise therapy==
{{main article| page_name=Graded exercise therapy|title1=Graded exercise therapy (GET)}}
Graded exercise therapy involves incremental increases in physical activity or exercise over time, is a controversial treatment for ME/CFS, due to [[exercise intolerance]] being a central feature of the disease.

== Excessive exercise ==
Excessive exercise in healthy people, particularly athletes, is known to cause [[overtraining syndrome]], which is typically recognized by unexplained decreased exercise capacity in combination with other symptoms.<ref name="jointstatement2012">{{Cite journal | last = Meeusen | first = Romain | last2 = Duclos | first2 = Martine | last3 = Foster | first3 = Carl | last4 = Fry | first4 = Andrew | last5 = Gleeson | first5 = Michael | last6 = Nieman | first6 = David | last7 = Raglin | first7 = John | last8 = Rietjens | first8 = Gerard | last9 = Steinacker | first9 = Jürgen | date = 2013-01-01 | title = Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM)| url = https://doi.org/10.1080/17461391.2012.730061|journal=European Journal of Sport Science|volume=13|issue=1 | pages = 1–24|doi=10.1080/17461391.2012.730061|issn=1746-1391}}</ref><ref name="Kreher2019">{{Cite journal| url = https://doi.org/10.1177%2F1941738111434406 | title = Overtraining Syndrome: A practical guide|website=SAGE Journals|language=en|doi=10.1177/1941738111434406|pmc=3435910|pmid=23016079|access-date=2019-02-28 | date = 2012 | last = Kreher | first = Jeffrey | authorlink = | last2 = Schwartz | first2 = Jennifer B. | authorlink2 = |archive-url=|archive-date=|url-status=|volume=4|issue=2 | pages = 128-138}}</ref> Overtraining syndrome, while commonly fatiguing, has different signs and symptoms than CFS,<ref name=":0" /><ref name="jointstatement2012" /><ref name="Derman2000" /> and effects of overtraining should not be confused with ME/CFS,<ref name="Mommersteeg2006">{{Cite journal | title = Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test | date = 2006-02-01| url = https://www.sciencedirect.com/science/article/pii/S0306453005001757|journal=Psychoneuroendocrinology|volume=31|issue=2 | pages = 216–225 | last = Mommersteeg | first = Paula M.C. | last2 = Heijnen | first2 = Cobi J. | last3 = Verbraak | first3 = Marc J.P.M. | last4 = van Doornen | first4 = Lorenz J.P. |language=en|doi=10.1016/j.psyneuen.2005.07.003|issn=0306-4530}}</ref> which is a multi-systemic neurological disease with a different symptom profile, involves multiple processes including [[mitochondria dysfunction]], [[neuroinflammation]], and [[#immune_system|abnormal immune system responses to exercise]], and has no known cure or established treatment.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = 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 | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 = N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = 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><ref name=":0" /> ME/CFS cannot be diagnosed when symptoms may be the result of excessive exertion, for example prolonged or intense exercise, or when there is inadequate nutrition, and the [[Definitions of myalgic encephalomyelitis and chronic fatigue syndrome|most widely used diagnostic criteria]] also requires 6 months of symptoms before diagnosis.<ref name=":0" /><ref name="spence">{{Cite web | last = Spence | first = Vance | authorlink = Vance Spence|website=Irish M.E. Association| title = Snippets {{!}} A presentation by MERGE Chairman Dr Vance Spence on 12 November 2005 at the Oak Tree Court Conference Centre, Coventry, at the invitation of the Warwickshire Network for ME | url = https://www.imet.ie/imet_website/snippets/7th_december_2005_snippets.html}}</ref><ref name="Derman2000" />
{{Main article|Overtraining syndrome}}

==Exercise in other chronic illnesses ==
Exercise and increased physical activity is increasingly being promoted and encouraged for patients with chronic diseases<ref name="MiraleCure2015">{{Citation | title = Exercise: The miracle cure and the role of the doctor in promoting it | date = 2015 | url=https://www.aomrc.org.uk/wp-content/uploads/2016/05/Exercise_the_Miracle_Cure_0215.pdf | last = McNally | first = S. | author-link = |work=Academy of Medical Royal Colleges|location=London}}</ref> due to the positive effects found in a considerable number of different chronic illnesses and diseases, including:
*psychiatric diseases:
** [[depression]]
** [[schizophrenia]]
** [[stress]] and [[anxiety]]
* neurological diseases:
** [[dementia]]
** [[multiple sclerosis]] - although a temporary worsening of symptoms is common
** [[Parkinson's disease]]
* metabolic diseases:
** [[diabetes]] (both types 1 and 2) - although it should be avoided or modified in some circumstances
** [[hyperlipidemia]]
** [[metabolic syndrome]]
** [[obesity]]
** [[polycystic ovarian syndrome]] (PCOS)
* cardiovascular diseases:
** [[cerebral apoplexy]] (stroke, cerebrovascular accident, apoplexy)
** [[claudication intermittent]]
** [[coronary heart disease]] - only if unstable angina are certain other conditions are not present, high-intensity workouts should be avoided
** [[heart failure]] - only if certain conditions are met
** [[hypertension|high blood pressure]] - high-intensity workouts should be avoided and medication may be needed to reduce blood pressure first
* pulmonary (respiratory) diseases:
** [[asthma]] - if no infection is present and it does not cause severe exacerbation of asthma
** [[chronic obstructive pulmonary disease]] (COPD) - oxygen may be needed during exercise
** [[cystic fibrosis]] - if no infection is present
* musculoskeletal disorders:
** [[lower back pain|back pain]] - only if no event fracture is suspected, and with certain conditions
** [[cancer]] - under certain conditions and with supervision
** [[osteoarthritis]] - under certain conditions
** [[osteoporosis]] - exercise should not involve risk of a fall
** [[rheumatoid arthritis]]<ref name="Pederson2015">{{Cite journal | title = Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases | date = Dec 2015 | url = https://onlinelibrary.wiley.com/doi/10.1111/sms.12581|journal=Scandinavian Journal of Medicine & Science in Sports|volume=25|issue= | pages = 1–72 | last = Pedersen | first = B.K. | author-link = | last2 = Saltin | first2 = B. | authorlink2 = |language=en|doi=10.1111/sms.12581|pmc=|pmid=|access-date=|quote=|via=}}</ref> - under certain conditions and with supervision

Regular exercise has general benefits in chronically ill people '''without ME/CFS''' depend on doing the correct type and intensity of physical activity for the illness in order to avoid aggravating symptoms; if done correctly these include
* reduced risk of falls and fractures
* reduced risk of additional chronic diseases
* reduced [[depression]], especially for people medically ill with mild or moderate depression
*reduced [[Chronic pain|pain]] in certain conditions, particularly musculoskeletal or pain conditions, if the most appropriate type and intensity of physical activity is used.<ref name="Gloth2001">{{Cite journal | title = Physical therapy and exercise in pain management | date = 2001-09-01| url = https://www.sciencedirect.com/science/article/pii/S0749069005700847|journal=Clinics in Geriatric Medicine|volume=17|issue=3 | pages = 525–535 | last = Gloth | first = Mark J. | last2 = Matesi | first2 = Ann M.|language=en|doi=10.1016/S0749-0690(05)70084-7|issn=0749-0690}}</ref><ref name="Kujala2006">{{Cite journal | title = Benefits of exercise therapy for chronic diseases | date = 2006-01-01| url = https://bjsm.bmj.com/content/40/1/3|journal=British Journal of Sports Medicine|volume=40|issue=1 | pages = 3–4 | last = Kujala | first = U.M. | language=en|doi=10.1136/bjsm.2005.021717|pmc=PMC2491939|pmid=16371482|issn=0306-3674}}</ref>

==Talks and interviews==
*2009, [https://www.youtube.com/watch?v=vqy4gVNh0rI][[Staci Stevens]] speaking to CFSAC meeting
*2010, [http://www.hhs.gov/advcomcfs/meetings/presentations/presentation_10132010_snell-stevens.pdf Slide presentation to CFSAC] by [[Staci Stevens]], [[CFSAC]]
*2012, [https://www.youtube.com/watch?v=nL49DwGRs30 Clinical exercise testing in CFS/ME research and treatment] - [[Christopher Snell]]
*2012, [https://www.youtube.com/watch?v=kCO3pAbSq3I MECFS Alert Episode 32] - [[Staci Stevens]], Director of the Pacific Fatigue Lab, [[ME/CFS Alert]]
*2012, [https://www.youtube.com/watch?v=B20H1u1LjCE&feature=youtu.be Top 10 Things You Should Know About Post-Exertional Relapse] - [[Staci Stevens]]
*2013, [https://www.youtube.com/watch?v=zZ8aPYihkpQ CFS gene expression after exercise (part 1)] - [[Lucinda Bateman]]
*2014, [https://www.youtube.com/watch?v=q_cnva7zyKM Exercise and ME/CFS, Part 1] - [[Mark VanNess]] at Bristol Watershed
*2015, [https://www.youtube.com/watch?v=F1PP21TmUPs 72. Gene-expression and exercise / Gen-expressie en inspanning]<ref name="Bateman20151103interview">{{Citation | last1 = Bateman | first1 = Lucinda| author-link1 = Lucinda Bateman| title = Video interview: Gene-expression and exercise | journal = Wetenschap voor Patienten - ME/cvs Vereniging | date = Nov 3, 2015 | url = https://www.youtube.com/watch?v=F1PP21TmUPs}}</ref> – Dr. [[Lucinda Bateman]], [[Science for Patients]])
*2016, [https://www.youtube.com/watch?v=FXN6f53ba6k Expanding Physical Capability in ME/CFS. Part 1 of 2.] Dr. [[Mark VanNess]]
*2016, [https://www.youtube.com/watch?v=7BceGgEdMpA Expanding Physical Capability in ME/CFS. Part 2 of 2.] - [[Mark VanNess]]

==Notable studies==
*2000, The Differential Diagnosis and Clinical Approach to the Athlete With Chronic Fatigue<ref name="Derman2000">{{Cite journal | last = Lambert | first = M.I. | last2 = Derman | first2 = W.E. | date = 2000-01-01 | title = The differential diagnosis and clinical approach to the athlete with chronic fatigue | url =https://www.researchgate.net/profile/Wayne_Derman/publication/304013746_The_Differential_Diagnosis_and_Clinical_Approach_to_the_Athlete_With_Chronic_Fatigue/links/5762fb7e08aecb4f6fee0463/The-Differential-Diagnosis-and-Clinical-Approach-to-the-Athlete-With-Chronic-Fatigue.pdf |journal=International SportMed Journal|language=en|volume=1|issue=3|issn=1528-3356}}</ref>
*2011, [[PACE trial]]
*2011, Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome<ref name="Nijs2011">{{Cite journal | last = Nijs | first = Jo | author-link = Jo Nijs | last2 = Aelbrecht | first2 = Senne | authorlink2 = Senne Aelbrecht | last3 = Meeus | first3 = Mira | authorlink3 = Mira Meeus | last4 = Van Oosterwijck | first4 = Jessica | authorlink4 = Jessica Van Oosterwijck | last5 = Zinzen | first5 = Evert | authorlink5 = Evert Zinzen | last6 = Clarys | first6 = Peter | authorlink6 = Peter Clarys | date = 2011 | title = Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome | url =http://emerge.org.au/wp-content/uploads/2014/11/Nijs-J.-et-al.-Tired-of-being-inactive.-Disabil-Rehabil-2011-3317-18.1493-1500.pdf | journal=Disability and Rehabilitation|volume=33|issue=17-18 | pages = 1493–1500|doi=10.3109/09638288.2010.541543|issn=1464-5165|pmid=21166613|quote=|via=}}</ref> [http://emerge.org.au/wp-content/uploads/2014/11/Nijs-J.-et-al.-Tired-of-being-inactive.-Disabil-Rehabil-2011-3317-18.1493-1500.pdf (Abstract)]
*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27187093 Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis]
*2016, [[Cochrane|Cochrane meta-analysis]]
*2017, [https://www.sciencedirect.com/science/article/pii/S088915911730051X Neural consequences of post-exertion malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name="PEM2017">{{Cite journal | last = Cook | first = Dane B. | author-link = Dane Cook | last2 = Light | first2 = Alan R. | authorlink2 = Alan Light | last3 = Light | first3 = Kathleen C. | authorlink3 = Kathleen Broderick | last4 = Broderick | first4 = Gordon | authorlink4 = Gordon Broderick | last5 = Shields | first5 = Morgan R. | authorlink5 = Morgan Shields | last6 = Dougherty | first6 = Ryan J. | authorlink6 = Ryan Dougherty | last7 = Meyer | first7 = JacobD. | author-link8 = Jacob Meyer | last8 = VanRiper | first8 = Stephanie | author-link8 = Stephanie Land | last9 = Stegner | first9 = Aaron J. | author-link9 = Aaron Stegner | date = May 1, 2017 | title = Neural consequences of post-exertion malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url =http://www.sciencedirect.com/science/article/pii/S088915911730051X|journal=Brain, Behavior, and Immunity|volume=62|issue= | pages = 87–99|doi=10.1016/j.bbi.2017.02.009|issn=0889-1591|quote=|via=}}</ref>
* 2020, Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patient<ref name="Kujawski2020">{{Cite journal | last = Kujawski | first = Sławomir | author-link = | last2 = Cossington | first2 = Jo | authorlink2 = | last3 = Słomko | first3 = Joanna | authorlink3 = | last4 = Dawes | first4 = Helen | authorlink4 = | last5 = Strong | first5 = James W.L. | authorlink5 = | last6 = Estevez-Lopez | first6 = Fernando | authorlink6 = | last7 = Murovska | first7 = Modra | author-link8 = Modra Murovska | last8 = Newton | first8 = Julia L. | author-link8 = Julia Newton | last9 = Hodges | first9 = Lynette | author-link9 = Lynette Hodges | date = 2020-10-26 | title = Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients |url =https://www.mdpi.com/2077-0383/9/11/3436|journal=Journal of Clinical Medicine|language=en|volume=9|issue=11 | pages = 3436|doi=10.3390/jcm9113436|issn=2077-0383|pmc = 7693605|pmid=33114704|access-date=|quote=|via=}}</ref> - [https://www.mdpi.com/2077-0383/9/11/3436/htm (Full text)]

==Learn more==
*2011 - [https://www.youtube.com/watch?v=Suq0dPMUbOk ME/CFS and Exercise: The VO2 Max Based Exercise Program, A Personal View] by Dan Moricoli
*2011 - [http://www.meresearch.org.uk/our-research/completed-studies/acidosis/ Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case–control study], an essay for [[ME Research UK]]
*2014 - [https://www.youtube.com/watch?v=kbaW4JKkin4 ME/CFS and Exercise: VO2 Max Testing with Nancy Klimas M.D. - PREVIEW] (this is a preview of a pay-per-view video)
*2014 - [http://www.deseretnews.com/article/865603384/Sufferers-of-chronic-fatigue-fibromyalgia-have-hope-in-new-diagnostic-tool.html Sufferers of chronic fatigue, fibromyalgia have hope in new diagnostic tool] by Wendy Leonard for ''Deseret News''
*2015 - [http://sallyjustme.blogspot.co.uk/2015/01/dr-vanness-on-recent-press-reports.html Dr. VanNess on recent press reports] by Sally Burch in [[Just ME]] blog
*2015 - [http://www.jacobspublishers.com/images/Physiology/J_J_Physiology_1_2_007.pdf Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome] by [[Frank Twisk|Frank N.M. Twisk]], and [[Keith Geraghty|Keith J. Geraghty]]<ref name="TwiskF2015">{{citation | last1 = Twisk | first1 = Frank NM | author-link1 = Frank Twisk | last2 = Geraghty | first2 = Keith J | authorlink2 = Keith Geraghty| title = Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome| journal = Jacobs Journal of Physiology | volume = 1 | issue =2 | pages = 007 | date = Jul 11, 2015 | url = http://www.jacobspublishers.com/images/Physiology/J_J_Physiology_1_2_007.pdf}}</ref>
*2015 - [https://www.omicsonline.org/open-access/objective-evidence-of-postexertional-malaise-in-myalgic-encephalomyelitis-and-chronic-fatigue-syndrome-2161-0673-1000159.pdf Objective Evidence of Post-exertional “Malaise” in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome] by Frank N.M. Twisk
*2015 - [https://cfsremission.wordpress.com/2015/12/19/exercise-alteration-of-the-cfs-microbiome/ Exercise alteration of the CFS Microbiome] from [[CFS Remission]] blog
*Jan 2016 - [http://www.hindawi.com/journals/jar/2016/2497348/ Review Article: Understanding Muscle Dysfunction in Chronic Fatigue Syndrome] by Gina Rutherford, Philip Manning, and [[Julia Newton|Julia L. Newton]]<ref name="RutherfordG2016">{{citation | last1 = Rutherford | first1 = Gina | author-link1 = Gina Rutherford | last2 =Manning | first2 = Philip| authorlink2 = Philip Manning | last3 = Newton | first3 = Julia L | authorlink3 = Julia Newton | title = Review Article: Understanding Muscle Dysfunction in Chronic Fatigue Syndrome | journal = Journal of Aging Research | volume = 2016 | issue = 4| pages = 1-13 | date = Jan 13, 2016 | pmid = 26998359 | doi = 10.1155/2016/2497348 | url = http://www.hindawi.com/journals/jar/2016/2497348/}}</ref>
*Feb 10, 2016 - [http://www.prohealth.com/library/showarticle.cfm?libid=25096 Lost in Translation - The ME-Polio Connection and the Dangers of Exercise] by [[Nancy Blake]] for [[ProHealth]]
*Jul 2016 - [https://meaustralia.net/2016/07/06/australian-metabolomics-study-of-young-women/ Australian metabolomics study of young women with ME/CFS (CCC)] by Sasha Nimmo for ''ME Australia''
*Aug 2016 - [http://solvecfs.org/neuromuscular-strain-in-mecfs-research-study-conclusion/ Neuromuscular Strain in ME/CFS – Research Study Conclusion] in [[Solve ME/CFS Initiative]] Newsletter
*Oct 2017 - [https://www.npr.org/sections/health-shots/2017/10/02/554369327/for-people-with-chronic-fatigue-syndrome-more-exercise-isnt-better For People With Chronic Fatigue Syndrome, More Exercise Isn't Better - Michaeleen Doucleff, Shots: Health News From NPR]

== See also ==
*[[Two-day cardiopulmonary exercise test]]
*[[Graded exercise therapy]]
*[[Burnout]]
*[[Delayed onset muscle soreness]] (DOMS)
*[[Muscle fatigability]]
*[[Mitochondrion]]
*[[Deconditioning]]
*[[Post-exertional malaise]]
*[[Glass ceiling effect]]

==References==
{{Reflist}}

[[Category:Potential treatments]]
[[Category:Psychological and behavioral therapies]]
[[Category:Energy system]]
[[Category:Depression alternative treatments]]
[[Category:Drug-free pain management]]
[[Category:Exercise treatments]]

COVID-19

2025-05-16T22:34:23Z

YellowWaterLilly:/* Emergency Warning Signs* */ Linked to related MEpedia pages.

'''COVID-19''', commonly referred to as '''COVID''' or even '''corona''', is '''Coronavirus Disease 19''', an infectious respiratory illness caused by the novel (new) [[severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), a virus discovered in 2019.<ref name="WHO-QA">{{Cite web | url = https://www.who.int/news-room/q-a-detail/q-a-coronaviruses | title = Q&A on coronaviruses (COVID-19) | last = World Health Organization | first = | author-link = World Health Organization | date = | website = [[World Health Organization]]|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web | url = https://www.cdc.gov/coronavirus/types.html | title = Human Coronavirus Types | last = Centers for Disease Control and Prevention | first = | author-link = Centers for Disease Control and Prevention | date = 2020-02-27 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status= | access-date = 2020-03-16}}</ref><ref>{{Cite journal | last = Li | first = Guangdi | author-link = | last2 = Clercq | first2 = Erik De | author-link2 = | date = Mar 2020 | title = Therapeutic options for the 2019 novel coronavirus (2019-nCoV) | url = https://www.nature.com/articles/d41573-020-00016-0 | journal = Nature Reviews Drug Discovery|language=en | volume = 19 | issue = 3 | pages = 149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web | url = https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it | title = Naming the coronavirus disease (COVID-19) and the virus that causes it | website = [[World Health Organization]]|language=en | access-date = 2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.''' Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal | last = Wei | first = Min | last2 = Yuan | first2 = Jingping | last3 = Liu | first3 = Yu | last4 = Fu | first4 = Tao | last5 = Yu | first5 = Xue | last6 = Zhang | first6 = Zhi-Jiang | date = 2020-02-14 | title = Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China | url = https://jamanetwork.com/journals/jama/fullarticle/2761659 | journal = JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal | last = Hui | first = David S. | last2 = Azhar | first2 = Esam I. | last3 = Madani | first3 = Tariq A. | last4 = Ntoumi | first4 = Francine | last5 = Kock | first5 = Richard | last6 = Dar | first6 = Osman | last7 = Ippolito | first7 = Giuseppe | last8 = Mchugh | first8 = Timothy D. | last9 = Memish | first9 = Ziad A. | date = 2020-02-01 | title = The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China | url = https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract | journal = International Journal of Infectious Diseases|language=English | volume = 91 | pages = 264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web | url = https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 | title = WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 | website = [[World Health Organization]]|language=en | access-date = 2020-03-28}}</ref> There is some evidence that COVID-19 may be a disease of the blood vessels, as well as a respiratory disease.<ref name="Ackermann2020">{{Cite journal | last = Ackermann | first = Maximilian | last2 = Verleden | first2 = Stijn E. | last3 = Kuehnel | first3 = Mark | last4 = Haverich | first4 = Axel | last5 = Welte | first5 = Tobias | last6 = Laenger | first6 = Florian | last7 = Vanstapel | first7 = Arno | last8 = Werlein | first8 = Christopher | last9 = Stark | first9 = Helge | date = 2020-07-09 | title = Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19 | url = https://doi.org/10.1056/NEJMoa2015432 | journal = New England Journal of Medicine | volume = 383 | issue = 2 | pages = 120–128|doi=10.1056/NEJMoa2015432|issn=0028-4793|pmc = 7412750|pmid=32437596}}</ref><ref name="NPR-5Nov2020">{{Cite web | url = https://www.npr.org/sections/health-shots/2020/11/05/917317541/clots-strokes-and-rashes-is-covid-19-a-disease-of-the-blood-vessels | title = Clots, Strokes And Rashes. Is COVID-19 A Disease Of The Blood Vessels? | website = NPR.org|language=en | access-date = 2020-11-06}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name="WHO-qa">{{Cite web | last = World Health Organization | first = | author-link = World Health Organization | url =https://www.who.int/news-room/q-a-detail/q-a-coronaviruses | title = Q&A on coronaviruses (COVID-19) | website = [[World Health Organization]]|language=en | access-date = 2020-04-21}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name="WHO-qa" /><ref name="CDC-symptoms">{{Cite web | url = https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html | title = Coronavirus Disease 2019 (COVID-19) – Symptoms | last = CDC | date = 2020-03-20 | author-link = Centers for Disease Control | website = Centers for Disease Control and Prevention|language=en-us | access-date = 2020-03-24}}</ref>

== Mild COVID-19 ==
The phrases '''''mild symptoms''''' and '''''mild or moderate cases''''' have commonly been used to decribe any patients not in need of urgent hospitalisation during the pandemic,<ref>{{Cite news |url =https://www.washingtonpost.com/opinions/i-probably-have-a-mild-to-moderate-case-of-covid-19-i-dont-think-i-could-survive-worse/2020/03/24/740b4d10-6de2-11ea-a3ec-70d7479d83f0_story.html | title = Opinion: I probably have a ‘mild to moderate’ case of covid-19. I don’t think I could survive worse. | last = von Drehle | first = David | date = Mar 24, 2020|work=Washington Post | access-date = 2020-10-12| archive-url = | archive-date = |url-status = | language=en-US|issn=0190-8286|quote=}}</ref><ref>{{Cite web | url = https://blogs.bmj.com/bmj/2020/07/28/nisreen-a-alwan-what-exactly-is-mild-covid-19/ | title = What exactly is mild covid-19? | last = Alwan | first = Nisreen A | author-link = Nisreen Alwan | date = 2020-07-28 | website = The BMJ|language=en-US|archive-url=|archive-date=|url-status= | access-date = 2020-10-12}}</ref> yet considerable numbers of patients with COVID-19 who were considered mild or moderate cases were extremely ill or developed [[Long COVID|long-term symptoms]] which prevented any return to work or normal life.<ref name="Navabi2020">{{Cite journal | title = Long covid: How to define it and how to manage it | last = Nabavi | first = Nikki | url = https://www.bmj.com/content/370/bmj.m3489 | date = Sep 7, 2020 | journal = BMJ | volume = 370 | pages = bmj.m3489}}</ref><ref name="long-haulers-redefining">{{Cite news |url =https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/ | title = Long-Haulers Are Redefining COVID-19 | last = Yong | first = Ed | date = Aug 19, 2020|work=The Atlantic | access-date = 2020-08-21| archive-url = | archive-date = |url-status = | issn=1072-7825|quote=}}</ref><ref name="BBClongcovid6m">https://www.bbc.co.uk/news/uk-england-leicestershire-54106073</ref>

{{See also|Long COVID|Long COVID|Post-COVID-19 illness|Post-COVID illness||}}

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* a new and continuous cough, coughing episodes, or a dry [[cough]]<ref>{{Cite web | url = https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/ | title = Symptoms and what to do - Coronavirus (COVID-19) | last = National Health Service | first = | author-link = National Health Service | date = 2020-03-24 | website = nhs.uk|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-04-21}}</ref><ref name="WHO-qa" /><ref name="CDC-symptoms" />
Most patients only have one or two of the common symptoms.<ref name="WHO-qa" /><ref name="Mizumoto">{{Cite journal | last = Mizumoto | first = Kenji | last2 = Kagaya | first2 = Katsushi | last3 = Zarebski | first3 = Alexander | last4 = Chowell | first4 = Gerardo | date = 2020-03-12 | title = Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020 | url = https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180 | journal = Eurosurveillance|language=en | volume = 25 | issue = 10 | pages = 2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc = 7078829|pmid=32183930}}</ref><ref name="Lan2020" /><ref name="WHO-symptoms">{{Cite web |url= https://www.who.int/westernpacific/health-topics/coronavirus | title = Coronavirus | last = World Health Organization | date = 2020-04-16 | author-link = World Health Organization | website = World Health Organization|language=en-us | access-date = 2020-04-21}}</ref>

=== Other Symptoms ===
* aches and [[Pain|pains]]
* [[dyspnea|shortness of breath]]
* nasal congestion
* [[sore throat]]
* very few people experience a runny nose, [[nausea]] or [[diarrhea]]<ref name="WHO-qa" /><ref name="WHO-symptoms" />
The World Health Organization that people call their doctor if they experience fever, cough or difficulty breathing.

=== Emergency Warning Signs* ===
* difficulty breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name="CDC-symptoms" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name="CDC-symptoms" />

See also the [[Emergency room|emergency room page]].

Additionally, there are reports that patients have lost or have a reduced [[changes in sense of smell|sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news |url =https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html | title = Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection | last = Rabin | first = Roni Caryn | date = 2020-03-22|work=The New York Times | access-date = 2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web | url = https://www.entnet.org/content/coronavirus-disease-2019-resources | title = Coronavirus Disease 2019: Resources | last = American Academy of Otolaryngology | date = 2020-03-15 | website = American Academy of Otolaryngology-Head and Neck Surgery|language=en | access-date = 2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced [[changes in sense of smell|sense of smell]] and loss of [[changes in taste|sense of taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

===Neurological symptoms===
Mao et al. (2020) reported that 36% of a group of 214 COVID-19 patients admitted to hospitals in Wuhan, China, had "neurologic manifestations" of the disease.<ref name="Mao2020">{{Cite journal | last = Mao | first = Ling | last2 = Jin | first2 = Huijuan | last3 = Wang | first3 = Mengdie | last4 = Hu | first4 = Yu | last5 = Chen | first5 = Shengcai | last6 = He | first6 = Quanwei | last7 = Chang | first7 = Jiang | last8 = Hong | first8 = Candong | last9 = Zhou | first9 = Yifan | date = 2020-06-01 | title = Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China | url = https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549 | journal = JAMA Neurology|language=en | volume = 77 | issue = 6 | pages = 683|doi=10.1001/jamaneurol.2020.1127|issn=2168-6149}}</ref>

Neurological symptoms were:
* [[central nervous system]] symptoms:
**[[dizziness]]
**[[headache]]
**impaired consciousness
**acute cerebrovascular disease
**[[ataxia]]
**[[seizure]]
* peripheral nervous symptoms:
**altered or loss of [[changes in taste|sense of taste]]
**altered or loss of [[changes in sense of smell|sense of smell]]
**[[visual dysfunction|impaired vision]]
**[[neuralgia|nerve pain]]
**skeletal muscular injury manifestations
*impaired or change in consciousness:
**[[somnolence]]
**stupor
**coma
**[[confusion]]
**delirium

==Asymptomatic carriers==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.''' Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal | last = Bai | first = Yan | last2 = Yao | first2 = Lingsheng | last3 = Wei | first3 = Tao | last4 = Tian | first4 = Fei | last5 = Jin | first5 = Dong-Yan | last6 = Chen | first6 = Lijuan | last7 = Wang | first7 = Meiyun | date = 2020-02-21 | title = Presumed Asymptomatic Carrier Transmission of COVID-19 | url = https://jamanetwork.com/journals/jama/fullarticle/2762028 | journal = JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal | last = Chan | first = Jasper Fuk-Woo | last2 = Yuan | first2 = Shuofeng | last3 = Kok | first3 = Kin-Hang | last4 = To | first4 = Kelvin Kai-Wang | last5 = Chu | first5 = Hin | last6 = Yang | first6 = Jin | last7 = Xing | first7 = Fanfan | last8 = Liu | first8 = Jieling | last9 = Yip | first9 = Cyril Chik-Yan | date = 2020-02-15 | title = A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster |url =https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract | journal = The Lancet|language=English | volume = 395 | issue = 10223 | pages = 514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal | last = del Rio | first = Carlos | author-link = | last2 = Malani | first2 = Preeti N. | author-link2 = | date = 2020-02-28 | title = COVID-19—New Insights on a Rapidly Changing Epidemic | url = https://jamanetwork.com/journals/jama/fullarticle/2762510 | journal = JAMA|language=en | volume = | issue = | pages = |doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name="Mizumoto" />

==Recovered patients testing positive==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal | last = Lan | first = Lan | last2 = Xu | first2 = Dan | last3 = Ye | first3 = Guangming | last4 = Xia | first4 = Chen | last5 = Wang | first5 = Shaokang | last6 = Li | first6 = Yirong | last7 = Xu | first7 = Haibo | date = 2020-02-27 | title = Positive RT-PCR Test Results in Patients Recovered From COVID-19 | url = https://jamanetwork.com/journals/jama/fullarticle/2762452 | journal = JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web | url = https://www.snopes.com/fact-check/covid-19-reinfection/ | title = Can People Who Recover from COVID-19 Become Reinfected? | website = Snopes.com|language=en-US | access-date = 2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal | last = Ye | first = Guangming | last2 = Pan | first2 = Zhenyu | last3 = Pan | first3 = Yunbao | last4 = Deng | first4 = Qiaoling | last5 = Chen | first5 = Liangjun | last6 = Li | first6 = Jin | last7 = Li | first7 = Yirong | last8 = Wang | first8 = Xinghuan | date = 2020-03-11 | title = Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation | url =https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract | journal = Journal of Infection|language=English | volume = 0 | issue = 0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left}}

{{clear}}

====Risk of COVID-19 in patients with ME/CFS====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web | url = https://www.youtube.com/watch?v=pkGXiJ1jM14 | title = COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020 | last = Klimas | first = Nancy | date = 2020-03-13|work=|access-date=Mar 24, 2020| archive-url = | archive-date = |url-status = | quote= | author-link = Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Dr [[Lucinda Bateman]] has said this is unknown.<ref name="Bateman20200323QA">{{Cite web | title = COVID-19 and ME/CFS/FM Frequently Asked Questions | last = Bateman | first = Lucinda | author-link = Lucinda Bateman | website = Bateman-Horne Center | date = 2020-03-23 | url = http://www.batemanhornecenter.org/wp-content/uploads/2020/03/COVID-19-FAQ-Public.pdf}}</ref>Klimas, Speight, Weir, Shepherd and Bateman have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections or after COVID-19.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /><ref name="Bateman20200323QA" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally '''''not''''' considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{Citation | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | author-link2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | author-link4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 =Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = 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="ICP2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | author-link2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | author-link3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | author-link4 = Nancy Klimas | last5 = Broderick | first5 = G | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 = N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | author-link20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | author-link21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | author-link22 = John McLaren-Howard | last23 = Mena | first23 = I | author-link23 = Ismael Mena | last24 = Miwa | first24 = K | author-link24 = Kunihisa Miwa | last25 = Murovska | first25 = M | author-link25= Modra Murovska | last26 = Stevens | first26 = SR | author-link26 = 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> A study in 2013 assessed immune system responses to the flu [[vaccine]] in people with ME/CFS, and found them similar to the immune responses of healthy controls, which indicated that vaccine effectiveness was similar in ME/CFS patients, although the study did not include a long-term follow-up to assess duration of vaccine effectiveness or overall effect on ME/CFS symptoms.<ref>{{Cite journal | last = Prinsen | first = Hetty | author-link = | last2 = de Vries | first2 = I. Jolanda M. | author-link2 = | last3 = Torensma | first3 = Ruurd | author-link3 = | last4 = Pots | first4 = Jeanette M. | author-link4 = | last5 = Mulder | first5 = Sasja F. | author-link5 = | last6 = van Herpen | first6 = Carla M. L. | author-link6 = | last7 = Elving | first7 = Lammy D. | last8 = Bleijenberg | first8 = Gijs | author-link8 = Gijs Bleijenberg | last9 = Stelma | first9 = Foekje F. | date = 2012-12-17 | title = Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome | url =https://doi.org/10.1186/1471-2172-13-71 | journal = BMC Immunology | volume = 13 | issue = 1 | pages = 71|doi=10.1186/1471-2172-13-71|issn=1471-2172|pmc = 3534525|pmid=23244635|access-date=|quote=|via=}}</ref> This means most ME/CFS patients would '''''not''''' be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web | url = https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/ | title = OMF-funded research: T cells and molecular immunology | last = Open Medicine Foundation | first = | author-link = Open Medicine Foundation | date = Feb 28, 2018 | website = Open Medicine Foundation|language=en-US|archive-url=|archive-date=|url-status= | access-date = 2019-07-11}}</ref> Evidence for this theory is limited.

===Drug related risks===
The following drugs may be used for some ME/CFS symptoms and are a possible concern
* '''[[Ibuprofen]]''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal | last = Day | first = Michael | date = 2020-03-17 | title = Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists |url =https://www.bmj.com/content/368/bmj.m1086 | journal = BMJ|language=en | volume = 368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web | url = https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/ | title = Stay at home advice - Coronavirus (COVID-19) | last = National Health Service | first = | author-link = National Health Service | date = 2020-02-28 | website = nhs.uk|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web | url = https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms | title = COVID-19 coronavirus and MS | last = MS Society | first = | author-link = | date = | website = mssociety.org.uk|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref><ref>{{Cite web | url = https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf | title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants) | last = Renal Association | first = | author-link = | date = 2020-03-17 | website = renal.org|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web | url = https://adisinsight.springer.com/drugs/800001203 | title = Rintatolimod - AIM ImmunoTech - AdisInsight | website = adisinsight.springer.com | access-date = 2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*'''[[Fludrocortisone]]''', a [[corticosteroid]] (steroid) - brand names include Florinef. This may be used by patients with [[Postural orthostatic tachycardia syndrome|POTS]], which is common in ME/CFS patients.<ref name="Fludrocortisone-Drugbank">https://www.drugbank.ca/drugs/DB00687</ref>
* Other '''[[corticosteroid]]s''' (steroids) if they could suppress the immune system.<ref name="UKgov-vulnerable">{{Cite web | url = https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults | website = gov.uk | access-date = 2020-04-06 | title = COVID-19 guidance on social distancing and for vulnerable people | last = Public Health England}}</ref>
* Any other '''immunosuppressant drugs or therapies''', including chemotherapy treatments and certain targeted cancer treatments<ref name="UKgov-vulnerable" /><ref name="UKgov-extremelyvulnerable">{{Cite web | title = Guidance on shielding and protecting extremely vulnerable people from COVID-19 | url = https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 | website = gov.uk | access-date = 2020-04-06 | last = Public Health England}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/> | author = [[Charles Shepherd]], ME Association | date = Mar 16, 2020 | title = Advice from the UK's ME Association}}

====Risk of death or serious complications in ME/CFS patients====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" /> | author = [[Nigel Speight]] | date = Mar 2020 | title = 25% ME Group for Severe ME}}

====Risk of developing ME/CFS after COVID-19====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===ME/CFS charity medical advisors' COVID-19 statements===
*Mar 30, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/ ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA30Mar20">{{Cite web | url = https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/ | title = ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 30 March 2020 | last = Shepherd | first = Charles | author-link = Charles Shepherd | date = 2020-04-06 | website = ME Association|language=en-GB|archive-url=|archive-date=|url-status= | access-date = 2020-03-30}}</ref>
*Mar 23 2020, Bateman Horne Center, [http://www.batemanhornecenter.org/covid19 COVID-19 resources]
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web | url = https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ | title = Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020 | last = Shepherd | first = Charles | author-link = Charles Shepherd | date = 2020-03-17 | website = ME Association|language=en-GB|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web | url = https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ | title = ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020 | last = Shepherd | first = Charles | author-link = Charles Shepherd | date = 2020-03-16 | website = ME Association|language=en-GB|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web | url = https://25megroup.org/download/1796/?v=3236 | author-link = Nigel Speight | last = Speight | first = Nigel | last2 = Weir | first2 = William | author-link2 = William Weir | title = re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 | date = Mar 2020 | website = 25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web | url = https://25megroup.org/download/1796/?v=3226 | author-link = Nigel Speight | last = Speight | first = Nigel | title = re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group | date = Mar 2020 | website = 25megroup.org|others=[[William Weir]]}}</ref>

===Research on ME/CFS and COVID-19===
COVID-19 is a new illness and research on the effects on ME/CFS patients has not been published yet. Patient surveys in progress include:
*[https://www.zorgvolg.nl/mecvscor.php Corona ME/CFS study] - [[ME/CVS-Stichting Nederland]] - in Dutch
:A Dutch patient organization survey to assess if the risk of contracting COVID-19 is higher for those with ME/CFS, and if symptoms are more severe in ME/CFS patients.<ref name="EMEA-q12020">http://europeanmealliance.org/news-Q12020-001.shtml</ref><ref name="MECVS-survey-23Mar2020">{{Cite web | url = https://mecvs.nl/nieuws/persbericht-covid-19-onder-me-cvs-patienten/ | title = Persbericht: COVID-19 onder ME/cvs patiënten | date = 2020-03-24 | website = ME/CVS Stichting Nederland|language=nl | access-date = 2020-10-06}}</ref> The [[European ME Alliance]] is suggesting that non-Dutch speakers use an online translation tool to complete it.<ref name="EMEA-q12020" />

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
 
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web | url = https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response | title = Coronavirus Cases Trigger EPA Rapid Response | last = US Environmental Protection Agency | first = | author-link = | date = 2020-01-29 | website = US EPA|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-23}}</ref><ref>{{Cite journal | last = Firquet | first = Swan | author-link = | last2 = Beaujard | first2 = Sophie | author-link2 = | last3 = Lobert | first3 = Pierre-Emmanuel | author-link3 = | last4 = Sané| first4 = Famara | author-link4 = | last5 = Caloone | first5 = Delphine | author-link5 = | last6 = Izard | first6 = Daniel | author-link6 = | last7 = Hober | first7 = Didier | date = June 2015 | title = Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/ | journal = Microbes and Environments | volume = 30 | issue = 2 | pages = 140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID 19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div>

===High touch surfaces: disinfect daily===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]] 
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web | url = https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html | title = Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations | last = CDC| first = | author-link = Centers for Disease Control and Prevention | date = 2020-02-11 | website = Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|url-status= | access-date = 2020-03-18}}</ref>
</div> 
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web | url = https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html | title = Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment | last = CDC| first = | author-link = Centers for Disease Control and Prevention | date = 2020-03-16 | website = Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|url-status= | access-date = 2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:''' If possible the '''sick person''' should also clean:
<div style="column-count:2;">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small, airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web | url = https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces | title = New coronavirus stable for hours on surfaces | last = National Institutes of Health | first = | author-link = National Institutes of Health | date = 2020-03-17 | website = National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal | last = Tellier | first = Raymond | author-link = | date = Nov 2006 | title = Review of Aerosol Transmission of Influenza A Virus |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/ | journal = Emerging Infectious Diseases | volume = 12 | issue = 11 | pages = 1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==Disinfecting your home if someone is sick==

The following is an abbreviated bullet-point list from the [[Centers for Disease Control and Prevention]] (CDC) article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web | url = https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html | title = Coronavirus Disease 2019 (COVID-19) | last = CDC | date = 2020-02-11 | website = Centers for Disease Control and Prevention|language=en-us | access-date = 2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:''' 
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">{{Cite web | url = https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html | title = Disinfecting your home {{!}} Coronavirus Disease 2019 (COVID-19) | last = CDC| first = | author-link = | date = 2020-02-11 | website = Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|url-status= | access-date = 2020-10-06}}</ref></div>

<div role="note" class="hatnote navigation-searchable" style="padding:0">Take additional steps covering '''soft surfaces, food, laundry, and trash''' as described{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
'''Severe Acute Respiratory Infection''' (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients.<ref name="vitCtrial">{{Cite web | url = https://clinicaltrials.gov/ct2/show/NCT04264533 | title = Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - ClinicalTrials.gov | website = clinicaltrials.gov|language=en | access-date = 2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Acute Respiratory Distress Syndrome==
ARDS is another complication of severe COVID-19, and may develop after 5-8 days of illness, along with pneumonitis and shortness of breath.<ref name="Jiang2020">{{Cite journal | url = http://techscience.com/cmc/v63n1/38464 | title = Towards an Artificial Intelligence Framework for Data-Driven Prediction of Coronavirus Clinical Severity | last = Jiang | first = X | author-link = | last2 = Coffee | first2 = M | author-link2 = | date = 2020 | website = | pages = 537-551|archive-url=|archive-date=|url-status= | access-date = 2020-04-01 | last3 = Bari | first3 = A | last4 = Wang | first4 = J | last5 = Jiang | first5 = X | last6 = Huang | first6 = J | last7 = Shi | first7 = J | last8 = Dai | first8 = J | last9 = Cai | first9 = J | last10 = Zhang | first10 = T | last11 = Wu | first11 = Z | last12 = He | first12 = G | last13 = Huang | last14 = Y | volume = 63 | issue = 1 | journal = CMC-Computers, Materials & Continua}}</ref> ARDS is a life-threatening condition that involves the patient's lungs becoming inflamed, and being unable to produce enough oxygen for the body's vital organs.<ref name="ARDS-NHS">{{Cite web | url = https://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/ | title = Acute respiratory distress syndrome (ARDS) | last = National Health Service | first = | author-link = National Health Service | date = 2017-10-17 | website = nhs.uk|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-04-01}}</ref>

== Long COVID ==
[[Long COVID]] is the name used for long lasting illness after COVID-19 infection, generally described as symptoms lasting many weeks or months. People with long COVID have reported symptoms easing and then returning, new symptoms occurring and in some cases persistent symptoms that are worse than their original COVID-19 symptoms.

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web | url = https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters | title = Coronavirus 2019 {{!}} Myth busters | last = World Health Organization | first = | author-link = World Health Organization | date = | website = [[World Health Organization]]|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web | url = https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread | title = Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks | website = BuzzFeed News|language=en | access-date = 2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web | url = https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing | title = Coronavirus Scams: What the FTC is doing | last = FTC| first = | author-link = | date = 2020-03-06 | website = Consumer Information|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web | url = https://www.who.int/about/communications/cyber-security | title = Communications {{!}} Cybersecurity | last = World Health Organization | first = | author-link = World Health Organization | date = | website = [[World Health Organization]]|language=en|archive-url=|archive-date=|url-status= | access-date = 2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles and blogs==
* Feb 29, 2020 - [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
*Mar 1, 2020, [http://www.investinme.org//IIMER-Newslet-20-0301covid.shtml COVID-19 and ME] - [[Invest in ME Research]] Newsletter
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN
*Apr 2, 2020, [http://simmaronresearch.com/2020/04/will-covid-19-leave-an-explosion-of-me-cfs-cases-in-its-wake/? Will COVID-19 leave an explosion of ME/CFS cases in its wake?] - blog by Cort Johnson
*Apr 8, 2020, [https://www.independent.co.uk/news/world/europe/coronavirus-greece-cases-deaths-flatten-curve-update-a9455436.html Coronavirus: How Greece managed to flatten the curve] - The Independent

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[http://batemanhornecenter.org/wp-content/uploads/2020/03/Medical-Care-Considerations-Letter-Final.pdf Useful medical information when treating COVID-19 in patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and severe fibromyalgia (FM)] - Dr Lucinda Bateman, Bateman Horne Center
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (COVID-19) Update | 09 March 2020] - The ME Association
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

'''COVID-19 vs Flu: Similarities and Differences'''
*[https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm Similarities and Differences between Flu and COVID-19] - CDC
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/coronavirus-disease-covid-19-similarities-and-differences-with-influenza Similarities and differences between COVID-19 and Influenza] - World Health Organization
*[https://www.theguardian.com/world/2021/jul/05/why-living-with-covid-would-not-be-the-same-as-flu Why living with Covid would not be the same as flu] - The Guardian, UK

==See also ==
*[[Long COVID]]
*[[Post-COVID-19 illness]]
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2)
*[[Severe Acute Respiratory Syndrome]]
*[[:Category:Disinfectants|Disinfectants Category]]

==References ==
{{Reflist}}

[[Category:Infectious diseases]]
[[Category:Viral diseases]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Inspiritol

2025-05-16T22:28:33Z

YellowWaterLilly:/* Theory */ Linked to related MEpedia pages.

{{stub}}
{{NeedsImage}}
'''Inspiritol''' is an experimental drug that aims to treat post-viral illness and respiratory distress.<ref name="inspiritol">{{Cite web | url = https://inspiritol.com/inspiritol | title = New inhaled drug created to treat Respiratory distress & post viral illness | last = | first = | authorlink = | date = | website = Inspiritol®|language=en-US|archive-url=|archive-date=|url-status=|access-date=2021-10-30}}</ref><ref name="wtvy2021">{{Cite web | url = https://www.wtvy.com/prnewswire/2021/10/25/inspiritol-effective-covid-19-long-covid-mecfs-patients/ | title = Inspiritol Effective In COVID-19, Long-COVID And ME/CFS Patients | last = | first = | authorlink = | date = | website = News4|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-30}}</ref> Inspiritol is the name of both the company developing the drug and the drug itself. Inspiritol has been reported to have been used experimentally on a small number of [[ME/CFS]] patients, [[long COVID]] patients, and people with [[influenza|flu]], COPD or asthma.<ref name="inspiritol" />

==Theory==
Inspiritol aims to alter the [[oral microbiome]] to reduce levels of bacteria that have previously been linked to [[inflammation]].
In a recent small study [[whole genome sequencing]] was used to sample the oral microbiome of patients who tested positive for COVID-19 at an [[emergency room]], fourteen of the patients later developed [[long COVID]]. The study's long COVID patients were found to have changes 19 species of [[bacteria]] in their oral microbiome that were not found in patients without long COVID.<ref name="Hagan2021">{{Cite journal | last = Haran | first = John P. | authorlink = John Haran | last2 = Bradley | first2 = Evan | authorlink2 = Evan Bradley | last3 = Zeamer | first3 = Abigail L. | authorlink3 = | last4 = Cincotta | first4 = Lindsey | authorlink4 = | last5 = Salive | first5 = Marie-Claire | authorlink5 = | last6 = Dutta | first6 = Protiva | authorlink6 = | last7 = Mutaawe | first7 = Shafik | last8 = Anya | first8 = Otuwe | last9 = Meza-Segura | first9 = Mario | date = 2021-10-22 | title = Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long COVID | url = https://insight.jci.org/articles/view/152346|journal=JCI Insight|language=en|volume=6|issue=20|pages=|doi=10.1172/jci.insight.152346|issn=0021-9738|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="umassOct2021">{{Cite web | url = https://umassmed.edu/news/news-archives/2021/10/umass-chan-study-finds-association-between-long-covid-symptoms-and-altered-oral-microbiome/ | title = UMass Chan study finds association between long-COVID symptoms and altered oral microbiome | last = Fessendener | first = Jim | authorlink= | date = 2021-10-22 | website = UMass Chan Medical School|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-30}}</ref>

Inspiritol consists of a number of different substances, some of which are believed to have anti-inflammatory, [[antiviral]], or [[Antibiotic|antibacterial]] effects.<ref name="inspiritol" />

==Evidence==
No clinical trials or case studies of Inspiritol have been published yet.

==Clinicians==
Inspiritol has been used in clinical trials by the following ME/CFS researchers:
*[[John Salerno]], who helped develop Inspiritol
*[[Anna Gill]], University of Massachusetts Chan Medical School
*[[Liis Selin|Liisa Selin]], University of Massachusetts Chan Medical School<ref name="inspiritol" /><ref name="wtvy2021" />

==Risks and safety==
Inspiritol remains in clinical trials so the side effects and risks are largely unknown, and it has not yet been given FDA approval.

== Ingredients ==
The article <ref>{{Cite journal|title=Identification of CD8 T-cell dysfunction associated with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID and treatment with a nebulized antioxidant/anti-pathogen agent in a retrospective case series|date=2024-03|url=https://doi.org/10.1016/j.bbih.2023.100720|journal=Brain, Behavior, & Immunity - Health|volume=36|pages=100720|last=Gil|first=Anna|last2=Hoag|first2=George E.|last3=Salerno|first3=John P.|last4=Hornig|first4=Mady|last5=Klimas|first5=Nancy|last6=Selin|first6=Liisa K.|doi=10.1016/j.bbih.2023.100720|pmc=PMC10847863|pmid=38327880|issn=2666-3546}}</ref> describes Inspiritol as a liquid suspension with five ingredients: glutathione, methylcobalamin, N-acetylcysteine, eucalyptol (1,8-cineole) and β-caryophyllene, in a proprietary liquid carrier. These five compounds are present in a concentration of a total of 8.1% (w/w) in a 90.9% (w/w) saline solution with a DMF-listed emulsifier.

==Costs and availability==
Inspiritol is an inhaled drug which is highly restricted due to not yet being [[U.S. Food and Drug Administration|FDA]]-approved.<ref name="wtvy2021" />

==See also==
*[[Myalgic encephalomyelitis]]
*[[Long COVID]]
*[[John Salerno]]

==Learn more==
*[https://inspiritol.com/# Inspiritol website]

==References ==
{{Reflist}}

[[Category:Potential treatments]]
[[Category:Anti-inflammatories]]
[[Category:Antivirals]]
[[Category:Antibacterials]]

Guide for patients having surgery

2025-05-16T22:13:31Z

YellowWaterLilly:/* See also */ Linked to related MEpedia pages.

== Talking to your surgeon ==

=== Pain management ===
It's helpful if you're familiar with your body's reactions to pain relieving drugs they may use post operatively.
{{See also|Analgesics}}

=== Electrolytes ===
Low intracellular [[magnesium]] and low [[potassium]] have been found in patients with ME. [[Red blood cell magnesium]] (an [[intracellular]] test) and serum potassium should be checked before surgery and replenished if borderline or low. Low magnesium or potassium depletion could potentially lead to [[cardiac arrhythmia]]s under anesthesia.<ref name="anapsid">{{Cite web | url=http://www.anapsid.org/cnd/drugs/anesthesia.html | title = Recommendations For Persons With CFS Or Fibromyalgia Who Are Anticipating Surgery | last = Lapp | first = Charles | authorlink = Charles Lapp | date = Jan 1, 2014 | website = Melissa Kaplan's Chronic Neuroimmune Diseases|archive-url=|archive-date=|url-status=|access-date=}}</ref>

==Talking to your anesthesiologist==
It is important to ask to meet with your anesthesiologist in advance to discuss the resources below.

=== Anesthetic agents ===
Whether or not you have a formal diagnosis, patients with ME may also have a diagnosis of [[mast cell activation disorder]] or may otherwise be sensitive to certain classes of drugs used for anesthesia. Your anesthesiologist may need to create a special anesthesiology protocol; for example, avoiding [[histamine]]-releasing, hepatoxic and
[[Category:Muscle relaxants|muscle-relaxing drugs]]
.

=== Hydration ===
Since ME/CFS patients have hydration/[[low blood volume]] concerns, ask if the anesthesiologist could allow you to drink clear fluids beforehand, depending on the surgery.

=== Cervical spine risks ===
In addition, patients with [[ME/CFS]] who have structural cervical issues such as [[craniocervical instability]] (CCI) or [[cervical spinal stenosis]] will need to have their head and neck kept in a neutral position during surgery to help limit the risk of exacerbation or damage. This is especially important for patients with [[hypermobility]], [[Ehlers-Danlos syndrome]] (EDS) or [[Postural orthostatic tachycardia syndrome]] (POTS).{{citation needed | date = 2022}}

=== Resources to share with your anesthesiologist ===

* [http://drlapp.com/resources/advice-for-pwcs-anticipating-anesthesia-or-surgery/ Advice for PWCs Anticipating Anesthesia or Surgery] - Hunter Hopkins Center
* [https://www.prohealth.com/library/evergreen_pages/anesthesia-recommendations-for-chronic-fatigue-syndrome-myalgic-encephalomyelitis Anesthesia Recommendations For Chronic Fatigue Syndrome & Myalgic Encephalomyelitis]

==Recovery at the hospital==
If you are staying overnight at the hospital, it's important to talk to your surgeon in advance regarding your needs for sleep and minimal disruption.

* Discuss in advance any [[sound sensitivity]], [[Photophobia|light sensitivity]] or [[Chemical sensitivities|chemical/fragrance sensitivities]] (if possible, a sign at your door or next to you can help remind nurses changing shifts)
* Ask for a sound-proof door (rather than an open curtain) and placement on a quiet ward
* Ask whether it's possible to minimize nighttime disruptions (e.g., middle of the night blood pressure monitoring) if this isn't a concern for your specific medical condition
* Discuss any [[food sensitivities]] in advance
* Discuss [[temperature sensitivity|temperature sensitivities]], and possible accommodations including adjustment of operating and recovery room thermostat, provision of extra blankets or ice chips
* If you have experience taking [[Intravenous saline|IV saline]], discuss the possibility that you will need extra hydration before, during, or after surgery. You may need to have your surgeon's office consult with your ME specialist as doctors may not be familiar with the finding that many [[Postural orthostatic tachycardia syndrome|POTS]] and ME patients have [[low blood volume]] and be reluctant to provide more hydration than they would a healthy person.

It may take you longer to recover and so if your procedure generally doesn't require an overnight stay, you might ask that they reserve a bed for you just in case. Or if your procedure requires an overnight, ask for a second night.

== Discharge ==
If you don't normally use a wheelchair, you may need one to get to your car. If you normally use a [[wheelchair]], you may need a reclining wheelchair or gurney. These scenarios are also best discussed in advance as nurses may not feel empowered to order these, especially if they are not a part of the general hospital protocol, and you may not have access to a doctor at time of discharge. The more you can make sure is entered into your chart in advance of your admission to hospital to address your unique, potential needs, the better.

== Considerations for specific diagnoses ==

=== ME/CFS Resources ===

==== ME/CFS Resources ====
* [http://drlapp.com/resources/advice-for-pwcs-anticipating-anesthesia-or-surgery/ Advice for PWCs Anticipating Anesthesia or Surgery] (Hunter Hopkins Center)
* [https://www.prohealth.com/library/evergreen_pages/anesthesia-recommendations-for-chronic-fatigue-syndrome-myalgic-encephalomyelitis Anesthesia Recommendations For Chronic Fatigue Syndrome & Myalgic Encephalomyelitis]
* [http://www.anapsid.org/cnd/drugs/anesthesia.html Surgery, Anesthesia and CFS/FM/MCS]

=== Postural orthostatic tachycardia ===

==== POTS Resources ====

=== Mast cell activation disorder ===

Pain and stress can trigger mast cell degranulation reactions; adapted pain management and sedation protocols may be indicated, especially if the patient has experienced medical trauma in the past. If the patient experiences anaphylactic reactions, epinephrine must be on hand during the procedure<ref name="mastocytosis">{{Cite web | url=https://www.mastocytosis.ca/en/treatment/surgery-and-anesthesia | title = Surgery and Anesthesia | last = Gould | first = Nancy | date = 4 May 2015 | website = Mastocytosis Society Canada|archive-url=https://web.archive.org/web/20180727182631/https://www.mastocytosis.ca/en/treatment/surgery-and-anesthesia|archive-date= Jul 27, 2018|url-status=|access-date=Jul 27, 2018}}</ref><ref name="TMS">{{Cite web | url=https://tmsforacure.org/perioperative-management/ | title = Perioperative Management | last = No Author | first = | date = 2018 | website = The Mastocytosis Society|archive-url=https://web.archive.org/web/20180727182816/https://tmsforacure.org/perioperative-management/|archive-date=Jul 27, 2018|url-status=|access-date=Jul 27, 2018}}</ref>. A pre-procedure round of corticosteroids may also be indicated.

Excessive bleeding is common in mast cell disorders, even when blood counts are normal. This is related in part to the release of heparin from mast cell granules<ref name="Afrin2014">{{Cite journal | last = Afrin | first = Lawrence B. | authorlink = Lawrence Afrin | date = Feb 6, 2014 | title = A concise, practical guide to diagnostic assessment for mast cell activation disease| url = https://www.wjgnet.com/2218-6204/full/v3/i1/1.htm|journal=World Journal of Haematology|volume=3 | pages = 1-17|via=Baishideng Publishing Group}}</ref>. Pressure dressings are indicated even for minor procedures. For major procedures, history of mast cell disorder should be included in bleeding risk assessment, and may require special protocols.

==== MCAS Resources ====
* [https://tmsforacure.org/wp-content/uploads/2016-TMS-ER-Protocol-Pages-2.pdf The Mastocytosis Society Emergency Room Protocols]

=== Ehlers-Danlos Syndromes ===
Local anesthetic might be less effective in many people with EDS joint hypermobilty type, but general anasthesia should not have special considerations. <ref name="EDS-skin">{{Cite web | url=https://www.ehlers-danlos.org/information/the-skin-in-hypermobile-ehlers-danlos-syndrome/ | title = The skin in hypermobile Ehlers-Danlos syndrome|website = The Ehlers-Danlos Support UK|language=en|access-date=2018-09-03}}</ref>

==== EDS Resources ====
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223622/ Recommendations for anesthesia and perioperative management in patients with Ehlers-Danlos syndrome(s)] (2014)

== See also ==

* [[Best practices for hospitals]]
* [[Emergency room|Emergency Room]]

== Learn more ==

* [http://drlapp.com/resources/advice-for-pwcs-anticipating-anesthesia-or-surgery/ Advice for PWCs Anticipating Anesthesia or Surgery] (Hunter Hopkins Center)
* [https://www.prohealth.com/library/evergreen_pages/anesthesia-recommendations-for-chronic-fatigue-syndrome-myalgic-encephalomyelitis Anesthesia Recommendations For Chronic Fatigue Syndrome & Myalgic Encephalomyelitis]
* [http://www.anapsid.org/cnd/drugs/anesthesia.html Surgery, Anesthesia and CFS/FM/MCS]

== References ==
{{Reflist}}

[[Category:Guides]]
[[Category:Potential treatments]]
[[Category:Surgical treatments]]

Emergency room

2025-05-16T22:12:59Z

YellowWaterLilly:Formatting

Emergency room

2025-05-16T22:12:15Z

YellowWaterLilly:Linked to related MEpedia pages.

[[Orthostatic intolerance]] is the most frequent acute cause for an '''emergency room''' visit for people with ME/CFS.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333158/ </ref>

== See also ==

* [[Guide for patients having surgery]]
* [[Best practices for hospitals]]

== Resources ==
* [[Bateman Horne Center]] handout: [https://batemanhornecenter.org/wp-content/uploads/filebase/education/top_resources/ER-and-Urgent-Care-Considerations-for-MECFS-1.19.22-005.pdf “Medical considerations when treating urgently ill patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)”]

== References ==
<references />

Best practices for hospitals

2025-05-16T22:07:33Z

YellowWaterLilly:/* Emergency room */ Linked to related MEpedia pages.

This is a set of best practices for hospitals to better provide care for patients in an in-patient, emergency room, surgical or out-patient setting. Patients with [[myalgic encephalomyelitis]] often have a variety of care needs that are not well-understood by the medical community.

== General considerations ==

== Emergency room ==
See [[Emergency room|Emergency Room]]

== Surgery ==

=== Anesthesia ===

It is important for patients to meet with their anesthesiologists in advance to discuss special considerations for anesthesia. Many patients with ME have [[mast cell activation disorder]] or are otherwise sensitive to certain classes of drugs currently used in anesthesia. Anesthesiologists may need to create a special protocols, for example, avoiding [[histamine]]-releasing and [[muscle]]-relaxing drugs.

In addition, patients with ME may have undiagnosed or subclinical structural cervical issues such as [[craniocervical instability]] or [[cervical spinal stenosis]]. It may be important for some patients, if at all possible, to have their head and neck kept in a neutral position during surgery to help limit the risk of exacerbation or damage. This is especially important for patients with [[hypermobility]], [[Ehlers-Danlos syndrome]] or [[Postural orthostatic tachycardia syndrome]].
==== Handouts====

*[http://drlapp.com/resources/advice-for-pwcs-anticipating-anesthesia-or-surgery/ Advice for PWCs Anticipating Anesthesia or Surgery] (Hunter Hopkins Center)

=== Recovery ===
Patients with ME will benefit from environments where they can sleep and have minimal disruption. Patients can benefit from:

* Sound-tight rooms (as opposed to open curtains) and rooms that can be made completely dark
* Placement on a quiet ward
* Chemical/fragrant-free nursing support

*Minimal nighttime disruptions (e.g., middle of the night blood pressure monitoring) if possible, depending on their medical condition; minimal daytime disruptions of patients with circadian rhythm sleep disorders such as delayed sleep-wake phase disorder (reverse sleep cycle)
*Extra IV saline, particularly for patients who are diagnosed with POTS, have [[low blood volume]], and/or have prior experience with saline.

It may take patients longer to recover and this should be planned for in advance. For example, if a procedure requires a one night stay for recovery, a patient with ME might need two.

== Mobility aids ==
Patients with ME may have unusual and unpredictable needs for mobility aids, especially in an emergency context or after surgery. For example, a patient who is usually ambulatory may find it difficult to walk (due to [[post-exertional malaise]]) or to maintain an upright posture (due to [[orthostatic intolerance]]). In this case, a wheelchair can be very helpful. A patient who is usually in a standard wheelchair may require transport via a reclining wheelchair or a gurney.

In addition, after surgery, patients who are having difficulty sitting upright or walking should be offered a bed pan or in-room commode, even if they don't usually need these devices at home.

== See also ==

* [[Guide for patients having surgery]]

== References ==
[[Category:Guides]]

User talk:DxCFS

2025-05-16T20:23:01Z

YellowWaterLilly:/* ME/CFS Ghost */ new section

Please join the discussion forum here http://my.meaction.net/local_chapters/mepedia :)

Can you please join us in the forum? It would help a lot! We're just at the beginning of this new project and collaborating on deciding important issues regarding editorial policy, formatting, etc. We'd love your help and your participation --[[User:JenB|JenB]] ([[User talk:JenB|talk]]) 12:03, 28 November 2015 (PST)]

::Sorry about any confusion with the pages for deletion. I think what happened is I started compiling the list before Ollie deleted them. I didn't know you had already sent Ollie a list. It looks as if the list is a duplicate and 'crossed in the mail.' Don't worry about the urls at the top of my list because they are pages I need deleted. I'll use them to kick off the new page titled "Category:Articles for deletion."

::Do you want to include the two redirects for the "Brains of People With..." listed below? Deleting the redirect does not affect the main page.
*http://me-pedia.org/index.php?title=Http://me-pedia.org/wiki/Brains_of_People_With_Chronic_Fatigue_Syndrome_Offer_Clues_About_Disorder_-_New_York_Times:_Well_(2014)&redirect=no
*http://me-pedia.org/index.php?title=Brains_of_People_With_Chronic_Fatigue_Syndrome_Offer_Clues_About_Disorder&redirect=no::I think what happened is I started compiling the list before Ollie deleted them. I didn't know you had already sent Ollie a list. It looks as if the list is a duplicate and 'crossed in the mail.' Don't worry about the urls at the top of the list because they are pages I need deleted. I'll use them to kick off the new page titled "Category:Articles for deletion.
[[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 10:15, 18 May 2017 (PDT)

::No problem. I don't think these redirects are needed as I made sure other pages had the direct internal link. I knew I messed something up with a Move and a Redirect. If you are able to sort it out and figure out what needs to be deleted that would be great. I am mixed up right now.--[[User:DxCFS|DxCFS]] ([[User talk:DxCFS|talk]]) 10:42, 18 May 2017 (PDT)

:::Okay, I'll add the redirects to Ollie's list for deletion. Hope all is well.

== ME/CFS Ghost -- [[User:YellowWaterLilly|YellowWaterLilly]] ([[User talk:YellowWaterLilly|talk]]) 20:23, May 16, 2025 (UTC) ==

Hello,
You have created this page: https://me-pedia.org/wiki/ME/CFS_Ghost that is about a video blog on YouTube. However, I wanted to inform you that the page seems to be outdated: none of the links seem to be valuable anymore and there is not other information.

The YouTube channel does not have any public videos (or not anymore), the Twitter / X account doesn't exist (or not anymore), and the Facebook account is either private or has been deleted.

The website says "Sorry, but the site is currently down for maintenance!" which could be temporary but with the other links not working I thought I'd bring the current issues to your attention.

Thank you for your contributions!

Category:Wearable devices

2025-05-16T19:21:05Z

YellowWaterLilly:Moved heart rate monitor from the "please create" category to "please expand". Added "pacing with a heart rate monitor" to the "please expand" category.

This category contains articles about wearable devices which are used to help manage ME/CFS symptoms or track activity, for example [[heart rate monitor]]s.

{{Main article|Heart rate monitor}}
{{Main article|Pacing}}

{{Category see also|Medical tests}}

==Please create these pages==
''You can add page requests here. Remove any blue links that have already been created.''
<div style="column-count:2">
*[[cardiac chest band]] for HRV<ref name ="PMC6943898">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943898/</ref>
*[[Step counter]]
</div>

==Please expand these stub pages==

* [[Heart rate monitor]]
* [[Pacing with a heart rate monitor]]

== References ==
[[Category:Management strategies]]

Heart rate monitor

2025-05-16T19:16:00Z

YellowWaterLilly:Added stub notice

{{stub}}
Devices that can detect and track your heart rate are called heart rate monitors.<ref>{{Cite web|url=https://my.clevelandclinic.org/health/diagnostics/23429-heart-rate-monitor|title=Heart Rate Monitors: How They Work and Accuracy|website=Cleveland Clinic|language=en|access-date=2025-05-16}}</ref> They can be helpful to give insight into activity and [[pacing]] for people with ME/CFS<ref>{{Cite web|url=https://batemanhornecenter.org/education/me-cfs/|title=ME/CFS|website=Bateman Horne Center|access-date=May 16, 2025}}</ref> to stay within their [[Energy limit|energy limits.]] Devices that monitor heart rate may also track heart rate variability.

=== See also ===
'''[[Glossary|Glossary:]]''' Heart Rate Monitor (HRM) - A device that measures your heart rate (pulse rate). Heart rate monitors may come as a chest strap, wrist strap, smartwatch, or even as a mobile phone app. Heart rate monitors are often used by ME/CFS patients to pace their exertion, in order to avoid post-exertional malaise (PEM).

[[Pacing with a heart rate monitor|'''Pacing''' with a heart rate monitor]].

=== References ===
<references />

Heart rate monitor

2025-05-16T19:10:20Z

YellowWaterLilly:Added References sub-heading

Devices that can detect and track your heart rate are called heart rate monitors.<ref>{{Cite web|url=https://my.clevelandclinic.org/health/diagnostics/23429-heart-rate-monitor|title=Heart Rate Monitors: How They Work and Accuracy|website=Cleveland Clinic|language=en|access-date=2025-05-16}}</ref> They can be helpful to give insight into activity and [[pacing]] for people with ME/CFS<ref>{{Cite web|url=https://batemanhornecenter.org/education/me-cfs/|title=ME/CFS|website=Bateman Horne Center|access-date=May 16, 2025}}</ref> to stay within their [[Energy limit|energy limits.]] Devices that monitor heart rate may also track heart rate variability.

=== See also ===
'''[[Glossary|Glossary:]]''' Heart Rate Monitor (HRM) - A device that measures your heart rate (pulse rate). Heart rate monitors may come as a chest strap, wrist strap, smartwatch, or even as a mobile phone app. Heart rate monitors are often used by ME/CFS patients to pace their exertion, in order to avoid post-exertional malaise (PEM).

[[Pacing with a heart rate monitor|'''Pacing''' with a heart rate monitor]].

=== References ===
<references />

Heart rate monitor

2025-05-16T19:09:42Z

YellowWaterLilly:Linked to related MEpedia pages.

Heart rate monitor

2025-05-16T18:56:46Z

YellowWaterLilly:Created page, added basic information.

User:YellowWaterLilly

2025-05-16T18:21:31Z

YellowWaterLilly:Welcome statement added

'''Welcome to my page!'''

MEpedia:Sample page

2025-05-16T18:20:36Z

YellowWaterLilly:Added links to MEpedia list of all pages and help tutorial.

Welcome to the '''sample page'''! This page has been created for anyone who wants to practice some edits on the site. Have a go, play around. Leave your edits behind for the next person who comes along to see.

=='''Introduction'''==111111111
this is new to me

== New Editor Questions ==

==Generic questions:==

===What is your favourite movie?===
Harold and Maude{{Citation needed|reason=We need documentation supporting this statement about a cat. | date=2018}}

===What is something that always makes you laugh?===

John Waters{{Citation needed|reason=We need documentation supporting this statement about a cat. | date=2018}}

===What is the weather currently like where you are?===
Early winter in drought-stricken California; 5-15 degrees Celsius and often-cloudy in daytime, 3-10 degrees at night, occasional drizzle/rain when we should be getting frequent rain, with occasionally drenching rainstorms.

===Where in the world are you right now, and where would you most like to be?===
In California. Would love to be in New Zealand, Norway, Switzerland, or the Czech Republic.

===What are a few of your favorite things?===

* L.Berlin: Funny cat videos, especially Siberian cats; laughing babies; any effective attack on Russia's war infrastructure, by Ukraine's home-grown missiles
* previous editor: Music, Fredo, crickets at night, autumn, my husband, being in water, water skiing

=== What are your favourite books? ===

* L.Berlin: Asimov's Treasury of Humor<ref>{{Cite book|title=Asimov's Treasury of Humor|date=1991|publisher=Houghton Mifflin|last=Asimov|first=Isaac|quote=A lifetime collection of favorite jokes, anecdotes, and limericks with copious notes on how to tell them and why}}</ref>
* next editor:

==An inspiring blog post==
My new blog.

==Notable studies==

==Online resources==
All [[Welcome to MEpedia|MEpedia]] [[Special:AllPages|pages here!]]

== See also ==
* [[MEpedia:Article outlines|MEpedia article outlines]]
* [[MEpedia:Help desk|Help desk]]
* [[Help:Tutorial|Help Tutorial]]

==References==
<ref>{{Citation | last1 = Mendelson | first1 = Scott| authorlink1 = Scott Mendelson | last2 = Smith | first2 = Scott
| display-authors = 1 | title = Star Wars: The Force Awakens: A Look at Its Record-Breaking Box Office Run
}}
</ref>
<references />
[[Category:MEpedia documentation]]

MEpedia:Sample page

2025-05-16T18:00:22Z

YellowWaterLilly:Capitalization of Celsius

Welcome to the '''sample page'''! This page has been created for anyone who wants to practice some edits on the site. Have a go, play around. Leave your edits behind for the next person who comes along to see.

==Introduction==111111111
this is new to me

== New Editor Questions ==

==Generic questions:==

===What is your favourite movie?===
Harold and Maude{{Citation needed|reason=We need documentation supporting this statement about a cat. | date=2018}}

===What is something that always makes you laugh?===

John Waters{{Citation needed|reason=We need documentation supporting this statement about a cat. | date=2018}}

===What is the weather currently like where you are?===
Early winter in drought-stricken California; 5-15 degrees Celsius and often-cloudy in daytime, 3-10 degrees at night, occasional drizzle/rain when we should be getting frequent rain, with occasionally drenching rainstorms.

===Where in the world are you right now, and where would you most like to be?===
In California. Would love to be in New Zealand, Norway, Switzerland, or the Czech Republic.

===What are a few of your favorite things?===

* L.Berlin: Funny cat videos, especially Siberian cats; laughing babies; any effective attack on Russia's war infrastructure, by Ukraine's home-grown missiles
* previous editor: Music, Fredo, crickets at night, autumn, my husband, being in water, water skiing

=== What are your favourite books? ===

* L.Berlin: Asimov's Treasury of Humor<ref>{{Cite book|title=Asimov's Treasury of Humor|date=1991|publisher=Houghton Mifflin|last=Asimov|first=Isaac|quote=A lifetime collection of favorite jokes, anecdotes, and limericks with copious notes on how to tell them and why}}</ref>
* next editor:

==An inspiring blog post==
My new blog.

==Notable studies==

==Online resources==

== See also ==
* [[MEpedia:Article outlines|MEpedia article outlines]]
* [[MEpedia:Help desk|Help desk]]

==References==
<ref>{{Citation | last1 = Mendelson | first1 = Scott| authorlink1 = Scott Mendelson | last2 = Smith | first2 = Scott
| display-authors = 1 | title = Star Wars: The Force Awakens: A Look at Its Record-Breaking Box Office Run
}}
</ref>
<references />
[[Category:MEpedia documentation]]