Post-COVID-19 illness

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Post-COVID-19 illness and recovery. A wave of chronically ill and slow-healing survivors is an inevitability we can and must prepare ourselves for. - Fiona Lowenstein

There have been some reports of long term illness in survivors of COVID-19; it is unclear how many people are affected at this stage.[1][2][3] One small study from Wuhan, China, found that survivors of COVID-19 who tested negative twice before discharge from hospital still had some abnormalities in metabolism and liver function markers when discharged.[4]

Relapse or reinfection[edit | edit source]

Some patients have described feeling fully recovered, then experiencing COVID-19 symptoms again, and feeling like their lungs were "on fire" for some weeks afterwards.[3] There is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.[citation needed]

Post-SARS illness[edit | edit source]

COVID-19 is caused by the SARS-CoV-2 virus; the similar SARS-CoV coronavirus causes SARS, and SARS is known to have caused long term illness in some survivors, including chronic fatigue syndrome and a post-SARS syndrome similar to fibromyalgia involving chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep.[5][6]

Severe COVID-19 survivors[edit | edit source]

ICU survivors[edit | edit source]

Post-COVID-19 illness. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion." - Stam, Stucki & Bickenbach (2020)
Post Intensive Care Syndrome symptoms. Source: J Rehabil Med 2020; 52: jrm00044. License: CC-BY NC.


Long term physical, cognitive and mental health problems have also been found to be relatively common in patients discharged from intensive care from illnesses other than COVID-19, with the length of time in intensive care influencing the long term health impacts.[7]

Post Intensive Care Syndrome (PICS) is one of several conditions that can result, including Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM), and requires both short and medium term rehabilitation treatments.[8]

COVID-19 pneumonia and SARI[edit | edit source]

Moderately ill patients with COVID-19 may develop mild viral pneumonia.[9] Severe acute respiratory infection (SARI) is known to develop in some people severely ill with COVID-19. SARI resulting from other illnesses has been studied.[citation needed]

Acute respiratory distress syndrome[edit | edit source]

Acute respiratory distress syndrome (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.[10] ARDS develops in 17-29% of hospitalized COVID-19 patients and is known to have long term effects.[11][12][9] ARDS can cause nerve and muscle damage, which causes pain and weakness.[10]

Mechanical ventilator effects[edit | edit source]

Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.[11]

COVID-19 complications[edit | edit source]

These include:

  • Anecdotal reports of DVT and PE in critically ill patients
  • Central nervous system encephalitis and encephalomyelitis
  • anecdotal evidence of pulmonary aspergillosis
  • pneumonia
  • hypoxemic respiratory failure/ARDS
  • sepsis and septic shock
  • cardiomyopathy and arrhythmia
  • acute kidney injury
  • complications from prolonged hospitalization including:

Fatigue after COVID-19[edit | edit source]

COVID-19 can cause severe fatigue, however experiencing fatigue after recovering from the virus should not be the considered the same as the illness chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), a neurological disease involving multiple bodily systems and sustained symptoms over an extended period of time.[13][14] Post-viral fatigue which does not meet the criteria for CFS or ME and lasts at least 6 months is known as chronic fatigue (without the "syndrome"), or idiopathic chronic fatigue if the cause is unknown.[15][16][14]

Potential brain damage[edit | edit source]

Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests COVID-19 can lead to severe neurological complications, including brain inflammation, psychosis and delirium.[17]
“Whether we will see an epidemic on a large scale of brain damage linked to the pandemic – perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic – remains to be seen,” said Michael Zandi, from UCL’s Institute of Neurology, who co-led the study.[17]

Notable studies[edit | edit source]

  • Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings[18]
A study by researchers at University College London (UCL) described 43 cases of patients with COVID-19 who suffered either temporary brain dysfunction, strokes, nerve damage or other serious brain effects.
The research adds to recent studies which also found the disease can damage the brain.[18]

Post-viral syndrome[edit | edit source]

Post-viral syndrome or post-viral state is sometimes used to refer to symptoms that occur as a result of a virus, which take longer than a few weeks to resolve. The older term Post-infective fatigue is no longer in use. Post-viral syndrome may include shortness of breath, fatigue, difficulty thinking, aches and pains, or other symptoms, and typically improves gradually over time. People who remain ill after 6 months may meet the criteria for postviral fatigue syndrome (PVFS), which is more commonly diagnosed as chronic fatigue syndrome or myalgic encephalomyelitis, although it may be possible to diagnose this sooner using the international consensus criteria.[14][16][15] For most people, this is a very disabling, long-term (chronic) illness.[1][13][14][16]

Dr. Anthony Fauci, the United States top infectious disease expert, acknowledged that many unrecovered COVID-19 patients may have ME, also known as chronic fatigue syndrome, or ME/CFS.[19][20] Dr. Fauci stated: “There may well be a post-viral syndrome associated with Covid-19,...If you look anecdotally, there is no question that there are a considerable number of individuals who have a post-viral syndrome that in many respects incapacitates them for weeks and weeks following so-called recovery,”[20] At the International AIDS conference, he stated: "Brain fog, fatigue, and difficulty in concentrating. So this is something we really need to seriously look at because it very well might be a post-viral syndrome associated with COVID-19.[21]

An internist at Texas Health Presbyterian Hospital, Dr. Donna Casey, said “We can now see documented abnormalities in your nervous, immune, and metabolic systems. So we’re seeing abnormalities in all three that create myalgic encephalomyelitis.”[22] Dr. Casey did say that we are not at the six month mark[23][24] for COVID, but she does see ongoing improvement in her hospitalized patients.[22] Dr. Amir K. Ghiassi, a pulmonologist with St. Joseph Hospital in Orange County, California said of the ongoing symptoms they were uncertain if it had to do with the virus or “because of the immune system reacting the way it does that causes symptoms.”[22]

Postviral fatigue syndrome and ME/CFS[edit | edit source]

COVID-19 and ME/CFS. "It’s quite likely that some people will be developing a post-viral fatigue syndrome, which may then lead into an ME/CFS-like illness." - Charles Shepherd, M.E. Association

Myalgic encephalomyelitis, better known as ME, is a neurological disease that commonly begins after a virus, although other possible triggers include bacterial infections, injuries, surgery and other events.[15][14][25] Some researchers and some patients use the term chronic fatigue syndrome (CFS), or ME/CFS to refer to ME, although CFS has different diagnostic criteria.[16][15][14] The older term Postviral fatigue syndrome (PVFS) is rarely used, although the World Health Organization recognize PVFS, ME, and CFS using the same diagnostic code. Some countries including the United States, deviate from this.[25][26]

PVFS (post-viral fatigue syndrome)

This term was introduced during the eariy 1980s in Britain as an alternative to ME. It remains a useful description for anyone whose illness can clearly be traced back to an acute viral infection. The drawback to PVFS is that it cannot be used to describe cases where some other factor (e.g. vaccination or pesticide) acted as the principal trigger.[27]

Dr Charles Shepherd, Living with M.E. (2008)

Moldofsky et al. (2011) conducted a long term follow up of 21 SARS survivors in Toronto, Canada, all of who remained too ill to return to work, and concluded that that chronic post-SARS was similar to fibromyalgia.[6] Lam et al. (2009) conducted a much larger long term follow-up of SARS survivors in Hong Kong, and reported that 27% had chronic fatigue syndrome, 40% had chronic fatigue, and 40% has depression.[5] A number of the SARS survivors unable to return to work were previously healthy health-care workers.[5] The high rates of chronic fatigue could not be accounted got by depression or psychiatric illness.[5]

Treatment[edit | edit source]

No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.[13]

A group of over 20 ME and chronic fatigue syndrome specialists and patient groups have recommended fatigue following COVID-19 should be treated/managed using:

Pacing[edit | edit source]

Less controversially, the self-help leaflet mentions pacing, a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.[29] ME patient associations surveys have found pacing helped most, but not all, patients.[30][31]

CBT and GET not recommended for fatigue[edit | edit source]

The Oxford Health NHS Foundation Trust published a Coping with Coronavirus: Fatigue leaflet referring to chronic fatigue syndrome, a neurological disease, as a possible mental health consequence of COVID-19, and confusing fatigue after COVID-19 illness with chronic fatigue syndrome. The leaflet recommenddations included the highly controversial use of cognitive behavioral therapy (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert David Tuller asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An open letter opposing the leaflet was signed by a large number of medical professionals and UK patient groups at around the same time.[13]

CBT for fatigue is a psychological therapy focused on treating a presumed illness beliefs such as a fear of activity and GET is exercise/activity based, both treatments rely on the assumption that there is no lasting physical damage or underlying illness process that could prevent full recovery. GET is particularly controversial and has been found to cause most patients with chronic fatigue syndrome (not resulting from COVID-19) to deteriorate, sometimes permanently.[13] CBT and GET are no longer recommended by the CDC, and their use within the UK's National Health Service is currently under review, with many concerns having been raised about high rates of patient harm resulting from these treatments, and a lack of effectiveness.[30][32][33][31] CBT and GET they are not recommended by the UK's ME Association, Action for ME, Invest in ME Research, MEAction, or The 25% ME Group.[32][33][34][31][33] CBT may be useful for depression or generalized anxiety.[35][36]

Recovery advice[edit | edit source]

Notable studies[edit | edit source]

No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

News articles and blogs[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.01.11.2 Wilson, Clare (Apr 15, 2020). "Could the coronavirus trigger post-viral fatigue syndromes?". New Scientist. 
  2. Kucher, Daniel (Apr 16, 2020). "User Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years". SOMAG news. 
  3. 3.03.1 Malamut, Melissa (Apr 17, 2020). "Coronavirus survivors say they fear long-term effects". New York Post. 
  4. Wu, Di; Shu, Ting; Yang, Xiaobo; Song, Jian-Xin; Zhang, Mingliang; Yao, Chengye; Wen, Liu; Huang, Muhan; Yu, Yuan (Apr 21, 2020). "Plasma Metabolomic and Lipidomic Alterations Associated with COVID-19". medRxiv: 2020.04.05.20053819. doi:10.1101/2020.04.05.20053819. 
  5. 5.05.15.25.3 Lam, Marco Ho-Bun; Wing, Yun-Kwok; Yu, Mandy Wai-Man; Leung, Chi-Ming; Ma, Ronald C. W.; Kong, Alice P. S.; So, W. Y.; Fong, Samson Yat-Yuk; Lam, Siu-Ping (Dec 14, 2009). "Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up". Archives of Internal Medicine. 169 (22): 2142–2147. doi:10.1001/archinternmed.2009.384. ISSN 0003-9926. 
  6. 6.06.1 Moldofsky, Harvey; Patcai, John (Mar 24, 2011). "Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study". BMC Neurology. 11 (1): 37. doi:10.1186/1471-2377-11-37. ISSN 1471-2377. PMC 3071317Freely accessible. PMID 21435231. 
  7. 7.07.1 Edwards, Erika (Mar 28, 2020). "Potential Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery". NBC News. 
  8. H J, Stam; G, Stucki; J, Bickenbach (Apr 15, 2020). "Covid-19 and Post Intensive Care Syndrome: A Call for Action". Journal of rehabilitation medicine. doi:10.2340/16501977-2677. PMID 32286675. Retrieved Apr 23, 2020. 
  9. 9.09.19.2 CDC (Feb 11, 2020). "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. Retrieved Apr 22, 2020. 
  10. 10.010.1 National Health Service (Oct 17, 2017). "Acute respiratory distress syndrome (ARDS)". nhs.uk. Retrieved Apr 1, 2020. 
  11. 11.011.111.2 Auwaerter, Paul G. (Apr 8, 2020). "Coronavirus COVID-19 (SARS-CoV-2)". Retrieved Apr 17, 2020. 
  12. CDC COVID-19 Response Team (Mar 27, 2020), "Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020", MMWR Morb Mortal Wkly Rep 2020, 69 (12): 343–346, doi:10.15585/mmwr.mm6912e2, PMID 32214079 
  13. 13.013.113.213.313.413.5 "Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"" (PDF). Apr 20, 2020. 
  14. 14.014.114.214.314.414.5 Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (Dec 15, 1994). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group" (PDF). Annals of Internal Medicine. American College of Physicians. 121 (12): 953–959. ISSN 0003-4819. PMID 7978722. 
  15. 15.015.115.215.3 Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6 
  16. 16.016.116.216.3 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7-115, doi:10.1300/J092v11n01_02 
  17. 17.017.1 "Scientists warn of potential wave of COVID-linked brain damage". Reuters. Jul 7, 2020. Retrieved Jul 8, 2020. 
  18. 18.018.1 Paterson, Ross W.; Brown, Rachel L.; Benjamin, Laura; Nortley, Ross; Wiethoff, Sarah; Bharucha, Tehmina; Jayaseelan, Dipa L.; Kumar, Guru; Raftopoulos, Rhian E. "The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings". Brain. doi:10.1093/brain/awaa240. 
  19. "Post-Covid syndrome prompts new look at chronic fatigue syndrome". STAT. Jul 21, 2020. Retrieved Jul 21, 2020. 
  20. 20.020.1 CNN, By <a href="/profiles/joshua-berlinger">Joshua Berlinger</a>, <a href="/profiles/brett-mckeehan">Brett McKeehan</a>, <a href="/profiles/ivana-kottasova">Ivana Kottasová</a>, Ed Upright, <a href="/profiles/meg-wagner">Meg Wagner</a> and Melissa Macaya (Jul 9, 2020). "Coronavirus may cause fatigue syndrome, Fauci says". CNN. Retrieved Jul 21, 2020. 
  21. "Fauci Warns About 'Post-Viral' Syndrome After COVID-19". Healthline. Jul 16, 2020. Retrieved Jul 21, 2020. 
  22. 22.022.122.2 Ramaswamy, Divya (Jul 17, 2020). "Fauci Warns Of 'Post-Viral Syndrome' Among COVID-19 Patients That Causes Fatigue, Brain Fog After Recovery". International Business Times. Retrieved Jul 21, 2020. 
  23. "IOM 2015 Diagnostic Criteria | Diagnosis | Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". www.cdc.gov. Nov 19, 2019. Retrieved Jul 21, 2020. 
  24. "Diagnostic Algorithm for ME/CFS". National Academy of Medicine (Formerly the Institute of Medicine). 
  25. 25.025.1 World Health Organization. "ICD-10: Version 2016". www.who.int. 
  26. Centers for Disease Control. "ICD-10-CM". www.cdc.gov. Retrieved Apr 17, 2020. 
  27. 27.027.1 Shepherd, Charles (Dec 5, 2008). Living With M.E. Random House. ISBN 978-1-4090-2095-0. 
  28. Vink, Mark; Vink-Niese, Alexandra (Sep 20, 2019). "Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies". Diagnostics. 9 (4): 124. doi:10.3390/diagnostics9040124. ISSN 2075-4418. 
  29. 29.029.1 Tuller, David (Apr 16, 2020). "Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID "CFS" Patients". virology.ws. 
  30. 30.030.1 ME Association (Apr 3, 2019). "Forward-ME and Oxford Brookes University announce results of Patient Survey on CBT and GET in ME/CFS | 3 April 2019". 
  31. 31.031.131.2 Invest in ME Research (Jul 17, 2017). "Response to NICE 10 year surveillance (2017) – Chronic fatigue syndrome/myalgic encephalomyelitis". www.investinme.org. Retrieved Feb 7, 2019. 
  32. 32.032.1 The ME Association (May 30, 2015). "ME/CFS Illness Management Survey Results "No decisions about me without me"" (PDF). 
  33. 33.033.133.2 Action for ME (2014). "Time to deliver: initial findings of Action for ME's 2014 survey" (PDF). Retrieved Jul 1, 2016. 
  34. Action for ME (May 17, 2017). "Our Board of Trustees on CBT, GET and PACE". actionforme.org.uk. 
  35. National Health Service (Oct 24, 2017). "Clinical depression". nhs.uk. Retrieved Apr 29, 2020. 
  36. National Health Service (Jul 18, 2018). "Generalised anxiety disorder in adults - Treatment". nhs.uk. Retrieved Apr 29, 2020. 
  37. Shumaker, Erin (Apr 17, 2020). "What we know about coronavirus' long-term effects". ABC news. 
  38. Bernstein, Lenny; Johnson, Carolyn Y.; Kaplan, Sarah; McGinley, Laurie (Apr 15, 2020). "Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere". Washington Post. 
  39. Lowenstein, Fiona (Apr 13, 2020). "We Need to Talk About What Coronavirus Recoveries Look Like". New York Times. 
  40. ME Association (May 2020). "MEA INFORMATION ON Post-viral fatigue (PVF) and Post-viral fatigue syndrome (PVFS) following coronovirus infection" (PDF). meassociation.org. Retrieved May 1, 2020. 
  41. Physio for ME; Workwell Foundation; ME Association (May 2020). "Post Covid-19 Rehabilitation". Physiosforme. Retrieved May 2, 2020. 
  42. Charles Shepherd (Apr 30, 2020). "Covid-19 and Post-viral Fatigue Syndrome by Dr Charles Shepherd | 30 April 2020". meassociation.org. Retrieved May 1, 2020. 

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

pacing - The practice of staying within one's "energy envelope" by interspersing periods of activity with periods of rest. ME/CFS patients use pacing to avoid or reduce post-exertional malaise (PEM). Some patients use a heart rate monitor to help with pacing.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

pacing - The practice of staying within one's "energy envelope" by interspersing periods of activity with periods of rest. ME/CFS patients use pacing to avoid or reduce post-exertional malaise (PEM). Some patients use a heart rate monitor to help with pacing.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

BMJ - The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.