Epidemiological and clinical factors associated with post-exertional malaise severity in patients with myalgic encephalomyelitis/chronic fatigue syndrome

Abstract

Background: Post-exertional malaise (PEM), the cardinal feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), occurs generally after exposure to a stressor. It is characterized by the worsening of ME/CFS symptoms and results in aggravating the course of the disease and the quality of life of patients. Due to its unpredictable onset, severity, and recovery time, identifying patients with higher risk for severe PEM would allow preventing or reducing its occurrence. We thus aimed at defining possible factors that could be associated with PEM severity. Methods: Adult patients fulfilling ME international consensus criteria who attended the internal medicine department of University hospital Angers-France between October 2011 and December 2019 were included retrospectively. All patients were systematically hospitalized for an etiological workup and overall assessment. We reviewed their medical records for data related to the assessment: epidemiological data, fatigue features, clinical manifestations, and ME/CFS precipitants. PEM severity was appreciated by the Center for Disease Control self-reported questionnaire. The study population was classified into quartiles according to PEM severity scores. Analyses were performed with ordinal logistic regression to compare quartile groups. Results: 197 patients were included. PEM severity was found to be positively associated with age at disease onset ≥ 32 years (OR 1.8 [95% CI 1.1-3.0] (p = 0.03)), recurrent infections during the course of the disease (OR 2.1 [95% CI 1.2-3.7] (p = 0.009)), and when ME/CFS was elicited by a gastrointestinal infectious precipitant (OR 5.7 [1.7-19.3] (p = 0.006)). Conclusion: We identified some epidemiological and clinical features, which were positively associated with PEM severity in subsets of ME/CFS patients. This could help improving disease management and patients' quality of life.

Analysis of post COVID-19 condition and its overlap with myalgic encephalomyelitis/chronic fatigue syndrome

“…The link between high levels of IL-6 (and other proinflammatory cytokines) and the development of post-COVID-19 symptoms, including fatigue and/or related sequelae, remains to be confirmed. However, the contribution of immune disbalances towards development of chronic fatigue is supported by several post-infection ME/CFS studies that analysed post-viral complications [20,32,35,39,41]. The wide scope of ME/CFS-associated pathologies supports the assumption that ME/CFS is a multifactorial illness with diverse molecular backgrounds.…”

“…The absence of targeted treatment and molecular-based diagnostic tools for this disease are attributed to the heterogeneity and unclear molecular mechanisms of ME/ CFS. Diagnosis for this disease is derived using symptom-specific case criteria [27,39,40], including presence of post-exertional malaise (PEM) [41].…”

Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…Cumulative life stress is considered a predisposing factor for ME/CFS (172), which is also thought to alter gut permeability and thus immune function (173). As in heat stroke, the microbiome disturbances and dysbiosis are associated with ME/CFS pathology (147,(174)(175)(176)(177)(178)(179). Gender is a risk factor for ME/CFS: the female-to-male ratio ranges from 2:1 to 6:1 (12).…”

Factors Influencing the Prognosis of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…The association of longer illness duration with a poor prognosis may be explained by the fact that longer-duration patients are less likely to experience spontaneous recovery [ 14 ] and more likely to develop cognitive decline [ 26 ], somatic complaints [ 42 ], allergies [ 26 ], and hypersensitivities [ 41 ]. Moreover, these patients are more susceptible to recurrent viral infections, which increase PEM severity and exacerbate baseline symptoms [ 43 ]. Comorbidities and reactive psychological distress that could occur over time may further worsen the prognosis.…”