Evaluating case diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): toward an empirical case definition

Conroy, Karl E; Islam, Mohammed; Jason, Leonard A.

doi:10.1080/09638288.2022.2043462

Cited by 28 publications

(18 citation statements)

References 39 publications

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“…Gastrointestinal symptoms such as nausea, bloating and vomiting may be linked to autonomic dysfunction. Our findings are also thus consistent with emerging literature that gastrointestinal distress and autonomic symptoms should be considered important symptom categories for ME/CFS 17 – 19 ; similarly, Jason et al 20 and Katz et al 21 found that days spent in bed since infectious mononucleosis, along with autonomic dysfunction two months after the diagnosis, were associated with postinfectious ME/CFS at six months. In addition, IL-13 and IL-5 were implicated as risk factors for the development of severe ME/CFS following IM, and there is evidence in human and mouse models that IL-5 and IL-13 contribute to the pathology associated with ulcerative colitis 22 , 23 ; IL-13 is thought to play a key role in the pathophysiology of ulcerative colitis and fistulizing Crohn’s disease, and IL-13 blockade is a promising therapeutic strategy for these diseases 24 However, it should be noted that in patients with Crohn’s disease, there is an overproduction of IL-13 whereas in the subjects with severe ME/CFS in the present study the IL-13 is lowered.…”

Section: Discussionsupporting

confidence: 92%

Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome following Infectious Mononucleosis

Jason¹,

Cotler²,

Islam³

et al. 2022

J Rehab Therapy

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Background: About 10% of individuals who contract infectious mononucleosis (IM) have symptoms 6 months later that meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our study for the first time examined whether it is possible to predict who will develop ME/CFS following IM. Methods: We have reported on a prospectively recruited cohort of 4,501 college students, of which 238 (5.3%) developed IM. Those who developed IM were followed-up at six months to determine whether they recovered or met criteria for ME/CFS. The present study focuses on 48 students who after six months had a diagnosis of ME/CFS, and a matched control group of 58 students who had no further symptoms after their IM. All of these 106 students had data at baseline (at least 6 weeks prior to the development of IM), when experiencing IM, and 6 months following IM. Of those who did not recover from IM, there were two groups: 30 were classified as ME/CFS and 18 were classified as severe ME/CFS. We measured the results of 7 questionnaires, physical examination findings, the severity of mononucleosis and cytokine analyses at baseline (pre-illness) and at the time of IM. We examined predictors (e.g., pre-illness variables as well as variables at onset of IM) of those who developed ME/CFS and severe ME/CFS following IM. Results: From analyses using receiver operating characteristic statistics, the students who had had severe gastrointestinal symptoms of stomach pain, bloating, and an irritable bowel at baseline and who also had abnormally low levels of the immune markers IL-13 and/or IL-5 at baseline, as well as severe gastrointestinal symptoms when then contracted IM, were found to have a nearly 80% chance of having severe ME/CFS persisting six months following IM. Conclusions: Our findings are consistent with emerging literature that gastrointestinal distress and autonomic symptoms, along with several immune markers, may be implicated in the development of severe ME/CFS. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating illness affecting over a million people in the US1. Six months after having had Infectious Mononucleosis (IM), about 9-12% of individuals are diagnosed with this syndrome. For example, Hickie et al.2 showed an 11% rate of ME/CFS six months following acute infection with Epstein-Barr virus as well as following two other similar systemic infections. Katz et al.3 found similar outcomes following IM in youth. In a recent prospective, longitudinal study, university students were assessed prior to IM, at the time of IM, and at a six-month follow-up. Those who developed severe ME/CFS had differences in several pre-illness domains compared to those who recovered from IM without further symptoms4. In addition, Katz et al.5 found that the severity of IM was predictive of severe ME/CFS 6 months following IM. We have used these baseline pre-illness behavioral and immune data along with severity of IM data to predict who will develop severe ME/CFS six months following IM.

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Section: Discussionsupporting

confidence: 92%

Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome following Infectious Mononucleosis

Jason¹,

Cotler²,

Islam³

et al. 2022

J Rehab Therapy

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“…Symptom presentations of ME/CFS participants were consistent with the findings of a large sample factor analytic study of diagnostic criteria in ME/CFS 39 . This study identified these apparent core symptom dimensions: cognitive dysfunction and post-exertional malaise (each endorsed by 90 + %) and sleep dysfunction (79%).…”

Section: Resultssupporting

confidence: 79%

Sex differences in post-exercise fatigue and function in myalgic encephalomyelitis/chronic fatigue syndrome

Friedberg

Adamowicz

Bruckenthal

et al. 2023

Sci Rep

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To assess biobehavioral sex differences in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) utilizing a low burden exercise protocol, 22 females and 15 males with ME/CFS and 14 healthy controls underwent two six-min walk tests. Fifteen daily assessments were scheduled for fatigue and function ratings and heart monitoring. Six-min walk tests were conducted on days 8 and 9. The ME/CFS group showed high self-report fatigue and impaired physical function, whereas healthy controls did not show fatigue or function abnormalities. In patients, no significant post-exercise changes were found for heart rate variability (HRV); however, heart rate decreased in ME/CFS males from Day 14 to Day 15 (p = 0.046). Female patients showed increased fatigue (p = 0.006) after the initial walk test, but a downward slope (p = 0.008) in fatigue following the second walk test. Male patients showed a decrease in self-report work limitation in the days after exercise (p = 0.046). The healthy control group evidenced a decrease in HRV after the walk tests from Day 9–14 (p = 0.038). This pilot study did not confirm hypotheses that females as compared to males would show slower exercise recovery on autonomic or self-report (e.g. fatigue) measures. A more exertion-sensitive test may be required to document prolonged post-exertional abnormalities in ME/CFS.Trial registration: NCT NCT03331419.

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“…In the ME/CFS field, using statistical methods to classify patients has helped identify latent factors [23], and similar methods are beginning to be employed to identify critical domains of COVID-19 and Long COVID symptoms. For example, Guo et al [24] [18] PCA resulted in the following five components: fatigue, post-exertional malaise, daytime sleepiness (lethargy), brain fog, and unrefreshing sleep.…”

Section: Infectious Diseases Observational Researchmentioning

confidence: 99%

An Exploratory Factor Analysis of Long Covid

Dorri

Islam

2023

CAJMHE

Self Cite

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An exploratory factor analysis (EFA) can provide a window into the latent dimensions of a disease, such as Long COVID. Discovering the latent factors of Long COVID enables researchers and clinicians to better conceptualize, study and treat this disease. In this study, participants were recruited from social media sites dedicated to COVID and Long COVID. Among the 480 participants, those who completed at least 90% of the survey, reported symptoms for two or more months since COVID-19 symptom onset, and had not been hospitalized for COVID were used in the EFA. The mean duration since initial symptom onset was 74.0 (37.3) weeks. A new questionnaire called The DePaul Symptom Questionnaire-COVID was used to assess self-reports of the frequency and severity of 38 Long COVID symptoms experienced over the most recent month. The most burdensome symptoms were “Symptoms that get worse after physical or mental activities (also known as Post-Exertional Malaise),” “Fatigue/extreme tiredness,” “Difficulty thinking and/or concentrating,” “Sleep problems,” and “Muscle aches.” The EFA resulted in a three-factor model with factors labeled General, PEM/Fatigue/Cognitive Dysfunction, and Psychological, consisting of 16, 6, and 3 items respectively (25 items in total). The reliability of the items in the EFA was .90 using a split-half reliability test. Finally, participant self-reported level of functional impairment was analyzed across the three EFA factors. Interpretations and applications to research and practice are provided.

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Evaluating case diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): toward an empirical case definition

Cited by 28 publications

References 39 publications

Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome following Infectious Mononucleosis

Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome following Infectious Mononucleosis

Sex differences in post-exercise fatigue and function in myalgic encephalomyelitis/chronic fatigue syndrome

An Exploratory Factor Analysis of Long Covid

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