Myalgic encephalomyelitis—a persistent enteroviral infection?

Abstract

Summary Myalgic encephalomyelitis is a common disability but frequently misinterpreted. Amongst 6,000 patients referred for general microbiological diagnosis between 1975 and 1987, 420 cases were recognized. Coxsackie B neutralization tests, in 205 of these, demonstrated significant titres in 103/205 (50%), while of 124 additionally investigated for enteroviral IgM, 38/124 (31%) were positive. This illness is distinguished from a variety of other post-viral states by an unique clinical and epidemiological pattern characteristic of enteroviral infection. Prompt recognition and advice to avoid over-exertion is mandatory. Routine diagnosis, specific therapy and prevention, await further technical advances.

An Accurate Diagnosis of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome requires strict Clinical Case definitions and Objective Test Methods

“…Note that chronic fatigue, the core of various CFS [13,14,25] /CF [17] criteria, isn't mandatory. Although the ICC criteria show the most resemblance with the original criteria, there are also relevant differences between ME/ICC [31] and ME as described in the literature [2,[5][6][7].…”

“…However, since the premise of the review that ME and CFS are similar disorders is invalid, the criteria [16], largely based on a review of research into CFS [14], define a 'hybrid disease' . If the original criteria of ME [2,[5][6][7] would have been taken into consideration and research into ME would have been involved in the review, the IOM most likely would have come to the conclusion that a new diagnostic entity cannot replace two distinct clinical entities with different definitions [15,32].…”

“…fatigue, non-refreshing sleep, headaches, and muscle and joint pain. None of the characteristic features of ME [2,[5][6][7] is mandatory to meet the diagnosis CFS, e.g. muscle weakness and cognitive impairment, while patients can meet the diagnostic criteria for CFS [14], and not experiencing any of the typical features of ME [15].…”

“…Typical features of ME [2,[5][6][7] include muscular symptoms, especially an unique form of muscle fatiguability (muscle weakness and pain after minor exertion lasting for days) and muscle tenderness, neurological symptoms, implicating cerebral dysfunction, e.g. impairment of memory and concentration, day-night reversal, and emotional liability, and symptoms indicating circulatory impairment, e.g.…”

The Development of a Revised Canadian Myalgic Encephalomyelitis Chronic Fatigue Syndrome Case Definition

“…In 1955, there was an outbreak of a CFS-like illness at the Royal Free Hospital and Ramsay (1981;1988), the medical consultant in charge, published a number of descriptions of this disease, which subsequently became known as Myalgic Encephalomyelitis (ME) (Hyde et al, 1992) (Ramsay used a different term in his early research, but he changed after Acheson (1959) came up with ME). Based on Ramsay's concept, research criteria were developed by Dowsett et al (1990) and (1994) and recently revised by Goudsmit et al (2009) in an effort to distinguish the ME criteria from that of CFS. These ME case definitions recognize the following four cardinal features: (1) physical or mental fatigue or muscle weakness after minimal exertion which may persist long after exertion ends; (2) circulatory impairment (e.g., feeling hot when it's cold, postural hypotension); (3) one or more symptoms indicating the involvement of the central nervous system such as impairment of memory and concentration and disturbed sleep patterns and (4) the marked fluctuation of symptoms.…”